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Trauma-Informed Care & Justice

1/22/2018

We greatly UNDER-ESTIMATE the time and energy it takes to sufficiently address human conflicts, and that is nowhere better seen than in the concerns of marginalized populations, especially those who have been so traumatized that their presentation is a PRIMAL SCREAM rather than a concise and clear presentation of facts, law, and argument.
BUT the TRUTH is without money or resources, even if they do present the facts, law and argument --- they maybe IGNORED.
Which only tends to FUEL the PRIMAL SCREAMS and HORRIBLY DAMAGING SENSE OF INJUSTICE that is pretty par for the course for a whole lot of poor people in our society, including a whole lot of people with "mental illness."
I think some of us may have "intuited" TRAUMA-INFORMED CARE for years however imperfectly, recognizing that the Client that seems so "OFF-THE-WALL" -- Hey, there's A LOT going on there. AND the more one digs into it, the more one UNDERSTANDS:

What's going on with the Client;
What's going on with the Situation;
What's going on with the Case;
AND What is it REALLY going to take to RESOLVE this conflict and ADDRESS the UNDERLYING ROOT CAUSES of the Problem(s) which are more often than not very COMPLICATED.

AND more often than not, one finds there is A LOT OF JUSTIFICATION for the CLIENT"S PRIMAL SCREAMS and SENSE OF INJUSTICE.
BUT how many hours did it take to get that UNDERSTANDING of someone who was poor, marginalized with a "mental illness"? Many, many hours.
The LONGER people are subjected to GROSS INJUSTICE the more their mental health is damaged by it -- AND the HARDER it will be to ultimately address.
People in PAIN perceive being IGNORED as a GROSS INJUSTICE and that's because it is. STATE ENGAGEMENT and SUBSTANTIVE ADDRESSING OF CONCERNS WITH poor, marginalized people who have been TRAUMATIZED is HUGELY IMPORTANT for the SENSE OF JUSTICE in our SOCIETY.
It is not easy -- it takes A LOT of TIME and ENERGY -- BUT it is much more effective than IGNORING PEOPLE AND FAILING TO PROVIDE INCLUSION, JUSTICE and ULTIMATELY HEALING.

The Surprising Truth About the Silent Treatment
https://www.heysigmund.com/the-silent-treatment/

"Dealing with Homeless, Fires and Lawsuits" -- A Modest Proposal

1/21/2018

With our Dark Humor, Colorado's situation of "Homeless, Fires, and Lawsuits," reminds us of the Plagues on ancient Egypt in the Bible.
Colorado's situation may not be as much Divine Intervention as the Chickens Coming Home To Roost -- of course, maybe it's the same thing.
In any case, we need NOT only to deal with the ROOT CAUSES of these problems --- BUT have the COURAGE & INTEGRITY to acknowledge the SCALE OF THE PROBLEMS.
On some level, Colorado is addressing the ROOT CAUSES of these problems -- BUT it hasn't really been wholly effective because STATE GOVERNMENT is afraid to acknowledge the SCALE of the Problems and their LEGAL RESPONSIBILITY to provide HOUSiNG & SERVICES for People with Disabilities or to Have a Plan to Bring Those Housing & Services to SCALE under the US Supreme Court's 1999 Olmstead Decision.
Why is that? Why are politicians afraid to do that?
I'm sure this is going to SHOCK everyone -- BUT the well recognized reason is that this isn't CHEAP -- in fact -- it's EXPENSIVE.
So when you have Governmental Entities not complying with various LAWS @ the State, County, or Municipal level --- LAWSUITS are pretty predictable.
Housing and Intensive Community Mental Health Treatment that many people who are Homeless need --- is EXPENSIVE.
There is not necessarily just one way to FUND that. One way that was pioneered by the City of Denver was the use of Social Impact Bonds.
We have said it before and we'll say it again -- one of the most SERIOUS & DANGEROUS problems Colorado State Government has is that it is woefully Under-Staffed.
As one professor said -- "You can't read 'War and Peace' while you're taking a shower."
You can't:

Make those applications for Social Impact Bonds;
Adequately Monitor Facilities
Sufficiently Engage with the Public on Innovative Ideas for a Pretty Broken Mental Health System
Etc.

