The Myth of Religious Persecution

A person with true faith would not seek martyrdom, though he/she would accept it. This is in contrast to the suicide bomber's perception of a righteous act.

BRAVO Setanta! Very well said!



Suffer? LOL Suffering in our society by MOST "christian" standards, as it seems to me anyway, is the air conditioner or heat not working at church on Sunday. Someone sitting in YOUR seat at church. The cable TV not getting hooked up fast enough when you move... Having to give your spouse a ride to work every day because one car is in the shop... Being "nice" to that dirty smelly man that comes to church once in a while, because after all that is the "christian" thing to do...

*sigh*

I have lived on all sides of life. I have experienced many things because of my upbringing and some choices I made along the way. I've been homeless. Gone a week without eating. Been abused, abandoned, used. Ridiculed and made fun of because I didn't do the things "real christians" do. Asked to leave churches because I didn't "fit their system of beliefs" I lived several years in the throws of alcohol addiction. As well as also having more than enough. Being able to go and buy whatever, when ever, just because I felt like it. Had nice cloths, a nice place, a good job, nice car. I don't cling to those things though because I've experienced the other side of life first hand and I know how quickly it can all turn into vapor and blow away.

Suffering is a state of mind. It is based out of ones inner most ideal of what is important in life. In THEIR life, that is. Whatever that is, the lack there of brings a feeling of suffering, loss, or lack. A lot of these "christians" who are so quick to call a lack of such simple things "suffering" have most likely not suffered much at all in their life. They haven't felt that fear that comes with not having a roof over your head. Not knowing if or when you will again. Where your next meal will come from. How you will get a shower and brush your teeth so you can actually go fill out an application for a job at Taco Bell, or the local grocery store.

They haven't experienced that fear of never being good enough to do anything outside of what your life has been up to that point. They haven't felt the pain their long stares inflict on someone who is an "outsider" to their church. How really those stares just confirm what they're already thinking, "I don't belong here. I knew I shouldn't have come." It is my belief that if "christians" truly followed the teachings of the bible that they say they are ooh sooo devoted to there would not be nearly as much howling about inconveniences in life, and a whole lot more people caring about others and trying to actually help those that are truly suffering, regardless of how they dress, what they do, who they hang out with, what their social status is, and so forth.

So did I.



True, but in the context it didn't make sense. There couldn't possibly have been a homeless person living in suburbia, because they cannot support themselves as well as they could if they were in a city.

Therefore, the people saw through the Priest's disguise all too readily. On the other hand, however, they shouldn't have been concerned about what a man dresses up in to go to Church. Although they may have thought this was disrespectful to God, was it really? Might want to make a different topic on that aspect, as I think we're going into off-topic realms. Would be interesting to discuss it, don't you think?



Uuuum... really it doesn't matter what I think here, however, I wouldn't do that. #1 I see no purpose or gain for anyone in doing such a thing. #2 They've got it all backwards. Easter Sunday is supposedly when Jesus arose from the dead. So why on the day He arose would you crucify yourself? Odd. That's very odd indeed...[/quote]

Or maybe it was on Good Friday... which would make more sense. The point is, they do it to remind themselves of what he experienced.

Those who wish to gain an insight into the alleged problem of "homelessness" are urged to read the recent best seller which has been highly critically praised-namely-Freakanomics.
Stven Leavitt, one of the authors and a brilliant Economist referenced a spokesman for the "homeless" named Mitch Snyder.It appears that Mr. Snyder testified before Congress about the MAGNITUDE OF THE HOMELESS PROBLEM. He told a college audience that 45 homeless persons die every second which would mean that 1.4 Billion Homeless people die inthe US every year. Then Mr. Snyder indicated that there were Three Million Homeless in the US. When the press hounded him for his sources, Snyder admitted it was a fabrication.

source- Freakanomics- p. 90

And so it goes in the area of "homelessness"- lies, fabrications and misinterpretations again and again and again.

Yeah, we all know that there's no homeless and hungry people in the wealthiest country in the world

Oh, wilso, there are., but not not, as Mr.Snyder said--Three Million-

You may be aware Wilso, that when the courts caused thousands of people who were institutionalized in the early eighties, it swelled the homeless ranks disproportionately.

A thoroughly incoherent sentence. When the courts caused thousands of people who were institutionalized to do what?

In fact, the political parties are responsible for the explusion of instituionalized adults from state facilities in the late 1970s and early 1980s, when tight budgets lead them to close state mental health facilities, reserving accomodation only for those adjudged to be dangerous to the general population.

Having worked in the "charity industry" in the late 1980s, i assert that the most profound cause of homelessness which we saw was the effect of "Reagonomics"--men and women who had worked hard and followed the rules all of their lives found themselves out of work, and they lost their homes. They were the easiest to deal with, though, as they were willing to work to get a decent place to live.

