From The Oregonian, December 29, 2009, 7:00PM

Drumming is part of the festivities at the New Year’s Eve Sobriety Pow Wow.

New Year’s Eve Sobriety Pow Wow
When: 1 p.m.-midnight Thursday
Where: Oregon Convention Center, 777 N.E. Martin Luther King Jr. Blvd., 503-235-7575

Admission: Free

Web site: naranorthwest.org

More than 3,000 people are expected at the Oregon Convention Center for Thursday’s 24th annual Sobriety Pow Wow, one of the city’s largest and longest-running holiday events.

But its organizers aren’t surprised if you haven’t heard about the party — which they expect to be the area’s biggest clean and sober New Year’s Eve celebration.

“The culture teaches us to be humble,” says Scott E. Buser, treatment director for Native American Rehabilitation Association of the Northwest, which goes by the acronym NARA. “From the beginning of the powwow, we haven’t advertised, we’ve just opened it up. We’ve said, ‘Here’s a place, if you want to come with your family and have a safe place on a treacherous night when a lot of people are out drinking.’ ”

The New Year’s Eve Sobriety Pow Wow was started by NARA’s traditional cultural director, Philip Archambault, who saw a need for a celebration free from some of the night’s common temptations. He also saw it as a good fit with NARA’s core mission of running “a treatment program that Indians could relate to.”

Founded in 1970 as an outpatient substance-abuse treatment center, the nonprofit agency has grown to include residential treatment and family resource programs as well as a primary care health clinic. The powwow is being billed as the kickoff to NARA’s 40th anniversary.

“The powwow is a symbol of the community and our role in it,” says executive director Jacqueline Mercer. “Our work is to be the servants of the community, and this is a big way of giving back for us.”

“There are two foundations to this event,” Buser says. “One is that it’s about the tradition of Native peoples coming together to celebrate. The other side of that is sobriety.”

The first of those foundations is addressed with a cornucopia of cultural activities. Archambault, a member of the Lakota Sioux Nation, presides over the event as master of ceremonies. Ed Goodell is what’s called “whip man,” whose ceremonial duties include preparing the dance floor by smudging sage, sweet grass, flat cedar and juniper. There’s a color guard and “grand entry” processionals to honor those in NARA’s residential family treatment center. There are children’s games and more than 50 vendors selling crafts, Indian tacos, fry bread and cookies.

Most important, there are drums and dancing. NARA All Nations Drum serves as the host ensemble, but the open-door policy prevails.

“Bring your drum if you want to play,” Archambault says. “Bring your costume if you want to dance.”

“We’ve had hoop dancers; this year we’ll have traditional Aztec dancers,” Buser says. “We’ve had bagpipers there.”

Bagpipers? You bet. Native culture may be the powwow’s main tool, but the goal is helping people in the community, so everyone is invited.

“Dude, if you’re an outsider and come there, you’re kind of in awe,” Buser says. “But if you’ve been through the program and you’ve been learning about your culture, it’s very emotional.”

Buser, of Chickasaw descent, started that learning in 1992, when he entered a NARA drug and alcohol treatment program. He later went to work for the organization and, through the years, progressed from cook to director of its treatment programs.

“I came in here and had no knowledge of my history,” he says. “The transition from living on the street, robbing people and hurting people to living clean and learning about the culture — that’s huge.

“If it wasn’t for that, I wouldn’t have changed. I wouldn’t have stayed clean.”

That’s just the sort of success story that Archambault, himself sober more than 30 years, believes the powwow and other such activities make possible.

“The ceremonies are what keep us tuned to our personal values as a people,” he says. “When you stand up and say, ‘I’m Indian and proud,’ you’re saying you live by positive values.”

From the Sacramento Bee, December 27, 2009

Thomas C. Gagen is CEO of Sutter Medical Center, Sacramento

It was with great interest that I read “Mental-illness cases test cops,” (Our Region, Dec. 13). I fully agree that law enforcement staff and individuals with mental health needs are at risk. Our community should also understand that because of budget cuts imposed by our elected county officials, our health care providers – and every member of this community – are at great risk.

Providing much-needed urgent acute psychiatric care without appropriate resources is an extreme disservice to care providers, law enforcement and the individuals requiring psychiatric care. These individuals are our families, neighbors and friends. Just as with other health issues, mental illness can be chronic, controlled and monitored over time with few side effects, or it can be acute and require immediate response. It is the latter that your article reports is a risk to law enforcement.

