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The ADA Was Never Meant To Be Run By Lawsuits -- The Bullying Behavior of Failing to Comply with the LAW

1/12/2018

Well, our point is really the ADA is being run by lawsuits and pretty ineffectively when it comes to Olmstead.
The Pacific Standard article is really about Attorney General Jeff Sessions' rescinding various Department of Justice Guidance especially as it relates to Sheltered Workshops for people with disabilities.
Now our understanding is that Sessions did not rescind the 2011 DOJ Guidance on Olmstead.
BUT very few States are following it anyway and that includes Colorado. Specifically, we are talking about the requirement that Olmstead Plans have:

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

The Minnesota Court-Ordered Olmstead Plan was really what finally held a State's feet to the Fire and more importantly the LAW when it comes to the requirements above.
We've really shared all kinds of information with the Hickenlooper Administration to no avail.
The reality is the Hickenlooper Administration is NOT some kind of "outlier" when it comes to State Administrations-- we'd like them to be & actually comply with LAW -- BUT they have so far NOT risen to the occasion.
Further, the Hickenlooper Administration's behavior at bottom has been abusive and bullying with a veneer of politeness and cordiality. The disability community doesn't have the resources to litigate and re-litigate rights that are so clearly stated.
"The Americans with Disabilities Act was never meant to be run by lawsuits."

The Americans With Disabilities Act was never meant to be run by lawsuits. Instead, since 1992, the Department of Justice (DOJ) has been releasing technical assistance documents in order to explain disability-related civil rights obligations in plain language.

The goal is to preemptively answer questions, but also to provide a model for consistency across the country. Private citizens and judges use these documents, as do people working on disability-related services in public, non-profit, and for-profit sectors.

n the two and a half decades since the ADA became law, the DOJ has offered guidelines on how to move people with disabilities out of institutional living, and out of segregated, disabled-people-only work environments . . .

https://psmag.com/economics/jeff-sessions-roll-back-disability-rights

The State Has Issues Too: Olmstead & Parity

1/10/2018

1. Maybe Olmstead Planning really does need to be left to the next Governor. The next Administration can work on:

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

And That Is Something The Candidates for Governor Should Be Addressing.

  2. With respect to Parity, that is NOW. Our BIG concern has been Assertive Community Treatment.

We might suggest looking into Social Impact Bonds as the City of Denver did, and that could also be paired with Housing and address some additional Olmstead concerns. Obviously, housing is a huge concern in Colorado generally and certainly for people with disabilities.

An additional idea is to make ACT a Medicaid Rehabilitation Service for Adults and Youth as Minnesota did.

Now, the Hickenlooper Administration may not do that. In which case, we do want to understand where the State is coming from before we complain to Region 8 for the Centers for Medicare and Medicaid Services. Right now, we have not heard back from the State since our latest correspondence.

The Point of this video is not to suggest putting up with abusive behavior is a good idea-- but we think to recognize that most people have "Issues" -- that are NOT "politically correct."
Further, it is generally NOT helpful to be judged for those issues, and if we are judged-- it is generally easy enough to judge others back -- and that includes the Court System and the State.

The Banning of A Dangerous, Unhealthy Coping Mechanism & Some Unintended Consequences -- Cigarettes

