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THE NEED FOR Comprehen-sive DISCHARGE PLANNING & BIOMARKERS IN the CERTIFICATION Process

6/18/2019

"I NEVER EVEN MET WITH A DOCTOR FOR DISCHARGE PLANNING OR MAKING A SAFETY PLAN AT HIGHLANDS BEHAVIORAL HEALTH"

There is a pretty good chance that by 2050 we will have Biomarkers for Mental Health Certification Determinations. We're already experimenting with blood tests for suicidality.
The current process in Colorado seems pretty incapable of satisfactorily addressing people who are "gravely disabled" and there may be a lot of reasons for that.
On the other hand, we can't give mental health professionals a blank check to certify people, especially when a lot of the problem is that they don't have OBJECTIVE TESTS to make these determinations..
While a BIG part of the problem is that we do need objective measures to make these determinations, mental health professionals are probably doing the best they can with what they've got -- BUT that isn't very good.
"Gravely disabled" is a category that was adopted around the Country to attempt to address the problem of people with mental illness who were homeless or otherwise couldn't care for themselves. It really hasn't worked.
Is that because 'gravely disabled" isn't "BROAD" enough -- it's pretty BROAD in Colorado. BUT THE RESOURCES JUST AREN'T THERE -- AND THEY HAVEN'T BEEN FOR DECADES.

2018: The California Assembly passed AB 1971, legislation which amends the state’s definition of “gravely disabled” to include medical treatment as a basic human need for those suffering from a serious mental illness, just as necessary to well-being as food, clothing or shelter. Photo Credit: scvnews.com

CRS 27-65-102(9)
(search for statute at http://www.lexisnexis.com/hottopics/colorado/ )

(9) "Gravely disabled" means a condition in which a person, as a result of a mental health disorder, is incapable of making informed decisions about or providing for his or her essential needs without significant supervision and assistance from other people.

s a result of being incapable of making these informed decisions, a person who is gravely disabled is at risk of substantial bodily harm, dangerous worsening of any concomitant serious physical illness, significant psychiatric deterioration, or mismanagement of his or her essential needs that could result in substantial bodily harm.

A person of any age may be "gravely disabled", but such term does not include a person whose decision-making capabilities are limited solely by his or her developmental disability.

IN AN AGE OF POSITIVITY & DENIAL-- OUR NEED FOR RESEARCH & MORE EFFECTIVE M.H. TREATMENT

6/17/2019

       Well, we are kinda coming to terms with the Mental Health Crisis in the US -- it just keeps outpacing us.
Governments are spending Millions & Billions of Dollars and they STILL CAN'T COMPLY with DISABILITY RIGHTS LAWS that are already on the books.
Family Members are afraid to acknowledge the need for Different/Improved Treatments because they are often NOT available. Right now, Ketamine is the big thing for TREATMENT RESISTANT DEPRESSION & most insurance won't pay for that. What about other "mental illnesses"?
The research is SO TANTALIZING regarding INFLAMMATION, the MICROBIOME, and the IMMUNE SYSTEM but you're probably not going to hear a lot about that from your Clinician or that Forensic Psychologist testifying in Criminal Court.
In a country in which almost 100 percent of the population has low-grade inflammation, we need to turn our POSITIVITY TO RESEARCH & HUMANE CARE & TREATMENT while also acknowledging the HORRIFIC REALITY of untreated or improperly treated Mental Illness in our Criminal Justice System.

Changing understand-ings of mental illness bring need for honesty & clinical trials

6/16/2019

A BIG need in Clinical Mental Health is that many mental health patients & family members need access to current & future research in experimental psycho-neuro-immunology and the microbiome.

This research appears to be changing our understanding of the nature of mental illness.

Further, as a Society & in individual cases, we need an "open dialogue" about the short-comings of current clinical understandings & treatments in many cases..

That HONESTY is the necessary precursor for Clinician/Patient partnerships with less than perfect alternatives.

Like Cancer physicians, psychiatrists should have access to a Network of Clinical Trials and discuss when appropriate with patients.