It doesn’t matter if police receive intense training for six hours, 13 hours or even 40 hours – it is not enough. We need the appropriate resources allocated to serve the mental health needs of our community.

However, I am more concerned about the health care providers in our local emergency departments and our other patients. Hospital emergency rooms are not physically designed or equipped to handle psychotic or violent individuals. In reality, they are far less equipped than law enforcement.

Since the unprecedented closure of county services for the mentally ill, our own hospital employees are regularly experiencing tense, sometimes dangerous and often physical encounters with individuals suffering acute mental health issues.

I am most distressed by the lack of concern that our community has shown about the county’s mental health cuts. Fifty psychiatric beds were closed at the Sacramento County-funded psychiatric hospital. The Psychiatric Crisis Stabilization Unit has been closed. Our Sacramento County supervisors, and even some members of the public, seem to think it is OK to abandon people with mental health needs. Budget cuts may currently be necessary, but it’s not OK to cut services that protect the community from injury and even death.

No one argues that the county budget is a mess, but one of the reasons we have local government is to provide certain essential services – such as services for those with mental health needs. Our elected officials can no longer ignore this issue; they should act now to find funding for this crisis situation.

From Willamette Week, December 22, 2009

Scott Westerman

The Portland police union’s push for better PR continues this month with a poll on public perception.

Sgt. Scott Westerman (see photo), head of the Portland Police Association, says the union paid for a poll of hundreds of Portland residents this month to learn their opinion on public safety.

“The PPA has hired a company to do polling of City of Portland residents to better communicate with our members the priorities the city of Portland has as it relates to police services,” Westerman says.

Westerman calls the poll part of a “long-term strategy” by the police union to better engage the public. The union hired Gallatin Public Affairs last fall to manage its PR campaign.

Details of the poll so far remain sketchy. Westerman declined to say how much the poll cost, calling it part of a package deal with Gallatin. And Gallatin partner Greg Peden said he could not provide details, including how many people were polled.

Peden said his firm hired New York-based Mercury Public Affairs to conduct the poll, and the results have not yet been released to the police union.

The poll and wider PR campaign come at a delicate time for the politically powerful union.

Cops say they’ve taken a battering in the media and from some activists over the 2006 in-custody death of James Chasse Jr as a civil trial between the city and Chasse’s family approaches. The trial was recently postponed from March to June.

The poll comes after the union won what some observers call a Pyrrhic victory in its recent stand-off with Police Commissioner Dan Saltzman and Chief Rosie Sizer.

By holding a massive rally and a no-confidence vote on Saltzman and Sizer — then agreeing to withhold the results — the union convinced Saltzman to back down from his decision to strip Officer Christopher Humphreys of his badge.

Humphreys, one of the officers involved in Chasse’s death, used a beanbag gun in November on a 12-year-old girl who was violently resisting arrest. The incident drew public criticism and may have increased rifts between citizens and the police union when its members rallied to Humphreys’ defense.

From Eugene Register Guard, December 21, 2009

Magnetic stimulation therapy added to psychiatry’s toolbox

Tiffany Marable was taking nine medications a day, and the depression still would not lift.

She could not get out of bed or stop crying. Holding a job was impossible. Just doing the dishes seemed overwhelming.

“I felt doomed,” said Marable, 32.

After years of taking heavy doses of antidepressants, mood stabilizers and other medications at a cost of $3,000 a month, the Aledo, Texas, mother of four agreed to try a new treatment that sounded like something out of a science fiction novel.

Transcranial magnetic stimulation therapy, or TMS, is one of psychiatry’s newest tools in the treatment of severe depression that is unresponsive to medication. It uses short, highly concentrated pulses of magnetic energy to stimulate the part of the brain that is believed to control moods.

The magnetic fields are the same type and strength as those produced by magnetic resonance imaging machines, or an MRI.

The magnetic field is applied above the left prefrontal cortex and does not affect the whole brain, said Dr. Gary Malone, medical director and chief of psychiatry at Baylor All Saints Medical Center.

For 37½ minutes, patients sit in what looks like a dentist’s chair as 8,000 pulses target an area of the brain about the size of a golf ball, he said.

