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IS IT LIABILITY OR REFORM FOR THE DSM & THE MENTAL HEALTH PROFESSION?

5/22/2019

Foreseeability Law and Legal Definition

"Foreseeability is a requirement under tort law that the consequences of a parties action or inaction could reasonably result in the injury. In such cases, the resultant injury was reasonably predictable by a person of ordinary intelligence and circumspection as in the case of throwing a heavy object at someone."
----USLegal.com

So the arguments against the DSM and for liability have been pretty general in nature. Saying that regardless of how the DSM might purport to limit its use:

it is in fact "reasonably foreseeable' that the diagnostic categories will be used in Criminal & Civil proceedings.

So the idea is that making a simple written disclaimer when one knows these diagnoses are being used in the Criminal context and people's lives are being greatly affected is NOT SUFFICIENT.

On the other hand, the DSM authors & really clinicians and forensic examiners have made an unwritten deal with the Society: that we're going to ASSUME THE RISK.

We're sure the DSM authors and distributors would say --you guys are assuming the risk -- & if anybody's liable it's the clinicians.

The clinicians are going to be arguing assumption of the risk by the Court System, etc. and that they relied to their determent on the DSM in about as open a way as possible -- OPEN COURT.

BUT what about all those people with partially understood cognitive disabilities whose lives are on the line?

It's just that the DSM is NOT a good deal anymore.

Is the answer to hold the DSM authors or clinicians liable? Well, those are possibilities.

WHAT REALLY NEEDS TO HAPPEN: Is we need to get honest and reform our Systems.

The REALITY is -- it is easier to reform our Health Care System -- than the Criminal Law.

Any SOCIETY with HEAVY CRIMINAL DOCKETS -- is a SOCIETY in MAJOR NEED of Health Reform -- including the Social Determinants of Health.

We can do that in a lot of ways -- including expanding the access to the "FREE ENTERPRISE SYSTEM."

BUT if we don't provide major Health Reform -- we are left with the LAW'S SOLUTION: Sue our well meaning and unconscionably struggling Mental Health Profession and American Psychiatric Association.

IS IT "RUGGED INDIVIDUALISM" OR "COMMUNITY INTERESTS?" --IT'S BOTH.

5/14/2019

  Our Society and Individuals within it have been doing A LOT OF HARD WORK when it comes to INTEGRATING both various disciplines and various important values.

It hasn't always been pretty and we're NOT out of the woods yet. BUT a LOT OF IDEAS that seem to be on the RIGHT TRACK -- especially with respect to Individualized Instruction and Individualized Medicine -- are beyond the "BRAINSTORMING" Stage even if they are not widely available.

Additionally, there is a greater recognition of the importance of the "Social Determinants of Health." Further, those "Social Determinants of Health" are intimately connected not only to PUBLIC HEALTH but some of our most difficult SOCIETAL PROBLEMS.

   [Parenthetically,  for Countries that may be experiencing Mass Immigration -- Jordan, Turkey, European Countries, the US & Canada -- the ANSWER is probably the IMPROVEMENT OF THE SOCIAL DETERMINANTS OF HEALTH in the HOME COUNTRIES of people desiring/needing to immigrate.]

  The US is both ahead and behind when it comes to INDIVIDUALIZED EMPLOYMENT.

ENTREPRENEURSHIP is certainly celebrated if not worshiped in the US. Further, ENTREPRENEURSHIP has sometimes been a successful haven for the "Ne'er Do Well," the Creative, the person with "ADHD" or some other DIFFERENCE.

   However, for as many people as ENTREPRENEURSHIP has "ECONOMICALLY SAVED"  it has failed many more -- often for fairly predictable reasons. The "Would-Be Entrepreneur" possesses SOME of the SKILLS of ENTREPRENEURSHIP in GREAT MEASURE -- BUT NOT ALL & DOES NOT HAVE ACCESS TO PEOPLE POSSESSING THE MISSING ESSENTIAL SKILLS.

