Blog Posts

Simplicity on the Near Side of Complexity --- PRISON BUDGETS

1/15/2023

Polis' $1 Billion State Prison Budget Isn't the Answer Anymore than A NARROW VIEW of "DE-INSTITUTIONALIZATION" was "THE ANSWER" for Mental Health

Olmstead is about preventing the "UNNECESSARY INSTITUTIONALIZATION" of people with Disabilities.

If we don't have any sense of a CONTINUUM --- you can end up where the DISABILITY COMMUNITY was 10 years ago --

We want people out of the Mental Institutes and
There are very few people with disabilities in the Criminal Justice System.

In the span of a DECADE --- that has CHANGED IN A BIG WAY.

Now most disability advocates would say the primary INSTITUTIONS for people with "MENTAL ILLNESS" are JAILS & PRISONS.

Our go to expert is often Former Director of the National Institute of Mental Health Thomas Insel who says Psychiatric Disorders are some of the most complicated problems in Medicine.

RAISING THE COMPLEXITY ANTE IN CRIMINAL JUSTICE

One of the other things that happened in the last decade was --- we started to realize how many people with BRAIN INJURY are in the Criminal Justice System
Statistics on BRAIN INJURY in CRIMINAL JUSTICE often run higher than PSYCHIATRIC DISORDERS --

RAISING THE COMPLEXITY ANTE EXPONENTIALLY in CRIMINAL JUSTICE

Developmental Disability (sometimes with IQ under 70, often with an IQ over 70),
Psychiatric Disorders
Brain Injury, and
Substance Issues

Well -- that sounds really complicated --- BUT these are often DISTINCT ISSUES that are well understood and we have great treatments for:

NOT SO MUCH
These are often BLURRED
Our TREATMENTS can be Medications that affect the BRAIN GLOBALLY --- and the precision medicine that's needed isn't there.

New Yorker: A New Hemingway Documentary Peeks Behind the Myth

One of the things that I appreciated about Ken Burns and Lynn Novick's documentary on Hemingway was Burns & Novick showed all the COMPLEXITY of Hemingway who was a talented guy AND who was often a NUT CASE ---He had mental illness, brain injury, substance issues (and I would say probably developmental issues)

Complex Patterns

Not an insignificant percentage of people in the Criminal Justice System are dealing with MULTIPLE COGNITIVE ISSUES.

So we're often dealing with the MOST COMPLEX ISSUES in MEDICINE in MULTIPLE in COMPLEX PATTERNS ---If we want to use $1 Billion Dollars to further the transition to a PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE --- that is probably not a bad thingBUT trying to placate a frustrated PUBLIC with more stuff that doesn't work isn't the way to go.

Jerry Lewis Telethon for Muscular Dystrophy

A lot of DISABILITY ADVOCACY is what to do when you DON'T HAVE THE "CURE" ---It's often an EXPLICIT REJECTION of the Jerry Lewis Telethon approach to DISABILITY ADVOCACY.

CNN: The AIDS activists of the past have more to teach us (2021)

Having said that --- AIDS ACTIVISTS did understand the importance of SCIENCE to their CAUSE and spent a lot of time ADVOCATING at the FEDERAL RESEARCH LEVEL.

When it comes to people with disabilities in the Criminal Justice System:

We need a Comprehensive Continuum of Care, and
- To me that is the States, Medicaid & HUD -- and we get rid of the well-intentioned Medicaid Institute of Mental Disease Exclusionary Rule that is making it hard for States to fund that Continuum of Care at higher levels of need.

UCHealth -- the picture is associated with a story on Covid --- but the University of Colorado and others are doing important work on PSYCHO-NEURO-IMMUNOLOGY

We need BETTER TREATMENTS ---

In a PBS Special funded by the American Psychiatric Foundation --- there was an acknowledgment that BETTER TREATMENTS are needed.
Research is probably primarily a FEDERAL ISSUE although Colorado has leading researchers and we should be CAPITALIZING on that to the MAXIMUM EXTENT POSSIBLE.

Making Society Neuro-Diversity FRIENDLY Is an OLMSTEAD ISSUE

1/15/2023

When we talk about Olmstead --- we're talking about:

Title II of the Americans with Disabilities Act and the ----- INTEGRATION MANDATE, and
The 1999 US Supreme Court Decision that the UNNECESSARY INSTITUTIONALIZATION of People with Disabilities VIOLATES THE INTEGRATION MANDATE.