Really? That's not what I read. I am sure that you are aware that the Democrats controlled the House and the Senate all through the 1970's and 1980's Mr. Setanta. I was referring to the information below in my sentence. Since you have a great deal of experience in the field, you say, you may wish to rebut the material below:

Developing a Cross Training Project: Manual

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SECTION ONE:
REVIEW OF THE LITERATURE
A. Current Situation

The 1970's brought a century of institutionalization for the mentally ill to an end: while many remained in state mental hospitals, the number of state mental hospital beds in the nation, which had reached a peak in 1955, has so substantially declined that the typical seriously mentally ill person is now spending little or no time in the state hospital. The 550,000 beds available in the nation in 1955 had shrunk to under 90,000 by 1990. During this time we have added seventy million people to the population of our country, so that the decline in beds per 100,000 population is even more extreme than the absolute numbers indicate.

Where did all the mentally ill go, and what happened to them? The partial answer is that many went to the streets, became involved with alcohol and other drug abuse, could not manage their lives in the community, and ended up institutionalized in our jails and prisons.

Problems of law breaking, substance abuse, or psychiatric problems have traditionally been dealt with separately, by systems designed expressly for each purpose. We have a criminal justice and corrections system; a substance abuse treatment system; a mental health treatment system. They were not created at the same time and have not been re-designed to work together. Each has its own philosophy, jargon, budget, personnel, and mission.

Jails are usually short-term detention facilities, usually operated by a county or municipality. Prisoners are either awaiting trial or serving short sentences, generally one year or less. Prisons, which may be either under state or federal jurisdiction, tend to be reserved for felons serving sentences of a year or longer. Due to space shortages it is possible to find a sentenced felon with a multi-year sentence still being held in a jail, awaiting space to open up in a prison so that a transfer can be effected. In 1972 the total number of jail and prison cells in the United States was 196,000. In 1994 prison cells exceeded 1 million, and there are approximately 500,000 jail cells in operation. Overall, between 1972 and 1994 we have seen a 750% increase in our jail and prison population.

Today's crisis exists because a great many individuals have, by their behavior, earned a ticket of admission to all three systems. However, few treatment resources are designed to provide concurrent mental health, substance abuse and criminal justice services. Restrictive admission criteria may block this population's access to treatment. When they are admitted to treatment, programs seldom provide comprehensive and coordinated services for their special needs. In addition, this population may find themselves prematurely discharged from a treatment program because some programs have fixed lengths of treatment rather than tailoring length of treatment to the individual's needs.

B. Description of the Offender with Co-Existing Disorders

Many communities are struggling to deal with increasing numbers of men and women who can be described by the following profile: a young adult; brought up by a single parent; became involved with drugs and alcohol before or during the teenage years; dropped out of school; developed early involvement with the criminal justice system; never developed adequate social, behavioral, and educational skills sufficient to obtain and maintain steady employment. Many such individuals suffer from a variety of personality immaturities and mental health symptoms, often meet criteria for one or more personality disorders from a mental health perspective, and also have significant symptoms of depression, anxiety, and cognitive confusion/disorganization. An unknown but significant percentage have been neglected as well as abused physically, psychologically, and/or sexually during childhood.

Offenders with co-existing disorders offenders are individuals who have both a mental and substance use disorder and are involved in criminal activities. These individuals have three potentially different points of entry into services: the mental health, the substance abuse, or the criminal justice systems. Because these three systems often work independently of each other it is quite possible that a dually disordered offender can receive services that fail to be comprehensive; that are uncoordinated; and that are unknown to the other involved systems, leading to potentially contraindicated interventions. In addition, this population is very transient and its movements back and forth between jurisdictions interfere with coordination of services. Without collaborative and integrated treatment planning between these three systems, this population will fail to receive either the comprehensive services or the monitoring it needs.

Though some form of collaboration and coordination of services is needed for all offenders with co-existing disorders, many members of this population can be successfully serviced without the full involvement of all three systems. Seven categories of individuals compose the dually disordered offender population. Some of these individuals can be effectively serviced by one system, others need two or all three systems to be involved. A description of these three categories follows:

Offenders with Co-existing Disorders Who Need the Involvement of only a Single System:

Type 1: An individual with a substance use disorder who wants to achieve abstinence and who has a non-severe mental disorder such as dysthymia which can be effectively controlled with medication. The individual is involved in minor criminal acts such as driving while intoxicated or processing or selling small amounts of a drug. The criminal behaviors would cease once abstinence is achieved. This individual can be treated effectively in a substance abuse program that provides medication services.

Type 2: An individual who uses alcohol and other drugs, who has an anti-social personality disorder and who may need medication for another mental disorder. The individual is involved in major criminal activities such as armed robbery, selling significant amounts of drugs, or major larceny or confidence activities. This individual may need mental health and substance abuse services but these services are best provided within the context of incarceration or intensive probation/parole activities such as a day reporting center to ensure compliance and participation.