    Ultimately, we need:

Highly Individualized Educational Instruction
Highly Individualized Medicine
Highly Individualized Employment, including Highly Individualized Entrepreneurial Services

John Wayne

Canada's Rise Asset Development Program

TRAUMA IN COLORADO -- & THE NEED FOR A "SYSTEMIC CHANGE" TRACK

5/10/2019

There are TRACKS that have been and need to be laid to address issues of individual and community grief and trauma in Colorado.

Especially in the South Metro where there are a number of TRAUMATIZED individuals, families and communities -- we can be at pretty different places in our "grief process."

This is the result not only of school shootings but also of several suicides.

What is "right" or "appropriate" for a VIGIL really has to be determined by the victim's family and friends. VIGILS in PARKLAWN were pretty political -- that's not necessarily going to work for everybody. It obviously didn't work for the STEM School.

On the other hand, the STEM VIGIL DEBACLE -- does point to the NEED for a SEPARATE SYSTEMIC TRACK to deal with YOUTH & SCHOOL SAFETY that addresses:

Mental Health
Youth Access to Guns, and
School & Mental Health Staffing

A LOT OF US -- Need that Track -- NOW -- for our own MENTAL HEALTH.

THERE'S NO MAGIC BULLET BUT WE CAN DO A LOT BETTER THAN WHAT WE'RE DOING When it comes to public education, Public Health & Employment

5/7/2019

We need to Concentrate on the ---
* SOCIAL DETERMINANTS OF HEALTH
* IDENTIFICATION & DEVELOPMENT OF "STRENGTHS"
* WORKAROUNDS AND REASONABLE ACCOMMODATIONS

Coming to Terms with the Specialized Needs of Some Older Children & Adults

The rationale articulated in the Denver Post article to the right has been around for decades to justify poor performance in public education and public mental health and to write-off older kids and adults with the most serious issues..

It's a HORRIBLE POLICY --- it DOESN'T WORK. Those written off people often have children of their own and we're looking @:

Child Welfare
Homelessness, and the
Criminal Justice System

----AND Mental, Emotional & Behavioral Problems can MULTIPLY over time as a result of this kind of GROSS SOCIETAL NEGLECT

THE LIMITS OF OUR "GREAT ECONOMY "

I pretty much believe that everyone running for public office has SOMETHING to offer the COUNTRY in whatever party. Setting them against each other in a winner take all contest is not necessarily in the Country's best interests.

Sen. Michael Bennett

Having said that we do agree with Sen. Michael Bennett's observations on the May 5, 2019 edition of Meet The Press regarding our "GOOD ECONOMY" and how it doesn't really TRANSLATE into HOUSING & other SOCIAL DETERMINANTS of HEALTH for many people.

We do not endorse political candidates.

Photo Credit: thedenverchannel.com

Some Colorado schools see less than half of students graduate, but state says that’s reality of working with challenging population

In 2017-2018, 81 high schools in Colorado graduated no more than half of their students within 4 years

By the time students arrive in alternative schools, they typically already have fallen far behind their peers, making it more difficult to catch up.

If schools want to increase graduation rates, they need to focus on laying a strong foundation with quality early childhood education, small class sizes and electives that keep students interested, said Julian Vasquez Heilig, a professor of education leadership at California State University Sacramento.

Unfortunately, many communities don’t have the resources to create that kind of system, and states haven’t provided the funding needed, he said.

“Education is cumulative,” Vasquez Heilig said. “When a kid comes in, they’re two or three grade levels behind, there’s no magic bullet to catch that kid up.”

THE PROBLEM WITH HIERARCHICAL SYSTEMS: ARAPAHOE HIGH SCHOOL CASE IN POINT

5/3/2019

What I find to be one of the most troublesome aspects of hierarchical systems is:

It places responsibility in one or a few individuals, and when things go wrong - as things have a tendency of doing -- the motivation is NOT to FIX the Problem -- it's to deny it, minimize it & cover it up.

I don't think changing the principal @ Arapahoe or an adminstrator @ a nursing home or the Superintendent @ the Colorado Mental Health Institute @ Pueblo is the FIX we really need.

AND all of those places can have some pretty SERIOUS PROBLEMS.