1/10/2018

One of the things that we are beginning to learn is that people with various nervous systems, make-ups -- are more likely to be drawn to certain substances.
Some of those substances that we label "BAD" and actually are pretty BAD -- are in some way helping the person to cope, sometimes with neurological deficits.
I remember one of the first things I learned working in the Older Americans Programs at The Legal Center, now Disability Law Colorado -- smoking rights for nursing home residents were a very BIG DEAL.
But I kinda already knew that. While I've never smoked, my maternal grandmother with polio smoked and so did my mother and aunt.
My grandmother ultimately quit smoking, she did die of a heart attack. My aunt as well quit smoking and died of severe heart problems. My mother never was able to quit smoking despite many tries and she ultimately died of a stroke.
When I was young I used to hide my mother's cigarettes behind the dryer -- that was probably a fire hazard -- but even as a kid in the early '70's they were teaching us smoking was dangerous --- and that was 4th grade.
BUT I also know what it was like being around someone who was trying to quit smoking and having a hard time -- it was NOT fun. "Let me get those cigarettes from behind the dryer."
AND I also so know what it is like to be in a car in the Summer in Oklahoma that is probably initially 130 degrees -- and have your mother light up a cigarette.
So something has to give -- AND it did.    We banned smoking from most public places and as much as possible we really guilt-tripped people who smoke.
I really am for banning smoking in public places and recognizing the HUGE health threat cigarettes present -- BUT we generally didn't ask "why" people were smoking or acknowledge that as much as they were destroying their health -- in many cases smoking was helping them function as well.
A lot of people with disabilities have traditionally smoked -- for stimulation some cases, and in the case of ADHD to calm down and focus.
Our new substitute for "smoking" seems to be legalized recreational marijuana. Many would argue the health effects of marijuana are less damaging than cigarettes. Hmmm . . .
In any case, I grew up with my mother smoking and talking with my grandmother, aunt, or a friend around the kitchen table.
At the end of my mother's life, she was smoking in the garage, outside, any isolated place -- by herself.
  Our son and daughter learned in school about how BAD sodas and diet sodas are for people, and they have been trying to get me off Diet Coke for sometime. As my Dad would say, I drink Diet Coke like it's going out of style -- AND I have for a long, long time.
I haven't always known that Diet Coke was bad for me -- BUT I've know for awhile. AND I've tried to quit many times.
I think when we have these substance issues -- legal or illegal -- we really have to find a "substitute" that works for us. We need to understand what we are needing to replace that was functional or semi-functional or a little, tiny bit functional.
I think at least in some cases, especially for those of us who are having "a hard time breaking the addiction," there's more going on than JUST the addiction -- and the addiction was plenty on its own.
  That substance is helping us function at the same time, in some or many respects, it is negatively impacting our health or functionality.
And more and more evidence is suggesting that for some of us that is because that substance is addressing a neurological deficit.

This video recommends going cold turkey on a Diet Soda addiction. I've heard Dr. Oz and even Doctors from Children's Hospital (I think) on local television recommend splitting Soda with Seltzer water.

This is a really fun book -- I'm trying some of the stuff out. It has some more "sciencey" aspects than what I quoted below.

I think 12 Step Programs really gave us a great concept: Take What You Like & Leave the Rest. -- That concept is NOT to be used for the LAW --- State of Colorado.

Whether it is Psychiatry or Nutrition or Exercise or Meditation -- we need to be able say when stuff isn't working -- and to be HEARD.

There are almost an infinite number of factors affecting physical and mental health or just HEALTH.

That is why individualized medicine is so important.

BERRIES

"For any illness with neurological symptoms berries are the answer."

"Invite a friend over to share a big bowl of berries. You'll be surprised at how emotional wounds start to lift and clear for both of you and your conversation becomes pleasingly sacred, deep, healing and, in the end, happy."

LEMON BALM TEA

"Stress and insecurites often cause us to feel fearful about what's around the bend. . . If your worried about what the future holds for yourself and others, lemon balm can take the worry away and replace it with a sense of peace."

The Crisis In Mental Health -- Is At Root A Scary Crisis In Knowledge & Treatment -- In the Meantime We Need To Pay Up --- Wouldn't We Do That for Alzheimer's Patients?

1/9/2018

The worry used to be: "What are we going to do when all those Baby-Boomers get Alzheimer's and hit the Country's Medical System."
Nobody really has seriously entertained doing what our society has done on the Epidemic in Mental Health:

Incarceration
Homelessness
We Just Fund Housing & Mental Health Community Services As We Damn Well Please {as well as bed space]

There are 3 BIG factors in that:

We're generally not afraid of frail, older people even if their behavior is off.
A lot of people still don't believe in "mental illness" -- seeing for Human Beings really is believing. Seeing a frail older person with Alzheimer's is believing -- seeing the wide range of people with "mental illness" can be pretty confusing.
Our professionals haven't had the best handle on "mental illness," even if they have done the best they could -- It's not good enough anymore, and many times it never really was.

Our problems with the Civil Commitment Statutes are really just a reflection of the lack of knowledge in the mental health professional community.

There is nothing wrong with saying you don't know -- in fact, it is often the most ethical thing to do. BUT the mental health profession can't have it both ways -- saying "I don't know" on civil commitment -- and serving as a critical expert in criminal proceedings.

Now one may say, "You're talking apples and oranges." BUT are we? There are serious, large knowledge gaps that the mental health profession by and large doesn't seem to have the awareness, ethics or morality to acknowledge -- AND it's hurting people.