Type 3: An individual with a major mental illness such as bi-polar disorder who abuses alcohol and writes bad checks only when manic. The individual is willing to take medication as prescribed and seek help for the manic symptoms when they appear. This individual can be treated effectively in a mental health program.

Offenders with Co-existing Disorders Who Need the Involvement of Two Systems:

Type 4: An individual who is dependent on alcohol or another drug and who has a non-severe mental illness which can be effectively controlled with medication. The individual is unwilling to achieve abstinence or participate in a substance abuse treatment program. The individual has become involved in the criminal justice system for such activities as driving while intoxicated or possession of an illegal substance. This individual can be successfully treated in a substance abuse program which provides medication once the criminal justice system requires involvement in treatment, and monitors the individual's participation and progress.

Type 5: An individual who has a major mental illness such as schizophrenia, whose use of alcohol or other drugs increases symptoms and reduces medication compliance. This destabilization results in minor criminal offenses such as trespassing, verbal harassment or drunk in public. The individual is resistant to abstinence and full participation in mental health services. The mental health system can successfully treat this individual once the criminal justice system requires abstinence and full participation and compliance with mental health treatment.

Type 6: An individual with a psychotic disorder such as schizoaffective disorder who abuses or is dependent on a substance which makes the symptoms worse. The individual is involved in some criminal behavior such as illegal possession of a substance or stealing beer from a store but has not been caught. The individual acknowledges that drug use increases the mental disorder symptoms and abstinence is needed. This individual can be successfully treated by either cooperative or integrated mental health and substance abuse treatment without the involvement of the criminal justice system.

Offenders with Co-existing Disorders Who Need the Involvement of all Three Systems:

Type 7: An individual who is dependent on one or more drugs, and resists substance abuse treatment; and who has a psychotic disorder such as schizophrenia, and resists medication compliance and other mental health treatment. The interaction of the substance use and mental disorder symptoms promotes participation in such criminal activities as assaultive behavior, petty larceny, or possession of an illegal drug. Without treatment for both disorders this individual will continue to be a danger to self and the community. Without involvement of the criminal justice system the individual will not participate fully in treatment.

C. What We Know About This Population

Having co-occurring substance abuse and mental health disorders increases the chance that an individual will be involved in the criminal justice system. The National Institute of Mental Health (NIMH) Epidemiological Catchment Areas (ECA)study estimated that 90% of inmates in surveyed correctional facilities who had a mental disorder also had a substance use disorder (Regier et al., 1990). Other research found that 25% of addicted offenders had a lifetime history of major depression, bipolar disorder or atypical bipolar disorder and 9% had a history of schizophrenia (Chiles Von Cleve, Jemelka, & Trupin, 1990; Cote and Hodgins, 1990). Abram (1990) found that 44% of the inmates had a lifetime history of substance use disorders co- occurring with depressive or antisocial personality disorders. Although only about 9% of the general population experience schizophrenic, schizoaffective, bipolar, or major depressive disorders in their lifetimes (Robins & Regier 1991), these disorders appear in much greater rates among persons who come in contact with the criminal justice system (Pepper & Ryglewicz, 1984; Regier et al., 1990; Test, Knoedler, Allness & Burke, 1985). Since these disorders have very high comorbidity rates with substance use disorders in the general population (Regier et al., 1990), it can be assumed that the prevalence of co-existing disorders is also higher in criminal justice settings.

These figures are really estimates rather than accurate numbers, because obtaining the exact number of individuals with co-existing disorders in the criminal justice system is greatly hampered by the fact that there is no single accepted definition of "mentally ill offender" (Jamelka, Rahman & Trupin, 1993). According to Jemelka, Trupin and Chiles (1989), the most commonly cited definition is "those individuals in prison and jails who have a diagnosable major psychiatric disorder (schizophrenia, unipolar and bipolar depression or organic syndromes with psychotic features)." This definition excludes many other significant and disabling psychiatric and personality disorders. For this reason, the Metropolitan Washington Council of Governments' Policy Report on Dual Diagnosis (1995) defined dual diagnosis as the co-existence of any mental disorder with a substance use disorder.

Additionally, statistical data, if kept at all, often fails to gather information in a consistent or reliable manner. A survey of 41 states found that only 9 (22%) kept records on the prevalence of mental illness among their probation and parole populations (Boone, 1995). The study also found that different states used different types of professionals to determine if an offender had a mental illness. Sixty-one percent of the states used mental health agencies for this determination, 27 percent of the states used private practitioners, 22 percent of the states used probation and parole agencies, and many states used a mixture of all these methods. Thus the reliability concerning accurate diagnosis can vary greatly depending on the professional training of those conducting the assessments and the definition of 'mental illness.'

