National Consumer Memorial Planned

A memorial to hundreds of thousands of people who died in state psychiatric hospitals—many of whom are buried in unmarked graves—has been planned for the grounds of St. Elizabeths Hospital in Washington, D.C. The proposed design for the memorial features peaceful gardens that reflect the era of moral treatment, which was introduced in U.S. asylums by English Quakers in the first half of the 19th century. Opened in 1855, St. Elizabeths was designed to be a model moral treatment asylum. However, by the end of that century it and other large psychiatric institutions had become crowded and neglected warehouses where people were segregated and often forgotten.

Several organizations are participating in planning the memorial and in efforts to raise more than $1 million over the next three years for its construction. They include the National Association of Consumer/Survivor Mental Health Administrators, Depression and Bipolar Support Alliance, National Alliance for Mental Illness Consumer Council, National Coalition of Mental Health Consumer/Survivor Organizations, National Association of State Mental Health Program Directors, Mental Health America, and the U.S. Psychiatric Rehabilitation Association (USPRA). A Memorial Advisory Council also includes members of the Georgia Mental Health Consumer Network, Consumer Action Network of D.C., and the Mental Health Empowerment Project.

The Memorial Steering Committee is led by Larry Fricks, who for 13 years was director of Georgia's Office of Consumer Relations and Recovery. Mr. Fricks was chosen because of his experience in leading efforts to restore cemeteries at the state psychiatric hospital in Milledgeville, Georgia, where nearly 25,000 patients were buried over many decades in six burial grounds. In 1997 when Mr. Fricks and a group of consumers visited the cemeteries, they found that many of the small rusted grave markers—bearing numbers only—had been removed to make it easier for grounds crews to mow the grass. They later learned that 40 years of burial records were missing, making it impossible to identify names to go with many of the markers that remained in place.

The story of the Georgia cemetery's restoration and of efforts to identify cremated remains of patients who died in psychiatric hospitals in Hawaii is told on a video titled "Recovered Dignity," which can be watched on the USPRA Web site (www.uspra.org). The video is introduced by former First Lady Rosalynn Carter, who discusses recovery from mental illness and the importance of projects such as the one in Georgia for ending stigma.

The supporting organizations and individuals are sharing resources to help build the memorial. The Mental Health America board voted to be the fiscal agent and has created a tax-exempt fund to bank donations. The board of the Depression and Bipolar Support Alliance voted to provide funding for the design of a traveling exhibit to help raise funds. Organizations outside the field of mental health have also offered support. The University of Georgia School of Environmental Design will provide consultation and student support.

Tax-exempt donations can be sent to Consumer Memorial Fund, C/O Mental Health America, 2000 North Beauregard St., 6th Floor, Alexandria, VA 22311.

News Briefs

Kaiser Commission resources on children's insurance coverage: The State Children's Health Insurance Program (SCHIP) covers six million low-income children and builds on Medicaid's coverage of 28 million children. Reauthorization of the program, which is scheduled to expire on September 30, 2007, has been the subject of an ongoing policy debate. The Kaiser Commission on Medicaid and the Uninsured has published an eight-page issue brief that highlights key questions underlying the debate and provides a side-by-side chart of the House and Senate legislative provisions for reauthorizing the program. The brief also describes states' experience with the ten-year-old program and challenges to their enrollment efforts. It presents estimates showing that current baseline funding of $25 billion over the next five years is inadequate and that $14 billion in additional funding is needed to maintain current eligibility levels. The Kaiser Commission has also recently released a study of "All Kids," the nation's first universal coverage program for children launched in Illinois in 2006. The initiative builds on the state's Medicaid and SCHIP programs but is funded exclusively with state funds. The program offers coverage to all uninsured children, regardless of income, health status, or citizenship. Under All Kids, families can purchase coverage on a sliding scale. The 25-page brief, A Race to the Top: Illinois's All Kids Initiative, describes early program experiences. Both reports are available on the Kaiser Commission Web site at www.kff.org/about/kcmu.cfm.

AHRQ analysis of off-label use of antipsychotics: The Agency for Healthcare Research and Quality (AHRQ) has released a report on the effectiveness of second-generation antipsychotics to treat conditions other than schizophrenia and bipolar disorder. The results of 84 published studies were analyzed, and no strong evidence was found that these agents are effective for any off-label uses. The report, which includes cost estimates, emphasizes that some of the medications can increase risks of serious side effects. The authors found that some studies suggest that second-generation antipsychotics may help patients with psychiatric conditions for which there are no approved alternatives. Risperidone and quetiapine, for example, help some patients with obsessive-compulsive disorder when used in conjunction with antidepressants. Risperidone and olanzapine improve sleep problems, depression, and other symptoms among men with combat-related posttraumatic stress disorder when used to augment therapy with antidepressants or other psychotropic medications. Overall, however, the authors found that much of the scientific evidence for off-label use of antipsychotics was of insufficient quality because studies were too small or lacked scientific rigor. The review, Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics, was conducted by AHRQ's Southern California-RAND Evidence-Based Practice Center. It is available on the AHRQ Web site at effectivehealthcare.ahrq.gov.

