Kenya hospital imprisons new mothers with no money


NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.


Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.


Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.


"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."


"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."


The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.


Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.


"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.


She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.


A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.


"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.


Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.


One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.


Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.


___


Associated Press reporter Tom Odula contributed to this report.


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Gen. 'Stormin' Norman Schwarzkopf Dead at 78













H. Norman Schwarzkopf, the retired general credited with leading U.S.-allied forces to a victory in the first Gulf War, died today at age 78.


The man who Defense Secretary Leon Panetta today called "one of the great military giants of the 20th century" died in Tampa, Fla., where he lived in retirement, the Associated Press reported.


"The men and women of the Department of Defense join me in mourning the loss of General Norman Schwarzkopf, whose 35 years of service in uniform left an indelible imprint on the United States military and on the country," Panetta said in a statement. "My thoughts and prayers are with the Schwarzkopf family in this time of sadness and grief."


Schwarzkopf, called "Stormin' Norman" because of his reportedly explosive temper, led America to two military victories: a small one in Grenada in the 1980s and a big one as de facto commander of allied forces in the Gulf War in 1991.


"'Stormin' Norman' led the coalition forces to victory, ejecting the Iraqi Army from Kuwait and restoring the rightful government," read a statement by former Secretary of State Colin Powell, who was chairman of the Joint Chiefs of Staff during the Gulf War. "His leadership not only inspired his troops, but also inspired the nation."


WATCH: Gen. Norman Schwarzkopf to Saddam Hussein: 'Get Outta Town'


Schwarzkopf's success during that fight, also known as Operation Desert Storm, came under President George H.W. Bush, who through his office today mourned "the loss of a true American patriot and one of the great military leaders of his generation."








Gen. Norman Schwarzkopf to Saddam Hussein: 'Get Outta Town' Watch Video









Gen. Schwarzkopf's '5 Minutes of Unimportant Questions' Watch Video









George H.W. Bush Hospitalized in ICU After 'Setbacks' Watch Video





"Gen. Norm Schwarzkopf, to me, epitomized the 'duty, service, country' creed that has defended our freedom and seen this great nation through our most trying international crises," Bush said. "More than that, he was a good and decent man -- and a dear friend."


Bush's office released the statement though the former president, himself, was ill, hospitalized in Texas with a stubborn fever and on a liquids-only diet.


The current White House occupant, President Obama, also memorialized Schwarzkopf, declaring him "an American original" who "stood tall for the country and Army he loved."


The future four-star general was born Aug. 24, 1934, in Trenton, N.J.


Schwarzkopf's father, who shared his name, directed the investigation of the Lindbergh baby kidnapping as head of the New Jersey State Police, later becoming a brigadier general in the U.S. Army.


Schwarzkopf was raised as an army brat in Iran, Switzerland, Germany and Italy, following in his father's footsteps to West Point, earning an engineering degree and being commissioned as a second lieutenant in 1956.


WATCH: Gen. Schwarzkopf's '5 Minutes of Unimportant Questions'


He earned three Silver Stars for bravery during two tours in Vietnam, gaining a reputation as an opinionated, plain-spoken commander with a sharp temper who would risk his own life for his soldiers.


"He had volunteered to go to Vietnam early just so he could get there before the war ended," said former Army Col. William McKinney, who knew Schwarzkopf from their days at West Point, according to ABC News Radio.


In 1983, as a newly-minted general, Schwarzkopf once again led troops into battle in President Reagan's invasion of Granada, a tiny Caribbean island where the White House saw American influence threatened by a Cuban-backed coup.


But he gained most of his fame in Iraq, where he used his 6-foot-3, 240-pound frame and fearsome temper to drive his forces to victory.


"He was known as a soldier's general," said retired Maj. Gen. Donald Shepperd, as he explained the "Stormin' Norman" nickname to ABC News Radio. "In other words, he really liked the troops and was soft on the troops. But boy, on his general officers, his officers, his NCO's, he was very, very tough and he had a real quick temper."


PHOTOS: In Memoriam: People We Lost in 2012


Gruff and direct, Schwarzkopf said during the Gulf War that his goal was to win the war as quickly as possible and with a focused objective: getting Iraq out of Kuwait.






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North Korea's China trade nearly triples in 4 years






SEOUL: North Korea's trade with China has nearly tripled since 2007, according to data published by South Korea, underlining the isolated state's deepening dependence on its only major ally.

Bilateral trade jumped from $1.97 billion in 2007 to $5.6 billion last year, Statistics Korea said, with North Korean exports accounting for $2.44 billion against imports from China of $3.16 billion.

Statistics Korea releases the annual data based on figures from trade and economic organisations at home and abroad. The North does not report economic data.