Most people with Brain Injury, Neuro-Developmental Disorders, and classic PSYCHIATRIC DISORDERS who are "INSTITUTIONALIZED" (many are not) ----

Are Institutionalized in Jails and Prisons
At great risk of institutionalization as a result of "Criminal Justice Involvement"
Or at great risk of institutionalization as a result of HOMELESSNESS.

What many of the people with BRAIN INJURIES and PSYCHIATRIC DISORDERS have IN COMMON is some type of NEURO-DEVELOPMENTAL DIFFERENCE such as:

ADHD
Autism
Dyslexia
Etc.

Lived Experience Educator

In one sense, the Society is REFUSING or CAN'T BE BOTHERED to accommodate COMPLEX EXECUTIVE FUNCTIONING DIFFERENCES ----

On the other hand --- they really don't know HOW.

Further, the Society is in the PROCESS of LEARNING THIS ---

So there is going to be some TRIAL & ERROR.

The Criminal Justice System and Law Enforcement have to be a part of OLMSTEAD PLANNING.

AND Justice Involved and Homeless people with disabilities ---- HAVE TO BE PART OF THE OLMSTEAD PLANNING PROCESS --- TOO.

Cognitive Disability and Mobility

1/10/2023

I think this is an important issue because it highlights the POLICY CHALLENGES for the people with Cognitive Disabilities who are MOBILE.

There are care challenges for people with cognitive disabilities who are in some way physically incapacitated --- BUT the SAFETY CONCERNS for others often goes way down and we're often more concerned about the SAFETY of the PERSON -- pressure sores, neglect, abuse, etc.

Mobile people with Dementia can present challenges in care and they are sometimes placed on locked nursing home wards to prevent not only wandering --- but so-called "BEHAVIORS."

One of the points I want to make is that Cognitive Disability rising to a level of danger to self or others or gravely disabled can occur at any point in someone's life --- but when that occurs with MOBILITY -- the Society is often trying to get it's OXYGEN MASK ON before it can even think about this person with a COGNITIVE DISABILITY who is MOBILE and STRUGGLING.

That "SOCIETY" includes Family Members, Health Care Professionals, Law Enforcement and the Broader Community.

All of those STAKEHOLDERS have an interest in seeing COMPREHENSIVE and EFFECTIVE OLMSTEAD PLANNING for all people with disabilities and ESPECIALLY THOSE WITH THE GREATEST NEED.

This typically does not work out well for anyone if we haven't done the HARD PLANNING & IMPLEMENTATION -- before the crisis hits.

Further, if we do that PLANNING & IMPLEMENTATION --- we will likely see a lot fewer crises.

Olmstead, Neuro-Developmental Differences & Psychiatric Disorders Cognitive / Remediation & Work-Arounds to Address Executive Functioning

10/20/2022

Conjecture

When we think about who is INSTITUTIONALIZED or AT RISK OF INSTITUTIONALIZATION we might think of that person who:
- Has a Developmental Disability & an IQ below 70.
- Has a Psychiatric Disorder, or
- Has a Brain Injury

The reality is a lot of people with a Psychiatric Disorder or a Brain Injury are also people who started out with a Neuro-Developmental Difference with an IQ above 70.

This is implicating so many "IDEAS" we have in our SOCIETY that are NOT AS CONNECTED TO REALITY as they might be.

A lot of this is not understanding how connected "TRADITIONAL INTELLIGENCE" is with SENSORY PROCESSING.

Surprisingly, people with Neuro-Developmental Differences and Psychiatric Disorders have HYPER-CONNECTED BRAINS.

One of the IRONIES of having a HYPER-CONNECTED BRAIN is that EMOTIONAL REGULATION is CHALLENGING ---
- You're spending a lot of time on that because THINGS ARE HITTING ALL AT ONCE.

PARSING OUR APPROACH to "MENTAL HEALTH"

Right now Mental Health has typically meant Talk Therapy and Medication.
- There's a role for those
What seems to be emerging is the need to address EXECUTIVE FUNCTIONING as much more THE MAIN COURSE.
Further, when we think about Olmstead & the Integration Mandate ---- addressing Executive Functioning --
- is probably one of the KEYS for both people with Neuro-Developmental Differences & Psychiatric Disorders
- On the other hand, it won't be enough if we don't develop and employ those BIG STRENGTHS that also come from HYPER-CONNECTED BRAINS.