Many systems serving young people and adults NEED MAJOR SYSTEMIC CHANGE.

INCLUSIVE Stakeholder groups to tackle the MOST DIFFICULT Problems can lead to REAL RESULTS. That way we're ALL RESPONSIBLE & WE ALL HAVE A STAKE IN SOLVING THE PROBLEM -- not toppling the hierarchy.

Littleton Public School District & Arapahoe High School -- need to BRING IN & INVOLVE their harshest critics -- including the Arapahoe High School Community Coalition.

[Val's Full Disclosure: Our son was in the school during the 2013 school shooting. Our daughter is graduating this year and has had friends who committed suicide.]

CO's Need for more thoughtful processes of inclusion

5/2/2019

I remember in High School as the editor of the H.S. newspaper, I took the School Administration to task for their handling of 2 church & state issues:

On the one hand, they were allowing the religious group "Youth for Christ" to meet @ the school;
On the other hand, school administrators "censored" a school play because the words "Jesus Christ" were spoken.

The issues of INCLUSION within Colorado State Government and monied &/or large Mental Health Advocacy Organizations -- remind me a lot of that.

In my opinion, it's good people/good organizations/administrators making bad decisions that matter more than they think.

We don't know what to say when we know that somebodies from the State routinely visit the Orchid site along with our followers outside of State government-- BUT the State doesn't include us as stakeholders in legislative initiatives that are what this website is all about.

We're not a membership organization -- although thousands of people follow us on Facebook & the website. Further, we're not a government funded organization.

A lot of our ADVOCACY is for INCLUSION because we are very well aware that a lot of people following us do not agree with everything we think and say. We speak our minds -- so do they.

They very much need to be included in decision-making processes. There are practical realities BUT it is pretty clear that INCLUSION has to be a TOPIC AREA for the Behavioral Health Task Force.

We don't know what to say when we go out of our way to include Mental Health Colorado in anything we think would interest them whether we think they would agree with us or not, and that courtesy is not extended to us.

We think it is hard to address issues of "INCLUSION."

Further, we don't think the people and organizations involved have any clue as to what a toxic environment that creates and how there is at least one person who is not going to speak out about it -- because it is TOO STRESSFUL.

After all is said and done, I am one of many people that needs to be included.

To do that is going to require different and more thoughtful processes and procedures. AND we're going to be working on that.

BIG BUDGETS DON'T MEAN BETTER IDEAS

INCLUSION: BETWEEN REPRESENTA-TIVE GOVERNMENT & DIRECT DEMOCRACY

5/1/2019

We think INCLUSION can be both HEALING for the SOCIETY & the INDIVIDUAL. INCLUSION is MORE THAN NOTICE & OPPORTUNITY TO BE HEARD or maybe it is a RE-THINKING of -- the twin pillars of AMERICAN PROCEDURAL DUE PROCESS.
Aristotle said that for Politics & Philosophy one needed a COMMONWEALTH & LEISURE. That LEISURE is often the result of MATERIAL WEALTH.
Task Forces & Stakeholder Groups have come to assume an important role in Colorado Representative Democracy. Unfortunately, they are still often dominated by government officials and industry representatives.
Quite frankly, it isn't easy to include the most DISENFRANCHISED MEMBERS of Colorado Society in DECISION-MAKING even in matters that are DIRECTLY AFFECTING THEM.
TECHNOLOGY has the potential to improve this situation to some degree as well as regular LISTENING SESSIONS & FOCUS GROUPS with comments made available to the public.
What 5th Century B.C. Athenian leader Pericles understood -- was that people had to be paid to participate in DEMOCRACY -- otherwise they couldn't afford it.
We would be in favor of MARRYING Andrew Yang's Universal Basic Income Proposal with Universal/Manageable Duties within the Democracy where the person is able to assume such duties.

Arapahoe H.S. & the divergent failures in the Public School & Mental Health Systems

4/30/2019

In some ways, Public Schools have the mirror opposite problem of the Mental Health System-- and yet in many ways it is the SAME PROBLEM .