So what do we know? We know that individuals with serious and persistent mental illnesses (SPMIs) began in the mid-1960's to be returned to the community from large state mental hospitals as part of the deinstitutionalization process. Since then, they have appeared in increasing numbers in the criminal justice system (Abram & Teplin, 1991; Pepper & Massaro, 1992). A major contributing factor in the involvement by this population in the criminal justice system is alcohol and drug use. The majority of individuals with SPMI use alcohol and other drugs (Ananth, 1989, Drake and Wallach, 1989, Regier et al., 1990). The interaction between serious and persistent mental illness and alcohol and other drug use greatly increases psychiatric symptoms and disinhibits behavioral controls (Barbee, Clark, Crapanzano, Heintz & Kehoe, 1989; Richard, Liskow & Perry, 1985). This explosive mixture often results in behavior that is disruptive and dangerous to the community, such as, disorderly conduct, shoplifting, trespassing, and assaultiveness (Test et al., 1985 and Yesavage & Zarcone, 1983).

Though research has found that any mental disorder might co-exist with a substance use disorder, certain mental disorders appear to cluster in much greater numbers with substance use disorders. The mental disorders found most often co-existing with substance use disorders are the mood disorders, especially bi-polar, dysthymia, and major depression (Drake et al., 1989; Hesselbrock, Meyer and Keener, 1985; Khantzian and Treece, 1985; Ross, Glasser and Germanson, 1988, Rousanville et al., 1982; Schuckitt, 1983; Weissman, Myers and Harding, 1980); the psychotic disorders, particularly schizophrenia and schizoaffective disorder (Damron and Simpson, 1985; Drake et al., 1989; Hesselbrock, 1984; Regier et al., 1990; Ross, Glaser et al., 1988; Safer, 1987); the anxiety disorders of social phobia and agoraphobia, obsessive- compulsive disorder and posttraumatic stress disorder (Hesselbrock et al., 1985; Regier et al., 1990; Ross, et al., 1988; Weiss and Rosenburg, 1985; Weissman, Myers and Harding, 1980); and anti-social and borderline personality disorders (Buyden-Branchey, Branchey and Noumair, 1989; Cloninger, 1987; Khantzian et al., 1985; Nace, 1989; Regier et al., 1990; Ross et al., 1988; Winokur, Reich, Rimmer and Pitts, 1970). The NIMH ECA study also found that individuals with co-existing disorders were twice as likely to be involved in treatment as individuals with a single diagnosis.

Currently there are no universally accepted intervention and treatment models for this population. Peters and Hill (1993) reviewed the professional literature concerning the treatment of individuals with co-existing disorders and concluded that "At present, few clear guidelines exist for the treatment of dual disorders in correctional settings." However they did find that treatment interventions found to be effective with the dually disordered population overlapped significantly with those employed in the treatment of major mental illnesses. Minkoff and Drake (1991) report that emergent themes in clinical literature concerning the treatment of co-existing disorders emphasize the need for integrated mental health and substance abuse services that also includes a vast array of other supportive services such as health, financial aid and housing. Boone (1995) however reports that currently there is a lack of coordination between probation/parole and mental health agencies, and the lack of coordination between mental health and substance abuse services is well documented (Hendrickson, Schmal, Albert & Massaro, 1994; Minkoff, 1991; Ridgley, Osher & Talbott, 1987). Davidson (1996) reports that it is rare to find case management or planning for mentally ill offenders across service provider lines.

Clear, Bryne and Dvoskin (1993) argue that "...there must be a point at which systems come together to benefit [correctional] clients." Wilson and Buckley (1992) report that multiproblem offenders released into the community nearly always are rehospitalized or reincarcerated. Dvoskin and Steadman (1994) proposed an intensive case management model that frequently monitors both illegal behaviors and symptoms of mental illness. Another variation of the case management approach is the Community - Client Protection System proposed by Pepper (1995). He proposed using a Community - Client Protection Team composed of mental health, substance abuse and correctional professionals who have court- ordered clients assigned to their team for both care and supervision. The team would provide continuous supervision and mental health and substance abuse treatment whether the client were located in the hospital, jail or community.

The dually disordered population is well established in the mental health, substance abuse and criminal justice systems. Even though many dually disordered clients are in need of all these services, there are currently few comprehensive and coordinated service arrangements between these three systems. Thus a significant gap exists between what we know to be the needs of this population and the actual services that we provide them.

D. Historical Perspective of Current Conceptual Models Used to Intervene with these Individuals

Paradigm I - The Colonial Period: Rough Justice

In 1607 the English created the first permanent settlement of Europeans in the New World, at Jamestown, Virginia. From 1607 until 1790 the new colonies dealt with those who broke community rules and laws with Rough Justice. The early colonies were poor, and could spare no resources to guard or rehabilitate law breakers.

