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Limitations, working together & -- We're #1

12/6/2018

I remember from my days working @ The Legal Center for People with Disabilities & Older People [now Disability Law Colorado] that 90% of the calls were from people wanting services we didn't provide and we weren't very clear about what we did and didn't do.

So, of course, people assumed we didn't do anything -- and nothing could be further from the truth.

So different entities have different problems and concerns when communicating their Limitations.

For the Government, they may be concerned about communicating the true state of their limitations because they have legal obligations to meet such as Parity, Medicaid Network Adequacy, Time Frames for Competency Exams, the larger crisis and shortage not only in psych beds but Medicaid Intensive Community Mental Health Services, Olmstead Compliance, etc.

Other entities like advocacy groups or innovation centers --- like to puff themselves up [we're not immune to that ourselves] --- "We're the Best, We're Number 1." And in one respect or another -- those claims are not necessarily untrue, but they generally fall far short of the extravagant claims -- and when they do--- people can feel misled.
A lot of it really comes down to clarity.
- If you are focusing on "Technology and Mental Health" and a lot of things are going to be put on the back burner -- you probably need to say that -- especially if you are advertising yourself as a "National Mental Health Innovation Center" -- CU we mean you.

The BOTTOM LINE:

People will forgive A LOT if others are responsive to them -- when they are not -- & the CU Innovation Center has not been responsive to us -- the judgments can be pretty harsh -- even when the entity may be doing good things.

P.S. I think we just got struck by lightning . . .

MAKING THE SUCCESSFUL HANDOFF FROM THE CRIMINAL JUSTICE SYSTEM TO INTEGRATED PHYSICAL & BEHAVIORAL HEALTH AND PUBLIC HOUSING OR RESIDENTIAL SERVICES

12/5/2018

Assertive Community Treatment & Flexible ACT Index

From my standpoint, the Criminal Justice System has been looking for alternatives to incarceration for decades.

I graduated from law school in 1988 and worked for 3 years @ the Oklahoma County District Attorney's Office. Even then in a conservative state, prosecutors were very open to considering drug or alcohol treatment or other appropriate treatment.

Later, in private practice, I represented a 16-year-old young man who was charged with Robbery with Firearms. He was certified to stand trial as an adult. The State recommendation was 25 to do. We entered a "Blind Plea" and the judge ordered him to a 90-day Program of "Regimented Inmate Discipline" [RID] and then a 5 year deferred sentence -- but if he came back the judge wrote that he was looking @ 45 years to do.

Guess what -- my guy ended up loving RID. The problem is many folks involved with the Criminal Justice System have extremely complicated difficult issues that are unlikely to get resolved in 90 days or even 180 days. In fact, my guy did end up picking up another charge.

When we make that hand-off to the Healthcare System we need to understand that we are making a potential LIFETIME COMMITMENT -- this isn't a term of years. That means using appropriate certification and substitute decision-making procedures when appropriate -- we don't want providers handing the person back to the Criminal Justice System. [There should also be an inclusive stakeholder group to oversee the use of such procedures]

It has been absolutely shocking to see Medicaid Mental Health Residential Service providers call law enforcement on minor matters when theoretically they should be able to initiate a 72-hour hold or petition the Court for an evaluation. Further, mental health patients who are just annoying as opposed to dangerous are @ great risk of this type of Mental Health Provider behavior.

Whether people with invisible disabilities or Mental Health Providers behaving badly -- in one sense, the problem is the same --- people are NOT getting enough support.

We can make this transition from INCARCERATION to HEALTHCARE -- BUT everybody needs to understand -- the State, providers, the Criminal Justice System, individuals, the Disability Community--that if providers do not seek appropriate certifications and or assisted/substituted decisionmaking when needed -- this is not going to work for many people.

On the other hand, providers must learn to deal with ANNOYING BEHAVIOR without resorting to the path of least resistance -- calling law enforcement. Note, most of this annoying behavior DOES NOT satisfy certification criteria for dangerousness; although most people in Medicaid Mental Health Residential arrangements probably do meet the criteria for "GRAVELY DISABLED" if they are not provided that residential support .