The Mental Health System during the last few decades has not had the resources to serve people with Intensive Mental Health Needs --- so they haven't -- and those people along with assorted other folks with brain injury, developmental disability and/or substance use problems have gone to the Streets & the Criminal Justice System.

There has been A LOT MORE PRESSURE on the Public School System to serve students with very high mental and emotional needs.

So what has been the TENDENCY of ERROR in the Public School System --- FAILING TO PROVIDE THE RESOURCES FOR HIGH NEEDS INSTRUCTION WHILE KEEPING STUDENTS WITHIN THE SCHOOL COMMUNITY.

  So for both Mental Health & Public Education -- there are inadequate resources & options --- that lack of options can potentially lead to the Criminal Justice System, and at Middle Class Schools it can and has led to an unsafe environment.

  On the one hand, UPPER Middle Class School Districts are much less likely to be accused of participating in the School to Prison Pipeline. On the other hand, bullying and other behavior issues within the school may be rampant -- but School officials issue a never-ending series of WARNINGS that may never ultimately SOLVE THE PROBLEM.

I don't believe in PUNISHMENT, but I do believe in SOLVING THE PROBLEM and the MENTAL HEALTH SYSTEM and the PUBLIC SCHOOL SYSTEM represent two systems that have been greatly challenged by the reality of young people and adults with serious mental, emotional & behavioral issues that can and will quickly become the COMMUNITY's issues if not handled appropriately.

  Public School Systems, the Mental Health System and Citizens have A LOT OF HARD WORK TO DO when it comes to having an adequate array of options to deal with mental, emotional and behavioral issues within our Communities.

HOW ARAPAHOE HIGH SCHOOL & THE REST OF THE COUNTRY GOT TO NOW: MENTAL HEALTH, UNCERTAINTY, & A CYA CULTURE

This page was Orchid's #1 Viewed Resource Page for April 2019

In praise of D.J. Jaffe & SB19-222 -- the unacknow-ledged Debt the State & Traditional disability advocates owe the conserva-tiveS & Moderates & Orchid

4/26/2019

SB19-222 requires the State to strengthen and expand the behavioral health safety-net system so that individuals who are the hardest to serve do not end up in jails, caught in the child welfare system or homeless.

This really marks a major shift in policy and position -- for the State, State Government & the Disability Community.

What role if any did Orchid play in that?

How does that inform what we will be doing going forward?

What we really did was MARRY the CONSERVATIVE DISABILITY ADVOCACY of D.J. Jaffe and the Mental Illness Policy Organization & Treatment Advocacy Center with the Traditional Disability Activism & Sensiibilities symbolized by Olmstead.

We think that is the MIDDLE GROUND that the Community & Many Advocacy Organizations & Institutions can EMBRACE.

SB19-222 really embraces that and we know that some within State government and advocates are familiar with our criticisms of Colorado's Mental Health System & its "Continuum of Care Hell."

We think it is that Middle Ground that can be embraced nationally by:

Mental Health America,
NAMI
the National Disability Rights Network [the Nation's federally-mandated Protection & Advocacy Offices],
SAMHSA, &
CMS

We don't agree with everything D.J. Jaffe and the Conservative Mental Health Advocacy Movement want -- BUT they FORCED a CONFRONTATION with REALITY that the Mental Health Advocacy & Activist Community was doing its very best to ignore.

That reality was largely related to the GROSS HUMAN RIGHTS VIOLATIONS against people with cognitive disabilities in the CRIMINAL JUSTICE SYSTEM & HOMELESS.

NOW the Activist Community is Embracing those concerns of people in the Criminal Justice System and Homeless and involved with the Child Welfare System.

Further, Mental Health Advocates and Disability Advocates in general had gotten so pressured into believing that the ECONOMIC CASE for SERVICES was more IMPORTANT than the MORAL CASE that the SYSTEM that was CREATED was INCAPABLE of adequately serving people with intensive needs.

AND make no mistake about it the Disability Community got co-opted by States into going along with inadequately resourced systems because there was no clear vision of a Continuum of Care just a disdain for Institutionalization.

