<![CDATA[Orchid Advocacy - Olmstead Law & Order Thursday]]>Fri, 17 May 2024 06:15:54 -0700Weebly<![CDATA[The State's Fundamental Alteration Defense]]>Wed, 15 May 2024 14:12:48 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/the-states-fundamental-alteration-defense
In 1999, the US Supreme Court issued a compromise ruling in Olmstead --- and States, people with disabilities and their advocates have been struggling with it ever since.

States ostensibly love Olmstead and people with disabilities, and States really struggle to comply with Olmstead.

Two Key Concepts:
  • If States have a Comprehensive, Effectively Working Plan to de-institutionalize people with disabilities where possible and support those at risk of institutionalization --- THEN states have a defense to a claim brought under Title II of the Americans with Disabilities Act (ADA)
  • That Defense is the Fundamental Alteration Defense --- State's are not required to make a fundamental alteration to the State's Plan for People with Disabilities if:
    • The State's Plan is comprehensive, effective and moving at a "reasonable pace."
ASIDE
  • The more science-based that Mental Health becomes --- the easier this will be for:
    • the Public to understand and support

Integrating Mental Health with the rest of Medicine is crucial.
Olmstead Condensed including
The Fundamental Alteration Defense
Olmstead Resources
(These Resources are Relatively New)
Most States' Plans for People with Disabilities have been relatively siloed and disjointed --- there has been a lot of effort to address that --- but it hasn't completely been solved.

So one of the points the US Department of Justice has made is that this State Plan for People with Disabilities is NOT LIMITED TO MEDICAID.

The big challenge is that Medicaid does not cover Housing --- that is a HUGE PROBLEM.

With regard to housing and supportive housing, most states do what they want and call it "reasonable."

That fiction becomes harder and harder to maintain if you've got a lot of people with cognitive disabilities incarcerated in jails and prisons or homeless --
  • and no comprehensive, effectively working State Plan for People with Disabilities moving at a reasonable pace.

Further, a lot of people with cognitive disabilities can live in supportive housing, not necessarily all.
]]><![CDATA[Denver is working with the State --- Denver needs to hold the state accountable for supportive Housing to scale]]>Sat, 20 Apr 2024 19:19:29 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/denver-is-working-with-the-state-denver-needs-to-hold-the-state-accountable-for-supportive-housing-to-scale
Val's Take
  • I heard Kyle Clark on Next say that Denver ran into REALITY when it came to homelessness and housing.
  • I think Denver and this Country need to "RUN INTO REALITY" --- a lot more than we have.
 
  • Many if not most chronically homeless people are going to meet the criteria for "disability."  Now has that been worsened by CHRONIC STRESS --- probably.
 
  • I've tried to make this point numerous times --- but it is actually the STATE that has a legal responsibility to provide:
    • MEASURABLE GOALS
    • REASONABLE TIME FRAMES, and
    • FUNDING TO SUPPORT THE PLAN
to prevent unnecessary institutionalization of people with disabilities and the unnecessary risk of  institutionalization inherent in homelessness.
So COLORADO should have an adequate Continuum of Care --- NOW --- but we don't --- we need to make that plan and get those MEASURABLE GOALS.

Now we have existing evidenced-based models that can help and provide safe places, and we have EMERGING MODELS that "may" dramatically improve the lives of some people on the neuro-developmental/psychiatric spectrum.

Conceptualizing this as an ENERGY ISSUE with MITOCHONDRIA DYSREGULATION seems to be an important step up in our understanding of some of these issues.

If we don't deal with the MITOCHONDRIAL DYSREGULATION --- it's going to be hard for people to "get back on their feet."
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What is Mitochondrial Dysfunction?
]]><![CDATA[A Better "MEDICAL MODEL" could sure reduce institutionalization]]>Sat, 06 Apr 2024 16:43:43 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/a-better-medical-model-could-sure-reduce-institutionalization
Val's Take
  • The Psychotropic Medications of the 1950s and 1960s along with NEXT GENERATION Medications---
    • have been a MIXED BAG
    • and instituted a BACKLASH in Mental Health AGAINST the Medical Model
 
  • The DSM 5 is an embarrassing list of categories with subjective symptom clusters that often don't track brain scans or the research.

