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D'Andre Ray was only four years old when he lost his father to gunshot wounds. Now 14 years old, D'Andre has since lost other relatives and friends to violence, and began receiving services from the Children Who Witness Violence (CWWV) program after his cousin was gunned down and died. According to his mother, Nneka Kemp, D'Andre's anxiety about violence and death has decreased significantly since he began working with a CWWV Counselor.

D'Andre's story is highlighted in a feature article for The Plain Dealer's Holiday Spirit program. Holiday Spirit helps clients of MHS and 19 other agencies during the holiday season, with money donated by readers. In past years, Holiday Spirit funds had helped families served by MHS to purchase basic bedding and kitchen supplies, make utulity deposits, or purchase medical supplies. All funds donated to the Holiday Spirit campaign goes to clients.

MHS is honored to be selected to participate in the 2008-2009 Holiday Spirit campaign. We are thankful to the helpful staff of The Plain Dealer, and to those in the community who made generous contributions to Holiday Spirit. MHS will use Holiday Spirit funds to help families referred to our Children Who Witness Violence (CWWV) program by police officers from participating communities, or by others in the community. CWWV was organized by the Cuyahoga County Board of Commissioners in 1999 to address the impact that domestic and other violence has on children and families. Families whose stories are featured in The Plain Dealer have provided written, informed consent for the disclosure of information about them.

Bridgeway, Inc., a community mental health center serving the west side of Cleveland, was said by William Denihan, Chief Executive Officer of the Cuyahoga County Community Mental Health Board (CCCMHB), to be "in danger of collapse," according to an article in The Plain Dealer.

Bridgeway has long been a well-respected provider of mental health services. Among its many important programs are those providing counseling, case management, crisis stabilization, and residential services. Bridgeway is also well-known for its innovative prevention and consumer-operated services.

The newspaper report notes a recent "scathing review" of Bridgeway's patient care by the CCCMHB, in addition to difficulties "in the transfer of 538 patients to another agency." David Lundeen, Bridgeway's Chief Executive Officer, disputed the conclusions reached by the CCCMHB's Chief Denihan. Mr. Lundeen told The Plain Dealer "Bridgeway has some work to do concerning transition costs and managing debt, but that doesn't mean Bridgeway is on the verge of collapse." Mr. Lundeen added "that there have been few consumer complaints about the care, and 'when there are, they're dealt with.' " Mr. Lundeen responds at length to The Plain Dealer report in a Letter to the Community on the Bridgeway website.

Funding reductions earlier this year have hurt the capacity of all community mental health agencies in Cuyahoga County to provide services for the growing number of those requesting care. MHS wishes Bridgeway Inc. well in its plans to reorganize its services and finances. MHS refers many clients served by the Mobile Crisis Team to Bridgeway for crisis stabilization and counseling services. In addition, MHS clients who have achieved stable housing on Cleveland's west side often transfer to Bridgeway for continued psychiatric and case management services.

MHS received notice today of a $200,000 award from the U.S. Department of Justice's Office for Victims of Crime (OVC) to create a system of comprehensive services for family members of homicide victims. Although nearly 30 organizations submitted proposals to OVC in April, MHS was the only organization in the nation selected to receive a grant award for this project.  A story of the grant award appeared in the online edition of The Plain Dealer of 20 October 2008, and in the print edition of 22 October.

OVC "oversees programs ... designed to benefit and assist victims of crime," according to the Office's website.

"OVC administers the Crime Victims Fund authorized by the Victims of Crime Act (VOCA) and grant programs to help crime victims. OVC grant programs include crime victim compensation, crime victim assistance, national scope training and technical assistance and demonstration programs, the children’s justice and assistance act, and services to federal crime victims."

During the project's first 18-month phase, MHS is to create a system of comprehensive and culturally-competent services that effectively address the practical and psychological needs of family members during the three-month period after a homicide. The Cleveland Division of Police, a collaborative partner in the project, is to refer family members for services, and help develop protocols for prompt and efficient service provision. The Cuyahoga County Witness/Victim Services Center will be another collaborative partner, providing families with advocacy services. In a subsequent phase of the project, MHS is to receive additional funding to replicate its service model in another community.

Homicides in Cleveland increased 58% from 2003-2007, despite a 5% population decrease in this period. Nationally, the number of homicides increased just 5% during these five years (FBI, 2003-2007), roughly equal to the percentage population increase. Cleveland's homicide rate (number/100,000 residents) of 27 in 2007 was nearly five times the national rate of 5.7.

Cleveland also has far higher rates of all violent crimes, compared with national figures, as shown in Table 1, below. Among U.S. cities with a population of at least 250,000, Cleveland had the 10th-highest murder rate (23.8) in 2006 (FBI, 2008). Although the rate of violent crimes rose only 1% nationwide from 2005-2006, it rose 11% in Cleveland (Guevara & Baird, 2007).

Research has shown that the impact of homicide on surviving family members is profound, complex, and enduring (Amick-McMullan et al., 1988; Danto, 1982; Hertz et al., 2003; Masters, et al., 1988.), particularly for those who live with chronic stressors and who have few resources to help them adjust to the loss of the victim. First, the homicide of a family member has been shown to have negative effects on the family's stability, communication patterns, and role functioning (Asaro & Clements, 2005). Second, symptoms of acute and post-traumatic stress disorder are common, and nearly two-thirds experience levels of stress warranting clinical intervention (Amick-McMullan et al., 1988). In several Cleveland neighborhoods, homicides occur in the context of community violence that has become a part of the residents' everyday life, a factor likely to exacerbate the severity of trauma symptoms.