Rough, summary justice was considered a necessity. Minor offenses were treated by public humiliation in the stocks at the town center, or by a public whipping. More severe offenses were treated by banishment or execution. Sometimes, if the behavior was seen as bizarre -what we might understand as mental illness today - a "witch" was burnt at the stake.

Paradigm II - The Philadelphia Quakers and the First Reform: The Correctional Institution

It is well known that during our colonial era the Quakers led the movement toward the abolition of slavery. It is less well known that they also advocated for the creation of jails, as a progressive reform and substitute for the severe forms of punishment which were then commonplace.

To pilot their new ideas the Quakers founded the Walnut Street Jail in Philadelphia in 1790. It was followed in 1817, by the Eastern Penitentiary, also in Philadelphia. These institutions provided individual cells to felons, and attempted to rehabilitate them through moral education, contemplation and penitence.

By 1816 New York State had an alternative to the Walnut Street Jail. The Auburn State Prison kept prisoners in individual cells at night, but during the day required them to work together. This prison industries model provided profit to the State of New York. Other states followed suit, and the profit-making prison became the model for the rest of the nation until the 20th century.

During the 19th century our cities and counties built jails for short-stay prisoners, while the states and the federal government built prisons for felons serving a year or more.

In 1972 the total number of federal and state prison cells for the nation was 200,000; in 1995 the number had increased to 1,500,000.

Paradigm III - From Dorothea Dix to the 1960's: The Mental Hospital

Beginning in 1841, a reform movement was begun, challenging the inclusion of mentally ill persons in jails and prisons. Dorothea Dix (1802-87), an eloquent advocate, persuaded the legislatures of 20 states to establish new institutions; mental hospitals. By 1955 the nation had a total of 550,000 state mental hospital beds.

Paradigm IV - From Institutional to Community Care

The decade of the 1960's is well-known to have increased civil rights for African-American and other minorities in the United States Eventually a spreading effect led to greater rights for women, children, the elderly, the mentally ill, the mentally retarded, and other minorities.

The push toward freedom for individuals in the community led to a movement against the excessive use of prisons, mental hospitals, and other closed institutions, and to an expanded call for systems of services in the community. This worked with regard to the state mental hospitals; by 1994 their bed complement had dropped from 550,000 to below 90,000. However, attempts to bring corrections toward a community focus by developing alternatives to incarceration and community corrections were not equally successful. They did not prevent the enormous growth of jails and prisons.

Paradigm IV - The Disease Concept: Development of a Substance Abuse Treatment System

The 1960's also led to a great increase in illicit substance abuse. In 1962 only 2% of adults had ever tried an illicit drug. By the 1980's nearly 50% of United States adults had tried drugs. Further, the age of first use of drugs has dropped steadily. The risk age for first use of illicit drugs and alcohol (whose use is illicit for those below 21) is now ages 8, 9, or 10.

During the 1960's and 1970's most states found it necessary to organize or expand drug abuse agencies. Since this occurred within the community treatment era, only a few states built large institutions for treating addicts. Instead, a model of funding community agencies was developed. Philosophies of substance abuse agencies grew out of the self-help movements of Alcoholics Anonymous (1935) and therapeutic communities for addicts (1960's) and thus developed quite apart from the mental health systems. Though a significant relationship exists between substance abuse treatment and criminal justice systems because most clients receive substance abuse treatment on a mandated basis, often the relationships between the staffs of these systems are limited or conflictual.

Current Paradigm: A Social Crisis

Until the 1960's, divorce, living together without benefit of marriage, and having children out of wedlock were stigmatized by our society. As a result, children tended to grow up in intact, and often multi-generational extended families. The 1960's saw this situation changing. Extended families became less common. Single parent families grew to be 30-40% of the population. By the 1980's changes in the economy made it necessary for most mothers to work, whether single or married, unless they were on welfare.

The 1990's has seen the advent of no-parent children. Out-of-wedlock pregnancies are now occurring as early as age 12. When children are having babies, both mother and child need mothering and child care. At the same time, schools are finding that many 6 year old children have not been socialized at home to the point of readiness for school. Drug abuse, violence, and lack of age-appropriate development in both rural and urban schools have become serious obstacles to education. It is this child-adolescent-young adult population that is fueling crime and social unrest.

Within this social context substance abuse, mental health and criminal justice professionals also find themselves embroiled in the evolutionary struggle within and among the mental heath, substance abuse, and criminal justice systems. The 20th Century has seen a see-saw struggle between two competing models for the provision of publicly funded services. The institutional model (mental hospital, prison) competes with the community care systems model (community mental health, community corrections). Although the two systems are linked, the linkages have often been weak. For the past thirty years, a smooth transition for the client from the mental hospital to the community mental health center has been interfered with by competition between hospital and community agencies for funding and other resources. Similarly, there are problems of resource allocation and competition between on the one hand, residential substance abuse treatment centers and correctional institutions, and community substance abuse treatment and community corrections on the other.