Having said all that, research of the last 10 years is making REAL BREAKTHROUGHS:
  • Discovery of lymphatic vessels in the brain.
  • Linking Maternal Immune Activation with Neuro-Developmental and Psychiatric Disorders as well as "Hyper-Connected" Brains
  • Recognizing the Metabolic aspects of Neuro-Developmental and Psychiatric Continuum and the role of Mitochondria and ATP.
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New insights into the role of mitochondria in autoimmune diseases (2019)

Mitochondrial DNA (mtDNA) normally stays within mitochondria, energy-producing structures inside cells. However, it can be released from the mitochondria into the cell in response to stress. When this happens, the mtDNA can trigger an overactive immune response, as occurs in autoimmune diseases.
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"In most cells, mitochondria (green) form complex tubular networks that help them distribute energy throughout the cell. Disruption of these mitochondrial networks is a hallmark of many human diseases."

Photo credit: UC San Diego Health Sciences
Video reports UC San Diego research
Biomarkers for Suicidal Thoughts in the Mitochondria
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Developmental Stage-Dependent Changes in Mitochondrial Function in the Brain of Offspring

Following Prenatal Maternal Immune Activation (2023)

  • As mentioned above, prenatal activation of the maternal immune system has been connected with both increased risk of ASD [Autism Spectrum Disorder] and with mitochondrial dysfunction.
  • It has been demonstrated that the mitochondria have a noteworthy relationship with the immune system, as they can impact the immune response and vice versa.
]]><![CDATA[What's "REASONABLE" when the system(S) to address Neuro-developmental & Psychiatric Disorders are already OVERWHELMED & RElying on A scientifically invalid DSM]]>Fri, 23 Feb 2024 00:28:25 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/whats-reasonable-when-the-systems-to-address-neuro-developmental-psychiatric-disorders-are-already-overwhelmed-relying-on-a-scientifically-invalid-dsm
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Val's Take/Conjecture

"University Teaching Hospitals"  are an important connection between RESEARCHERS and CLINICIANS.

One of the scariest things to observe in Mental Health is the LARGE DIVIDE that has grown up between the RESEARCHERS and the CLINICIANS.
Generative AI in Healthcare
  • Is this an Olmstead Issue?

So Olmstead is about preventing the unnecessary institutionalization of people with disabilities.

Further, it is currently understood to include the risk of institutionalization of people with disabilities that is inherent in HOMELESSNESS.
OVER10 Years After the National Institute of Mental Health Called Out the DSM 5 --- Where Are We?
  • NIMH's idea which sounded good at the time and probably is still good in many respects was the RDoC Program.
    • The DSM was not tied to the underlying biology BUT
    • The RDoC Program and its "MATRIX" would be.
In the intervening 10 years, we've learned a lot more and seen the emergence of:
  • The Microbiome
  • Immuno-Psychiatry
  • Metabolic Psychiatry
  • Neuro-Endocrine Psychiatry
  • Maternal Immune Activation
  • A Neuro-Developmental-Psychiatric Continuum

The number of variables is staggering.
I do think we are reaching our limits to process information.  There is a need to expand those limits to achieve more effective individualized medicine.

AND

The largest institutions for people with mental illness are JAILS & PRISONS.
Even if we don't readily have available the absolute answer --- If we had a mental health profession that was MORE AWARE of its knowledge limitations ---
  • we might have the INTELLECTUAL MATURITY to get more people out of jails and prisons.
  • and provide the ALTERNATIVES currently necessary.
]]><![CDATA[Cross Disability and the Dynamic Duo of Julie Reiskin & Kevin Williams]]>Fri, 16 Feb 2024 12:39:26 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/cross-disability-and-the-dynamic-duo-of-julie-reiskin-kevin-williams
What Julie and Kevin and many others created at the Colorado Cross Disability Coalition was an incredibly effective approach of:---
  • ORGANIZING,
  • LEGISLATIVE & EXECUTIVE AGENCY ADVOCACY and
  • LITIGATION
If Julie was the proverbial BITCH ON WHEELS --- Kevin was the proverbial GENTLEMAN ATTORNEY ON WHEELS who was happy to "STROLL INTO COURT" and sue your pants off.

I've always thought of them as GOOD COP/BAD COP with Julie as BAD COP and Kevin as GOOD COP.
The Global Disability Movement began in the 1970s --- and in some ways Denver was ground zero.