If you don't have the Bandwidth to do it.

There is a HUGE NEED within the Colorado Dept. of Health Care Policy and Financing (HCPF) for MORE HUMAN RESOURCES to deal with the TRANSFORMATION that needs to take place in MEDICAID to ADDRESS the MENTAL HEALTH CRISIS that Colorado is experiencing and is seen in the rest of the Country as well.

Further, while we understand that the Office of Behavioral Health and HCPF are closely coordinating ---- we think these offices need to be fully integrated--- so that concerns relating to Institutional and Community Mental Health Care are seamlessly addressed.

Additionally, LET'S BE VERY CLEAR --- IT IS OFTEN CHEAPER FOR GOVERNMENTAL ENTITIES TO VIOLATE THE LAW AND PAY ATTORNEYS FEES FOR THE OCCASIONAL LAWSUIT THAN IT IS TO COMPLY WITH THE LAW THE WAY THE LAW IS CURRENTLY ENFORCED.

So if one's most important value is "saving taxpayer dollars" -- Colorado's got the Government for you.

BUT make no mistake about it, it comes with a lot of abuse and neglect of people with disabilities and inhumane treatment of people with mental illness on the streets and in jails and prisons.

If we work together, we can figure out a way to pay for Sufficient Housing & Services for People with Disabilities and make a Plan to bring those Housing and Services to SCALE.

Colorado Springs Gazette: Letter to the Editor

Dealing with homeless, fires, lawsuits

If you build it, more will come. We will never have enough space until the homeless get mental help to change their lifestyles.

I am referring to the hard core group (mainly singles) that refuse to obey any laws that don't suit their style of living.

I would also like to thank the ACLU for helping put fear in our community, especially legal residents of the Westside (Old Colorado City), by not allowing Colorado Springs to enforce it's laws for fear of being sued and wasting precious taxpayer dollars on legal fees.

Tom Gallivan
Colorado Springs

http://gazette.com/letters-dealing-with-the-homeless-fires-taxes-and-lawsuits/article/1619255

Colorado Abuse & Neglect Scandals Involving People with Disabilities

Integration of Community & Institutional Mental Health Policy @ the Federal & State Levels with Corresponding Appropriations to Deal with Decades of Neglect

1/20/2018

I'm really glad people are taking the Opioid Crisis seriously. We're beginning to address the Crisis in Mental Health as well as the Criminal Justice System -- BUT there is a LONG, LONG WAY TO GO.
With respect to Mental Health --- it has been a pretty WILD RIDE.
I think we are primed for a more BALANCED and INTEGRATED MENTAL HEALTH POLICY than we ever have been before.
We've mentioned this before that we seem on the CUSP of a CONSENSUS when it comes to Mental Health Policy among what have historically been warring views across the Mental Health & Disability Advocacy Spectrums.
We "think" a CONSENSUS "might" look like this:

Requirements to continuously update data and analysis on the need for:
- Housing
- Appropriate Community Mental Health Treatments, Including Intensive Community Treatments such as Assertive Community Treatment;
- Institutional Care
Get rid of the Institute for Mental Disease Exclusionary Rule or IMD Rule and fully Incorporate the Institutions into the State's Olmstead Planning Process.
Allow Medicaid to Cover Housing for people needing Long Term Care

There was a BIG PUSH in 2015 to persuade Medicaid to cover Housing. Advocates and for that matter even States were rightly chanting a mantra of "Housing is Healthcare."

Well what Medicaid did was that it said it would fund a lot of peripheral services around Housing -- BUT NOT THE HOUSING.

Ironically what CMS did do was remind States of their responsibilities under OLMSTEAD. -- YEAH!