National Cancer Institute's National Clinical Trials Network

National Database for Autism Research

Clinicaltrials.gov

National Institute of Mental Health -- Clinical Trials

PATIENT ABANDONMENT IN COLORADO MEDICAID MENTAL HEALTH

6/15/2019

I remember my College Ethics Professor, who was also an ordained minister, calling out the idea that ethics could be boiled down to the Golden Rule.

He likened that to saying that "Twinkle, Twinkle Little Star" could sum up Astronomy.

We've gone through a week of State, Regional Accountable Entity, Mental Health Centers, etc. --- being horribly OUT OF STEP with the Music, the LAW and the NEEDS of the Patient.

Of course, it is really not just a week -- a period of years for this individual, a period of decades for Coloradans with Serious Mental Illness & their families.

So I got home last night at about 10 p.m. doing the Medicaid Mental Health System's job. Mind you -- I had gone to extreme, explicit lengths to avoid this -- contacting everybody @ the State including the Attorney General's Office that I could think of.

Pretty much my analysis of the situation is that:

placement of a person who meets certification criteria on the streets and/or a homeless shelter -- represents IRREPARABLE HARM sufficient for the granting of a Preliminary Injunction.
If that harm can be temporarily avoided by institutional placement pending arrangements for Housing and Intensive Services that is not UNREASONABLE.

A lot of the time spent yesterday had been cooked into the mix by the poor actions of a Mental Health Center and a Therapeutic Living situation.

Did the Mental Health Center abandon their patient -- They absolutely did. Did they understand that -- probably not.

Did the State understand their duties to provide Housing when the State wouldn't respond to us on their duty to provide Housing? They probably did.

Image Credit: "Patient Abandonment and the Difficult Patient," David E. Kolva, M.D.

IS CO State Gov't EVER GOING TO ACCEPT ITS RESPONSI-BILITIES UNDER OLMSTEAD TO PROVIDE HOUSING FOR PEOPLE WITH DISABILITIES?WITHOUT MAJOR CHANGES -- IT DOESN'T LOOK LIKE IT

6/15/2019

Any State Administration is faced with A LOT of issues. The more they have to RE-INVENT THE WHEEL the longer things are going to take, especially if they feel like they have financial and or political incentives not to do it.

    This has really been a corrupting influence on some of the nicest people in Colorado politics, including the Hickenlooper Administration.

Well, now we have the Polis Administration which is setting off on a bold & ambitious Behavioral Health Task Force that is really largely the culmination of a 10-year lawsuit against the State -- the Jail Wait Case.

THIS IS REALLY, REALLY PROMISING.

But we still have the promise of the Americans with Disabilities Act, Olmstead, subsequent caselaw and US Dept. of Justice Guidance that if States can't fully comply with legal requirements to provide services, housing, etc. to prevent unnecessary institutionalization of people with disabilities -- States need Comprehensive, Effectively Working "Olmstead Plans" with:

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

Is Colorado going to get to that anytime soon? Colorado's affordable housing crisis hits people with cognitive disabilities pretty much like A TON OF BRICKS.

Providers and Case Managers can't spin straw into HOUSING .

  Under Olmstead, housing for people with disabilities who are institutionalized or at great risk of institutionalization such as from homelessness is the responsibility of the STATE.

  Is that ever going to be realized without more SUPPORT & ENFORCEMENT from the FEDS for Compliance with the pre-imminent Federal Disability Civil Rights Law of this Country -- the ADA. .

  Well, maybe BUT it is probably going to take much longer without MAJOR FEDERAL ENHANCED SUPPORT & ENFORCEMENT. Further, a lot of the people who are suffering NOW will be gone if we stay on our current trajectory.

The Olmstead US Supreme Court decision was decided in 1999.

Photo Credit: atlantalegalaid.org

IRREPARABLE HARM, HOMELESS-NESS & MEDICAID REASONABLE ACCOMMODA-TIONS PENDING HOUSING

6/13/2019

WHEN THE STATE DOESN'T HAVE THE RESOURCES & PROVIDERS ARE BURNT OUT--

Maybe we wouldn't be so persistent IF we hadn't been here before --- but we have -- in a situation that was arguably much less dire than this.

Cclorado's lack of Affordable Housing and Comprehensive Mental Health Continuum of Care is AT THE ROOT of Many Crises Affecting Coloradans with Mental Illness.