I have in the past compared living and working in the Denver Metro Disability Legal & Advocacy Community as sort of living in Alexandria at the height of the Great Library of Alexandria in Egypt, Rome, Athens --- sort of all rolled up into one.
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Julie Reiskin
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Kevin Williams
There's no question that the baton is passing and CCDC members have created an organization that will out live the founders and new leaders have emerged.

To my mind, the new leaders have their work cut out for them in working to equal the Bad Cop/Good Cop Duo of Julie Reiskin and Kevin Williams.
Kevin Williams, “tireless” Colorado disability rights attorney, dies at 57

Williams founded the Colorado Cross-Disability Coalition’s legal program in 1997 and became a powerful part of the disability rights enforcement effort statewide, colleagues said.
]]><![CDATA[Denver Mayor Johnston's numeric goals, SUPPORTIVE HOUSING and the state]]>Fri, 16 Feb 2024 11:59:44 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/denver-mayor-johnstons-numeric-goals-supportive-housing-and-the-state
Val's Take
  • Olmstead Plans need Reasonable, Measurable, and Numeric Goals.
    • If you don't have that --- that is one of the first tip offs that you don't have a legally compliant OLMSTEAD PLAN.
    • COLORADO DOES NOT HAVE A FEDERALLY COMPLIANT OLMSTEAD PLAN and MOST STATES DON'T.
      • It appears Minnesota's Olmstead Plan has Numeric, Measurable Goals --- after Federal Judge Donovan Frank threw more than one hissy fit.
  • Johnston is a mayor, a former legislator --- he's largely focused on the most pressing problems and set Numeric Goals and gone from there.It hasn't always been pretty--- but things don't seem STUCK in ANALYSIS/PARALYSIS.  
The grand OLMSTEAD Soviet-Style Plan hasn't really worked over the past 20 years since Olmstead was decided.States by and large are OVERWHELMED with the MAGNITUDE of the ISSUES ---
  • States try to stay as VAGUE as possible so they are NOT ACCOUNTABLE
  • & Generally do "some good things."
 The Disability Community often doesn't feel like it can look Olmstead --- this gift horse --- too closely in the mouth --- and the US Department of Justice files "some cases" (including in Colorado) ---
  • BUT WIDESPREAD NON-COMPLIANCE IS THE NORM.

We need STATE NUMERIC YEARLY GOALS for SUPPORTIVE HOUSING
  • I think the State needs an "Objective Measure" for that --- Medicaid Long Term Care might be such a measure.
  • Further, partnering with municipalities probably makes a lot of sense.
  • Further, there are various funding streams this could come out of.
]]><![CDATA[Homelessness, Criminal Justice, IDIOSYNCRATIC BRAINS, Olmstead and the Prodigal Son]]>Thu, 21 Dec 2023 12:35:16 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/homelessness-criminal-justice-idiosyncratic-brains-olmstead-and-the-prodigal-son
One of the things that is happening with the recognition of:
  • the prevalence of Neuro-Diversity in Homelessness and Criminal Justice, and
  • the IDIOSYNCRATIC nature of Neuro-Diversity in which brains differ from the NORM but in IDIOSYNCRATIC WAYS
  • we're called on to invest in highly person-centered INDIVIDUAL supports
    • that requires us to really understand the person and his or her strengths and challenges
      • that is a form of love and an investment of time, energy and resources --- that amounts to love
      • that we may not really be feeling as a society.
The only problem is --- lesser strategies often fail.
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Abba Eban was a South African-born Israeli diplomat and politician, and a scholar of the Arabic and Hebrew languages. --- Wikipedia
State officials in Colorado and around the Country may finally come to Olmstead Compliance after much passive resistance.