So this brings up one of the REALLY INCONVENIENT SYSTEMS FAILURES --the Mental Health Profession itself.

Where is the LEADERSHIP in the Mental Health Profession to address this -- we don't know.

We definitely need the American Psychiatric & Psychological Associations to step up to the plate & take responsibility and remedy the DSM 5 debacle.

That could be accomplished by just acknowledging their IGNORANCE -and stop allowing themselves to be improperly used by the Criminal Justice System.

Most specifically mental health professionals need to stop handing out those DAMNING "anti-social personality disorder" diagnoses -- when they really don't have knowledge to know what's going on.

Further, the mental health profession needs to wait for the National Institute of Mental Health's Research Domain Criteria Program to reform the DSM 5.

This is necessary in order to avoid the unscientific pronouncements the mental health profession is currently making that have the potential and often reality of greatly HARMING the lives of poor marginalized people with only partially understood cognitive issues.

There does seem to be INSIGHT & LEADERSHIP in the RESEARCH COMMUNITY and the Mental Health Activist Community to address what appears to be pretty inadequate mental health care in many cases.

We are interested in MARRYING the insights of the Immune-Brain-Gut Triad with approaches such as "Open Dialogue."

We're not for letting the Mental Health Profession continue to BILL for "CARE" without any commitment to address the HAVOC caused by a SCIENTIFICALLY INVALID DSM 5.

So what we really brought to the Table over the past 5 years was:

Information
Systemic Focus
Root Cause Analysis
& a willingness to Address Reality
while respecting Individual Rights & Needs

We've said this situation with THOUSANDS of Coloradans with cognitive disabilities in the Criminal Justice System & Homeless did NOT happen because 1 System FAILED.

Multiple Systems have FAILED. We will be continuing to provide information, a systemic focus and root cause analysis regarding those SYSTEMS THAT ARE IN DESPERATE NEED OF SUPPORT EVERY BIT AS MUCH AS THE INDIVIDUALS WHO DEPEND UPON THEM.

Of course, NONE OF IT WILL WORK WITHOUT INCLUSION.

SB19-222:

Individuals At Risk Of Institutionalization
Concerning the improvement of access to behavioral health services for individuals at risk of institutionalization, and, in connection therewith, making an appropriation.

BILL SUMMARY

The bill requires the department of health care policy and financing (state department) to develop measurable outcomes to monitor efforts to prevent medicaid recipients from becoming involved in the criminal or juvenile justice system.

The bill requires the state department to work collaboratively with managed care entities to create incentives for behavioral health providers to accept medicaid recipients with severe behavioral health disorders.

The bill requires the state department to determine if seeking a 1115 demonstration waiver is the necessary response to the requirements of 42 CFR 438.6 (e) to ensure inpatient services are available to individuals with a serious mental illness.

If the state department determines it is not appropriate, the state department is required to submit a report to the general assembly with the state department's reasoning and an alternative plan and proposed timeline for the implementation of the alternative plan.

The bill requires the state department to develop and implement admission criteria to the mental health institutes at Pueblo and Fort Logan.

The bill creates a community behavioral health safety net system (safety net system) and requires the department of human services (department), in collaboration with the state department, to conduct the following activities:

Define what constitutes a high-intensity behavioral health treatment program (treatment program), determine what an adequate network of high-intensity behavioral health treatment services includes, and identify existing treatment programs;

Develop an implementation plan to increase the number of treatment programs in the state;

Identify an advisory body to assist the department in creating a comprehensive proposal to strengthen and expand the safety net system;

Develop a comprehensive proposal to strengthen and expand the safety net system that provides behavioral health services for individuals with severe behavioral health disorders;

Implement the comprehensive proposal and the funding model no later than January 1, 2024; and
Provide an annual report from January 1, 2022, until July 1, 2024, on the safety net system to the public through the annual SMART Act hearing.

The bill makes an appropriation.

Beyond "Psychological Fitness for Duty"

4/24/2019

Art is not very good @ working out the "detailed solutions" to problems.

BUT Art often does pick up on the internal conflicts plaguing the Society and puts them into High Relief.

