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THE HARD ISSUES REGARDING THE SHAKY FOUNDATION OF PSYCHIATRIC DIAGNOSTICS

8/16/2019

Our Mental Health Profession has so many FUNDAMENTAL logical and scientific problems.

We're NOT going to solve our Mental Health Crisis until we get the COURAGE to tackle those issues.

Russell Copelan, M.D.

August 13, 2019

By Russell Copelan, M.D.

Despite the Zero Suicide initiatives, information resources, telephone numbers, best practices, mental health first aid -- and yes, board certification and other tools distributed for safer suicide care -- from 2000 to 2017, the suicide rate in the U.S. increased to a 50-year high, and the youth suicide rate of 14.6 per 100,000 appears to be the highest it's been since the government began collecting such statistics in 1960.

Among other reasons, two of the primary and persistent puzzlements affecting these dreadful statistics include:

(1) the incongruity between society's obvious mental health needs and what society chooses to pay for suicide and violence risk assessment, and

(2) the presence of high barriers to implement innovative tools that guide clinical judgment, such as pervasive administrative resistance and special organizational interests, for example, the APAs valuable DSM property.
In part, these stupefactions stem from:

(1) the troika of ineffective access, incompetent training, and inept assessment in psychiatric emergencies,

(2) the painstaking difficulty in defining "mental illness" and suicide and, relatedly,

(3) the unsettling amorphous shape of diagnostic psychiatry.

MENTAL HEALTH ADVOCATES, PROFESSIONALS, & THE SOCIETY: IT IS TIME TO COME TO TERMS WITH PROF. ROBERT SAPOLSKY'S "BEHAVE"

8/12/2019

The are several primary logical problems with our routine debates about "Mental Illness" and "Criminal Behavior":

We currently don't have scientifically valid diagnostic categories of "mental illness" -- we have descriptions of symptoms that fall far short of the necessary bio-markers. The US National Institute of Mental Health understands this problem and has been trying to re-orient its research away from DSM categories.
- Further Canadian and UK researchers have found the current diagnostic categories are "scientifically meaningless" on different grounds:
  - Canadians found the categories did not accurately track brain imaging; and
  - UK researchers found the categories did not sufficiently account for the relevance of TRAUMA.
Current Research -- appears to be identifying bio-markers in the blood, the microbiome and through brain scans BUT this is all still being refined.
"Mental Illness" is a HUGE CATEGORY and unfortunately the overwhelming majority of people in it have often been the greatest enemies of those with mental illness or other cognitive disorders who are in the Criminal Justice System. Further, this is often done in the name of STIGMA PREVENTION --and it is the basis of the GROSS HUMAN RIGHTS VIOLATIONS in the Criminal Justice System.
If you're paying attention you know that generally the question isn't really does the person in the Criminal Justice System have a cognitive disability? It is really: What cognitive disability or combination of cognitive disabilities does the person have?
We do need to get away from singling out "MENTAL ILLNESS" and refer instead to "Cognitive Disability" -- this can be brain injury, "mental illness," developmental disability, substance issues, neurological disorders, etc. -- and is often a combination.
We do need to understand our most dangerous biology and get away from these HUGE CATEGORIES-- and we really need to understand that it is BIOLOGY whether we attribute the "bad behavior" to "mental illness" or something else.

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

INFORMATION OVERLOAD AS THE KEY TO ENLIGHTENMENT

8/9/2019

We don't have perfect knowledge -- anything we do must be continually revised and improved.
BUT we have the knowledge to know what we are doing in the Criminal Justice System is WRONG -- EVEN if that knowledge hasn't been incorporated into every discipline.
We need to start voluntarily screening people involved in the Criminal Justice System for:
- Brain Injury
- Autism
- ADHD
- Mental Illness
- Other forms of Developmental Disability
- Substance Issues
- Etc.
Medicaid Network Adequacy as well as other laws demand that we have sufficient treatment modalities available for this population -- the vast majority of which will ultimately be released to the Community.
So much of this is an INFORMATION OVERLOAD PROBLEM -- BUT we can't go back -- and we can't solve these issues unless we get widespread incorporation of the vast amount of knowledge we actually do have and is gushing down the pike @ this minute.
That is going to bring a lot of things -- EVEN MORE RELIANCE on TECHNOLOGY and another in a long line of traumatic re-evaluations of what it means to be HUMAN.
BUT this time in Modern Society-- it may be our "Evolving" Religious Traditions that are leading the way --
- Helping Us to Understand Just How Much that "Lost Sheep" really has to teach us
- We have some pretty significant mind & body limits, and
- It's probably best that we don't judge AND
- We are part of SOMETHING bigger than ourselves -- even if we don't have a clear understanding of what that is.
- Much will come after us, building on what has come before
AND those understandings could maybe, kinda sorta help our DYSFUNCTIONAL HUMAN FAMILY bind itself up.