MOST PEOPLE WANT "HELP." MOST PROVIDERS WANT TO HELP. Not all providers are competent to handle every person. Throwing some providers in WAY OVER THEIR HEADS -- isn't helping anyone -- not the person, not the provider.

So we are aware of a situation in which the Mental Health Center washed its hands of the person, and a PROPERTY MANAGER was left to deal with someone with very complex needs.

We must provide a ROADMAP to providers to deal with these difficult situations & that probably needs to be in Volume 8 of the regulations for the CO Dept. of Health Care Policy & Financing.

Providers-- what support do you need to make the transition from Incarceration to Healthcare?

Complex Behavioral Problems are often NOT SOLVED on the Time Table provided by the Criminal Justice System

One of the reasons ACT is considered the GOLD STANDARD in Intensive Community Mental Health Treatment -- IT IS NOT TIME LIMITED

Our Innovation Woes: Innovation w/o "Real" inclusion is usually TOO little innovation

11/25/2018

Innovation is one of those words, like many, that can mean a lot of different things to different people & entities.

To Us, Innovation is:

Innovation [in Funding, Policy, etc.] to Comply with Existing Legal Requirements

Bringing Evidenced Based

Intensive Mental Health Services & Housing to Scale [This is really legally required under
Parity, Medicaid Network Adequacy &
Olmstead]

Innovation to bring promising research to clinical practice much faster than what we are currently doing

Innovation to deal with the horrific moral & ethical problems associated with the mental health profession relying on a scientifically invalid DSM 5 in the Criminal Justice System

***Some Institution(s) needs to have the COURAGE to get on this with an inclusive group of stakeholders

We need to JUMP START even more INNOVATIVE research probably in the areas of the Microbiome, the Immune System [including specifically inflammation], etc. and figure out ways to get this to clinicians & patients in ways they can use much, much faster.

Once again, the proof is really in the pudding. If we are innovating enough -- we don't have thousands of coloradans or US citizens with mental illness who are homeless or incarcerated.

CO JOINT YEAR ROUND COMMITTEE Treatment of Persons with Mental Health Disorders in the Criminal Justice System

CO Criminal & Juvenile Justice Commission

Our Love Hate Relationship with the Institutions

---Look we need institutions like those to the left and we need those perspectives;
----But by and large they are NOT very innovative or they are NOT as innovative as they need to be, although they do good things

It helps to have A LOT of SKIN IN THE GAME -- to be truly innovative ---that means including people with mental illness who are homeless or in the criminal justice system and their families and advocates.

That is one of the many reasons why INCLUSION is so important.

Now there are a lot of degrees of lack of inclusion.

BUT we have people with mental illness who are currently on the Streets or conveniently in State Custody and somehow we can't listen to them.

Further, we must bring together quite COMMUNITARIAN CONCERNS to deal with problems that could not be more Individual and require CUTTING EDGE INDIVIDUALIZED MEDICINE.

Is all of our criticism of institutions completely FAIR? Probably not. BUT institutions typically have very complicated political considerations that make progress at a reasonable pace very difficult without committed gadflies.

People with mental illness and other disabilities are dying right now -- on the Streets and in Jails and Prisons because we haven't

INNOVATED ENOUGH.

IF WE WANT TO CLIMB THE GLOBAL MENTAL HEALTH MOUNTAIN --- WE'RE GOING TO HAVE TO WORK TOGETHER

11/9/2018

There are A LOT of FACTORS for the global epidemic in Mental Health concerns. Some of those FACTORS are more prominent in some regions of the world than others. For example, there is a 60% rate of PTSD in Afghanistan -- the TRAUMA of war probably has a lot to do with that.

We also see PTSD in American Veterans and victims of Child Abuse, Sexual Assault, etc.

BUT that is NOT all that is going on --- those antibiotics that are preventing disease are also killing off our good microbiota that mediate the immune system and ultimately mental health.

Further, our food is very different than it used to be --- certainly in the West and especially in the US.

There are over 60 Million refugees in the world today--- living very hard lives. What is one of their major health issues -- mental health problems. That's also putting A LOT of Pressure on established Nation States to take in those refugees. That's causing A LOT of Stress and mental health concerns in the populations of established Nation States.

