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AGGRESSION & SEXUALITY: THE NEED FOR BIOLOGY IN CRIMINAL JUSTICE

1/26/2020

Some academics are making the point that life today is much less violent than in the past.

While for some people, it is still pretty violent -- human history is marked by violence and atrocities -- so for some of us it does seem better.

When we think about the extremes of War -- we think of the "DOGS of WAR" -- that are unleashed.

I'm probably not the first person to submit that those "DOGS of WAR" are biologically powered, and a BIG CONTRIBUTOR may be that the more AGGRESSIVE we become, the more AGGRESSION CELLS we get, and the more AGGRESSIVE we become -- and it does become the proverbial vicious cycle.

In Modern Times, we tend to think of sex and aggression as quite separate things, but they seem to be quite intertwined in our biology in very complex ways.

Further, while there are some general observations to be made, we are starting to find specific biology associated with different types of sex crimes such as sexual abuse of children and pedophilia.

So when we think about the criminal law, it is more about the need to add, rather than subtract.

The criminal act and criminal intent are still relevant -- BUT they are BIOLOGICALLY driven.

That doesn't make the need for SAFETY less, and in some cases that increased understanding may make the perceived need for SAFETY greater.

Two of many excruciating aspects of current knowledge are that:

we often fail at prevention and
sometimes our after-the-fact treatments are partial or non-existent.

Luckily we have our Spiritual Traditions, and a tradition of care for the sick that goes back to prehistoric people and even the neanderthals.

We just have A LOT more knowledge now.

Science News: "Mapping Aggression in the Brain"

European Union: "Stop Rape In War"

Baycrest: Inappropriate Sexual Behavior in Dementia

A Candid Conversation About Sexual Aggression

The Brain Forum: "The Neural Circuitry of Sex & Violence" -- Caltech Neuroscientist David Anderson

Brainlinemilitary: "How Can Brain Injury Affect A Person's Sexuality"

CGTN (China Global Television Network) War Crimes Committed in China by the Japanese

Hannover Medical School, Germany

Child sexual offenders show prenatal and epigenetic alterations of the androgen system

Aggression: Humanity's Ultimate Double-Edged Sword

"OLMSTEAD" & COURT DEFERENCE TO STATE DISABILITY PLANNING

1/24/2020

In deciding "Olmstead" 20 years ago, the US Supreme Court was very aware that States were responsible for providing a FULL RANGE of services and placements -- not just in the community.

So while the Court did hold that unnecessary institutionalization of people with disabilities amounts to discrimination under Title II of the Americans with Disabilities Act -- it gave States some defenses.

Olmstead does not require a fundamental alteration of the STATE PLAN to serve people with Disabilities
- (which is NOT the same thing as the State's Medicaid Plan -- and can and should include HOUSING).
- Further a US Department of Justice findings letter found that bringing existing services such as Assertive Community Treatment to SCALE does not amount to a Fundamental Alteration.

States have a defense to an Olmstead action if they have Comprehensive, Effectively Working Plans to eliminate unnecessary institutionalization of people with disabilities.
- that generally now includes people being released from incarceration and people who are homeless or at great risk of institutionalization or homelessness.
- DOJ guidance and court decisions require:
  - Measurable Goals
  - Reasonable Time Frames, and
  - Funding to Support the Plan

So these are critical reasons why "Olmstead" is a STATE issue -- it is only the STATE that can provide the comprehensive, effectively working plan to eliminate unnecessary institutionalization and homelessness of people with disabilities.

STATE COST-SHIFTING TO MUNICIPALITIES & COUNTIES

1/21/2020

Municipalities & County Jails are the governmental subdivisions that are hit the hardest with homelessness and jail incarceration.
In both cases, there is cost-shifting from the States to municipalities and county governments.
The STEPPING UP Initiation to reduce/eliminate inmates with mental illness from jails -- requires STEPPING UP from everybody, especially the FEDS and the STATES.
Right now, the LEGAL OBLIGATION to provide housing for people with disabilities who are institutionalized or homeless or at great risk of those things is on the STATES.
That State Legal Obligation requires a comprehensive, effectively working plan with:

Measurable Goals
Reasonable Time Frames and
Funding to Support the Plan

So that sounds deceptively easy -- it requires quite an infrastructure within the State to do it -- and if that infrastructure isn't there -- it generally doesn't get done.
Well, so what? That leads to the incarceration, homelessness, and institutionalization of 1000s of people with disabilities. It can even lead to death or maiming.
Does anybody in State Government want those HORRIFIC CONSEQUENCES? -- no. Unfortunately, those consequences are NATURAL & PREDICTABLE -- and they are going to keep happening until we take Disability Civil Rights Laws seriously.