Further, for the States such as Colorado we need to pay for the Housing and Services people with "mental illness" NEED -- not what we DAMN WELL PLEASE. Of course, complying with the Americans with Disabilities Act, the Olmstead Decision, and Parity would be a great move in the right direction -- COLORADO.

SO we need a HUGE AMOUNT in RESOUCES for people with Mental Illness for the States and Colorado to comply with the LAW and common notions of ethics & morality.

BUT one of the things we need to understand is we need all those resources because our knowledge and treatments are so lacking.

We're not saying get rid of all the mental health professionals, BUT we need to recognize that the primary research model for Mental Health is the Immune-Gut-Brain Triad -- & mental health disorders are more and more being recognized as immune disorders [See our button on New Science is Amazing & It Has HUGE Moral Implications NOW!].

Mental health professionals need to be trained in immunology as well--- at least on some level. AND there needs to be greater and more expert evaluation of people with "mental illness" from the perspective of immunology.

We have often said we did not get into this horrific multiple system mental health mess because of one factor -- there are a lot of factors.

BUT the more we know what we are doing with regard to the treatment of "mental illness" --- the more it is going to help.

"Too Dangerous To Treat": Is there a CO Mental Health Center Refusing To Treat BUT NOT Seeking Certification of Some Patients?

[Blog Above: Contains Reference to CRS CRS 27-65-106(1) --- Court Ordered Evaluations with Persons with Mental Health Disorders]

Is It Time To Re-Think "Imminent Danger" on 72-Hour Hold Emergency Procedures

New Science is Amazing & It Has Huge Moral Implications Now!

UCLA Cousins Center for Psychoneuroimmunology
(Most Colorado Mental Health Centers are probably recommending things like Tai Chi, Yoga, and Mindfulness.)

We're all for that -- and we're also about kicking it up a few notches in Rigor & Integrating the Latest Research-- something we think CO Mental Health Centers could do in collaboration with the Univ. of CO & the CU Behavior Health Innovation Center.

Mental Health & the Immune System

1/8/2018

Like a lot people with mental health concerns, I also have more recognized auto-immune concerns, specifically thyroid concerns.
I was interested to see in the list of articles that "osteoporosis" is now being considered for possible inclusion as as an auto-immune disease.
Like a lot of older, short women -- I have issues with that, too.
So if one has had the experience of one's cognitive functions essentially breaking down -- and I hope you never do -- it's clear to those around you and ultimately to yourself that something is going on -- but what that something is -- isn't very clear.
So we just give it our best guess. Our guesses have been getting better -- BUT still . . . they can miss the mark rather dramatically.
AND that is really the spark or the raging wildfire for the anti-psychiatry movement.
I really do believe in science. AND I think the answer for inadequate science is better science -- and listening to people.
Our mental health system costs a helluva lot for a lot of reasons, one of those is that it is just not based on the lastest science or the best treatments for what is essentially in many cases an immune disorder.

See Also:

The Telegraph (UK)

“You can’t separate the mind from the body,” said Prof Sir Robert Lechler, President of the Academy of Medical Sciences.

“The immune system does produce behaviour. You’re not just a little bit miserable if you’ve got a long term condition, there is a real mechanistic connection between the mind, the nervous system and the immune system.

“Our model of healthcare is outdated.

"We have a separation. Mental healthcare is delivered by mental health professionals, psychiatrists, mental health nurses and so on, often in separate premises from where physical health care is delivered and that is simply wrong and we need to find ways to ever more closely integrate and train amphibious healthcare professionals who can straddle this divide.”

"Research has also shown that people who have suffered severe emotional trauma in their past have inflammatory markers in their body, suggesting their immune system is constantly firing, as if always on guard against abuse."
. . .

One promising treatment for depression on the horizon is the use of electrical stimulation to change the signals between the brain and the immune system.

Prof Kevin Tracey, President and CEO, of the US Feinstein Institute for Medical Research, discovered that the brain controls production of a deadly inflammatory chemical called TNF, which if released in high doses can be fatal, causing people to, literally, die of shock.

He has recently developed a electrical device which reproduces the connection and switches off the chemical. Three quarters of patients with rheumatoid arthritis recovered following trials.

“This is the tip of the iceberg of a new field called bio-electric medicine,” he said.