Parable of the Lost Sheep. Photo Credit: lds.org [BTW: We take a pretty 12-Step attitude towards various religious traditions -- taking what we want & the leaving the rest.]

Dr. Daniel Amen's Over 83,000 Brain Scans

Enlightened Self Interest

Bringing Religion In From the Cold

Nearly 65% of prisoners at women's jail 'show signs of brain injury' --- Call for screening as women tell study their injuries were caused by domestic violence

The Guardian provides a warning that the article above regarding Brain Injury is over 5 months old. That's how fast information is accumulating and changing.

WE'VE GOT ONE OF HELL OF A "COMPETENCY" PROBLEM IN THE MENTAL HEALTH PROFESSION

8/8/2019

THIS IS NOT REALLY THE FAULT OF CLINICIANS -- BUT THE STAKES ARE FAR TOO HIGH TO IGNORE IT

So ultimately one of the things that INTEGRATION of Physical & Mental Health needs to mean is bringing Mental Health Professionals "OFF THE ISLAND" and fully incorporated into general HEALTH CARE.

   It's not really that Mental Health Professionals are any more "INCOMPETENT" than general practitioners or other specialties-- BUT they are making pronouncements in the Criminal Justice System -- invited by desperate Defense Attorneys and/or a desperate PUBLIC -- beyond the mental health profession's knowledge base.

So when the MENTAL HEALTH professionals say -- there's no linkage between mass shooters and mental illness [and that's based on "scientifically meaningless" categories in the DSM -- that's a BIG PROBLEM].

Further, professionals and the public generally read those pronouncements to mean -- the person is just EVIL.

    Further, just because the Mental Health professional doesn't have a biological explanation for the behavior doesn't mean there isn't one -- and that may or may be something we would think of as "mental illness."

We need to understand how BLURRED these distinctions are between:

developmental disability [including High IQ DD]
mental illness
brain injury, and
substance use issues

When we see these horrible acts -- we need to be bringing in:

brain injury experts and researchers
researchers in the immune system and behavior
researchers in the microbiome and behavior
experts in developmental disabilities [including HIGH IQ DD -- with special attention to emotional regulation]
etc.

Further, as a Society we must provide an EVER MORE SOPHISTICATED INFRASTRUCTURE for our Health Care Professionals to stay on TOP of what is MUCH MORE INFORMATION than Human Beings can process on their own.

In that endeavor, we will be changing the character of the Mental Health professional from largely the sole health care professional in the Criminal Justice System to one of many healthcare professionals whose expertise is consulted.

At the same time, we need to raise the pay and status of mental health care to that of other professionals within the Health Care System and fully integrate it -- so there is a better understanding of the overall SYSTEM.

When we don't have the mental capacity to remember all the details -- such as in some forms of ADHD -- we often have to pivot to understanding the SYSTEM. Our mental health professionals have got to understand the HUMAN BIOLOGICAL SYSTEM -- a lot better than they do.

Ironically, it is focus on the SYSTEM that brings INDIVIDUAL ANOMALIES into HIGH RELIEF as indicators of INCORRECT UNDERSTANDING and the need for REVISION & iMPROVEMENT.

Blurred Lines

Executive Functioning & "Prison Brain"

The Immune System, the Endocrine System, Physical Illness & Mental Health

We've Got a Problem with the Statement of the APA President on Mass Shootings & Mental Illness

8/7/2019

GETTING BEYOND THE BAD SCIENCE OF THE MENTAL HEALTH PROFESSION & OUR CURRENT DEBATES --

LET'S TALK "COGNITIVE DISABILITY"

If the US Nat'l Institute of Mental Health [NIMH] determined we don't have a valid Diagnostic Manual -- and we don't even have an agreement on what "mental illness" is --

How could you possibly know if most violence is a result of "mental illness" or not? The answer -- you couldn't know.

After every tragedy, professionals and advocates make their moral case for STIGMA PREVENTION -- the only problem is IT IS DOING MORE HARM THAN GOOD.