There's a REASON why there are so many TV shows exploring policing, lawyering, being on the wrong side of the law, etc.

Now a lot of people would say that those shows are not "realistic" -- BUT in many cases the objective is to:

Elevate the tensions so they will be perceived [maybe some in the Society are already keying in on those tensions, maybe a lot of people aren't]

When it comes to "psychological fitness for duty" --- some writers and dramatists have recognized that's not just a question of what one initially brings to the table:

In extreme cases, it could involve anger & aggression from PTSD brought on by a violent work environment.
It could also be shaped by a WORK CULTURE that has its own problems and we haven't figured out how to solve them.

Sweden's Linköping University

SCIENCE NORDIC
EVEN IN SUPPOSEDLY
"ENLIGHTENED" SWEDEN -

FEAR OF REPRISALS MUZZLES SWEDISH POLICE
JULY 8, 2018
THE CONSEQUENCES OF WORKING IN A CULTURE OF FEAR CAN BE SERIOUS.

We expect law enforcement officers to pursue wrongdoers and speak the truth. But it turns out that some men and women in uniform don’t necessarily feel free to do this when it comes to their own workplace.

A Linköping University researcher found that the majority of 33 Swedish police officers she interviewed about their working conditions said they did not want to speak up about problematic situations on the job because of fear of reprisals.

"I felt it was wrong to hold back, but I knew: If I open my mouth now, it’s all over. I won’t be welcome here anymore. So I chose to remain silent," one of the officers told researcher Malin Wieslander, who is a postdoc at the university.

"Most people reported that they or others have encountered unpleasant consequences when they have spoken up," Wieslander said.

Her interviewees reported hearing rumours about colleagues who have been cut out, frozen out, relocated in a worse position or bullied until they quit. But where did this information actually come from? Wieslander wanted to know.

http://sciencenordic.com/fear-reprisals-muzzles-swedish-police

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Val's Blog

IS IT LIABILITY OR REFORM FOR THE DSM & THE MENTAL HEALTH PROFESSION?

IS IT "RUGGED INDIVIDUALISM" OR "COMMUNITY INTERESTS?" --IT'S BOTH.

TRAUMA IN COLORADO -- & THE NEED FOR A "SYSTEMIC CHANGE" TRACK

THERE'S NO MAGIC BULLET BUT WE CAN DO A LOT BETTER THAN WHAT WE'RE DOING When it comes to public education, Public Health & Employment

THE PROBLEM WITH HIERARCHICAL SYSTEMS: ARAPAHOE HIGH SCHOOL CASE IN POINT

CO's Need for more thoughtful processes of inclusion

INCLUSION: BETWEEN REPRESENTA-TIVE GOVERNMENT & DIRECT DEMOCRACY

Arapahoe H.S. & the divergent failures in the Public School & Mental Health Systems

In praise of D.J. Jaffe & SB19-222 -- the unacknow-ledged Debt the State & Traditional disability advocates owe the conserva-tiveS & Moderates & Orchid

Beyond "Psychological Fitness for Duty"

SCIENCE NORDIC
EVEN IN SUPPOSEDLY
"ENLIGHTENED" SWEDEN -

FEAR OF REPRISALS MUZZLES SWEDISH POLICE
JULY 8, 2018
THE CONSEQUENCES OF WORKING IN A CULTURE OF FEAR CAN BE SERIOUS.

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SCIENCE NORDICEVEN IN SUPPOSEDLY"ENLIGHTENED" SWEDEN -FEAR OF REPRISALS MUZZLES SWEDISH POLICEJULY 8, 2018 THE CONSEQUENCES OF WORKING IN A CULTURE OF FEAR CAN BE SERIOUS.

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Archives

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SCIENCE NORDIC
EVEN IN SUPPOSEDLY
"ENLIGHTENED" SWEDEN -

FEAR OF REPRISALS MUZZLES SWEDISH POLICE
JULY 8, 2018
THE CONSEQUENCES OF WORKING IN A CULTURE OF FEAR CAN BE SERIOUS.