Blog Archives

BRINGING STATES TO OLMSTEAD COMPLIANCE --- CO CaSE In POINT

9/17/2020

Colorado is an interesting case in point with regard to treatment of Cognitive Disability and People who are Homeless and/or in the Criminal Justice System.

Prior to Covid, Colorado was one of the top economies in the Country. Colorado politicians love to tout that as they failed to comply with Olmstead.
Because of our economy, Colorado is a lot less sympathetic than some poor states.
Coloradans are of two minds when it comes to gun control --- BUT both sides have significant problems:
- Gun control is NOT a SUBSTITUTE for the MAJOR INVESTMENTS in Housing, Intensive Services and Placements that this State Needs and that are Legally Required for people with cognitive disabilities.
- Things can be pretty out of control in this country when it comes to Guns & Behavior. Further, Mental Health Professionals don't have a perfect handle on it --- and we haven't made the necessary investments in Translational Research & Medicine to deal with this.
Colorado has been sued A LOT when it comes to its Mental Health Programs ---- for good reasons. Further, Colorado and a lot of States are primed for Olmstead Lawsuits --- IF ADVOCATES CAN GET THE RESOURCES --- That's a big if.
- Further, suing during Covid maybe isn't the best strategy.
- Of course, nobody is against doing this the EASY WAY -- let's just all work together.
Colorado SEEMS to have a fair amount of RESISTANCE to Olmstead Compliance even under Polis --- WE NEED FEDERAL LEADERSHIP
There are a lot of states out there and people with cognitive disabilities and their families need FEDERAL LEADERSHIP to overcome obstacles to State Olmstead Compliance.

It would be ridiculous not to acknowledge the unprecedented challenges of Olmstead Compliance during a time of Covid.

The problem is we're more than 20 years out from Olmstead --- and conditions are NEVER PERFECT.

Olmstead and the ADA (Americans with Disabilities Act) are very much about what is "REASONABLE."

What has been "UNREASONABLE" about State attempts at Olmstead Compliance --- they have failed to have:

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

We NEED to have those components to State Olmstead On-going Planning.

What is "REASONABLE" in terms of

Measurable Goals
Time Frames, or
Funding

Can change based on a lot of factors.

BUT JUST NOT taking the trouble to make those reasonable:

Measurable Goals
Time Frames
& Funding to the Support Plan (even if that is extended because of Covid -- and there should be on-going and modifiable planning)

Is Clear NON-COMPLIANCE.

FUNDING HUMANE TREATMENT

9/16/2020

There is plenty of SUFFERING in the Criminal Justice System on all sides.

There are a lot of aspects to addressing that suffering. A very important aspect is bringing housing, intensive services and placements to SCALE to meet the NEED.

One of the things that psychiatrists are sometimes fond of saying -- and I actually agree with ---
- "When you've seen one case of Schizophrenia or Bipolar Disorder -- you've seen one case of Schizophrenia or Bipolar Disorder."
There are Immune Connections to a whole lot of things --- we've certainly understood that with infection and cancer, but it is really in the last few years we're connecting the Immune System to Social Behavior, Intelligence, Developmental Disabilities, Psychiatric Disorders, Brain Injuries and Substance Issues.
That's a lot to ADD to the KNOWLEDGE BASE.
But it is NOT just ADDING ALL OF THAT to the KNOWLEDGE BASE of CLINICIANS --- it's ADDING that KNOWLEDGE to INSTITUTIONS of the SOCIETY, POLICYMAKERS, Other Professionals and Individuals & Families.
There is a DISTINCTION between:
- Understanding an issue or problem is more complex than we thought ---
- AND having a COMPLETE UNDERSTANDING or an UNDERSTANDING SUFFICIENT for an ADEQUATE REMEDY in all cases.
The "IDEAS" around:
- Danger to Self or Others,
- Gravely Disabled

 Are largely good.

BUT we just don't fund the Housing, Intensive Services, and Placements that people need.

Further, a lot of people, including a lot of clinicians --- are really in over their heads when dealing with some people in the Criminal Justice System.

It's very easy to check that "Anti-Social Personality Disorder" BOX --- when your own PSYCHIATRIC MANUAL is OUT OF DATE.

We need policymakers to ensure that people in the Criminal Justice System are treated humanely as we come to grips with Human Behavior that is even more complicated than we thought --- and we already thought it was complicated.

Roddy Ricch -- The Box
"Please Excuse Me for Being Anti-Social"

THE CRYING NEED FOR STATE OF THE ART MEDICINE, HUMILITY & OPEN DIALOGUE

9/14/2020

BEYOND PRO-PSYCHIATRY & ANTI-PSYCHIATRY

  People are so STRESSED by the COMPETITIVE NATURE of the SOCIETY as well as ECONOMIC & POLITICAL PRESSURES --- they can't really do a GOOD JOB.