So the proposed answer is often to go to the ACUTE TREATMENT UNIT. This often DOESN'T WORK to solve access to Affordable Housing or a Comprehensive Mental Health Continuum of Care.

BUT MAYBE IT COULD.

Quite frankly, Regional Accountable Entities, Intensive Case Managers don't have the MOJO to come up with HOUSING on the FLY and they are already pretty BURNT OUT.

Now, we're really in the situation with the person with a mental illness -- with the provider with burnout. We could say: YOU SHOULDN'T BE BURNT OUT. That is not going to change anything. And like most mental conditions, there are good reasons for it.

Colorado State Government under the Polis Administration is in the process of doing a major overhaul of Behavioral Health -- BUT all of that is in PROCESS.

So how could we work with the ATUs and what Colorado Medicaid currently has with "REASONABLE ACCOMMODATIONS" to buy more time to get the LEAST RESTRICTIVE ENVIRONMENT the LAW provides for.

DISCHARGE PLANNING

Acute Treatment Unit, Discharge to
Nursing Home, discharge planning arrangements to
Housing & Intensive Treatment

In many cases Nursing Homes are going to be the better choice because they have access to Medicaid Nursing Home Transition Coordinators already.

If there are no nursing homes that will take the person, Medicaid coverage of short-term hospitalization up to 45 days could also provide the necessary bridge to Housing and Intensive Treatment with enhanced discharge planning.

"RESEARCH IS EVERYBODY'S BUSINESS"

6/12/2019

A key AHSC [Academic Health Science Centre] priority is to nurture a research culture and boost numbers of Healthcare Professionals engaging in clinical academic research across all AHSC partner members. There is a growing number of healthcare professionals bringing their expertise and questioning minds to the research table and leading high quality research aligned to patient and health service priorities.

----Imperial College London

Britain like the US is facing a Mental Health Crisis straining its Economic Resources. They also recognized that it was taking 17 years for most discoveries in the lab to make it to patients.

Some of the most important mental health research is going on in the US and Colorado, much is also going on in the UK and other countries.  Further, in the UK-- a conscious, concerted effort has begun to span the GAP between Researchers and Clinicians.

   Additionally, mental health research is much more broadly reported in the UK, with much credit owing to BBC Health & Science Reporter James Gallagher.  Some of the research we put on the Orchid website -- may sound really "out there" to our primary audience -- some of it might be old news in the UK -- and certainly if one is paying attention.

RIght NOW, Colorado and pretty much the rest of the US is on track to get current research understandings to Clinicians in 17 to 20 years.

Researchers don't have all the answers, but many of our Mental Health Researchers do know better than what our Clinicians are doing. That is NOT the fault of Clinicians.

   If we want to do better we need to start providing greater INTEGRATION of Research and Clinical Practice as the UK and Europe are starting to do.

BBC Health & Science Correspondent James Gallagher

BBC health reporter James Gallagher explores the increasing body of evidence that a dysfunctional immune system is responsible for the depression or psychotic illness experienced by hundreds of thousands, perhaps millions, of people in the UK.

James talks to the psychiatrists investigating this new understanding of mental illness and to people who may benefit from treatments aimed at the immune systems rather than their brain cells.

Inflammation, the Immune System & Mental Health

"The UCLPartners [Academic Health Science Centre] AHSC harnesses world-class academic and clinical specialty expertise to accelerate the development of new treatments, diagnostics and prevention strategies to transform the health of the population.

"The UCLPartners AHSC is one of six accredited AHSCs in England and is the largest in Europe. The role of AHSC – awarded in recognition of depth and breadth of clinical and academic excellence – was originally granted in 2009 and was renewed for a further five years in April 2014.

"Over this period, we have sought to set a new benchmark for what can be achieved through academic and clinical partnership, by harnessing strengths and aligning resources from across our eight partner organisations to drive world-class research, translation, care and education."

BREAKDOWN: Disability civil rights

6/11/2019

THE NEED FOR TEMPLATES & CHECKLISTS

FOR "REASONABLE ACCOMMODATIONS," "LIMITED" GUARDIANSHIPS, VARIOUS CERTIFICATIONS TO AVOID TREATMENT DENIAL, HOMELESSNESS, INCARCERATION, ETC.