At least in 2022, this needs to be a Hybrid Approach with:

Occupational Therapy, Cognitive Remediation Therapy and/or Coaching, etc. on the one hand, and
Work-Arounds and Accommodations on the other hand.

By and large, I don't think the current diagnostic categories are FUNDAMENTAL insofar as:

Most disorders share common genes
Many to most people with a Neuro-Developmental/Psychiatric Disorder have MULTIPLE DIAGNOSES
- The University of Colorado has recognized this is NOT HELPFUL.

Recognizing the role of MATERNAL IMMUNE ACTIVATION in many cases and the IDIOSYNCRATIC NATURE OF THAT on SHARED GENES --- I think helps to explain the wide variety in the population.

To me, it's about SHARED GENES and at least in many cases MATERNAL IMMUNE ACTIVATION --- and the current diagnostic categories are falling apart.

DRAFT: Occupational Therapy, Cognitive Remediation Therapy & Coaching to address Executive Functioning in Neuro-Developmental & Psychiatric Disorders

In this video, Florence Welch isn't "FREE" in the way we want to believe.

The FEELINGS are HITTING ALL AT ONCE --- A HUNDRED TIMES A DAY. Further, this video shows the FATIGUE of NEURO-DIVERSITY like nothing I've ever seen before.

Welch has Dyslexia and Dyspraxia and has spoken about Addiction and Severe Depression.

Environmental Mutagenesis and Genomics Society (2020)

Grandmaternal Smoking & Risk for ADHD

Gyeyoon Yim, PhD student, Harvard University Speaking on Heritable Hazards of Smoking

Messy, Messy Chic
The Radical History of Women Smoking

History, Neuro-Diversity AND INFLAMMATION

I don't think that Neuro-Diversity is that new -- but I think the PROXIMATE CAUSES can change, especially since INFLAMMATION seems to be such a UNIVERSAL LANGUAGE -- coding for a WIDE VARIETY OF THINGS.
So I think Maternal & Grandmaternal Smoking during the 20th Century are BIG DRIVERS of the Neuro-Diversity Explosion we're seeing in the 21st Century.
That's probably not true historically.
What I'm trying say is that I think we have HUGE GENERATIONAL, BIOLOGICAL CHALLENGES with regard to NEURO-DIVERSITY in this SOCIETY.
Further, those CHALLENGES are BIOLOGICAL but they are weirdly SOCIAL in that our IMMUNE SYSTEMS control social behavior and being at the bottom of the Social Heap damages the immune system.
We are ahead of ANCIENT ROME and their CRAZY EMPERORS --- but we're not as far along as we think ---
- Whether it's Clinton, Trump or Putin.
- Or a Legal Profession & a Judicial Bench full of "emotionally intense gifted/asynchronous people" or a modern Mental Health Profession that's not on the top of the research but is happy to testify in CRIMINAL COURT and do their pro-socially competent duty.

We're being called on to handle "MORE REALITY" than what we've been doing --- and that literally isn't easy --- it takes time and energy to do.

3 Olmstead Complaints: Georgia, New York & Mississippi

10/13/2022

3 Olmstead Complaints that include a Request for Declaratory Judgment against:

Georgia
New York, and
Mississippi

Upper Right: Factual Allegations from each of the 3 complaints.

Below Right: single document with the "Prayers for Relief."

Factual Allegations

Prayers for Relief

Part I: Threading the NEEDLE and "Dangerous Binaries" When it comes to People with Serious Mental Illness and Fair Housing

10/12/2022

*DOJ --if you're gonna enforce Olmstead uniformly & across the board and obtain SUPPORTIVE HOUSING for People with SMI in this Country --- great --- If not, what are ya thinkin'? --- Residents & Families United to Save Our Adult Homes, et al. v. Zucker

In some instances we have tried to "BACKDOOR" Community Living for people with SMI (Serious Mental Illness) with:

Medicaid’s Institutions for Mental Diseases (IMD) Exclusion Rule ...

"The IMD exclusion rule, which has been in place since the beginning of the Medicaid program in 1965, bars the use of federal Medicaid funds to finance services for individuals ages 22 to 64 residing in “institutions for mental diseases” or IMDs—hospitals, nursing homes, or other institutions with more than 16 beds that are primarily engaged in providing diagnosis, treatment, or care of persons with “mental diseases” other than dementia or intellectual disabilities."