They have also had to erect a lot of BOUNDARIES to SURVIVE emotionally and economically.

   That's true in LAW --- It's true in Mental Health. It's true in most of American Society.

With most JOBS -- the GOAL should really be to WORK OURSELVES OUT OF A JOB -- GET TO THE ROOT CAUSE OF THE PROBLEM --- and move on to the NEXT.

  We're not in danger of running out of problems.

I recently came across an Initiative of the American Psychiatric Association --- I was excited --- I thought it was going to be about getting on top of the latest science.

This new APA Initiative was about marketing and expanding one's business. I just wanted to cry . . .

In fairness, the APA does have Educational Initiatives -- BUT they seem so far behind and propriety in their RESISTANCE to acknowledging that the DSM 5 is not only OUT OF DATE --- IT'S DANGEROUS.

PROVING that the Mental Health Profession isn't really on top of it -- isn't really that hard, BUT THAT'S JUST THE TIP OF THE ICEBERG --- talk about COLD COMFORT.

There's A LOT OF HEAVY LIFTING HERE:

Modern Societies and increasingly developing societies have an increased incidence of autoimmune disease and depression, and likely other psychiatric disorders as well.
These psychiatric disorders involve multiple complex systems of the body, including not only the Brain, but also the Immune System, the Endocrine System and the Microbiome.
The FACTORS that can impact these systems of the body are LEGION.
How these FACTORS play out is HIGHLY INDIVIDUAL and demands PRECISION MEDICINE of the HIGHEST ORDER.

Even if the APA and Psychiatric Establishment got up to speed -- TODAY -- there's so much work to done and so much DAMAGE to be undone, especially in the Criminal Justice System.

A lot of "getting up to speed" is recognizing how COMPLICATED this really is --- and How some of our toss off "personality disorders" have done so much damage.

We can't change the past, BUT we can work in the PRESENT to REMEDY as much as we can.

We NEED NOW:

A Public Health Approach to Criminal Justice -- Olmstead Planning could help get us there; and
Major Investments in Translational Research & Medicine, involving:
- National Research Institutions
- University Research & Teaching Hospitals, and
- Clinicians

New York University, Clinical and Translational Science Institute

Finnish Mental Health Approach: "Open Dialogue"

Integrating BIOLOGY and the FULL SPECTRUM of ENVIRONMENT

Those Soft Concerns like Environment, and Soft Treatments do have Biomarkers.

Understanding the COMPLEX DYNAMICS we're faced with:

BIOLOGIES WE WERE NOT EXPECTING:
- a Human Being and other animals that are NOT individuals the way we thought, but ECO-SYSTEMS and can't function well without a healthy and diverse MICROBIOME;
- an immune system that controls "social behavior" -- who would've THUNK IT.
COMPLEX ENVIRONMENTS: we're tethered to our Social Environments in very COMPLEX ways, including BIOLOGICAL WAYS with BIOMARKERS
NOT HAVING ALL THE INFORMATION WE NEED: To really understand what is working and not working for people, we must have OPEN DIALOGUE
THE MAJORITY. The Majority often thinks what it is doing is working because it is working for the "MAJORITY" --- if it's not working for the INDIVIDUAL PERSON [microbiome and all] --- it's not working.

THE CRYING NEED FOR RAMPED UP SYSTEMATIC TRANSLATIONAL RESEARCH & MEDICINE IN US MENTAL HEALTH

9/13/2020

Some popular websites are starting to address the Immune System Connection to Mental Health a little more seriously.
This is probably 5 years or more after the UK. Of course, some of the STARS of this research are in the UK ---- but STILL --- this has been SLOW to catch on in the US.

That's regrettable --- but in the US --- Mental Health is both the Step-Child of Medicine and the 900 pound gorilla in the Criminal Justice System.

The fact that US MENTAL HEALTH PROFESSIONALS might not, probably can't distinguish between:

Complex behavioral issues involving not only the Brain, but also the Immune System, the Endocrine System and the Microbiome and
An Archaic Personality Disorder Classification of "Anti-Social Personality Disorder"

RUINS Lives Every Day in this Country. Further, those are often the Lives of Poor People and People of Color.

Right now --- Mental Health private and public practitioners are very ISOLATED and are not thoroughly INTEGRATED with the REST OF MEDICINE.

That's a HUGE PROBLEM for psychiatric and behavioral disorders that appear to have a LARGE IMMUNOLOGICAL COMPONENT.