Cognitive Disabilities are very individual and many people who commit crimes have more than one. Don't try to prevent the appropriate treatment of these individuals in the name of STIGMA PREVENTION.

Professionals this is especially true for you when you have not adequately addressed the HUGE MORAL & ETHICAL problems of a DSM 5 -- NIMH and other researchers around the world have found "invalid" and "scientifically meaningless."

Science Up

The DSM 5 & Its Divergent Critics

BAD ACTS: IT'S BIOLOGY -- AND IT'S BEYOND "MENTAL ILLNESS"

8/6/2019

  I don't necessarily agree with everything neuroscientist Robert Sapolsky says, but I agree with a lot.
    AND when he says it is ALL BIOLOGY when it comes to human behavior -- I AGREE. Further, the biology interacts with the environment and it can't really be separated.
  MOST BLASPHEMOUS: I believe intent is a function of biology. But far from believing that takes us farther from spiritual redemption -- I believe it brings us closer.
The vast, vast majority of people in Modern Society are not intending or committing horrible crimes.
BUT earlier times were more violent, and I think that probably has something to do with the level of aggression that people believed was needed to survive. AND THAT AGGRESSION BUILDS ON ITSELF.
The fact of the matter is horrible acts are generally directly related to the Biological Cognitive Problems of the Person --- but those COGNITIVE PROBLEMS are in no way limited to MENTAL ILLNESS.
    Further, we don't even have a valid diagnostic manual for mental disorders -- so how could one know the incidence of "mental illness" among perpetrators? The answer -- you couldn't know.
Three of the reasons we have mental illness deniers is:

We are afraid criminals will get off and not be punished for their bad acts,
We are afraid we won't be safe, and
We are mental illness deniers in the name of stigma prevention.

We gotta have SAFETY -- but we really can let go of the rest.

One of things that freaks people out about the discussion of mental illness -- is it really fails to realize:

What a HUGE Category "mental illness" is -- millions -- maybe even a BILLION people fall in this category.
It's almost like equating all of physical illness with EBOLA -- yeah some people with physical illness do have EBOLA -- but the vast, vast majority -- don't.
A lot of people with serious Cognitive Disabilities who commit horrible crimes have other things going on besides "mental illness": including Brain Injury, Developmental Disability, Brain Tumors, etc. -- even though most people with those issues don't commit crimes -- those issues can greatly impact a person's Executive Functioning.

While the ultimate cause is BIOLOGY that isn't to say we can't try to address that with LATERAL PROBLEM SOLVING such as:

greater gun control, and
reducing the contentiousness in the society [We think Pres. Trump actually did make important steps in the right direction by:
- acknowledging the value and dignity of every person,
- denouncing racism, and
- denouncing white supremacy

People all over the world suffer from the most extreme impacts of Cognitive Disability. All communities need assistance in addressing this.

We also need TARGETED RESEARCH and Evidenced-Based RISK ASSESSMENTS to get to our most dangerous BIOLOGY.

Aggression: Humanity's Ultimate Double-Edged Sword

CIVIL RIGHTS, BIG DATA & COGNITIVE DISABILITY-- SCIENCE & POLICY

8/5/2019

I've always been a lot more interested in people than machines.
But the GUSHING & DEBILITATING FIRE HOSE of INFORMATION that is coming out on:

HIGHLY RELEVANT SCIENCE from the Research Community

Is leaving not only policymakers and attorneys pressed up against the wall -- but clinicians as well and even those very same researchers..

One of the phrases that comes to mind is -- "ACTIONABLE INTELLIGENCE."

We know that:

a lot of what we are doing in the Criminal Justice System is WRONG,
we know that living in a discriminatory society can have mental health effects -- further those impacts may be felt by subsequent generations,
Further, there are not one or two but many causes of severe mental and or cognitive problems

THE ROLE OF THE THE NAT'l INSTITUTE OF HEALTH, CMS & HUD AS DATA COLLECTOR-IN-CHIEF

Data Collection is a Civil Rights Issues.

If we're going to comply with the Disability Civil Rights Laws we've got on the books we need DATA and that needs to be ACCESSIBLE online.

Once we've got the DATA -- there are a lot of ways to SOLVE the problem and for that matter comply with the LAW -- but without the DATA the problems don't get solved and States don't comply with critical disability civil rights laws.