So we actually have the LAWS now to REQUIRE STATES to Avoid the Unnecessary Institutionalization or Risk of Institutionalization of People with Disabilities.

We didn't have those LAWS when
De-Institutionalization was first becoming a big thing in the 1950s.

Deinstitutionalization: Definition & History | Study.com

BUT our thinking on this has "EVOLVED" quite a lot. The miracle of Psychotropic Drugs for some people led us not to build the INFRASTRUCTURE we needed to successfully integrate people with SMI in the Community.

I do think DOJ has a pretty good handle on what that SMI COMMUNITY LIVING INFRASTRUCTURE is or needs to be---

DOJ does NOT have a good handle on enforcing that SMI COMMUNITY LIVING INFRASTRUCTURE across the STATES uniformly to prevent INCARCERATION and HOMELESSNESS of people with SMI and other Cognitive Disabilities.

THIS FAILURE OF ENFORCEMENT or POLITICS or whatever to provide that SMI COMMUNITY LIVING INFRASTRUCTURE ---- HAS ENORMOUS CONSEQUENCES --- namely, the MENTAL HEALTH CRISIS we're currently in ---

And a lot of INCARCERATION and HOMELESSNESS of people with SMI and other Cognitive Disabilities

Image Credit: PaulClairereaux.com

*Residents and Families United to Save Our Adult Homes, et al. v. Zucker

"On May 31, 2022, the United States filed a Statement of Interest in the consolidated case of Residents and Families/Empire v. Zucker. Residents and Families/Empire challenges a New York State regulation limiting admission of individuals with Serious Mental Illness (SMI) into segregated settings called Adult Homes, by alleging that the regulation violates the Fair Housing Act and the Americans with Disabilities Act.

"The State issued the regulation in conjunction with the United States’ settlement in U.S. v. New York, No. 13-cv-4165 (E.D.N.Y. 2013) and consistent with its Office of Mental Health’s determination that Adult Homes “are not clinically appropriate settings” for individuals with SMI, “nor are they conducive to the rehabilitation or recovery of such persons.” The Statement of Interest explains that the regulation does not violate the Fair Housing Act or the Americans with Disabilities Act. (5/31/22)"

Why Is This Problematic?

Advocates & Attorneys around the country like myself want to use Fair Housing and the ADA to get people with SMI a safe place to live.

Further, those people want a safe place to live.

Horror Stories

So if we don't UNDERSTAND --- THE REALITIES ON THE GROUND --- namely many people with SMI are trying to navigate a MINEFIELD in which ---"ADULT HOMES" or even "NURSING HOMES" are not the "BEST" OPTIONS and they may not even be "GOOD" options--BUT the HORRIFIC OPTIONS that we thought our Society was TOO HUMANE TO ALLOW --- Is ALLOWING THEM.

Vox: Jails, prisons hold 10 times more mental health patients than state hospitals (2014)

NOT SO RANDOM THOUGHTS

10/11/2022

The History of Ideas Discussion Meetup based out of Cork, Ireland has a WAITLIST for Candide or Optimism

Could we get a WAITLIST for Assertive Community Treatment in Colorado Medicaid?
and
A WAITLIST for HOUSING out of the Colorado Division of Housing for people with disabilities who are institutionalizated or at risk of institutionalition?
and
BOTH WAITLISTS moving at a "REASONABLE PACE" -- ?

This isn't just "IDEALISTIC" ---- THEORETICALLY, if we bothered to comply with FEDERAL LAW --- this would already be done.

Fair Housing, the Co Dept. of Law, Disability Housing & Olmstead

10/10/2022

Lack of Disability Housing both Accessible Housing & Supportive Housing is a MAJOR FAILURE of Colorado Policy and Compliance with Federal Law.

Olmstead provides that if States want a DEFENSE to not having DISABILITY HOUSING to SCALE (as well as other things) ---

Then States need a COMPREHENSIVE, EFFECTIVELY WORKING PLAN ---- and WAITLISTS moving at a "REASONABLE PACE."

In 1999, the US Supreme Court in Olmstead was really talking about waitlists of PEOPLE --- moving out of institutions.

BUT that is HARD TO DO if you don't DRILL DOWN a little further and understand what SERVICES, HOUSING, PLACEMENTS, etc. that you need to move people out of institutions.