“This is a new way of thinking about medicine. We’re using electrons to replace drugs. This will not replace all drugs. But there will be many drugs that are either too expensive, too toxic which may be replaced by these devices.”
http://www.telegraph.co.uk/science/
2017/09/08/depression-physical-
illness-could-treated-anti-inflammatory/

New Science Is Amazing & It Has Huge Moral Implications NOW!

Search Terms on PubMed: Mental Health and the Immune System

Search results
Items: 1 to 20 of 1470
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Select item 292926111.[SERUM CYTOKINE CONCENTRATIONS ASSOCIATION WITH THE SEVERITY OF SYMPTOMS IN MAJOR DEPRESSION].
Madi Y, Yogev A, Bar-Gad M, Amital H, Barak V, Amital D.
Harefuah. 2017 Dec;156(12):753-756. Hebrew.

PMID:

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Select item 292912062.Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Sosa-Reina MD, Nunez-Nagy S, Gallego-Izquierdo T, Pecos-Martín D, Monserrat J, Álvarez-Mon M.
Biomed Res Int. 2017;2017:2356346. doi: 10.1155/2017/2356346. Epub 2017 Sep 20. Review.

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29291206

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Select item 292784643.The sinonasal microbiota, neural signaling, and depression in chronic rhinosinusitis.
Hoggard M, Nocera A, Biswas K, Taylor MW, Douglas RG, Bleier BS.
Int Forum Allergy Rhinol. 2017 Dec 26. doi: 10.1002/alr.22074. [Epub ahead of print]

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Select item 292767344.Stress & the gut-brain axis: Regulation by the microbiome.
Foster JA, Rinaman L, Cryan JF.
Neurobiol Stress. 2017 Mar 19;7:124-136. doi: 10.1016/j.ynstr.2017.03.001. eCollection 2017 Dec. Review.

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29276734

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Select item 292735935.Novel Susceptibility Loci for Moyamoya Disease Revealed by a Genome-Wide Association Study.
Duan L, Wei L, Tian Y, Zhang Z, Hu P, Wei Q, Liu S, Zhang J, Wang Y, Li D, Yang W, Zong R, Xian P, Han C, Bao X, Zhao F, Feng J, Liu W, Cao W, Zhou G, Zhu C, Yu F, Yang W, Meng Y, Wang J, Chen X, Wang Y, Shen B, Zhao B, Wan J, Zhang F, Zhao G, Xu A, Zhang X, Liu J, Zuo X, Wang K.
Stroke. 2018 Jan;49(1):11-18. doi: 10.1161/STROKEAHA.117.017430.

PMID:

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Select item 292681016.Developmental selenium exposure and health risk in daily foodstuffs: A systematic review and meta-analysis.
Ullah H, Liu G, Yousaf B, Ali MU, Abbas Q, Munir MAM, Mian MM.
Ecotoxicol Environ Saf. 2018 Mar;149:291-306. doi: 10.1016/j.ecoenv.2017.11.056. Epub 2017 Dec 18. Review.

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Select item 292163837.Genetic Susceptibility to Hemolytic-Uremic Syndrome after Shiga Toxin-Producing Escherichia Coli (STEC) Infection: a Centers for Disease Control and Prevention (CDC) FoodNet Study.
Kallianpur AR, Bradford Y, Mody RK, Garman KN, Comstock N, Lathrop SL, Lyons C, Saupe A, Wymore K, Canter JA, Olson LM, Palmer A, Jones TF.
J Infect Dis. 2017 Dec 6. doi: 10.1093/infdis/jix633. [Epub ahead of print]

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Select item 292132718.Visceral Inflammation and Immune Activation Stress the Brain.
Holzer P, Farzi A, Hassan AM, Zenz G, Jačan A, Reichmann F.
Front Immunol. 2017 Nov 22;8:1613. doi: 10.3389/fimmu.2017.01613. eCollection 2017. Review.

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Select item 292010459.Functional Bowel Disorders Are Associated with a Central Immune Activation.
Farup PG, Ueland T, Rudi K, Lydersen S, Hestad K.
Gastroenterol Res Pract. 2017;2017:1642912. doi: 10.1155/2017/1642912. Epub 2017 Oct 23.

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Select item 2915016610.Exercise and mental health.
Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V.
Maturitas. 2017 Dec;106:48-56. doi: 10.1016/j.maturitas.2017.09.003. Epub 2017 Sep 7. Review.