Trade with China as of last year accounted for 70.1 percent of the North's entire trade of $8.0 billion, up from 41.7 percent in 2007.

During the same period, trade with South Korea -- the North's second-biggest partner -- fell from $1.79 billion to $1.71 billion.

Cross-border relations have been on ice since outgoing President Lee Myung-Bak, known for his hawkish stance towards the communist North, took office in 2008.

Lee suspended humanitarian aid to the North in 2010 and tied any resumption to progress on resolving the issue of Pyongyang's nuclear programme.

Inter-Korea commerce, which accounted for 38 percent of the North's total trade in 2007, was down to 21 percent last year.

Apparently fearful of the consequences of North Korea collapsing, China has pumped in fuel and aid to its neighbour for years.

The nuclear-armed North is subject to international sanctions imposed after its nuclear tests in 2006 and 2009, and those may be tightened or expanded following its successful long-range rocket launch earlier this month.

Pyongyang said the launch was a purely scientific mission, but most of the world condemned it as a disguised ballistic missile test that violated existing UN resolutions.

- AFP/al



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Gulvez thought NCC would help him become a cop

NEW DELHI: By the time Gulvez Ahmad reached the final year of his B Com Honours course, he had changed his mind. He had joined the NCC in school thinking it would boost his chances in a career in policing . But when his father, Kafeel Ahmad, saw him off on December 21, he was looking forward finishing college and joining an MBA programme . Ahmad was one of the five students from the Delhi unit of the National Cadet Corps who drowned in the Periyar at Kochi on Wednesday . The others are Dilshad Alam, Tabish Baqri, Mohammad Zeeshan and Hemanth Kumar.

"He was called Hafiz," says Ahmad's uncle, Faheemuddin, "It means one who has learnt the Quran by heart. He was austere like a maulavi" But Ahmad, a student of Shaheed Bhagat Singh College , was a sharp one as well. Neighbours say he brought home awards and shields, was the "brightest of them all" and was expected to shine more. The news reached his home in Old Govindpura before his father, an embroiderer , did. "He was so young. I even accompanied to the railway station the day he left," says an inconsolable Kafeel Ahmad. Of the 96 cadets attending the trekking camp in Kochi, 53 were from Delhi.

"We've been trying to talk to him on the phone since morning but somebody would disconnect. In the evening, his mobile was switched off," says Dilshad Alam's mother. Dilshad's family was told that two of the five kids had slipped into the river and the other three had been trying to rescue them. "Dilshad could not swim," says his sister Ayesha Jabeen. He, along with Tabish and Zeeshan were engineering students at Jamia Millia Islamia University . Tabish and Zeeshan, were from Uttar Pradesh; Dilshad's family, is based close to the university , in Zakir Nagar. Alam's mother always checked on him when he went out on trips and this was his first one out of the state with the NCC. His father, Khursheed Alam, doesn't hold a steady job and is away most of the time. There was a lot riding on Dilshad's engineering degree.

Baqri came to Delhi from Amroha in Uttar Pradesh three years ago. His younger brother Danish - Baqri was one of six siblings - is concerned about the arrival of his body. "He called us four to five days ago to tell us he is leaving for the trip. My parents are devastated . They have fallen silent," says Danish. They heard of the tragedy on Wednesday evening. Mohammad Zeeshan, another engineering student at Jamia, was from Uttar Pradesh too. The only school student among the casualties was Hemanth Kumar, a student of Government Boys Senior Secondary School at GBlock , Kalkaji.

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Predicting who's at risk for violence isn't easy


CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.


Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.


But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.


"They're yellow flags. They only become red flags once the blood is spilled," he said.


Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.


Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)


Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.


Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.


"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."


The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."


In a guidelines for families, the academy lists several risk factors for violence, including:


—Previous violent or aggressive behavior


—Being a victim of physical or sexual abuse


—Guns in the home


—Use of drugs or alcohol


—Brain damage from a head injury


Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.


Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.


Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.


According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.


Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.


Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.


And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.


All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.


Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.


Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.


Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.


___


Online:


American Academy of Child & Adolescent Psychiatry: http://www.aacap.org


___


AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner


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Toyota Agrees to $1B Settlement in Acceleration Case












Toyota has agreed to pay more than $1 billion to customers to settle a class action lawsuit that alleged its vehicles accelerated dangerously and without warning, according to statements by the carmaker and the plaintiffs' attorney.


The deal, which still needs approval by a federal judge in California, includes a $250 million fund to be paid to Toyota owners who sold their cars at a loss following reports of vehicle malfunctions, as well as the installation of a brake override system in about 3.25 million vehicles


An additional $250 million fund will be created to pay those owners whose vehicles are not eligible for the retrofitted brakes.