Further, ACCESSIBLE HOUSING for people with "physical disabilities" has been CLEARER even though we haven't provided enough.

I'm not sure that SUPPORTIVE HOUSING was the buzz word in 1999 that is today --- but it is pretty clear in 2022 that SUPPORTIVE HOUSING is a BIG PIECE of the Puzzle for people with "cognitive disabilities."

I'm using "cognitive disability" in a BROAD SENSE of PSYCHIATRIC DISABILITY, DEVELOPMENTAL DISABILITY, BRAIN INJURY and SUBSTANCE ISSUES.

Further, these issues are often overlapping or CO-OCCURRING.

The Colorado Dept. of Law's Fair Housing Unit is to be focused on STATE LAW --- but I'm not sure with respect to "DISABILITY" that is hugely different from Federal Law.

Bringing in the CO Dept. of Law's Fair Housing Unit as well as CO Dept. of Regulatory Agencies as OFFICIAL STAKEHOLDERS in a CO OLMSTEAD PLANNING PROCESS could help to RAISE THE STATUS of the DISABILITY HOUSING ISSUE.

Finally, in the words of the US DEPT. OF JUSTICE:

Measurable Goals
Reasonable Time Frames, &
Funding to Support the Plan

HB22-1082

Establish Fair Housing Unit Department Of Law

Concerning the enforcement of state housing laws by the department of law, and, in connection therewith, establishing a fair housing unit within the department of law.

Below via CO Department of Regulatory Agencies --
Civil Rights Division

Protected Classes Enumerated at C.R.S. § 24-34-502

Disability (a mental or physical impairment which substantially limits a major life activity)

Race
Creed
Color
Religion
Sex
Sexual Orientation (which is statutorily defined as "including transgender status" - i.e. Gender Identity)
Martial Status
Familial Status
National Origin
Ancestry
Source of Income*
Persons who have engaged in protected activity (such as making a complaint of discrimination, or requesting a reasonable accommodation) are protected from retaliation for doing so.

* Source of Income as a protected class effective January 1, 2021, see HB20-1332

See Also:

Fixing HCPF's FAIR HOUSING PROBLEM

OLMSTEAD & INCARCERATED & CHRONICALLY HOMELESS PEOPLE WITH COGNITIVE DISABILITIES

10/6/2022

Conjecture

Let's just say that all things being equal (and they're not) there are people in both major political parties at the top of this society with Behavioral Challenges that with any "justice" would be INCARCERATED -- and they're not.
- & I'm not even for incarceration.

I think it is clear that people with cognitive challenges can live in the COMMUNITY WITH SUPPORT.

The CHALLENGE for our Society is getting beyond a BLANK CHECK for a few at the top and addressing SERIOUS COGNITIVE DISABILITY in this SOCIETY in an ECONOMICALLY & MORALLY Responsible Manner ---
- Part of that would be complying with Olmstead.

The late D.J. Jaffe of the Mental Illness Policy Organization was fond of taking government and the mental health industry to task for focusing on "THE WORRIED WELL" and not the people with the most serious challenges.

Olmstead makes a PRIORITY of those people with disabilities that are INSTITUTIONALIZED or AT RISK of INSTITUTIONALIZATION.

Addressing Assertive Community Treatment in the 2023 CO Legislative Session

10/4/2022

Indiana's Criteria for Assertive Community Treatment & Recognizing ACT as an Olmstead, Parity & Human Rights Issue

2022 Indiana Administrative Code: Assertive Community Treatment Teams

2021 Minnesota Statutes: 256B.0622 ASSERTIVE COMMUNITY TREATMENT AND INTENSIVE RESIDENTIAL TREATMENT SERVICES.

Minnesota Department of Human Services: Assertive Community Treatment Policies & Procedures

Assertive Community Treatment is used globally to provide Intensive Community Mental Health Treatment and to provide an alternative to the Criminal Justice System --- see Eppa Worldwide

This is a beautifully made video on Housing First and Assertive Community Treatment from British Columbia, Canada from 2014.

I've posted it many places on the website because it does have so many gems.

Most countries are in the situation of the US --- trying to figure out how to bring ACT to SCALE.

In the US, that's probably state statutes addressing the issue.

Draft Addressing Assertive Community Treatment for the 2023 CO Legislative Session

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