Channel 7: Man Sues Sheriff's Office After Psychotic Break and Gouging His Own Eyes Out.

SUPPORTIVE HOUSING: THE GOLD STANDARD IN LONG TERM CARE IN THE COMMUNITY

1/20/2020

NY Medicaid Redesign Team (MRT)- Using state Medicaid dollars for Supportive Housing

CSH (Corporation for Supportive Housing)

The 1999 ADA/Olmstead decision is intimately connected with Homelessness.

The State and municipalities need a Comprehensive, Effectively Working Plan to Provide Supportive Housing to SCALE.

[People with disabilities who are institutionalized or homeless (or @ great risk of those things) -- are the Olmstead target population -- and the legal responsibility is on the State.]

This is our pitch for the State to just comply with the law, or a team lawyers to take this on.

We are concerned about the Polis Administration and Olmstead Compliance .

In a lot a ways this is similar to Solitary Confinement in which Support is needed to eliminate it in jails and prisons.

We think States need a lot of SUPPORT to bring Supportive Housing to SCALE.

BUT Supportive Housing is too important not to pursue.

Confessions of "Pocahontas"

1/20/2020

As an Oklahoma native whose family made the RUN -- it is just not that uncommon for "white" and "black" Oklahomans to have some Native ancestry.

My maternal grandmother did have jet Black hair -- I don't.

When I think of all the places human beings have been -- those are MY STORIES.

I don't just participate in Humanity figuratively -- but literally and cellularly.

SUPPORT: ENDING SOLITARY CONFINEMENT

1/17/2020

One of my great heroes is Sheriff Dart of the Cook County Jail in Chicago.
He has really been at the forefront of ringing the alarm bells regarding the high incidence of mental illness among jail inmates.
So I was not surprised to see that Cook County Jail eliminated Solitary Confinement.
I was surprised to see Local Media alleging inmates were still having a hard time accessing mental health treatment.
The Vera Institute of Justice has the very real potential to provide States and Law Enforcement the Support they need in constructing alternatives to solitary confinement.
Colorado has some restrictions on solitary confinement in prisons, we must eliminate the use of solitary confinement in Colorado Jails & Prisons.

[One of the things this 60 Minutes clip does not address is the Scientific Limbo many mental health patients find themselves in with:

a Diagnostic & Statistical Manual (DSM) that the National Institute of Mental Health is "agnostic" on,
Treatments that have stagnated
& costs that are through the roof.

Something is going to have to give. We need a REAL PLAN to deal with our Mental Health Crisis]

Sheriff Tom Dart says Cook County Jail is the first to end solitary confinement. Here’s what it looks like from the inside.

The Special Management Unit is supposed to be an alternative to isolating people who are violent in jail or break the rules, but a recent tour raises questions about how rehabilitative it is, especially for those in need of mental health care.

Safe Alternatives to Segregation Resource Center

WHAT ARE THE IMPLICATIONS OF ALL THIS BIOLOGICAL INFORMATION? AND WHO IS SUPPOSED TO HAVE THE BURDEN OF PROOF?

1/13/2020

    So we rely on the work of a lot of researchers -- BUT the attitude of most of these researchers is -- Well, once we get it completely figured out maybe the Criminal Justice System should incorporate this in Punishment Decisions.

    Stanford Neurobiologist & MacArthur Genius Award winner Robert Sapolsky is one of the very few who understands the POWERFUL TRAJECTORY of this KNOWLEDGE and it is the basis of his book -- "Behave: The Biology of Humans at our Best and Worst"

So if we place a SPECIFIC LEGAL OR EVEN DE FACTO burden on the Individual to prove his or her behavior IS the result of BIOLOGY -- what kind of lie are we living?

Well, I would argue quite a big one.

Further, it is a lie that does NOT promote SAFETY for anyone.

   Of course, much of our current knowledge brings KNOWLEDGE without ADEQUATE TREATMENT.

AND that is the ETHICAL DILEMMA of OUR TIME.

AND it is the basis of RESISTANCE to sufficient funding of LONG TERM CARE for Younger Individuals with Cognitive Disability.

    [The vast majority of people with cognitive disability in Colorado don't need Long Term Care -- but thousands of Coloradans do.]