In addition, funding based on a single disability has greatly hindered both the substance abuse and mental health systems in combining or developing services for individuals with multiple disorders. Philosophical differences between the professional disciplines within the mental health, substance abuse and criminal justice systems have also hindered the development of services for clients who cross disability lines.

The situation in the mid-1990's leads us to call for integration of these three systems into one overarching super-system, as we plan for protection of the community and treatment of the individual.

E. Laying the Foundation for a New Paradigm: Understanding the Relationship Between Crime, Substance Use, and Mental llness

Finally, any work with this population requires an understanding of how substance use, mental illness and criminal behavior interact with each other. The following seven facts developed by Pepper (1993) provide a working paradigm about the complex relationships which exist between substance use, mental illness and crime.


1. Psychiatric patients who do not abuse alcohol or street drugs are no more likely to commit crimes than the public-at-large.
2. Alcohol is responsible for more criminal behavior than any other drug, and perhaps as much as for all other drugs combined. Its disinhibitory effects can lead to a variety of impulsive and illegal acts.

3. Psychiatric disorders and their symptoms frequently lead to alcohol or other drug abuse, which may, in turn, lead to crime. This is in part explained by the self-medication hypothesis, which is supported by data from the National Institute of Mental Health (NIMH) (Robins, et al., 1991). These data indicate that, in a dually-disordered individual, the odds are nearly 3 to 1 that psychiatric symptoms will pre-date the individual's abuse of alcohol or other drugs.

4. Psychiatric patients who abuse alcohol and other drugs have an increased incidence of severe, and sometimes violent, psychotic episodes and out-of-control behavior.

5. Abuse of cocaine, alcohol, marijuana, PCP, LSD, and other drugs is highly correlated with violent psychosis.

6. The abuse of alcohol or other drugs often cause psychiatric symptoms, leading to an error in diagnosis. In susceptible individuals, these drugs can cause: symptoms of psychotic illness, such as schizophrenia; panic and other symptoms of anxiety disorders; and depressive symptoms of varying degrees of intensity.

7. Psychiatric disorders per se tend to lead to inhibition of action, whereas alcohol or other drug abuse more often lead to disinhibition.



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I searched in vain for a proposal by Senator Ted Kennedy, the conscience of the Senate, to re-open more of the facilities that were closed.

I found none. Do you know of any.?In the meantime, I willsrive to provide court decisions which militated against what they called "The warehousing" of the mentally ill. There is now good evidence that these poor people would have been better served in mental hosptials than on the street.

In fact, my contention is that institutionalized adults were put on the streets by the closing of state-run facilities in the 1970s and -80s. Your copy and paste job confirms this in the first paragraph:



Those facilities were state facilities, run by each state's version of a Department of Mental Health and Developmental Disability. It is surprising to see you suggest that the Federal government is responsible for solving the problems of the states--hardly consistent with your typical rants.

I did not claim to have any expertise in the matter of mental health and developmental disabilities--although my mother retired after more than thirty years working for one such state department, and in the last decade of her career, spent her time travelling from one facility to the other to oversee the closing of the facilities.

I pointed out that i had worked in the "charity industry" in the late 1980s, and that the main cause of homelessness with which we dealt was the economic hardship of families resulting from the rising unemployment which put the principle bread-winners out of work and unable to pay rent or mortgages.

No, sorry. I was pointing out that you are wrong. You said: And this

On Monday, Stephen Lewis, the U.N. Secretary-General's special envoy for HIV/AIDS in Africa, said U.S. cuts in funding for condoms and a new emphasis on promoting abstinence had contributed to Uganda's condom shortage.


''To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa,'' Lewis told a teleconference sponsored by health and human rights organizations.

Uganda had been one of a handful of countries to significantly cut its HIV infection rate, from 15 percent in 1992 to six percent by 2002. The United States is Uganda's main donor for HIV/AIDS prevention.

Now, that progress is at risk, according to CHANGE. The administration of President George W. Bush and the office of Uganda's first lady, Janet Museveni, have emphasized abstinence and funneled money to religious groups who push it to the detriment of the other two planks of Uganda's successful anti-AIDS platform, known as ABC for ''Abstinence, Be Faithful, and Condoms.''

''Religious fundamentalists, some financially supported by the U.S. government and the office of the first lady Janet Museveni, have become prominent in attacking condoms and those who distribute them,'' CHANGE said in a report.
In consequence, Ugandans had seen a 300 per cent increase in condom prices and free condoms could not be found at the usual distribution points, said Jodi Jacobson, CHANGE's executive director.

Human Rights Watch (HRW), a sponsor of Monday's teleconference, charged in March that U.S.-funded abstinence-only programs put millions of young Ugandans at risk of AIDS by denying them information about proven methods to protect themselves.