So the biggest problem facing people with COGNITIVE DISABILITIES is largely LACK OF RESOURCES.
BUT we make our RESOURCE NEEDS even LARGER when we can't effectively utilize the LAWS & RESOURCES we already have.
Colorado's Cross Disability Coalition has really been on the CUTTING EDGE of this with regard to:

Limited Guardianships
& the Right to "Reasonable Accommodations" under the Americans with Disabilities Act & Section 504 of the Rehabilitation Act of 1973 for government programs such as Medicaid.*

    Are these brand new laws? No, but if you're working with a BLANK SLATE of "REASONABLE ACCOMMODATIONS" or "LIMITATIONS to GUARDIANSHIP"-- these laws can be pretty difficult to implement even with a high knowledge of the law -- which most people don't have.

   By and large most providers want to do the right thing, BUT by and large most providers are often NOT doing the right thing when it comes to their most difficult mental health patients.

   Even IF the tools already exist to deal with our most difficult situations:

If we're not aware of those tools, and/or
Don't know how to use them --

Those tools are not going to help providers or individuals. Further, there are not enough attorneys or advocates to help the THOUSANDS that need them.

These issues do impact a significant percentage of people with mental illness, they also greatly impact people with a full range and combination of cognitive disabilities.

We need government subdivisions working with inclusive groups of Stakeholders to work on these issues so that NONE OF US are left with a BLANK SLATE often rendering laws meant to protect people with disabilities MEANINGLESS.

*Section 504 of the Rehabilitation Act prohibits discrimination in federally funded programs. Title II of the Americans with Disabilities Act prohibits discrimination in Local & State Services. Medicaid is a hybrid Federal/State program.

The US Supreme Court's decision in "Olmstead" [1999] is NOT limited to Medicaid and does include HOUSING for people with disabilities to prevent unnecessary institutionalization or the great risk of institutionalization inherent in homelessness.

CCDC's Probate Power Program

Probate Power focuses exclusively on special needs planning, estate planning, and probate administration services.

These services include, but are not limited to, simple and complex wills, special needs trusts, revocable living trusts, financial power of attorney documents, uncontested guardianships/ conservatorships, ABLE accounts, and advanced medical directives.

THE CLOCK IS TICKING . . . INDIVIDUALS WITH SERIOUS MENTAL ILLNESS & THEIR FAMILY MEMBERS NEED EMERGENCY RULE MAKING to address medicaid Provider resort to criminal Justice System

6/10/2019

So let's say, the Medicaid mental health provider of someone in a residential placement :

filed a restraining order
pursued criminal charges for "harassment"
the person with serious mental illness is now or is on the verge of becoming homeless

What kind of human resources must be allocated to avoid homelessness or incarceration @ this point: A LOT.

Even if the Medicaid provider or Regional Accountable Entity finally steps up to do the right thing, they are often NOT prepared for the HEAVY LIFTING that is required. -- and the CLOCK IS TICKING.

This week we will start work on a Draft Application for Emergency Order and post on the website focusing largely on a Medicaid mental health recipient who is facing lack of treatment and homelessness due to State inaction or action. The Mental Health Center and the Regional Accountable Entity will also likely be included as Defendants.

If the situation in question is resolved QUICKLY -- our Application may not be necessary. Unfortunately, this is NOT an isolated incident.

While it is true much work is going on @ the state level on Behavioral Health -- Medicaid recipients with serious mental illness & their families need EMERGENCY RULE MAKING to address their concerns.

In some situations, it may be appropriate for the State to provide Hotel Vouchers until permanent housing can be obtained and the Mental Health Center and Regional Accountable Entity can arrange intensive services, including Assertive Community Treatment if appropriate.

Getting the situation out of the EMERGENCY category reduces the Stress on EVERYONE and increases the likelihood of cooperation and better decisions going forward.