BUT Olmstead isn't being enforced the way it should be and States are pretty cavalierly resistant to this DISABILITY CIVIL RIGHTS LAW in no small measure because of the Housing Liability.

AND who should be caught in the middle: People with Significant Disabilities.

So the BOTTOM LINE is we don't care who pays for adequate Housing, Services, and Institutional Care -- BUT some governmental entity needs to pay for it. The State has a LEGAL DUTY to either provide all this or have a plan to do it for the Housing & Community Services and in Colorado with respect to inmates needing Competency Exams -- the State is under a Settlement Agreement.

Now because we have been neglecting this for DECADES -- we do need to JUMP START it with major appropriations. From both the Feds and the States.

MAYBE If we're NOT FIGHTING with each other and working together to get the Scale of Housing, Services, and Institutional Care we need-- we might get it.

In the meantime, I will be contacting the State to let them know they have until Thursday January 25, 2017 to get back with me on Parity and ACT to try to work something out otherwise I will be complaining to CMS REGION 8.

CMS -- Coverage of Housing-Related Activities -- June 26, 2015

Housing: A Conundrum for the States -- A Nightmare for People with Mental Illness

The Role of Counties & Municipalities In Insisting that States, like Colorado, Comply with the State's Obligations for Housing & Intensive Services for Citizens with Mental Illness

1/19/2018

The National "Stepping Up" Movement to get people with mental illness out of jails is sponsored in no small measure by the National Association of Counties.
Counties are often the ones funding the jails and the Sheriff's Offices.
So why would they do that? There are a lot of additional medical costs as well as heightened liability costs in trying to provide for people who really need a mental health facility or Intensive Community Mental Health Treatment and Housing.
This really should be a State Funding Responsibility and under the Americans with Disabilities Act and Olmstead -- IT IS.
So it is NOT like States aren't doing anything. They are. BUT they are NOT doing enough to comply with the LAW.
NOW if this was anybody else -- would partially complying with the LAW be enough?
Further, for the people with mental illness who find themselves caught in the Homeless/Incarceration Cycle --- that often is NOT enough, and it certainly wouldn't be enough in many cases if they had prior convictions that are really based on a Lifetime of mental illness and a State over decades failing to comply with the LAW.
SO We See the Injustice of This --- and its not like Coloradans aren't already paying for people with mental illness with intensive needs --- It is just that they are paying for it out of County and Municipal Coffers --- and more often than NOT what they are paying for is INHUMANE TREATMENT.
AND that is coming often from the Sheriff's and Deputies around the Country and in Colorado -- who have turned into some of the most eloquent Mental Health Advocates our Country and State have.
Colorado is already doing a lot of Collaborative work ---- it NEEDS to be much more inclusive of People with Mental Illness with experience with the Criminal Justice System -- and it is a very good start.
BUT State Government is still NOT complying with the Law. AND that can't be considered adequate or acceptable, especially given the damage and human toll that is resulting from the State's FAILURE to comply with the LAW.
Maybe a funding measure that would benefit the Counties and Municipalities for Housing for People with Disabilities as well as Funding to ensure that Intensive Community Mental Health as well as Institutional Mental Health Services were available where necessary.
We are going to make the argument that funding for Institutional Mental Health Services can be Olmstead Services when:

They are Directly Tied to Housing and Intensive Services in the Community, if necessary.
There is Strength-Based, Person-Centered Care Planning and Discharge Planning.
Discharge Planning Begins Upon Admission
The Mental Health Institutes assess and advise what services would be necessary in the Community for this Individual to Successfully Live in the Community.
If such services are NOT available. Consult with Colorado's Protection and Advocacy Office for People with Disabilities as well as the Colorado Department of Health Care Policy & Financing.

We do think it is important to get to a more HOLISTIC & COMPREHENSIVE approach to the provision of Mental Health Services and Housing both at the State and Federal Levels.