Susan Neth, Interim Executive Director of MHS, said of the award, “There is a tremendous need for this type of initiative in our community. We look forward to working closely with the Cleveland Police, Cuyahoga County Witness/Victim Service Center and healthcare and social service providers to provide the intensive services necessary for those devastated by a homicide in their family.” Rick Oliver, Director of Crisis Services, immediately began working with Rosemary Creeden, Alexia Gardi, and Dana Santo to implement the program. They have already met with Janet L. Kronenberg, Manager of the Cuyahoga County Witness Victim Service Center, and Michael McGrath, Chief of Police for the City of Cleveland, who are collaborative partners in the project.

Below is The Plain Dealer article about the project.

MHS mourns the sudden death of U.S. Congresswoman Stephanie Tubbs Jones, who for ten years represented Ohio's 11th Congressional district that comprises portions of the City of Cleveland, and 22 of its suburbs. She died of a brain aneurysm at 6:12 p.m. on Wednesday, 20 August 2008 at Huron Hospital, where she had been taken by ambulance earlier in the day. A lifelong resident of Cleveland, Congresswoman Tubbs Jones earned her Juris Doctorate from Case Western Reserve University in 1974, served as a Cuyahoga County prosecutor, and later served as a Cuyahoga County Common Pleas Court Judge.

In 1998, she became the first African-American woman from Ohio to be elected to the U.S. Congress, serving the district that had been represented by Louis Stokes, the first African-American man from Ohio to be elected to the U.S. Congress. She led the U.S. House of Representatives' Committee on Standards of Official Conduct, and was the first African-American woman to serve on the House's influential Committee on Ways and Means. She was one of only 11 Democrats to oppose a 2003 House resolution authorizing the use of U.S. force in Iraq.

She was known for her tireless empathy and advocacy for her constituents, and she was a fierce proponent of legislation to provide healthcare for vulnerable citizens. In 1998, she sponsored the Child Abuse Prevention and Enforcement Act that became law. She also sponsored legislation providing healthcare for low and middle-income families, and a bill establishing a national system for tracking chronic diseases. When a technicality threatened renewal funding for the successful MHS Outreach & Representative Payee program in 2000, Congresswoman Tubbs Jones intervened with staff members of the U.S. Department of Housing & Urban Development to ensure the program's continuation.

The Trustees and staff members of MHS honor her legacy of service to her constituents, and offer our condolence to her family, friends, and colleagues.

References

Rep. Stephanie Tubbs Jones dies of aneurysm. (2008, August 21). Reuters. Retrieve the article from Reuters.

Koff, Stephen, & Eaton, Sabrina. (2008, August 20). Stephanie Tubbs Jones, passionate politcian, dies at 58. Cleveland, OH: The Plain Dealer. Retrieve the article from Cleveland.com. (Articles are available without charge for a limited time.)

"Cuyahoga County's mental health system is again grappling with financial turmoil at a large service provider, while a number of agencies are turning away uninsured patients or making them wait months for services."

This is the lead sentence of an article by Harlan Spector in The Plain Dealer, describing plans of Bridgeway, Inc. to lay off 27 workers, and transfer outpatient care for more than 500 clients to Connections (formerly North East Ohio Health Services).

The article notes that other agencies, "including Murtis H. Taylor and Recovery Resources, had either closed intake services or had long waiting lists for patients without Medicaid..."

The reduction in services is certainly related, at least in part, to a reduction of about $2.5 million in funds from the Cuyahoga County Community Mental Health Board (CCCMHB) to its contract agencies for services to those without Medicaid or other healthcare insurance. This disturbing development was highlighted by Harvey Snider of NAMI Ohio in a discussion broadcast 4 August 2008 on WCPN-90.3FM, and described here.

As shown in the table at left, from page 7 of the Fy2009 Non-Medicaid Budget Book approved by the CCCMHB on 26 March 2008, funding to Bridgeway for services to uninsured people was reduced 5.5% for the year beginning 1 April 2008.

Further funding cutbacks are expected in 2008. William M. Denihan, Chief Executive Officer of the CCCMHB, writes in the publication "CEO Headliners" of 23 July 2008 that "With the unstable economy, decreased housing values, foreclosures, and increased costs, the Board of County Commissioners has indicated that county departments and boards should brace for a possible funding reduction in calendar year 2009. The amount of a reduction is not known at this time. The County budget cycle will begin in September or October."

These funding cutbacks affect those for whom healthcare insurance is unavailable or unaffordable - a particularly vulnerable group that includes those with severe mental illnesses who are being discharged from psychiatric hospitals or released from jails and prisons. Because of the disorganized thought and conduct that characterized the episode of illness preceding their hospitalization or incarceration, these people often miss the reinstatement meeting that is required for maintenance of their Medicaid benefits. They then return to the community without the Medicaid benefits needed to pay for outpatient services, and for any medicines they may be prescribed for mental and physical illnesses.

Cuyahoga County urgently needs a plan to quickly address these funding reductions, and to provide the funding to serve these vulnerable citizens of our community.

References

Denihan, W.M, (2008, July 23). CEO Headliners. Cleveland, OH: Cuyahoga County Community Mental Health Board. Volume 5, Issue 7, p. 1. Retrieve this publication from the Board's website.

Gambatese, K.E. & Denihan, W.M. (2008, March 26). Fy2009 Non-Medicaid Budget Book. Cleveland, OH: Cuyahoga County Community Mental Health Board. Retrieved 7 August 2008 from: http://www.cccmhb.org/publications/FY09%20CCCMHB%20Non-Medicaid%20Budget%20Book.pdf

Spector, Harlan. (6 August 2008). Mental health agency Bridgeway limits, transfers patients. Cleveland, OH: The Plain Dealer, p B4. Retrieve the article from Cleveland.com. (Articles are available without charge for a limited time.)

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