SAMHSA resources on HIV-AIDS:Mental Health AIDS is a quarterly newsletter published by the Substance Abuse and Mental Health Services Administration (SAMHSA) that provides updates of biopsychosocial research. The summer 2007 issue presents detailed summaries of 11 new empirical studies of AIDS prevention interventions, two studies of assessment of at-risk and infected populations, and five studies of treatment issues, especially in regard to adherence to antiretroviral therapy. Brief summaries of 13 nonempirical articles and recently published books are also provided. A "Tool Box" section offers guidance on tailoring evidence-based risk-reduction interventions to the characteristics of a target audience. SAMHSA has also recently published a brochure, "Drugs, Alcohol, and HIV/AIDS: A Consumer Guide for African Americans." It describes the increased risk of HIV transmission among people who abuse substances and includes hotline numbers and Web sites to help people find treatment. These resources can be downloaded from the SAMHSA Web site at www.samhsa.gov.

Primer on health care costs: In 2005 U.S. spending on health care amounted to $2 trillion—16% of the gross domestic product (GDP) and $6,697 per capita. Since 1970 health care costs have grown on average 2.5 percentage points faster than the U.S. GDP. In 2005 just 5% of the population accounted for almost half of all health care expenditures. In 1996 about a fourth of poor people (26%) spent more than 10% of their income on health care. In 2003 the proportion of poor people had risen to 33%. Between 2000 and 2006 insurance premiums rose 87%, more than four times the growth in wages. These figures are from a new primer on health care costs recently released by the Kaiser Family Foundation. The primer describes the types and sources of health care spending and the demographic factors associated with higher or lower levels of spending. It also discusses other factors that influence health care spending growth, including new medical technology, population changes, and changes in disease prevalence. The 15-page primer is available on the Kaiser Foundation Web site at www.kff.org.

National Institute on Aging publication on mourning: Faced with the death of a spouse, many older people struggle with feelings of shock, sorrow, anger, fear, and occasionally guilt. Grief can make everyday activities difficult. To help older people cope with grief, the National Institute on Aging (NIA), part of the National Institutes of Health, has added "Mourning the Death of a Spouse" to its Age Page series of easy-to-read brochures. The new publication provides useful and practical advice on topics ranging from reactions to death to taking charge of life again. The brochure covers many facets of mourning and learning to live without a partner. A free copy of the brochure can be obtained by calling the NIA Information Center at 800-222-2225 or visiting www.nia.nih.gov.

APA Web site focuses on mental health of college students: The Web site of Healthy Minds, Healthy Lives is currently featuring resources for students who are starting or returning to college and their families. Healthy Minds, Healthy Lives is the American Psychiatric Association's (APA's) consumer campaign to improve understanding of mental illnesses and effective treatment options, as well as to reduce stigma. Several brochures from APA's "Let's Talk Facts" series are featured, including brochures on alcohol abuse by college students and on depression, eating disorders, teen suicide, and choosing a psychiatrist. In the "Expert Opinion" column Jerald Kay, M.D., chair of APA's Corresponding Committee on Mental Health on College and University Campuses, answers questions from parents and students about mental health services on campus and warning signs of mental illness and violence. Links are provided to the National Suicide Prevention Lifeline and to videos about people with mental illness who were helped by treatment. The resources are available at www.healthyminds.org.

Conference to address transcultural issues: The World Federation for Mental Health (WFMH) is sponsoring a conference "Transcultural Mental Health in a Changing World: Building a Global Response" from October 29 to 31 at the Minneapolis Marriott Hotel City Center. The conference is the first to be convened by the WFMH Center for Transcultural Mental Health. It will highlight the major influence that culture plays in how individuals, communities, professionals, and service organizations perceive mental health and mental illnesses and how services are planned and delivered in a multicultural community. Collaborating with the WFMH are Minnesota-based mental health, health, social, and human service organizations. The conference is aimed at mental health professionals from all disciplines, advocates, educators, consumers, and policy makers. More information about the conference, including registration materials, is available on the WFMH Web site at www.wfmh.org.