David Zalubowski/AP PHoto







Toyota recalled more than 14 million vehicles after reports of sudden, unexplained acceleration in several models began to surface between 2009 and 2010. There were also reports of brake problems with the Prius hybrid.


Toyota insists that it was not an electrical flaw that caused the acceleration problems, but driver error, floor mats and sticky gas pedals.


Both the National Highway Traffic Safety Administration and NASA have said there is nothing in wrong with programs that run the vehicles' onboard computers


"From the very start, this was a challenging case," said Steve Berman, the plaintiffs' lawyer. "We brought in automotive experts, physicists and some of the world's leading theoreticians in electrical engineering to help us understand what happened to drivers experiencing sudden acceleration."


The settlement also includes $30 million to be given to outside groups to study automotive safety.


In a statement, Toyota agreed to the deal.


"In keeping with our core principles, we have structured this agreement in ways that work to put our customers first and demonstrate that they can count on Toyota to stand behind our vehicles." said Toyota spokesman Christopher P. Reynolds.



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Mental illness, poverty haunted Afghan policewoman who killed American


KABUL (Reuters) - The Afghan policewoman suspected of killing a U.S. contractor at police headquarters in Kabul suffered from mental illness and was driven to suicidal despair by poverty, her children told Reuters on Wednesday.


The woman was identified by authorities as Narges Rezaeimomenabad, a 40-year-old grandmother and mother of three who moved here from Iran 10 years ago and married an Afghan man.


On Monday morning, she loaded a pistol in a bathroom at the police compound, hid it in her long scarf and shot an American police trainer, apparently becoming the first Afghan woman to carry out such an attack.


Narges also tried to shoot police officials after killing the American. Luckily for them, her pistol jammed. Her husband is also under investigation.


Her son Sayed, 16, and daughter Fatima, 13, described how they tried to call their parents 100 times after news broke of the shooting, then waited in vain for them to come home.


They recalled Narges's severe mood swings, and how at times she beat them and even pulled out a knife. But the children said she was consistent in bemoaning poverty.


"She was usually complaining about poverty. She was complaining to my father about our conditions. She was saying that my father was poor," Sayid said in an interview in their damp, cold two-room cement house.


On the floor beside him were his mother's prescriptions and a thick plastic bag filled with pills she tried to swallow to end the misery about a month ago. On another occasion, she cut her wrist with a razor, Sayed said.


"My father was usually calm and sometimes would say that she was guilty too because it wasn't a forced marriage. They fell in love and got married."


There was no sign in their neighborhood of the billions of dollars of Western aid that have poured into Afghanistan since the ouster of the Taliban in 2001, or of government investment.


RAW SEWAGE, STAGNANT WATER, DIRT ROADS


The lane outside their home stank of raw sewage.


Dirty, stagnant water filled holes in dirt roads nearby, where children in tattered clothes played and butchers stood by cow's hooves in shops choked by dust.


Afghanistan is one of the world's poorest nations, with a third of its 30 million residents living under the poverty line.


The sole distractions from the daily grind appeared to be a deck of playing cards and a compact disc with songs from Iranian pop singers, scattered on the floor of a room where Narges would lock herself in and weep, or sit in silence.


At times, Narges would try to focus on building her children's confidence, telling them to be guided by the Muslim holy book, the Koran, to tackle life's problems.


Sayed and Fatima said she never spoke badly of the U.S. presence in Afghanistan or of President Hamid Karzai's government.


Neighbor Mohammad Ismail Kohistani was dumbfounded to hear on the radio that Afghan officials were combing Narges' phone records to try to determine whether al Qaeda or the Taliban could have brainwashed her into carrying out a mission.


But he was acutely aware of her mental problems and often heard her scream at her husband, whose low-level job in the crime investigation unit of the police brought home little cash.


Kohistani, who operates a small sewing shop with battered machines, never imagined his neighbor could be accused of a high-profile attack that raised new questions about the direction of an unpopular war.


"I became very depressed and sad," said Kohistani, sitting on the floor few feet from a tiny wood-burning stove in Narges's home, alongside family photographs and a police training manual.


Fatima would often seek refuge in Kohistani's house when her mother's behavior became unbearable. "She did not hate us, but usually she was angry and would not talk to us," said Fatima, her eyes moist with tears.


Nevertheless, she missed her mother. The children were staying with a cousin.


"I ask the government to free my mother, otherwise our future will be destroyed," said Fatima.


Officials described it as another "insider shooting", in which Afghan forces turn on Westerners they are meant to be working with to stabilize the country. There have been over 52 such attacks so far this year.