In October 2008, the Food and Drug Administration cleared the device, made by NeuroStar, for the treatment of severe depression. Almost two years earlier, an FDA advisory panel found that the device was safe but questioned its efficacy. Side effects include headaches and lightheadedness.

It could be an alternative to medication for some of the 15 million Americans who have major depression.

For Marable, who was first treated for depression at age 13, the results were life-changing.

“I could do homework with my kids or go to a game and not be afraid to be around people,” she said. “I just felt normal.”

The treatment, given five days a week for six weeks, is effective in 50 percent to 60 percent of patients and is well-tolerated, said Dr. Deborah Kim of the University of Pennsylvania, where she is researching the use of TMS on pregnant women.

About 8 percent of people treated with antidepressants do not respond. Electroconvulsive therapy, also known as shock therapy, is very effective for severe depressive episodes; it has serious side effects and requires hospitalization.

In clinical trials for TMS, half the patients experienced an improvement and a third were able to go off medication, Malone said. Of the three patients he has treated with TMS, all responded within two weeks.

The treatment holds promise for pregnant women because antidepressants are not safe for fetal health, said Kim, a member of the American Psychiatric Association.

It has also been shown to relieve the pain and depression of fibromyalgia, a condition characterized by widespread pain. How long treatment works is unclear because long-term research isn’t available, Kim said.

About 50 percent of patients being treated with TMS at the University of Pennsylvania do maintenance treatment, Kim said. There’s no reason why they cannot repeat the therapy at a later time if necessary.

Still, it’s not for everyone.

“If you’re depressed because you had a fight with your wife or you have addictive issues, this will not help,” Malone said.

For those like Marable whose depression makes it difficult to function, relief comes at a price. The six-week treatment costs about $12,000 and is generally not covered by insurance.

From OPB News, December 21, 2009

Recently, a video of Portland police officer Chris Humphreys arresting a 12-year-old girl by shooting her with a bean bag, highlighted a disconnect between members of the community and police officers.

Kathleen Ris: “In my opinion, there’s obviously something that needs to change with that officer and he should be on administrative leave.”

Mark White: “We saw Chris Humphries do precisely what needed to be done. It was a reasonable response…”

The time most people find themselves dealing with a police officer is during a traffic stop. If you have your license and insurance, it’s basically a question of whether you can schmooze out of a ticket.

For most people, it doesn’t feel like a life or death situation. But for an officer, says retired Portland Policeman Mark White, it’s different.

Mark White: “In the back of your mind, if you can’t see what’s going on in of the car, which is often the case, especially at night, you can’t see who you’re stopping. You have to be on alert. You have to have somewhat of a combat mentality, initially. Once you’ve made that initial contact and you’re comfortable this person doesn’t present a threat to you. Then the dymanics change at that point.”

White starts up one of the half dozen motorbikes in his garage. He’s got time to tinker with them now he’s retired after 29-years on the force.

During that time, he never shot anybody. In fact, he says, most cops aren’t interested in getting into a fight.

Mark White: “There’s too much liability now. There’s too much scrutiny on use of force. and I think that they screen for people that are more likely to negotiate, which is good. You’re going to find an officer here and there, maybe having a bad day. Maybe he has had previous contact with somebody, his patience is running thin. He’s not going to spend a half hour negotiating with somebody. He could have another 10 calls stacked upon his MDC, he’s going to take action.”

Each officer gets an area in which they’re expected to clear the calls.

Of course if there’s a 9-1-1 call for a robbery-in-progress or some other such emergency, they jump on it.

Mark White: “There is a bit of a combat mentality to day-in and day-out living as a cop. You know it’s unlikely that you’re going to get in a gunfight that shift. But it’s always a possibility.”

That possibility is something that adds to the disconnect between how officers see the world, and how many Portlanders see it.

It’s a disconnect that the chief, Rosie Sizer, deals with every day.

Traditionally, police brass have been loath to second guess an officer’s use of force. But after Sizer became chief, she directed officers to take control of a situation using the minimum force necessary — and only if that didn’t work, to step up to the next level.

Mark White: “I don’t think there’s a big objection to that kind of philosophy. It’s certainly not practical in all situations. There can be any number of kinds of scenarios where an officer might have to go to deadly force in a split second. There’s no time to go through a continuum of any kind.”

It’s that kind of split-second decision that terrifies Kathleen Ris.