PMID:

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Select item 2914149111.Association of psychosis, affective disorders and diseases affecting the immune system.
Larsen JB, Iversen VC, Reitan SK.
Nord J Psychiatry. 2017 Nov 16:1-5. doi: 10.1080/08039488.2017.1402952. [Epub ahead of print]

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Select item 2914112512.Elevated Proinflammatory Markers in 22q11.2 Deletion Syndrome Are Associated With Psychosis and Cognitive Deficits.
Mekori-Domachevsky E, Taler M, Shoenfeld Y, Gurevich M, Sonis P, Weisman O, Weizman A, Gothelf D.
J Clin Psychiatry. 2017 Nov 14. pii: 16m11207. doi: 10.4088/JCP.16m11207. [Epub ahead of print]

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Select item 2912408213.Is osteoporosis an autoimmune mediated disorder?
Iseme RA, Mcevoy M, Kelly B, Agnew L, Walker FR, Attia J.
Bone Rep. 2017 Oct 16;7:121-131. doi: 10.1016/j.bonr.2017.10.003. eCollection 2017 Dec. Review.

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Select item 2912297214.Eating Disorders, Autoimmune, and Autoinflammatory Disease.
Zerwas S, Larsen JT, Petersen L, Thornton LM, Quaranta M, Koch SV, Pisetsky D, Mortensen PB, Bulik CM.
Pediatrics. 2017 Dec;140(6). pii: e20162089. doi: 10.1542/peds.2016-2089. Epub 2017 Nov 9.

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Select item 2908784615.The Role of Inflammation in Late-Life Post-Traumatic Stress Disorder.
Miller K, Driscoll D, Smith LM, Ramaswamy S.
Mil Med. 2017 Nov;182(11):e1815-e1818. doi: 10.7205/MILMED-D-17-00073.

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Select item 2907435616.Anti gliadin antibodies (AGA IgG) related to peripheral inflammation in schizophrenia.
Kelly DL, Demyanovich HK, Eaton WW, Cascella N, Jackson J, Fasano A, Carpenter WT.
Brain Behav Immun. 2017 Oct 23. pii: S0889-1591(17)30476-2. doi: 10.1016/j.bbi.2017.10.020. [Epub ahead of print]

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Select item 2907218717.Substance abuse and cancer.
Moussas GI, Papadopoulou AG.
Psychiatriki. 2017 Jul-Sep;28(3):234-241. doi: 10.22365/jpsych.2017.283.234.

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Select item 2905746718.Vortioxetine exerts anti-inflammatory and immunomodulatory effects on human monocytes/macrophages.
Talmon M, Rossi S, Pastore A, Cattaneo CI, Brunelleschi S, Fresu LG.
Br J Pharmacol. 2018 Jan;175(1):113-124. doi: 10.1111/bph.14074. Epub 2017 Nov 28.

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Select item 2905312619.[Effect of cytokine genes and season of birth on personality].
Alfimova MV, Golimbet VE, Korovaitseva GI, Lezheiko TV, Kondrat'ev NV, Gabaeva MV.
Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(9):82-87. doi: 10.17116/jnevro20171179182-87. Russian.

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Select item 2903876720.Evaluation of plasma cytokines in patients with cocaine use disorders in abstinence identifies transforming growth factor alpha (TGFα) as a potential biomarker of consumption and dual diagnosis.
Maza-Quiroga R, García-Marchena N, Romero-Sanchiz P, Barrios V, Pedraz M, Serrano A, Nogueira-Arjona R, Ruiz JJ, Soria M, Campos R, Chowen JA, Argente J, Torrens M, López-Gallardo M, Marco EM, Rodríguez de Fonseca F, Pavón FJ, Araos P.
PeerJ. 2017 Oct 12;5:e3926. doi: 10.7717/peerj.3926. eCollection 2017.

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We Are Getting Ready To Break Out of Our Latest Dark Age Regarding Mental Illness--Time Is Relative -- It's Time To ACT UP!

1/6/2018

I remember growing up and thinking I really lucked out to be born in a Time of such Knowledge, Reason, and Compassion.
Human History is NOT that pretty. BUT it is ALL better NOW.
Well, in a lot ways it is better; things have improved a lot. BUT in a lot of ways it is still pretty scary.

Exhibit A: Mass Incarceration of People with Invisible Mental Health & Cognitive Disabilities
Exhibit B: Homelessness of People with Invisible Mental Health & Cognitive Disabilities
Exhibit C: Professional reliance on an outdated and discredited [by the former National Institute of Mental Health Director Thomas Insel no less]--- DSM 5 -- Ya Gotta Love It.