We need to be FUNDING:

Greater Multi-Disciplinary Translational Research & Medicine at the Nation's University Research & Teaching Hospitals
Integrate Clinicians into that process as the UK is trying to do
Fund an integrated PUBLIC HEALTH APPROACH to Criminal Justice. (Our level of KNOWN IGNORANCE is FAR TOO HIGH to engage in the HISTORIC PUNITIVE MEASURES of the Criminal Justice System.)
Ironically, our widespread MENTAL HEALTH CRISIS and OPIOID CRISIS and other Crises --- may provide a MAJORITY that not only sees but feels the need to adopt a PUBLIC HEATH APPROACH to Criminal Justice WITHOUT SACRIFICING SAFETY.

CONCEPTUALIZATION MATTERS: WHAT IS "MENTAL ILLNESS"

9/7/2020

Human "moral" sense is a MIXED BAG and in 2020 - there is really just EDUCATING IT, NOT trying to ELIMINATE IT which would probably be a very BAD THING.
That is why "KNOWLEDGE" / "SCIENTER" is such a BIG THING in THE LAW and it is also how we EXPAND and CHANGE our MORAL SENSE.
What did you know and when did you know it?
Let's APPLY this concept of "KNOWLEDGE" and "SCIENTER" to EVOLVING CONCEPTS of "Mental Illness"
- If we think someone is possessed by a demon then burning them at the stake or treatment by Hyena -- might drive out that demon. Right?
- Punishing those "BAD ACTS" and "BAD INTENT" could send the person a message --- unfortunately even in 2020 corrections systems struggle with RECIDIVISM.
- It now is much clearer that people may be struggling with Executive Functioning Issues, especially Problems in Emotional Regulation.
- The Brain is a BIG PLAYER in Cognitive Disability/ "Mental Illness" --- BUT in 2020 --- it is clear the Immune System, the Endocrine System and the Microbiome are CRITICAL PLAYERS as well.
- BUT WE DON"T KNOW AS MUCH ABOUT THOSE OTHER SYSTEMS OF THE BODY in relation to "MENTAL ILLNESS."
- We've got a Criminal Justice System that TRADES in "PROOF BEYOND A REASONABLE DOUBT."
- That Mental Element of the Crime is often focused on various levels of Punishment.
- Some countries such as Sweden have moved away from a Punitive Model of Criminal Justice -- and many countries are moving to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE.
- That Public Health Approach is perhaps the much more PRAGMATIC APPROACH rather than engaging in some type of OVERHAUL of the CRIMINAL LAW.
- Further, we really need that PUBLIC HEALTH APPROACH -- when we don't have all the answers and the knowledge base in constantly changing and expanding.

AFTER ALL IS SAID & DONE -- TRILLIONS of POTENTIAL VARIABLES if NOT MORE

The Brain
The Immune System
The Endocrine System
The Microbiome
Other?

LAW ENFORCEMENT GOING OFF THE DEEP END AND TAKING US WITH THEM

9/5/2020

The DYNAMICS of Law Enforcement Bad / Horrific Behavior are every bit as COMPLICATED as Bad or Horrific Behavior from ANYONE ELSE.
Should Law Enforcement be BETTER than EVERYONE ELSE? The question itself REVEALS a FUNDAMENTAL MISUNDERSTANDING of what's going on.
We're NOT better than other people and they're NOT better than us.
Should Law Enforcement Behavior be BETTER? Yeah -- But what's it going to take to accomplish that --- SOME REAL CHANGE.
A LOT of People in this SOCIETY are WORKING SOME FAILED ASSUMPTIONS as Hard as they CAN -- and we're just getting to the WRONG PLACE --- FASTER.
We MUST get on the SAME TEAM --- and that means getting on the SAME TEAM with regard to ECONOMICS & HEALTH CARE & AGGRESSION in the SOCIETY. It's FEAR of ADDRESSING those questions that is keeping us STUCK.
That Old LAW & ORDER DEBATE misses A LOT --- and it is trying to address the SYMPTOMS without addressing the ROOT CAUSES.
Most specifically, we're living in a very AGGRESSIVE SOCIETY for 2020 and some of that is STATE-SANCTIONED or at least TOLERATED AGGRESSION generally against relatively powerless and marginalized people.
We must have SAFETY --- BUT TO GET TO THAT --- WE MUST MAKE SOME CHANGES.

Aggression: Humanity's Ultimate Double-Edged Sword

Hard Issues & the CO Behavioral Health Task Force

9/5/2020

It doesn't get much more difficult than the daunting resource issues facing Behavioral Health and Cognitive Disability more broadly.
A "ONE-STOP SHOP" which is being floated by the BEHAVIORAL HEALTH TASK FORCE could be a part of dealing with that -- BUT if that's it --- it's an EPIC FAIL.
Now Covid-19 presents a lot of challenges, but it could be a great time to do:
- even greater integration with Criminal Justice and Homeless Providers (we know there is some going on -- we need more)
- comprehensive data collection, and
- PLANNING to bring SERVICES, HOUSING, & PLACEMENTS to SCALE.