This violated the ''human right to information, to the highest attainable standard of health, and to life,'' the rights watchdog said.

U.S.-based Christian groups and their political allies long have promoted the programs in Uganda, elsewhere overseas, and at home. The abstinence-only approach began to take root in U.S. aid policy under President Ronald Reagan. This year, Washington has budgeted some $8 million for abstinence-only programs in Uganda alone under the. Bush administration's global AIDS plan.
http://us.oneworld.net/article/view/117935/1/

Many AIDS officials blame the abstinence push on pressure from U.S. conservative groups, such as the Heritage Foundation and Focus on the Family, and on the Bush administration program the President's Emergency Plan for AIDS Relief, or PEPFAR.
The five-year, $15-billion program has dramatically increased U.S. funding for AIDS work in Africa, but it includes a hefty earmark for programs that deal exclusively with abstinence and faithfulness. Two-thirds of its AIDS prevention budget must be spent on the A-B of A-B-C.

One casualty so far is condom-distributor Population Services International, which lost its funding recently after being attacked by Ssempa and U.S.-based Focus on the Family.

Last month, the United Nations' special envoy on fighting AIDS in Africa attacked the U.S. influence.

"The condom crisis in Uganda is being driven and exacerbated by PEPFAR and by the extreme policies that the administration in the United States is now pursuing in the emphasis on abstinence," said Stephen Lewis, former Canadian ambassador to the U.N.

U.S. officials insist that they have not interfered in Uganda's AIDS debate and note that the program's funding for abstinence is part of a massive increase in overall aid. U.S. AIDS assistance in Uganda is about $150 million a year, more than the total spent between 1986 and 2001.
http://www.ph.ucla.edu/epi/seaids/ugandaabstinence.html

Now, I don't think you can say (at least with a straight face) Fundamentalist Church leaders in America have no part in the problem in Uganda. While they may not be physically present, they seem to play a large part in the "abstinence-only" policy.
P

Mr. Setanta- You may note that 27 % of the funding came from the Federal Government.




Section 3: Status of Mental Health Services at the Millennium
Chapter 8. The Mental Health Economy and Mental Health Economics
Richard G. Frank, Ph.D.,* and Thomas McGuire, Ph.D.*

*Harvard University; *Boston University

Introduction

The mental health economy in the year 2000 looks much more like the rest of the U.S. economy than it did in 1960 or even in 1980. Resource allocation of mental health care has been decentralized over the past 35 years. In the 1950's, roughly 75 percent of episodes of treatment were provided by public mental hospitals, whereas in the 1990's, less than a quarter of treatment episodes are provided by publicly owned mental hospitals. In the 1950's through the 1970's the mental health system operated as a planned economy. Today, markets for insurance, services, and even management of mental health systems are common features of mental health care delivery. The vast majority of people in the United States obtain their care for mental health problems from private providers that compete for customers. Their care is most often paid for by a public or privately funded health insurance plan (e.g., Medicaid, Medicare, or an employer-sponsored health maintenance organization [HMO]). Only a modest segment of treatment delivered in the year 2000 is directly paid for and provided by government-owned providers. Finally, in many States, administrative functions in the mental health delivery system have been delegated to private managed care organizations by State government, using competitive procurement methods.

Accompanying the dramatic structural changes in mental health care has been the emergence of a line of scholarship that applies economics to the problems of efficiently and effectively providing treatment for mental disorders. Research on economics and mental health has addressed a number of key mental health policy issues, including the design of insurance, methods for reimbursing providers, the use of incentive contracts in public mental health systems, the organization and financing of managed behavioral health care organizations, the cost-effectiveness of new mental health treatments, competition between mental health professionals, and equity in access to care for special populations.

In this chapter, we will review a number of important lessons that have been learned from applying economic analysis to a rapidly changing mental health delivery system. We will begin by briefly reviewing the transformation of the mental health system and then touching on four major lessons from research on economics and mental health.

The Transformation of the Mental Health Economy

As noted above, two of the most significant aspects of the transformed mental health economy have been the altered role of government and the emergence of private markets for mental health care.

The Role of the Public Sector

Rashi Fein (1958) estimated the direct costs of spending on mental health care in 1955 and 1956 to be approximately $1.14 billion. Government spent the vast majority of the money, 84 percent, on publicly owned providers. The other 16 percent of those funds was spent on private psychiatrists and private psychiatric hospitals. These figures highlight the fact that the mental health economy of the 1950's was largely centrally planned and did not use the market to allocate resources. It also shows the narrow range of providers and modalities in use at the time. McKusick and colleagues (1998) estimated that by 1996, $66.7 billion was being spent on mental health care. They also estimated that roughly 53 percent of that total spendingoriginated from public sources. Clearly, the relative role of government as a payer for mental health care has been reduced. The nature of how government pays for care has also changed. For example, in Fein's analysis, about 15 percent of spending in 1956 came from private sources (insurance and out-of-pocket payments), 58 percent from State government, and the remaining 27 percent from the Federal government (largely through the Veterans Administration). Neither States nor the Federal government had any significant insurance programs paying for mental health care in the 1950's. Utilization patterns reflect the financing arrangements. Kramer (1977) estimated that 49 percent of all treatment episodes were provided by public psychiatric hospitals. An additional 5 percent of episodes were supplied by the Veterans Administration and 23 percent by outpatient psychiatric services, many of which were publicly owned and operated.