-----Johnny Cash

Medicaid's Institute for Mental Disease Rule, Olmstead, Parity, & CMS/ HUD Enforcement--Some Motivational Therapy & Incentives So States Will Stop Hurting People with Mental Illness & Comply with the Law

1/18/2018

Whether its Individuals, Corporations, Governmental Entities or whoever -- Lying generally takes place where people are afraid.
At bottom, we think States are just "AFRAID" they don't have the resources for the Scale of the Problem when it comes to the Housing and Service Needs of people who are institutionalized or at great risk of institutionalization..
We are running into a lot of MORAL HAZARDS where almost 20 years after Olmstead it is pretty acceptable behavior among the States to claim they are complying whether they are or not. The vast majority are not, including Colorado.
Unlike a State like Mississippi, Colorado is a rich State BUT the political realities of TABOR are not leading to an abundance of HONESTY, even though theoretically Olmstead and Parity as Federal Law TRUMP TABOR.
You can see TABOR's affect in Governor Hickenlooper's really very well-intentioned "State Comprehensive Behavioral Health Care Plan" -- that is NOT an Olmstead Plan -- but focuses on trying to make Behavioral Health more "efficient" -- which is not a bad thing and it's a smart thing to do.
BUT we're still not complying with the Law. Most states aren't either.
Our proposal would be to Lift the Medicaid IMD Rule for those States that have and are implementing a State Olmstead Plan with:

Measurable Goals
Reasonable Time Frames, and
Funding to Support the Plan

---The Plan must be designed to bring Housing & Services to Scale to Meet the Need.
---Specifically include assessment for Intensive Community Mental Health Services, including Assertive Community Treatment and planning.
---Comply with Parity
---Continuously Updated; and
---Inclusive of the Disability Community

Of course, this doesn't really require anything States shouldn't already be doing -- BUT they're not doing it.

The Institute for Mental Disease Rule or IMD Rule under Medicaid was really designed to "incentivize" States to provide Intensive Community Mental Health Services, including small housing situations by refusing to fund "Institutes" of 16 beds or more in which a majority of the residents had mental illness.

Well, that didn't work -- the States didn't put the money in Institutions but they didn't adequately fund Intensive Community Mental Health needs either.

Further, we're going to need some ENFORCEMENT on this -- we sure as hell can't rely on the States to police themselves.

There needs to be provision for Administrative Enforcement through the Centers for Medicare & Medicaid Services (CMS) as well as HUD (US Dept. for Urban Development).

The Scale of these Problems is HUGE and Complex -- BUT we can't continue to allow the LAWLESSNESS of the STATES when it comes to FEDERAL DISABILITY CIVIL RIGHTS LAW.

We think lifting of the Medicaid IMD Rule for States that Comply with Olmstead & Parity and that is Administratively Enforced through CMS & HUD could bring some BALANCE to an OUT-OF-BALANCE SYSTEM(s) that is HURTING A WHOLE LOT OF PEOPLE.

Lois Curtis -- one of the original Plaintiffs of the 1999 US Supreme Court Olmstead Decision, holding that unnecessary institutionalization of people with disabilities amounted to Discrimination and Violated Title II of the Americans with Disabilities Act (ADA).

Medicaid & the IMD Rule (Resources)

Medicaid Is A Mixed Bag And It Is NOT Some Innocent By-Stander in the Current Mental Health Crisis whether in Colorado or the Rest of the Country

1/17/2018

We're going to pick-apart Jaffe's summarized analysis of Medicaid's role in the current crisis and suggest why both Conservative and Liberal Mental Health Advocates have plenty to fear from Medicaid Mental Health and the States who administer the State Medicaid Programs.