It could be in their own best interest to collect the data to make the case for more Federal assistance, especially around Supportive Housing and integrating neuro-diverse folks into the work force.
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Which son is the true Prodigal Son in Luke 15:11-32?
Two-Minute Museum
Rembrandt's The Return of the Prodigal Son
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Aurora Mayor Mike Coffman who is now calling for a "Work First" solution to Homelessness is more sophisticated than he lets on.
He knows that "Housing First" is NOT SUFFICIENT and he has said as much --- recognizing that mental health and substance treatment were big parts of the equation --- but municipal officials don't have the resources for that.
Further, I don't see how we effectively address Homelessness or Criminal Justice unless we do a better job of INTEGRATING Neuro-Diverse folks into the work-force.
Employment of people with disabilities or perceived to have disabilities is an Olmstead Issue.
]]><![CDATA[A Strict Constructionist Supreme Court and Olmstead]]>Mon, 11 Dec 2023 01:08:43 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/a-strict-constructionist-supreme-court-and-olmstead
Val's Take

In the US Supreme Court's decision denying VETERAN'S DISABILITY BENEFITS due to late filing even under extremely compelling facts involving schizophrenia, bipolar disorder and tardive dyskinesia ---
  • The Supreme Court may be signaling that they are not going to play favorites --- or they at least want to be perceived that way;
  • "Dobbs" (the Supreme Court's 2022 decision overturning Roe v. Wade) was not an anomaly --
  • and strict constructionist views (both Constitutional and Statutory) are going beyond "THE RIGHT TO PRIVACY."

I could be WRONG --- but I don't see the current Supreme Court overturning Olmstead. YET.
  • BUT the little dance that advocates and states are required to do under OLMSTEAD is PROBLEMATIC.
  • Further, it is NOT CLEAR what the current Court would do with current US Department of Justice Guidance on OLMSTEAD.

I think most everyone likes OLMSTEAD IN PRINCIPLE --- just ask STATE OFFICIALS ---
  • BUT I think People with Disabilities Need MORE ACCESSIBLE ACCOUNTABILITY and
  • STATES need MORE MONEY and TECHNICAL SUPPORT from the FEDS even as we're maintaining FLEXIBILITY.

Back in 1999 when Olmstead was decided --- I don't think people were necessarily ready to get rid of the Medicaid Rule Prohibiting Medicaid Funding of "Institutes of Mental Disease."
  • BUT they also often hadn't been ready to acknowledge the numbers of people with brain injury, neuro-developmental disorders and psychiatric disorders in Jails and Prisons.
    • That has changed a lot, especially in the last 10 years.

Further, PERMANENT SCATTERED SITE SUPPORTIVE HOUSING is widely recognized as a VIABLE HOUSING & SERVICE MODEL for many people in a way that it wasn't 20 years ago even if some professionals knew about it.
SCOTUS’ First Decision of the Term Is a Unanimous Blow to Disabled Veterans (2023)

Why did the liberals co-sign Justice Amy Coney Barrett’s harsh opinion?

The Supreme Court's opinion in Arellano v. McDonough

What are some POTENTIAL OUTCOMES of INDIVIDUAL OLMSTEAD COMPLAINTS in the NEAR TERM?
  • Making A Record
  • Public Education
  • CREATIVE PROBLEM SOLVING
I think if the FEDS were to get rid of the IMD Rule -- they need to STATUTORILY require States to develop Comprehensive Plans of Care, Placement and Housing for People with Disabilities who are Institutionalized or at Risk of Unnecessary Institutionalization with:
  • Measurable Goals
  • Reasonable Time Frames
  • and Funding to Support the Plan
]]><![CDATA[Late Diagnosis of Developmental issues and Failure to Accommodate executive Functioning challenges raises risk of institutionalization]]>Tue, 10 Oct 2023 20:44:34 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/late-diagnosis-of-developmental-issues-and-failure-to-accommodate-executive-functioning-challenges-raises-risk-of-institutionalization
Conjecture

CMS (the Centers for Medicare & Medicaid Services) and others have championed Physical and Mental Health Integration --- one of the other important components to that is DEVELOPMENTAL HEALTH.

We currently have a sizable number of people who are getting a LATE DIAGNOSIS of a NEURO-DEVELOPMENTAL DISORDER such as ADHD and/or AUTISM that come with significant EXECUTIVE FUNCTIONING CHALLENGES.

I would submit that LATE DIAGNOSIS of NEURO-DEVELOPMENTAL DISORDERS is INCREASING INSTITUTIONALIZATION of people with Neuro-Developmental & Psychiatric Disorders insofar as NEURO-DEVELOPMENTAL and PSYCHIATRIC DISORDERS appear to be on a CONTINUUM.