We need RESEARCH [& the established Nation States are in the best position to do that]. We also need a commitment by all governments to focus on the SOCIAL DETERMINANTS of HEALTH of their populations. THAT MEANS EVERYBODY.

PTSD Is Silently Killing Afghanistan -- Free Women Writers (2017)
Antibiotic Use and Microbiome Function --- Biochemical Pharmacology (2017)
Metabolic abnormalities and low dietary Omega 3 are associated with symptom severity and worse functioning prior to the onset of psychosis: Findings from the North American Prodrome Longitudinal Studies Consortium. --- Schizophrenia Research (Sept. 2018)
The Mental Health Crisis Among Migrants --- Nature (2016)

Author and Polymath John Green argues that disease affects human history much more than we realize.

We would submit that the Global Mental Health epidemic is affecting human history much more than we realize from Mass Incarceration to the Refugee/Immigrant Crisis --- etc.

Further, the competence of our clinical mental health profession is just this side of that of the clerics during the Black Death.

We need a "Marshall Plan" to bring research to clinicians in ways they can use much, much quicker than what we are currently doing.

Making the world safe for politicians to be honest

11/3/2018

It has taken us a long time to view what we perceive to be the passive aggressive behavior of the Hickenlooper Administration in a more "systemic" light.
That is mainly because we were pretty naive and just didn't expect it from the Hickenlooper Administration, even though it kept happening and happening -- not just to us but to others in the Disability Community, and probably not to everyone.
When we say "passive aggressive" behavior -- what are we referring to:

Stonewalling
Failing to keep commitments
Mischaracterization of concepts that had been addressed over a period of years.
and a veneer of politeness and cordiality to use as a defense.

Now if one of these things happens -- it may just be a mistake -- BUT when they keep happening --- that's something else. BUT what is that something else?
It is no secret that politics and certainly some higher levels of government are full of "People Pleasers" who are sometimes challenged to speak the truth. AND let's be clear, we are NOT against politeness and cordiality.
BUT this passive aggressive behavior is a much more systemic issue and it is in fact in part what voters were trying to get away from when they elected Trump -- someone who is just aggressive.
We do need politeness and cordiality ---- BUT we are going to have to dig deep to address the root causes of "passive aggressive" behavior that is pretty endemic to American politics on both sides of the aisle.
Neither aggression nor passive aggression will bring the Country together. Failure of politicians to comply with the LAW whether its the Americans with Disabilities Act & Olmstead or something else -- won't bring people together either.
For the most part, if it is SAFE for people to be honest --- they will be, if not they won't. In our Federalist System, we have a tendency to mandate a lot on the States and don't give them the money or the technical support to do what is mandated. Further, there is often a lack of enforcement.
How does that happen? Well, often the same People Pleasing passive aggressive behaviors that lead to disregard of the law.
The Housing & Services mandated under the ADA & Olmstead are like REALLY, REALLY IMPORTANT. We can't play these games.
I don't know how many times I tried to have a real conversation with the Hickenlooper Administration over the past 4 to 5 years about barriers they might have to compliance and how we might work together to overcome them.
That was always a non-starter, probably because people were afraid to honestly discuss those issues.
And that ultimately leads to a lot of lying & failure to comply with the law -- not just by Governors in poor states -- but by the Hickenlooper Administration in Colorado -- the nation's #1 economy.

Giddy Up.

We can mark the above as: Mission Accomplished.

Wash. Post: No Offense, All of Politics is Passive Aggressive

Part I of our series unequal justice: Laying down our hypocrisies

10/24/2018

We think when we really start to get viable solutions is when all sides lay down their hypocrisies.

CO is at the top of the list for Substance Use issues. Some Coloradans have been using substances such as alcohol or illegal drugs since they were children.

Further, discrimination and unconscious bias are real things that adversely affect one's mental and physical health.

I don't know how many times it has to be documented that the American Criminal Justice System discriminates against poor people and/or people of color before we sufficiently fund the necessary treatments, placements and housing to get to the root causes of these health issues as best we can -- and for heaven's sake not make them worse with incarceration. Sometimes secure placements are needed.