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As I stated, the courts(and I remember this very clearly) became involved by ruling that patients were to be treated in the "least restrictive setting" Note below. Those least restrictive settings, for some of the homeless who need continual care in a mental hospital, turned out to be the cardboard boxes some of them live in. Note below:


These changes were not sufficient to prevent judicial scrutiny of institutionalization. By the late 1960's and early 1970's, lower federal and state courts, which had traditionally been content to leave mental health policy to psychiatrists, became increasingly willing to intervene when it seemed that patients' civil liberties were being violated. In 1966, Judge David Bazelon of the District of Columbia Circuit Court of Appeals issued a ruling, Rouse v. Cameron, that set the law on a collision course with state commitment procedures. Bazelon asserted that individuals sent to mental hospitals by criminal courts had a right to therapeutic treatment and that denial of such treatment constituted cruel and unusual punishment, denial of due process, and violation of equal protection of the law. Later that year, Bazelon issued another ruling that established patients' right to treatment in the least restrictive setting suited to their condition. Two years later, the Massachusetts Supreme Court followed Bazelon's line of argument and ruled that patients who had been sent to mental hospitals after being deemed incompetent to stand trial for criminal offenses had a right to expect treatment.[98] In New York State, the Court of Claims ruled in 1968 that a man who had been held in Matteawan State Hospital for more than fourteen years because he had allegedly violated his parole had been treated unjustly and awarded him some $300,000 in damages.[99] In the years that followed, many other state and federal courts ruled that some commitment practices violated the Eighth and Fourteenth Amendments. This trend culminated in the U.S. Supreme Court's 1975 decision in O'Connor v. Donaldson. The court did not find that mental patients had a right to treatment, but it unequivocally stated that people who were not dangerous to themselves or others and who were capable of living independently or with assistance from willing family and friends could not be institutionalized against their will.[100] In addition, a number of lower court rulings, including New York City Health and Hospitals Corporation v. Stein, afforded mental patients the right to refuse treatment if they so chose.[101]

In the wake of these decisions, public-interest lawyers, who had during the 1960's begun working with African-Americans, Latinos, women, and other groups traditionally ill-served by the law, started to defend the rights of the mentally ill and the developmentally disabled. In New York State, the New York Civil Liberties Union (NYCLU) initiated a new campaign upon behalf of mental patients. Led by David Ennis, who had little prior knowledge about the inner workings of the mental health system apart from reading of the works of Thomas Szasz, the campaign was also supported by Brooklyn lawyer Morton Birnbaum, the author of a 1960 American Bar Association Journal article that had heavily influenced David Bazelon.[102] The NYCLU initiated New York State Association for Retarded Children v. Rockefeller, the landmark case more popularly known as Willowbrook. Although the court's 1973 ruling stopped short of asserting that people in New York State facilities for the mentally ill, the mentally retarded, and the developmentally disabled had a right to treatment, it found that overcrowding at the Willowbrook State Hospital, a facility for the mentally retarded and the developmentally disabled, violated patients' right to protection from harm and ultimately handed down a consent decree that mandated that all Willowbrook patients were to be placed in community residences.[103] The Willowbrook case gave added impetus to the discharge of patients from state facilities: at least some DMH and other state health officials were afraid that state hospital administrators might eventually have to contend with a Willowbrook-type ruling.[104] In response to this fear, the department may have assigned discharge quotas to administrators of state mental hospitals in an effort to reduce the inpatient census and avert unfavorable legal rulings.

None of that alters the fact that, as your other article points out, the number of beds in state hospitals was reduced from 550,000 to 90,000 in the period 1955-1970. The courts did not order the states to abandon these people by simply ruling that many did not need as restrictive an environment.

But i don't want to spoil your obsessive-compulsive fun. If you want to rant about the courts, you just have a big time.

Oh, I don't want to rant about the courts. I only want to point out the ruling( noted in my post) by Judge Bazelon that patients had a right to treatment in the "least restrictive setting" suited to their condition.

This had ended up many times in a situation where "patients" were not under supervision and were living on their own. These patients who were supposed to report for treatment often did not do so since they were no longer in a hospital setting. Many of these make up the population of "homeless" people. We can thank Judges like Bazelon for that phenomena.