Further, CHRONIC STRESS resulting from UN-ACCOMMODATED EXECUTIVE FUNCTIONING CHALLENGES is increasing the burden on individuals, families and the communities in this country as well as other countries.

In some ways --- this may not be that new --- we just didn't recognize it. 

In the 20th Century --- SMOKING EXPLODED --- and a population that had significant Neuro-Developmental Disorders was perceived calmer and more stable in some respects --- even as large numbers of people were dying of heart disease from smoking.

Further, smoking during pregnancy multiplies the risk of ADHD in the child and that appears to go to  the 3rd Generation and maybe beyond.

We don't have the same level of smoking anymore --- but the current "Mental Health Crisis" is spiralling out of contol without better CONCEPTUALIZATIONS and TREATMENTS.

Further, this isn't just related to our "Mental Health Crisis" --- it also seems to be related to our CHRONIC DISEASE EPIDEMIC where people with ADHD and/or AUTISM seem more vulnerable to these diseases.

Additionally, our MODERN ALIENATED, INDIVIDUALIST WORLD VIEW has not always been helpful in understanding this --- if we think this is just about the "LIFESTYLE CHOICES" of the INDIVIDUAL --- IT'S NOT.

Further, it is not just about the LIFESTYLE CHOICES OF THE PARENT. 

BUT LIFESTYLE CHOICES going forward do need to "ACCOMMODATE" and/or ADDRESS these DEVELOPMENTAL DIFFERENCES.

Our current go to of a MENTAL HEALTH PROFESSION that thought its mission was to help people change is a MIXED BAG --- it is BOTH HELPING AND HURTING.

Further, when I started as a mental health advocate in 2007 --- the Mental Health Centers didn't think it was their responsibility to deal with DEVELOPMENTAL DISORDERS.

On the other hand, individuals have been "UNCONSCIOUSLY MASKING" for as long as they could and many of these "HYPER-CONNECTED BRAINS" --- had a hard time understanding why they would have EXECUTIVE FUNCTIONING CHALLENGES and so did everybody else.

You can start to see why this isn't really working. 

Now that is slowly changing, but people with these "DEVELOPMENTAL DIFFERENCES" have to be part of the process of constructing appropriate supports going forward.
The Impact of Systemic Inflammation on Neurodevelopment (2018)


Cytokines and neurodevelopment

In the past several decades, inflammation has been increasingly recognized as an important contributor to central nervous system (CNS) injury in both the developing and adult brain [1,2] (Table 1).

The brain is particularly vulnerable in utero as well as during infancy and early childhood, and insults that occur during these critical periods have the potential to cause long-term damage.

Several neurodevelopmental disorders have been linked to early life immune activation and inflammation, including autism spectrum disorders (ASD), schizophrenia, cerebral palsy, epilepsy, cognitive impairment, and depression
]]><![CDATA[Looking to Collaborate with Atlantis]]>Fri, 11 Aug 2023 20:05:24 GMThttps://orchidadvocacy.org/olmstead-law--order-thursday/looking-to-collaborate-with-atlantis
Val's Take
  • So the first thing I should say is that Mike Oxford with Atlantis gave me a little TUTORIAL on OLMSTEAD in our conversation in late July.
  • "Hey, I already know a lot about Olmstead --- Buddy" (and actually I do know a lot --- But I don't know everything).

History of Using the ADA's "Integration Mandate" in the Context of LONG TERM CARE
  • Mike credits legendary Disability Rights Attorney Steve Gold with being the first to use the Integration mandate in the context of LONG TERM CARE --- to get some residents out of nursing homes back east.
  • That rationale was ultimately used in Olmstead which involved a Mental Health Institute in Georgia.

Further --- Steve Gold served as an attorney for Atlantis and ADAPT (begun in DENVER).
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Interim Director of Atlantis --- Mike Oxford
As far as I know, the US Department of Justice (DOJ) was the first to use Olmstead in a LARGE WAY in the context of INCARCERATION.

This involved a 2010 Settlement Agreement with the State of Georgia to provide housing and services for THOUSANDS of GEORGIA INMATES with DEVELOPMENTAL DISABILITIES (DD) and/or SERIOUS MENTAL ILLNESS (SMI) upon release.
Attorney Steve Gold:  A Leader in Fighting for Disability Rights
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