COGNITIVE DISABILITY & HARD TIME -- & HAVING THE DATA & RESOURCES TO REALLY ADDRESS THIS

8/4/2019

So we need:

Voluntary Screening and Assessment for a Wide Range of Cognitive Disabilities among inmates in prisons
To make available the current array of services and placements where "reasonably medicaily necessary."
To create a State Standing Committee of professionals, individuals who are or have served significant prison time with a cognitive disability, advocates, law enforcement, victims and victims rights advocacy groups, family members of inmates and victims to direct:

 Comprehensive Data Collection, and
Service and Placement Proposals

Decarceration Nation makes the point that we have to go beyond misdemeanors in addressing Cognitive Disability in the Criminal Justice System.

People have a lot of different opinions about this.

So on the one hand moving away from punishment -- sounds pretty NICE.

And in one respect it is. It is also a lot tougher -- without the BLUSTER.

It is absolutely about HUMANE TREATMENT -- it is also about getting away from viewing BAD CONDUCT as isolated intentional BAD ACTS -- and recognizing the long term threat they pose to the person and the community.

I don't have a problem with Civil Commitment of people coming within the context of "Violent, Dangerous Sexual Predator" statutes.

That's a small percentage of people with cognitive disabilities in prison.

Further, the Treatment & Placement Needs of the prison population ABSOLUTELY have to be considered to determine MEDICAID NETWORK ADEQUACY.

THE NEED FOR FEDERAL LEADERSHIP TO ADDRESS UNCERTIFIED "GRAVELY DISABLED" -- THE ANSWER IS NOT CERTIFICATION

7/29/2019

So all of this has a great deal to do with:

folks with cognitive disabilities that have mental illness
brain injury
substance issues, and
developmental disabilities

AND

are homeless or @ great risk of homelessness
involved with CHILD WELFARE
involved with and or @ great risk of involvement with the Criminal Justice System

WestWord did a story recently on how "insanity" isn't just a plea for murderers anymore. The ax murderer or Aurora Theater shooter is who we often think of as the person with mental illness in the Criminal Justice System.

There are thousands of people with MI & Brain Injury & Substance Issues in the Criminal Justice System while Incompetent to Proceed and Insanity are strictly construed.

CO Medicaid Providers & the CO Dept. of Health Care Policy and Financing have no idea how @ risk these folks are, even as Medicaid's own providers are pursuing harassment charges.

Further, most Medicaid folks are not familiar with the TONE of JUDGES towards people with disabilities, MOST IMPORTANTLY in the JUDGE's SENTENCING.

All those THOUSANDS of people with cognitive disabilities didn't go to prison by accident. AND every little prior builds on itself.

We've got to get really honest about what it takes to keep people with cognitive disabilities out of the Criminal Justice System.

So the conservative Treatment Advocacy Center as well as the Mental Illness Policy Organization have been big proponents of certification and assisted outpatient certification -- which Colorado has.
Further, Colorado state officials have in the past backed amendments to Colorado's certification statutes broadening the definition of "gravely disabled." This has been supported by a number of Colorado organizations including Mental Health Colorado and NAMI Colorado.
Similar actions have been taken in other states.

Certification statutes are State Statutes.

On the other hand, the following are Federal Statutes:

The Medicaid Act, including Medicaid Network Adequacy
Section 504 of the Rehabilitation Act [reasonable accommodations]
The Americans with Disabilities Act [including Olmstead and "reasonable accommodations of policy, practice & procedure"]
The Federal Fair Housing Act [reasonable accommodations]
Mental Health Parity & Addiction Equity Act of 2008

Further, broad concepts such as "reasonable accommodations" and "parity" require an enormous amount of guidance.

We favor highly detailed but flexible Federal data-driven templates for States to comply with, and state ability to request data-driven modifications of such detailed templates if not contrary to law .

It is a lot easier to work off something -- than to create it out of whole-cloth.

A HUGE, COMPLICATED issue is FAIR HOUSING as it relates to Medicaid State Agencies, Medicaid Providers and people with cognitive disabilities.

Colorado & Most States are NOT complying with:

Olmstead (1999) -- most States are very aware of Olmstead, or
The Federal Fair Housing Act (1968); Amendments (1988)

[CO's Dept. of Health Care Policy & Financing is NOT familiar with the Federal Fair Housing Act even though it directly impacts their agency, placement providers, case managers and consumers -- Further, a lot of this does relate to the INFORMATION OVERLOAD that is stressing the entire society.]