WE"RE HOPING the CO Behavioral Health Task Force will recommend:

Comprehensive Data Collection of the Needs of People with Cognitive Disabilities who are Homeless or Being Released from Incarceration, as well as
A PLAN to INCREASE & Bring to SCALE:
- Intensive Services
- Housing, and
- Placements

THE TRAGEDY OF MODERN SOCIETY -- IT'S ALWAYS THE "WRONG PERSON"

9/3/2020

"FLEA BAG" & JAMES BALDWIN & JOHANN HARI & GRAHAM ROOK & JACOB BRONOWSKI

First, if you want to live in this society --- you better not leave your CRITICAL THINKING SKILLS at home --- and "Fleabag" has them with her at all times.
BUT all that AWARENESS that supposedly makes her different from other animals isn't really helping.
By her own description -- she has an empty heart and no friends.
There's no time for friends -- "Fleabag" wants the money and so does her therapist.
Now there are a lot of DIFFERENT CURRENCIES in our society --- maybe it's MONEY, or ATTENTION, or LOVE, or RESPECT or all of the above.
But when the Therapist says it's a little late for Fleabag to ask for the money --- What does that mean?
It probably means a lot of things. One of things it may mean is that a girl with an empty heart and no friends -- needs a therapist to talk to.
But Fleabag can't afford to talk to the Therapist on a regular basis --- she's there as a BIRTHDAY PRESENT from her Father.
Of course, it's her Father she really needs to talk to.

RELIGION: Despite the fact that RELIGION is desperately needed in our society --- SOME RELIGIOUS PATHS ARE STUCK IN THE PAST --- and relatively F'ING USELESS for many people.

Further, becoming SELF-RIGHTEOUS often doesn't make us feel as POWERFUL as we think it will -- as the Therapist seems to note.

WARNING: Language / Adult Topics Fleabag with Phoebe Waller-Bridge -- When Your Dad Gets You Therapy for Your Birthday

Orchid Note: Hari's insights and revealed wisdom are so important for Modern Society.

On the other hand --- Professor Graham Rook at University College London --- probably has hit on biological reasons why modern people are seeing more autoimmune and psychiatric illness. See --

Old Friends Hypothesis

It is important to realize that MANY, MANY THINGS can lead to PSYCHIATRIC SYMPTOMS just as MANY, MANY THINGS can lead to PHYSICAL SYMPTOMS.

A BIG TASK is INTEGRATING the INCOMPLETE and IMPERFECT KNOWLEDGE we do have --- and ACKNOWLEDGING THE MANY QUESTIONS THAT IMPERFECT KNOWLEDGE RAISES, and the IMPLICATIONS that IGNORANCE has for our CURRENT SYSTEMS --- including the CRIMINAL JUSTICE SYSTEM.

British mathematician and historian Jacob Bronowski: Knowledge or Certainty -- There is no absolute knowledge.

Major Investments & Innovative Cost-Savings

We've got to invest the resources for STAGE 4 -- People who are Homeless or Incarcerated due to Cognitive Disability
There are some people who would benefit from the DOING THERAPIES & ANIMAL THERAPIES more than traditional TALK THERAPY.
There is a BIG ROLE the Rec Centers could play in the overall health and well-being of the community --- that should be even further developed. -- and funded.

THAT "PRO-SOCIAL" MENTAL HEALTH PROFESSION THAT's TANKING*

9/2/2020

We Need Policymakers to ASK SOME TOUGH QUESTIONS regarding current mental health treatment?
Why can't we seem to get a handle on our "MENTAL HEALTH CRISIS"
Should we be asking patients and families what they think would help them PERSONALLY?

Additionally, we don't want Policymakers to continue to ABANDON the people with the GREATEST NEEDS as the result of cognitive disability or disabilities.

That INCLUDES sticking with people when we DON"T ALWAYS HAVE GREAT TREATMENTS.

*"TANKING:" To fail often at great financial cost -- Informal Dictionary

Scientific American (2015)

Mad Science: The Treatment of Mental Illness Fails to Progress

Recent questions about the validity of diagnostic criteria for mental illness have raised deeper questions about the current state of psychiatry

For Scientific American Article ----- Click Here

Science Up

New Science is Amazing & It Have Huge Moral Implications for Our Society -- Now

What In the Hell --- All too often if our Mental Health Profession doesn't know the Answer -- they think the Answer is Jail or Prison