PART II: HOW COULD WE CUT CRIMINAL JUSTICE DOCKETS IN HALF OR MORE? THE "HORCRUX" OF THE PROBLEM IN CRIMINAL JUSTICE

6/8/2019

The "Horcrux" of the problem in Criminal Justice is NOT that we're concerned about SAFETY. It is that our concern for PUNISHMENT is preventing us from realizing our SAFETY objectives.
It has also created one of the most inefficient, ineffective & unjust systems in American Society & largely the Western World -- the American Criminal Justice System.
Those long criminal dockets are pretty darn unnecessary.
There are some cases in which everything is @ issue. That's not most cases.
The primary issue in most cases is the PUNISHMENT.
Well, the Criminal Justice System has been trying to include TREATMENT in its range of options for decades. The advent of Medicaid Managed Care has not made that easy. Of course, it wasn't easy to begin with.
Further, the Criminal Justice System is going to determine homelessness, discrimination, poverty, substance issues, & disability largely IRRELEVANT to their determinations, except in very narrowly prescribed circumstances.
SO we can never reduce the CRIMINAL JUSTICE DOCKETS because we can't, we think we can't or we won't deal with underlying ROOT CAUSES.

The DUE PROCESS people need is not in trips to the Courthouse for Arraignment and the many court dates set after that for DISPOSITION -- because the range of alternatives is INSUFFICIENT and can be HORRIFIC.

There are cases that DO NEED a lot of attention in order to DETERMINE THE FACTS -- but those cases/people can't get it because the SYSTEM is so overrun with cases that don't need to be there.

Further, if we try to work with people rather than against them we may find that in some cases it is THEY not US who are arguing for a HIGHER LEVEL of TREATMENT & PLACEMENT.

The more we base treatment & placement decisions on objective health & social determinant of health data and on an inclusive set of considerations rather than an exclusive set of considerations-- the more COMMON GROUND we'll find.

J.K. Rowling

A Horcrux is an object formed by dark magic that is used by a wizard or witch in the Harry Potter series. Horcruxes are created to achieve immortality by splitting a dark wizard's soul into separate pieces.

--dictionary.com

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Val's Blog

THE NEED FOR Comprehen-sive DISCHARGE PLANNING & BIOMARKERS IN the CERTIFICATION Process

"I NEVER EVEN MET WITH A DOCTOR FOR DISCHARGE PLANNING OR MAKING A SAFETY PLAN AT HIGHLANDS BEHAVIORAL HEALTH"

IN AN AGE OF POSITIVITY & DENIAL-- OUR NEED FOR RESEARCH & MORE EFFECTIVE M.H. TREATMENT

Changing understand-ings of mental illness bring need for honesty & clinical trials

PATIENT ABANDONMENT IN COLORADO MEDICAID MENTAL HEALTH

IS CO State Gov't EVER GOING TO ACCEPT ITS RESPONSI-BILITIES UNDER OLMSTEAD TO PROVIDE HOUSING FOR PEOPLE WITH DISABILITIES?WITHOUT MAJOR CHANGES -- IT DOESN'T LOOK LIKE IT

IRREPARABLE HARM, HOMELESS-NESS & MEDICAID REASONABLE ACCOMMODA-TIONS PENDING HOUSING

WHEN THE STATE DOESN'T HAVE THE RESOURCES & PROVIDERS ARE BURNT OUT--

"RESEARCH IS EVERYBODY'S BUSINESS"

BREAKDOWN: Disability civil rights

THE CLOCK IS TICKING . . . INDIVIDUALS WITH SERIOUS MENTAL ILLNESS & THEIR FAMILY MEMBERS NEED EMERGENCY RULE MAKING to address medicaid Provider resort to criminal Justice System

PART II: HOW COULD WE CUT CRIMINAL JUSTICE DOCKETS IN HALF OR MORE? THE "HORCRUX" OF THE PROBLEM IN CRIMINAL JUSTICE

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"I NEVER EVEN MET WITH A DOCTOR FOR DISCHARGE PLANNING OR MAKING A SAFETY PLAN AT HIGHLANDS BEHAVIORAL HEALTH"​

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"I NEVER EVEN MET WITH A DOCTOR FOR DISCHARGE PLANNING OR MAKING A SAFETY PLAN AT HIGHLANDS BEHAVIORAL HEALTH"