DR. ROBERT SAPOLSKY IS A PROFESSOR OF BIOLOGY, NEUROLOGY AND NEUROLOGICAL SCIENCES, AND NEUROSURGERY @ STANFORD UNIVERSITY:

"You are never really going to understand what is going on if you get it into your head that you're going to be able to explain everything with this is--

the part of the brain

the childhood experience

the hormone

the gene

or the evolutionary mechanism

---That explains everything.

"It doesn't work that way. Instead any behavior is the result of biology that occurred a second ago, hours ago, days ago -- a million years ago."
. . . .

"O000h it's complicated. Well, that's very useful.

"How 'bout, 'OOOh it's complicated and you better be really careful and really cautious before you think you understand the causes of a behavior, especially if it's a behavior you judge harshly.' "
. ------Prof. Robert Sapolsky Stanford

"EFFICIENCY" AND A MENTAL HEALTH DEBACLE

1/12/2020

So our Society is RIFE with a "Big, Little Lie."

That "Big, Little Lie" is --- just call for help and you'll get fixed up.

In many cases, maybe that is TRUE -- but in a SIGNIFICANT PERCENTAGE it is NOT.

AND in a SIGNIFICANT PERCENTAGE of those cases, it is because the standard treatments are INADEQUATE.

What does it mean that the Standard Treatments are INADEQUATE for someone with:

Mental Illness
Brain Injury
Substance Issues, and/or
Developmental Disability

That person MAY need a lot of SUPERVISION and there need to be clear, rational criteria for Institutional versus Community Levels of Supervision.

In many cases our Society has just BLOWN THIS OFF and let Criminal Justice & the Streets step in-- because it doesn't look very "Efficient" -- and it costs a lot of money.

So we do "SOMETHING" far below the SCALE NEEDED -- and we are shocked that our DEBACLE has not resolved itself.

We're really picking on Gov. Polis and his comments on "Efficiency" and may be that is the language to use with the Legislature -- but Colorado has a HORRIBLE HABIT of not complying with the LAW.

AND quite frankly, we have a lot of concerns about how much the "Behavioral Health Task Force" is actually going to do. That may be horribly unfair -- we hope it is.

DISCRIMINATION: MEDICAID'S IMD EXCLUSION RULE & MEDICAID'S FAILURE TO FULLY FUND SUPPORTIVE HOUSING

1/12/2020

Underneath the Medicaid Institutes of Mental Disease Exclusion Rule and Failure to Fund Supportive Housing -- is a Failure to Appreciate the Need for Long Term Care among people with Cognitive Disabilities.

When you've got jails, prisons and the streets to take care of these invisible people -- who needs adequate healthcare -- well currently thousands of Coloradans who aren't getting it.

GOT HEALTH EQUITY? Hell, no.

Further, it often just doesn't make sense to talk about Mental Illness in isolation, when it is often a co-occurring condition.

We don't have Healthcare Systems that are good at dealing with co-occurring Cognitive Issues.

That has to be a priority.

With respect to DISCRIMINATION and the IMD Rule -- I often think of the Mental Health Parity and Addiction Equity Act of 2008. If we fund hospitalizations for people with physical ailments, we need to fund hospitals beds for people with cognitive ailments.

With respect to Supportive Housing, Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act prohibit discrimination in government programs and require REASONABLE MODIFICATIONS in Policies, Practices & Procedures.

Supportive Housing isn't just an issue for people with Cognitive Disabilities, but it can make it HARDER due to:

Fair Housing Non-Compliance among Medicaid Assisted Living & Nursing Homes -- the obvious alternatives to Supportive Housing
A high level of tolerance and comfort in incarcerating and relegating people with cognitive disabilities to the streets.
An absence of legally required alternatives

BUT we must have VIABLE ALTERNATIVES TO INCARCERATION AND THE STREETS -- and not just the one off innovative program -- thousands of people need a COMPREHENSIVE CONTINUUM of Care that includes Hospitalization and Supportive Housing.

TAC: End IMD Exclusion

KFF: State Options for Medicaid Coverage of Inpatient Behavioral Health Services

COGNITIVE DISABILITY, MEDICAID & "DISCRIMIN-ATION"

1/12/2020

  A big part of our challenge is understanding what "DISCRIMINATION" looks like when it is directed towards people with Cognitive Disabilities.

   If someone has significant problems with "emotional regulation" and/or "organization": What kinds of Reasonable Accommodations/Modifications in Policy, Practice & Procedure must be made?