The shooting at the police headquarters may have alarmed Afghanistan's Western allies. But some Afghans have grown numb to the violence.


Kohistani's 70-year-old father Omara Khan, who sports a white beard, sat twirling prayer beads beneath a photograph of Narges in a black veil beside one of her husband.


Asked what he thought of the attack, he laughed.


"This is common in Afghanistan," said Khan, who lived through decades of upheaval, including the 10-year Soviet occupation and a civil war that destroyed half of Kabul and killed some 50,000 civilians.


"People are killed every day."


(Editing by Ron Popeski)



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Myanmar probes deadly plane crash-landing






HEHO, Myanmar: Myanmar was on Wednesday probing the cause of an air accident that left two people dead and 11 injured when a passenger jet packed with foreign tourists crash-landed and caught fire.

The incident raised fresh questions about the safety standards of Myanmar's fast-growing but overstretched aviation and tourist industries as foreign visitors flock to the country which is emerging from decades of junta rule.

The ageing Fokker 100 jet came down in heavy fog Tuesday in a field short of the runway at Heho airport -- the gateway to the popular tourist destination of Inle Lake -- breaking its tail and catching fire, according to officials.

One Burmese tour guide on board was killed along with a motorcyclist on the ground. The government earlier said an 11-year-old passenger had died but it appeared to be a case of mistaken identity.

The airline said the injured included two Americans who were flown to Bangkok for treatment, as well as two Britons, one Korean man and the two pilots.

"We are still working to find out the cause," Civil Aviation Department deputy director general Win Swe Tun, who is heading the investigation into the crash, told AFP at Heho airport.

He said the plane appeared to have hit a power cable while approaching the runway.

"Seventy of the 71 people on board survived and one died -- it's very rare," he added.

Air Bagan, which described the accident as an "emergency landing", said it had retrieved the plane's black box data recorder.

One eyewitness said flames were already spewing from the plane before it crash-landed.

"We followed the plane as it flew on fire," said 27-year-old villager Phoe La Pyae.

"When we saw the plane, the wing was broken already," he said. "It was so lucky. If the emergency exit had not been opened, no one would have survived".

"We helped to send some seriously injured people to hospital. Their skin was burnt because of fire. Foreigners seemed really scared about what happened," he added.

The body of the aircraft was almost entirely burned while part of a wing was seen lying next to a nearby road, according to an AFP reporter at the scene.

The carrier said 26 passengers were flown to Yangon on a special flight Tuesday and taken to hospital for examination while others would follow.

"Air Bagan deeply regret the deaths of two persons and tender its condolences to the bereaved families," the airline said in an English-language statement posted on its Facebook page.

"Air Bagan in collaboration with the Ministry of Transport is investigating into the cause of the accident. We will take full responsibility for all passengers and will release further information as we received it."

The airline is one of several domestic carriers seeking to profit from a tourist boom in Myanmar as it emerges from decades of military rule.

It is owned by tycoon Tay Za, who is known for his close links to the former junta and has been blacklisted by the US Treasury which once described him as "a notorious regime henchman and arms dealer".

The Fokker 100, which is no longer manufactured, was one of two operated by the airline along with four ATR turboprop aircraft, according to the company's website.

A surge in demand for air travel as Myanmar opens up has stretched the impoverished country's aviation infrastructure, in particular in remote airports.

- AFP/ck



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Home ministry announces Rs 10 lakh ex-gratia for family of dead constable Subhash Tomar

NEW DELHI: The home ministry announced on Wednesday an ex-gratia of Rs 10 lakh to the next of kin of Delhi Police constable Subhash Chand Tomar, who died here on Tuesday morning.

An ex-gratia of Rs 10 lakh will be given to the family of Tomar in addition to the financial and other relief announced by the Delhi Police, a home ministry spokesperson said.

The 47-year-old constable, who was injured during violent protests at India Gate on Sunday, died on Tuesday after battling for life in a city hospital.

Tomar was posted in Karawal Nagar area and was called for maintaining law and order at India Gate area during the weekend protests over the gangrape of a 23-year-old girl.

Read More..

Predicting who's at risk for violence isn't easy


CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.


Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.


But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.


"They're yellow flags. They only become red flags once the blood is spilled," he said.


Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.


Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)


Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.


Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.


"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."


The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."


In a guidelines for families, the academy lists several risk factors for violence, including:


—Previous violent or aggressive behavior


—Being a victim of physical or sexual abuse


—Guns in the home


—Use of drugs or alcohol


—Brain damage from a head injury


Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.


Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.


Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.


According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.


Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.


Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.


And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.


All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.


Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.


Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.


Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.


___


Online:


American Academy of Child & Adolescent Psychiatry: http://www.aacap.org


___


AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner


Read More..