She says her 19-year-old son, Joe, is bipolar, suffers from severe anxiety, and won’t take his medications. He lives on the streets downtown.

She’s petrified that one day, he’ll come face to face with a police officer.

Kathleen Ris: “You know, there are key words that you can use and it’s just a matter of body language and things that you can say to de-escalate a situation. To drop that level of volatility. To drop the level of adrenaline. And sometimes it’s just taking a step back and breathing for 10 seconds. You know if it’s not an absolute threat, if someone’s not standing in front of you waving a gun, why can’t they do that.”

Her fears stem in part from the case of James Chasse, a mentally-ill man who died in police custody three years ago.

She thinks officers need to consider themselves social workers as much as law enforcement officials.

Kathleen Ris: “I don’t envy their job because they have to deal with every personality in the book. And I just don’t think they equip the officers with the right kind of training or social skills to go out and deal with the vast majority of the population. Especially here in downtown Portland.”

Meanwhile, she goes about her day in fear.

Kathleen Ris: “I get up every morning and pray that I don’t get the phone call. That’s he’s not dead.That he’s not incarcerated again. That he hasn’t been shot. That he hasn’t been sexually assaulted. I just thank God every morning that I wake up, that I didn’t get that call.”

From the Portland Observer, December 18, 2009

Portland Police Chief Rosie Sizer spoke to the city’s Human Rights Commission’s Committee on Police and Community Relations last night.

Portland Police Chief Rosie Sizer spoke to the city’s Human Rights Commission’s Committee on Police and Community Relations last night.

The Portland Human Rights Commission’s committee on police relations took up a high-profile use of force incident last night at its meeting.

At the meeting, the term “the community” was present on nearly every committee members’ lips. During the meeting, members of the committee noted that community was unhappy with the handling of the incident. They noted that the community was uneasy with the police, and that the community had a hard time distinguishing between the police union and the police bureau.

Portland Police Chief Rosie appeared before seven members of HRC’s Community and Police Relations Committee and Maria Lisa Johnson, the director of the city’s Office of Human Relations, to discuss the incident and how the bureau was handling it.

Last month, Officer Christopher Humphreys, a controversial officer who was disciplined for his role in the death of James Chasse, caused a firestorm when he shot a 12-year-old girl with a beanbag gun at close range at MAX stop.

Humphreys was initially put on a desk job while the incident was being investigated, but Police Commissioner Dan Saltzman went further and suspended him. This caused the police union to stage a demonstration and hold a vote of no confidence on Sizer and Saltzman, that wasn’t released after Humphrey’s suspension was reversed.

Speaking to the committee, composed of police officers and citizens, Sizer acknowledged that there are issues with police use of force, but insisted that the bureau was making progress on them.

She explained that officers operate under trying conditions, and forming guidelines for the use of force is very difficult since it gets tied into a dizzying array of legal issues. Officers are often left with an unclear sense of when they can use force, she said.

“Unfortunately, for them that line is not very bright,” she said.

Sizer repeatedly cited a report issued earlier this year that showed that police were using less force.

However, several members of the committee expressed discomfort with how the incident with Humphreys was handled.

“In my experience, whenever the police do something, whether it be the right thing or the wrong thing, it’s justified [by the bureau],” said Patricia Ford, a member of the committee who also asked if the 12-year-old girl got any support.

Sizer said that she couldn’t comment on whether the girl got support, and explained that holding officers accountable can be complicated since there needs to be a careful review of employment case law before an action can be taken.

Darryl Kelley, a former gang member who serves on the committee, questioned whether the officer should have shot a 12-year-old girl when he was clearly bigger and stronger.

“When you think about excessive force, that’s pretty excessive,” said Kelley, who wondered out loud how much support he’d get if he shot someone.

Kelley said that the incident was a “huge step backward” for community policing.

Hector Lopez, a former United Church of Christ minister who serves as the committee’s chair, asked Sizer to comment on the actions of the police union.
Sizer described the union’s actions as “overtly political.” She also noted that the union was willing to be part of dialogue on the issue.

Stephen Manning, an immigrant lawyer and member of the committee, said that people have a hard time distinguishing between the police union and the police bureau.

Ford added that she has an 11-year-old grand daughter who asked if she would be shot by the police.

“To the community, it feels like this officer is going to do whatever,” she said.