Aggression is an issue for some people and for some of our law enforcement. Why might that be? The research appears to show that the more aggressive one is -- the more aggression nerve cells are developed -- Crazy, huh?

It is really NOT us against them -- AND it could be us for us -- in our communities, law enforcement and in our public policies.

WARNING: Video Shows Florida Police Officer Hitting a 14-Year-Old Girl During Arrest

Beneath the Vest: Police Officer with PTSD

God of the Gaps, Criminal Liability of the Gaps

Aggression: Humanity's Ultimate Double-Edged Sword

Aggression As A Protection Against Depression In Bipolar Disorder & Sleep Apnea Does Affect One's Risk for Bipolar

Colorado stands out as the only state which is a top consumer of all four substances [marijuana, cocaine, non-medical opiods, and alcohol]. -- Washington Post (2016)

Karolinska Institutet -- Sweden (May 2018)

Aggression neurons identified

High activity in a relatively poorly studied group of brain cells can be linked to aggressive behaviour in mice, a new study from Karolinska Institutet shows.

Using optogenetic techniques, the researchers were able to control aggression in mice by stimulating or inhibiting these cells.

The results, which are published in the scientific journal Nature Neuroscience, contribute to a new understanding of the biological mechanisms behind aggressive behaviour.

https://ki.se/en/news/aggression-neurons-identified

no good deed goes unpunished

10/15/2018

Oscar Wilde, "No Good Deed Goes Unpunished."

Neuroscience News

In one of the biggest breakthroughs in schizophrenia research in recent times, Professor Cynthia Shannon Weickert from Neuroscience Research Australia (NeuRA) and UNSW Sydney has identified immune cells in greater amounts in the brains of some people with schizophrenia.

https://neurosciencenews.com/schizophrenia-immune-cells-9867/

NO GOOD DEED GOES UNPUNISHED

There's a lot of "no good deed goes unpunished" in our attacks on the Mental Health Profession.

But we are in an intolerable situation with gross knowledge gaps, a scientifically invalid diagnostic manual, treatment stagnation, and horrific moral and ethical problems involving people with mental health needs in the Criminal Justice System, homeless, and in the society at large.

We don't think the Mental Health Profession is going to go away anytime soon, but we do think mental health concerns are going to involve other areas of medicine that may ironically predominate over traditional mental health care such as immunology and there are others.

Clarence Darrow: "In one sense, we're all equally good and equally bad. We all do the best we can under the circumstances." ---Address to the Inmates of Cook County Jail 1903

The Immune System

There are probably an infinite number of ways to break an arm
It's turning out that there are a whole lot of ways to damage the human immune system and ultimately the brain
All this has been pretty unknown for most of human history---and many of the discoveries by research institutions around the world are pretty recent.
See below.

New Science Is Amazing AND It Has HUGE Moral Implications for Our Society: NOW

Physical Health Issues, the Immune System & Mental Illness

We don't really think some mental health professional relationships are all that healthy ---- We think @ least some of us would like to move to a more traditional doctor patient relationship --- BUT that's been really difficult with the knowledge gaps in the profession.

History Rolls On -- AND All of Us At Some Point End Up in the Ash Bin of History BUT We Do Learn From One Another

We need to deal with the biology of suicide directly & immediately

10/2/2018

There are a lot of things that ostensibly cause a suicide -- more and more we're observing elevated inflammatory biomarkers in people with suicidal thoughts and people who have completed a suicide.

Now there are a lot of different individual reasons for those inflammatory biomarkers.

AND we absolutely need to understand those.

In the meantime, people are dying.

There was another suicide @ Arapahoe High School in Littleton.

In the words of our daughter, "I already know what it feels like the day after a suicide."

So do many of us -- and the years that are to follow.

This is a PUBLIC HEALTH CRISIS and we need to invest in the research to address the underlying biology of suicide that seems to be exacerbated in high altitude regions.

Such investments may very well have benefits beyond preventing and treating suicide and depression.

High Altitude

Journal of the American Medical Assn. (Sept. 2016)

Association of Systemic Inflammation With Risk of Completed Suicide in the General Population
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2542679

There is a growing prima facie case for inflammation being associated with suicide. In cohort studies, elevated levels of inflammatory markers have been linked to the future occurrence of depression, a known risk factor for suicide.