Well, this presents A LOT OF HEAVY LIFTING for the BUREAUCRACY -- and if the BUREAUCRACY is trying to do this HEAVY LIFTING within EXISTING RESOURCES -- the HEAVY LIFTING generally doesn't get done.

  What does this HEAVY LIFTING look like:

Administrative Assistance
Legal Compliance Assistance -- Ensuring Medicaid Providers are complying with Fair Housing Law
Paying for Ad Hoc Placements when the Medicaid Network is Inadequate

We would argue that failure to do that is DISCRIMINATION and it is a problem at Colorado's Department of Health Care Policy and Financing.

We want state funding of a Medicaid Re-Design Team that will address:

Supportive Housing
Cognitive Disability among Justice Involved Individuals, and
Cognitive Disability among Homeless Individuals, and
Spearhead Comprehensive Olmstead Planning with:
- Measurable Goals
- Reasonable Time Frames, and
- Funding to Support the Plan

Discrimination on the Basis of Disability

As they apply to entities under the jurisdiction of the Office for Civil Rights (OCR), OCR enforces:

Section 504 of the Rehabilitation Act of 1973, including programs and activities that are conducted by HHS or receiving Federal financial assistance from HHS
Section 508 of the Rehabilitation Act of 1973, covering access to electronic and information technology provided by HHS
Title II of the Americans with Disabilities Act (ADA) of 1990, covering all health care and social services programs and activities of public entities
Section 1557 of the Patient Protection and Affordable Care Act (ACA), ensuring that an individual is not excluded from participating in, denied benefits because of, or subjected to discrimination as prohibited under Section 504 of the Rehabilitation Act of 1973 (disability), under any health program or activity, any part of which is receiving federal financial assistance, or under any program or activity that is administered by an Executive Agency or any entity established under Title I of the Affordable Care Act or its amendments.
Rights and Responsibilities under Section 504 and the ADA, Section 504 and the ADA protect qualified individuals with disabilities from discrimination on the basis of disability in the provision of benefits and services.

See the Facts Sheet - PDF and the Regulations for an explanation of who is a qualified individual with a disability and more detailed information about rights and responsibilities.

Covered entities must not, on the basis of disability:

Exclude a person with a disability from a program or activity;
Deny a person with a disability the benefits of a program or activity;
Afford a person with a disability an opportunity to participate in or benefit from a benefit or service that is not equal to what is afforded others;
Provide a benefit or service to a person with a disability that is not as effective as what is provided others;
Provide different or separate benefits or services to a person with a disability unless necessary to provide benefits or services that are as effective as what is provided others;
Apply eligibility criteria that tend to screen out persons with disabilities unless necessary for the provision of the service, program or activity.
Covered entities must:
Provide services and programs in the most integrated setting appropriate to the needs of the qualified individual with a disability
Ensure that programs, services, activities, and facilities are accessible
Make reasonable modifications in their policies, practices, and procedures to avoid discrimination on the basis of disability, unless it would result in a fundamental alteration of the program
Provide auxiliary aids to persons with disabilities, at no additional cost, where necessary to afford an equal opportunity to participate in or benefit from a program or activity
Designate a responsible employee to coordinate their efforts to comply with Section 504 and the ADA
Adopt grievance procedures to handle complaints of disability discrimination in their programs and activities
Provide notice that indicates:
That the covered entity does not discriminate on the basis of disability
How to contact the employee who coordinates the covered entity’s efforts to comply with the law
Information about the grievance procedures

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Val's Blog

AGGRESSION & SEXUALITY: THE NEED FOR BIOLOGY IN CRIMINAL JUSTICE

"OLMSTEAD" & COURT DEFERENCE TO STATE DISABILITY PLANNING

STATE COST-SHIFTING TO MUNICIPALITIES & COUNTIES

SUPPORTIVE HOUSING: THE GOLD STANDARD IN LONG TERM CARE IN THE COMMUNITY

Confessions of "Pocahontas"

SUPPORT: ENDING SOLITARY CONFINEMENT

WHAT ARE THE IMPLICATIONS OF ALL THIS BIOLOGICAL INFORMATION? AND WHO IS SUPPOSED TO HAVE THE BURDEN OF PROOF?

"EFFICIENCY" AND A MENTAL HEALTH DEBACLE

DISCRIMINATION: MEDICAID'S IMD EXCLUSION RULE & MEDICAID'S FAILURE TO FULLY FUND SUPPORTIVE HOUSING

COGNITIVE DISABILITY, MEDICAID & "DISCRIMIN-ATION"

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