Portland Police Officer Deanna Wesson (left), Sergeant Anthony Passadore (center), and Commander Mike Crebs (right) serve on HRC’s Community and Police Relations Committee.

Commander Mike Crebs, a member of the committee, said that the guidelines for police use of force, which once had clear rules for what officers could do, are being replaced with ones that use “the totality of circumstance.” He said this was a difficult transition for many officers who were accustomed to being judged on much they could bench press or how fast they could run the 100, and are now expected to show “empathy.”

Sizer also commented on the issue of accountability in the bureau. She said that officers are quietly dismissed from the force on a regular basis, but the public is largely unaware because they are lower profile. She also said that some officers worry that if “something bad happens” they’ll lose their jobs.

“Police officers react to fear with that,” she said.

Officer Deanna Wesson, a committee member, said that the officer in the incident was in a difficult position. She noted that the girl was allegedly fighting officers trying to arrest her, and hoped people would consider his perspective.

She said that women “are more flexible” and sometimes fight harder.

“If you decide to fight us, we’ll fight back,” she said reluctantly, noting the presence of television cameras.

Sizer concluded by saying that the police are burdened beyond capacity, and are routinely confronted with socio-economic and educational issues that are outside the scope of the bureau.

At the public comment period, Dan Handelman, of Portland Copwatch, said that officers who cheat or steal might get kicked off the force, but found it troubling that officers who use force against people aren’t.

He also said that the complaints are not thoroughly investigated, and that he was troubled by the amount of money the city pays out in settlements from lawsuits stemming from police use of force.

“A lawsuit comes out of our pockets,” he said.

Don Bray passed away at home surrounded by family after living with Alzheimer’s since 2003. He was born August 28, 1930 and died December 3, 2009.

James Donald Bray M.D.

He was born in Pratt, Kansas, first son of Dorothy and Harold Bray. He attended Kansas State University, where he was a member of Beta Theta Pi. At age 19 he explored South America, Europe, and Africa. He returned to Kansas, where he married his first wife, Rose Ann Ledferd, in 1952. Don graduated from Washburn University in 1954, was commissioned as a 2nd Lieutenant in the Air Force, and served as a hospital administrator at Laughlin Air Force Base in Del Rio, Texas.

Don graduated from the University of Kansas School of Medicine in 1961, followed by an internship at St. Margaret’s Hospital in Kansas City, Missouri. With his family, Don moved to Salem, where he completed a psychiatric residency at Oregon State Hospital.

He joined the Oregon Division of Mental Health, served twice as division head, and remained until his retirement in 1989. Don also taught in the Department of Psychiatry at the Medical School at OHSU.

His pioneering leadership was recognized by the National Institutes of Mental Health. As their consultant, Don evaluated many state mental health programs around the nation. He served two terms as president of the National Association for Mental Health Program Directors. Following retirement, Don consulted with the state of South Carolina, resulting in the successful move of many patients to community settings.

Don had a lifelong love of sailing and singing. He played guitar and ukulele and taught each of his children to play those instruments. He is preceded in death by his first wife, Rose Ann Ledferd Bray; and his daughter, Ann (Mike) Jones. He is survived by his wife, Rebecca Bray; five children, Chris Bray (Dave Sweet), Kathi (Tom) Douglas of Salem, Jamie (Furd) Halsell of Pilot Point, Texas, Lisa (Eric) Utz of Florence, Jim (Holly) Bray, of Salem; and his brother, Jerry (Mary) Bray of Salem. Don had nineteen grandchildren, two great-grandchildren, two step-children, Sherrie (Brooke) Burdick of Mukilteo, Wash., and Mark (Tam) Miles, M.D. of Pauline, S.C. and four step-grandchildren. A memorial service will be held at 11 a.m. on January 16 at First United Methodist Church, 600 State Street in Salem. Private interment on December 19.

From Examiner.com Portland, December 14, 2009

Will Hall, Portland Hearing Voices

Will Hall’s past was a nightmare of forced hospitalizations, mind-numbing drugs, and nights wandering the streets. Today, Hall is a controversial reminder that recovery is possible.

Hall lives and works in Portland. He manages his schizoaffective disorder with a combination of natural methods, including diet, yoga and acupuncture, plus heavy doses of awareness and support. His guide to the “harm reduction” approach to coming off psychiatric drugs, based on a model widely used in addiction treatment, has been nationally recognized.