So there are a lot of things going on with regard to these issues. Resources being a HUGE issue.

Nobody knows better than we do that accommodations can take resources, especially in light of the fact we recently had a situation figuratively "blow up" on us when we didn't have the resources to make the accommodations needed for an individual.

There are a lot of practical aspects to this that need to be worked through -- Technical Assistance Centers could really help with that. We don't need to re-invent the wheel in 50 States -- but we do need to give States the opportunity to make data-driven modifications if not contrary to the law.

Gravely Disabled

Ethics & The Current System

7/27/2019

When we think about problems with the Mental Health System 2 Common issues that come up are:

Civil Commitment Statutes, and
HIPAA

Neither of these issues really gets to the root cause of most problems.

If there are sufficient:

housing
placements,
services, and
reasonable accommodations --

The rest is largely moot. When there aren't -- providers, family members and attorneys have a lot of hard choices to make.

We've learned the hard way how difficult it is to make the decision to file a petition for court-ordered evaluation even when the grounds may exist -- time, resources, unnecessary further upset, etc.

We've talked some on this page about what the goal is -- and not mistaking the "means" as the end. The goal is NOT certification.

The goal is adequate placements and services and avoidance of homelessness and criminal justice involvement.

That is not cut and dry. AND most importantly, are we going to do more harm than good?

That is the difficult problem many providers, family members and attorneys are faced with.

So the ultimate answer is not Civil Commitment Statutes that providers, family members and even attorneys may feel could make the situation worse.

But providers, family members, attorneys and the communities need VIABLE alternatives. Right now we don't have too many alternatives. That is why so many people rotate in and out of the Criminal Justice System despite being on Medicaid and often dumped by their providers.

HCPF [Colorado's Dept. of Health Care Policy & Financing] has not sufficiently addressed this.

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Val's Blog

THE HARD ISSUES REGARDING THE SHAKY FOUNDATION OF PSYCHIATRIC DIAGNOSTICS

MENTAL HEALTH ADVOCATES, PROFESSIONALS, & THE SOCIETY: IT IS TIME TO COME TO TERMS WITH PROF. ROBERT SAPOLSKY'S "BEHAVE"

INFORMATION OVERLOAD AS THE KEY TO ENLIGHTENMENT

WE'VE GOT ONE OF HELL OF A "COMPETENCY" PROBLEM IN THE MENTAL HEALTH PROFESSION

THIS IS NOT REALLY THE FAULT OF CLINICIANS -- BUT THE STAKES ARE FAR TOO HIGH TO IGNORE IT

We've Got a Problem with the Statement of the APA President on Mass Shootings & Mental Illness

GETTING BEYOND THE BAD SCIENCE OF THE MENTAL HEALTH PROFESSION & OUR CURRENT DEBATES --

LET'S TALK "COGNITIVE DISABILITY"

BAD ACTS: IT'S BIOLOGY -- AND IT'S BEYOND "MENTAL ILLNESS"

CIVIL RIGHTS, BIG DATA & COGNITIVE DISABILITY-- SCIENCE & POLICY

THE ROLE OF THE THE NAT'l INSTITUTE OF HEALTH, CMS & HUD AS DATA COLLECTOR-IN-CHIEF

COGNITIVE DISABILITY & HARD TIME -- & HAVING THE DATA & RESOURCES TO REALLY ADDRESS THIS

THE NEED FOR FEDERAL LEADERSHIP TO ADDRESS UNCERTIFIED "GRAVELY DISABLED" -- THE ANSWER IS NOT CERTIFICATION

Ethics & The Current System

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Val's Blog

THIS IS NOT REALLY THE FAULT OF CLINICIANS -- BUT THE STAKES ARE FAR TOO HIGH TO IGNORE IT

GETTING BEYOND THE BAD SCIENCE OF THE MENTAL HEALTH PROFESSION & OUR CURRENT DEBATES --​LET'S TALK "COGNITIVE DISABILITY"

THE ROLE OF THE THE NAT'l INSTITUTE OF HEALTH, CMS & HUD AS DATA COLLECTOR-IN-CHIEF

Author

Archives

Categories

GETTING BEYOND THE BAD SCIENCE OF THE MENTAL HEALTH PROFESSION & OUR CURRENT DEBATES --

LET'S TALK "COGNITIVE DISABILITY"