In psychiatric patients, inflammation is positively associated with the intensity of self-reported suicidal ideation, and those who commit suicide have higher cytokine levels post mortem relative to control patients.

Furthermore, individuals with asthma, a condition characterized by inflammation, experience higher rates of suicide mortality than their nonatopic counterparts.

CNS & Neurological Disorders - Drug Targets (2016)

Blood-Brain Barrier Changes in High Altitude
http://www.eurekaselect.com/145660/article

Science & Religion, Rejecting social Darwinism for a Road less travelled

9/27/2018

There is no universally agreed upon definition of "religion" and we are using it in the broadest sense regarding how we should live our lives and what ethical and moral principles should guide our lives and our societies.

Not everyone feels comfortable with a broad view of religion, like a lot of things in modern society -- our definitions of "religion," "God," "mental illness" and many others are undergoing revision.

In some senses religion in modern Western society has been pretty marginalized, bringing out religious leaders at funerals.

But religious and spiritual beliefs are NOT just for funerals.

I'm not a big fan of de facto Social Darwinism or how it plays itself out in some of our laws and public policies.

We absolutely have to have science, and to my mind science is just as consoling as religious & spiritual beliefs.

But science without religion, without ethical and moral guideposts, is quite horrific.

     In modern society today we have quite a mess with mediocre to bad science dictating conclusions in criminal court and a broken moral & ethical compass in our treatment of people with "invisible disabilities" who find themselves in the criminal justice system or homeless.

Is the way we are proposing hard? Yeah, it is. And if we take the road less travelled, we will be better for it.

But . . .

Faith, Criminal Justice, AND bringing religion in from the Cold

9/21/2018

It took A LOT OF FAITH to put out into the world some of the radical religious and spiritual ideas that have been around for thousands of years.

One of the most challenging is that "God" is not just with me or for me -- but God is with my adversary and for that person as well.

So that's a pretty big incentive to find areas of mutual benefit.

Speaking of which, when it comes to the Criminal Justice System, our society is really very receptive to treatment options for bad behavior -- BUT they gotta work & we gotta fund them. We can't just engage in them as a matter of "Faith."

But if we conclude these treatment options have weaknesses or they are not available -- we can't just go back to this person is "evil" -- even though the acts more than qualify as evil.

What does it mean for "God" and us to be on the side of both society's victims, perpetrators, and often people who occupy both roles?

That's a tough question -- some of our marginalized religious folks might be able to help us answer it.

Religious Historian Karen Armstrong asks the provocative question [paraphrasing]: "If you don't believe in God -- which God don't you believe in?"

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Val's Blog

Limitations, working together & -- We're #1

MAKING THE SUCCESSFUL HANDOFF FROM THE CRIMINAL JUSTICE SYSTEM TO INTEGRATED PHYSICAL & BEHAVIORAL HEALTH AND PUBLIC HOUSING OR RESIDENTIAL SERVICES

Our Innovation Woes: Innovation w/o "Real" inclusion is usually TOO little innovation

Once again, the proof is really in the pudding. If we are innovating enough -- we don't have thousands of coloradans or US citizens with mental illness who are homeless or incarcerated.

IF WE WANT TO CLIMB THE GLOBAL MENTAL HEALTH MOUNTAIN --- WE'RE GOING TO HAVE TO WORK TOGETHER

Making the world safe for politicians to be honest

Part I of our series unequal justice: Laying down our hypocrisies

no good deed goes unpunished

We need to deal with the biology of suicide directly & immediately

Science & Religion, Rejecting social Darwinism for a Road less travelled

But . . .

Faith, Criminal Justice, AND bringing religion in from the Cold

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Val's Blog

Once again, the proof is really in the pudding. If we are innovating enough -- we don't have thousands of coloradans or US citizens with mental illness who are homeless or incarcerated.​

But . . .

Author

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Once again, the proof is really in the pudding. If we are innovating enough -- we don't have thousands of coloradans or US citizens with mental illness who are homeless or incarcerated.