Hall’s activities include leading the Portland Hearing Voices group, for those who hear voices, see visions, or have unusual beliefs. Hall advocates mental diversity and acceptance.

But what, exactly, is “mental diversity”? Is it responsible to advocate “acceptance” for serious mental illness? What about the risk of violence? In our three-part interview, Will Hall answers the tough questions.

Portland Mental Health Examiner: Would you explain the concept of “mental diversity”?

Will Hall: “Instead of fearing and judging others by one standard of what is normal, mental diversity means learning about and accepting different minds and experiences.

“Some of us in the community have psychiatric diagnoses like bipolar, schizophrenia, or depression.

We want to be met for the unique individuals we are, not just stereotyped. Many of us take medications, while many of us don’t; some of us hear voices or see visions or get paranoid; some of us act eccentric or have strange moods and unusual beliefs. This can go along with terrible suffering, while some of us learn to cope and live with our voices and visions. It may even be part of our art and our spirituality.

“Did you know that studies show many people hear voices at some time in their lives, but don’t have any problem with it? Did you know most of us are trauma survivors and need help overcoming histories of abuse and violence?

We need to be more open to the diversity in mental experience, rather than pushing unusual minds into the shadows.”

Will Hall Interview, Part 2: Anti-medication or pro-choice?

From Examiner.com Portland, December 14, 2009

Portland Hearing Voices is pro-diversity

In Part 2 of our interview, Will Hall, of Portland Hearing Voices, talks about the decision to take psychiatric medications.

Portland Mental Health Examiner: Are people who take psychiatric medications welcome in your group?

Will Hall: “Yes, we offer support groups where diversity is welcomed. Most people who come do take medications, and some don’t.

“I am diagnosed with schizophrenia and haven’t taken medications in 14 years. We respect diverse pathways to recovery.

People need good information and support so they can make their own decisions about balancing medication risks with benefits. Medications have serious side effects, and everyone should learn about and consider alternatives, such as holistic health and nutrition, as well as coming off or reducing medications. There is no ‘one size fits all.’”

PMHE: Suppose someone came to you and said, “I hear voices and have experiences that are scary and distressing. With medication, I’m able to work and I feel better. But now I’m worried about the risks and side effects.” What would you say?

WH: “People do come to me–that’s why I wrote the ‘Harm Reduction Guide to Coming Off Medications.’ ‘Harm reduction’ means it’s not an either-or choice of taking medications or getting no help at all. Doctors should be collaborators supporting you to make wise decisions, not like bosses telling you what to do.

“I don’t give medical advice, but

I would recommend the person speak frankly with their doctor and start to become educated about how to deal with fear and distress in ways beyond medications. There are also methods to talk with the voices and learn coping techniques. Then they might get support to consider a very small medication reduction, a switch in medications, or supplements and lifestyle changes to reduce side effects.

“Many have been in the same situation and been able to improve things, if they go slow and look at options. More and more people who don’t take medications are coming forward, showing

there’s more than one way to live with mental extremes.”

Will Hall Interview, Part 3: What happens if psych patients go off their meds?

From Examiner.com Portland, December 14, 2009

Will Hall’s Harm Reduction Guide

In the conclusion of our interview with Will Hall, of Portland Hearing Voices, we ask the question on many people’s minds: what about violence?

Portland Mental Health Examiner: A small number of people have a risk of acting out violently. Do they have any kind of obligation to take medication?

Will Hall: “Hollywood and tabloid television spread harmful stereotypes. Studies show that people diagnosed with mental illness are not more likely to be violent. In fact, because we are often isolated and vulnerable, we are more likely to be survivors of trauma and targets of violence ourselves. Let’s stop stereotyping.

“No diagnosis can predict in itself who will be violent, and we are not a dictatorship where we lock people up just because a doctor suspects they might commit a future crime. Many people have problems with anger and aggression and need help, including therapy and ways to manage anger, such as addressing alcohol use.

“Let’s also remember that medication side effects can themselves sometimes cause agitation, aggression, and suicide. When a fearful society is afraid of the killer next door, it’s nice to think an easy fix like medications is the solution. It’s not.

I’m more worried about the danger of car accidents than I am about people diagnosed with mental illness.”