With regard to "anti-psychotics," historically people and professionals including advocates thought they were going to work a lot better across the board than they did. So they were a HUGE part of de-institutionalization and the community mental health movement.
NOW -- we recognize that "genetic testing" may be really necessary to decide which medications are best. Further, a lot of these medications work on the brain globally and not on individual neural circuits and that is probably not a good thing, according to Cal-Tech neuroscientist David Anderson.
Further our whole understanding of "mental illness" is changing to something much more related to the brain, the gut and "immune system" than it was before. So the point being, we don't have a complete and comprehensive understanding of "mental illness" and and we're very slow to change incorrect old ideas.
So if you thought "anti-psychotics" were going to solve all these problems and "medication adherence" you probably didn't think you needed a lot in Community Mental Health and Medicaid Mental Health.
50 Years on or So -- SURPRISE! People with mental issues need a lot more than medication, the medication is more complicated than advertised, and "Medication Adherence" requires a competent profession and one that listens to its patients. We are lacking in both.
You just can't be a viable medical/healthcare profession and rely on outdated science like the DSM 5. Mental health professionals are NOT paid as much because they are NOT worth as much. Hopefully, the integration of physical and mental health which is so desperately needed in mental health will help both people with mental illness and the mental health profession raise its standards and its salaries.
So Medicaid is a BIG PART of that integration of physical and mental health care AND they deserve A LOT of credit for that.
BUT what happened when we realized "anti-psychotics" weren't going to be enough? We rushed right in to fund effective and expensive intensive community mental health treatments like -- Assertive Community Treatment, right?
HELL NO! We let the jails, prisons, homeless shelters and streets handle the intensive treatment needs.
This has gotten pretty nightmarish and Orwellian in Colorado where the State won't even answer a question whether it has an objection to a "waitlist" for ACT.
BUT now we're supposed to have Medicaid Parity, and the State continues to fail to fund this treatment as it would a medical/surgical treatment.
So it is this INTENSE STATE RESISTANCE to adequately fund Intensive Community Mental Health Treatments on par with medical treatments that led to:
- the Mental Health Crisis;
- Calls to get rid of the Institute for Mental Disease [IMD] Rule in Medicaid;
- AND a Call to a Return to Asylums
When State Medicaid Programs like Colorado's Resist the Large Funding Needs of People with Serious Mental Illness -- They Are Also Violating the Law & Civil Rights of Thousands of Coloradans with Mental Illness who are Homeless and Incarcerated.

From "Insane Consequences" . . .

"In spite of common lore, it is Medicaid, more than the advent of anti-psychotics and tranquilizers, or the construction of community mental health centers, that caused and continues to cause "de-institutionalization."

"The overall effect of exclusion [Medicaid's exclusion of payment for Institutes of Mental Disease] has been to create incentives or states to move patients out of state hospitals, which has contributed to homelessness and inappropriate incarceration."

See page 187 of the book.

See the Caption below for Colorado's Version of the Orwellian Nightmare

The Orwellian Nightmare is in one instance the Dominance of Irrational Political Concepts. Kind of like Colorado Medicaid's Refusal to Provide Assertive Community Treatment where "Reasonably Medically Necessary" Helps Coloradans with the most serious community mental health needs. Perhaps most distressing, the Orwellian practice of the Hickenlooper Administrations confusing politeness and cordiality with good faith and complying with the law.

Citizen Kane and the State's Legal Responsibility for Housing People with Disabilities who are Institutionalized or At Great Risk of Institutionalization

1/16/2018

When we think about State Obligations to provide for the "general welfare" --- that is generally pretty squishy and elastic and States are given pretty much carte blanche -- or a blank check to do what they want or don't want.
In large measure that is why we have an Olmstead Decision -- what the States were doing to provide sufficient housing and services for people with disabilities to leave Institutions or prevent such institutionalization was NOT only grossly insufficient -- it violated the law under Title II of the Americans with Disabilities Act (ACT).
The US Supreme Court in 1999 went to some great lengths to "Balance the Interests" between States and People with Disabilities.
It MIGHT have worked very well IF the States and People with Disabilities were on an equal playing field when it comes to power, resources, etc. to enforce the law. BUT that is hardly ever the case.
So, we don't want to get rid of Olmstead Protections for People with Disabilities. What we do want is that States not only understand that it is their LEGAL RESPONSIBILITY and NOT their gift -- BUT more crucially, that they ACT accordingly and Comply with the Law:

Measurable Goals
Reasonable Time Frames
Funding to Support the Plan

There are a lot of ways to solve these problems, we really need something that is going to work across the Board.
In the meantime, we are now working with others on State Audit Requests. Julie Reiskin, Executive Director of the Colorado Cross Disability Coalition, has indicated the need to include concerns of people with physical as well as mental health disabilities in this process.
There's a lot of flexiblity under Olmstead -- it's just NOT the bullying flexibility of the Hickenlooper Administration and most state administrations that don't comply with Law and don't understand Olmstead is NOT an option and it's NOT a gift.
With respect to Housing -- generally States don't have any responsibility to provide Housing other than their own self-interest -- BUT when it comes to the State's Responsibility to provide Housing for People with Disabilities that is DIFFERENT because of Olmstead --- and most States are afraid to OWN the full ramifications of that and the consequences of that failure are quite horrific.

Lord knows, those consequences are horrific in Colorado.

These Audits are so desperately needed NOT so much because the State of Colorado doesn't know the LAW or the Scale of the Housing problem for People with Disabilities in the State.

Rather these Audits are needed because the Hickenlooper Administation and plenty of others won't Comply with the Law because they are TOO AFRAID of the Scale of the Problem and the State's LEGAL RESPONSIBILITIES.

On this MLK Day: Do We Live in a "S**hole" Country, State or City?

1/15/2018

Martin Luther King, Jr. wasn't perfect and neither are we.
Whether it is in:

Justice -- in which the US is ranked #15 among countries in the world; largely because of the World's concern regarding our racially discriminatory Criminal Justice System;
Our expensive Healthcare System that does not produce better results.
A country awash in guns that would do well to look @ an Australian-style buy-back program.
A Country largely dominated by a Religion of Material Wealth and has the Spiritual Depth to show for it -- that is NOT lost on the rest of the World.
Or a Behemoth of a Country that is largely still challenged to Capitalize on Diversity rather than bullying and often imprisoning those who are different.
And those stuggling people are often a direct result of the Country's bullying.

we might not want to cast those stones @ others too hard.

In the 2016 Denver MLK Marade video, in answer to the question "Why is Michael Marshall Dead?" one of the men says because Michael Marshall was:

Poor
Homeless
Black, and
Was a Person with a Mental Illness

We have always thought that was a pretty accurate answer.

The Michael Marshall case finally settled for $4.6 million with Denver and the Sheriff's Office.

We have always felt strongly that the failure of the State of Colorado to provide adequate Housing and adequate Intensive Mental Health Services were HUGE Factors in the Marvin Booker jail death, Michael Marshall jail death, Ryan Partridge self maiming while experiencing psychosis in the Boulder Country jail -- as well as other horrific incidents and the daily violation of human rights of people with mental illness that we have become numb to.

So we have to work with our imperfect Brothers and Sisters where ever they may be to fix these horrors.

That means that ALL Sides have to insist on Truth while recognizing whether one lives in a "S**hole" Country, State or City" --- is generally a matter of perspective.

Assertive Community Treatment, Parity and An Opportunity

1/14/2018

As Governor Hickenlooper said there is still time left on this Administration, and if Parity got resolved that would be a HUGE Accomplishment and go a long way to soothing the Bad Feelings on Olmstead.

Under Mental Health Parity Analysis, there are 4 major classifications of benefits:

Inpatient
Outpatient
Emergency Care
Prescription Drugs

Assertive Community Treatment is considered an "Outpatient Treatment."

The Federal Parity Regulations allow although do not mandate that "Outpatient" can be subdivided into:

(A) Office visits (such as physician visits); and

(B) All other outpatient items and services (such as outpatient surgery, facility charges for day treatment centers, laboratory charges, or other medical items).

Under Page 36, of the CMS Parity Tookit, CMS likens Assertive Community Treatment to "outpatient surgery."

So a lot of the confusion with respect to Parity Analysis comes with respect to analysis not of individual benefits per se [or a least not in the first instance] but Analysis of Benefit Classifications.

The primary issue presented under Parity is not NEED BUT is the Mental Health Outpatient Classification more restrictive in some way than the Medical/Surgical Outpatient Classification.

So while the language is "Parity" it is really about not discriminating between mental health care and medical/surgical care in Quantitative Limitations and Non-Quantitative Limitations.

So what about Colorado Medicaid Alternative Mental Health Services? Those "altermative services" are "limited" by the "savings" of the Managed Care Program or at least have been and have NOT been rationally based on "medical necessity."

This is HUGELY important because one of these "alternative services" is Assertive Community Treatment and it is considered by many to be the Gold Standard in Intensive Community Mental Health Treatment -- and it's not EXPERIMENTAL -- it's been around for a long time -- further it is generally a component of US Dept. Of Justice Mental Health Olmstead Settlements.

Further, CMS in their Parity Toolkit on page 36 used Assertive Community Treatment as an example where it may be necessary to go beyond the classifications and look @ individual treatments.

In that case, CMS found a State's limitation of ACT to "reasonable medical necessity" did NOT violate PARITY since comparable medical/surgical items were so limited.

BUT what about Colorado? Colorado does NOT limit ACT by "reasonable medical necessity," we limit it on budgetary grounds we do NOT see recognized under Parity.

Further, a California Court found that a California State Parity Law did cover assertive community treatment -- otherwise, the law would be meaningless.

We need the State to address this and it would probably be helpful to include other stakeholders as well.

State Audit Requests, A New Governor Next Year, & Olmstead Can't Serve as an International Model If We Won't Comply With It

1/13/2018

My Take & Update:

I think Medicaid Community Mental Health Services are hard for States because they are paying a lot for mental health services. So the problem isn't so much that they aren't spending any money, but that isn't really well correlated with the NEED.

If States are adequately addressing the NEED, by and large you're not going to have a lot of homeless and incarcerated people with mental illness. That includes other disabilities as well such as traumatic brain injury and developmental disabilities.

NOW one may say: These people are refusing "treatment." Well, one of the things that makes it more expensive and actually more effective, is that the "treatments" need to be individualized to the person and they NEED to be strength-based and person-centered and person-directed to the extent possible.

That "extent possible" is generally quite a bit and it can be time-consuming. On the other hand, it is generally more effective and ultimately cost effective.

When we look @ the Finnish model "Open Dialogue" that has now been adopted in some other countries, including piloted in Massachusetts and Georgia in the US, upfront it is NOT cheap.

It is over the long-term that it is cost-effective.

We are talking to other mental health and housing advocates about probably looking @ seeking 2 separate audits:

The Sufficiency of Medicaid Mental Health Community Services for Specific Populations -- that will probably also look @ what is available from CDHS.
AND Housing for People with Disabilities generally with an eye to the State's Obligations under Olmstead.

We are hopeful that a new Governor will be more inclined to address our concerns on Olmstead Planning. There is NO GUARANTEE of that, and in fact things could get worse, we hope they don't.

As an aside I was contacted yesterday by a Judge in the United Kingdom who handles mental health and child protection matters and is also a professor of Mental Capacity Law @ University College London. He is interested in Human Rights and has done some work with African countries, wanting to know if there were "endeavors" we might partner together on.

What I'm thinking and have been thinking for some time is that Olmstead and Olmstead Planning is such a great model for the rest of the world --- BUT WE DON'T DO IT!

How do we make this something that is just NOT on paper and is ridiculously hard to enforce? How do we get Governments to participate? Is "reasonable" too vague? Do we need to nail this down -- is all this "reasonableness" just causing confusion.

That's what they finally had to do in the Family Law context with support issues -- provide specific guidelines.

This really is a "support issue." The legal responsibility of the State to "support" people with disabilities to live in the Community who are institutionalized or @ great risk of institutionalization.

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