In the meantime, there is a pretty substantial growing body of evidence that at least some mental health problems and other disorders including Alzheimers are related to injury to the immune system which ultimately leads to cognitive problems.

It is really time for the Mental Health Community & the larger Disability Community to take a page from the AIDS Community and ACT UP!

Luckily, we've got great role models in the ADAPT folks right here in Colorado.

WE CAN'T CONTINUE TO PUT UP WITH THE BAD TREATMENT & BAD SCIENCE WE'RE JUST SUPPOSED TO ACCEPT.

Our E-mail to the State on Parity, Assertive Community Treatment, & Innovation

It seems to me ACT (assertive community treatment) is covered under Parity & the State can require:

Reasonable Medical Necessity, &
That there is not a viable less expensive treatment that is just as effective.

As currently constructed Colorado Intensive Case Management is not a substitute for ACT.

That is not to say something couldn't be constructed that would be a substitute in some cases. That really should be an inclusive process.

A lot of things are breaking scientifically that are changing our understanding of neurological disorders from Alzheimer's to traditional mental illness such as schizophrenia and bipolar disorder.

AND in both the case of Alzheimers and mental illness that should lessen the need for long-term care such as ACT, nursing home care, etc.

A lot of that activity is going on @ the University of Colorado.

Further, the University of Colorado has the National Behavioral Health Innovation Center.

Additionally, CO Medicaid is leading in the integration of physical & mental health issues.

That is really important because these new understandings regarding mental illness are very much tied to the immune system and immunology and the microbiome.

See:

Neuroscience News: Treatable Immune System Disorder Could Be Mistaken For Schizophrenia or Bipolar Disorder in Significant Number of People http://neurosciencenews.com/schizophrenia-immune-disorder-bipolar-8179/

"Researchers at Houston Methodist believe that a significant number of people diagnosed with schizophrenia or bipolar disorder may actually have a treatable immune system condition.

"A new research study could have a significant impact on the millions diagnosed with schizophrenia or bipolar disorder, including many homeless."

I don't really have a problem with creatively and ethically containing the costs of care for people with mental illness. I have a big problem in pretending they just don't need it or somehow some critical treatment isn't covered by the LAW.

New Science Is Amazing & It Has HUGE Moral Implications NOW!

Dr. Peter Fonagy on the 17-year lag time to get evidence-based treatments to the people who need them & how people with physical illness would NEVER put up with the poor care associated with our current Mental Health Systems among other topics.

Science Up

OK-- States Can Do Prior Authorization for ACT Under Parity BUT NOT On Cost Alone

1/5/2018

So the BIG QUESTION is not can States require prior authorization for Assertive Community Treatment -- BUT on what grounds.

We think it pretty clear that States can require prior authorization based on:

reasonable medical necessity (See CMS Parity Toolkit);
a viable less expensive alternative treatment that is just as effective (we would note there is research showing that intensive case management is NOT as effective as assertive community treatment in appropriate cases)

So that brings us to the CRUX of the MATTER -- Can States Deny ACT Based on Cost Alone Where:

Reasonable Medical Necessity is Satisfied, and
There is NO Viable Less Expensive Alternative that is Just As Effective

Our Answer is NO the State Cannot Deny ACT Under Those Circumstances. Otherwise, what is the Point of Parity.

And that was really the ANSWER of the California Court in addressing the issue under the California State Parity Law as well.

Washington State Parity Analysis

In order to rectify the discrepancy between the outpatient BH and M/S benefits, the state will remove the language in BHO contracts that requires initial authorization for all outpatient services.

The contract language will allow authorization of some of the highest intensity services, such as the Program for Assertive Community Treatment (PACT).

Allowing the BHOs to require prior authorization for some, but not all, of their outpatient benefit brings that system in alignment with the outpatient
M/S benefit.

The state will incorporate these changes into the January 2018 BHO contracts. This allows time for contract negotiation, execution, and submission to CMS. In the coming weeks, the state will meet with BHOs to better define which high-intensity outpatient services may require additional authorization (e.g. PACT) and to identify data and operational changes.

Eligible Recipients for ACT in Minnesota -- Colorado NEEDS to Catch Up With the Law & Stop Harming Its Citizens

1/4/2018

Below from the Minnesota Dept. of Human Services website:

Eligible Recipients

Recipients eligible to receive ACT [Assertive Community Treatment] services must meet the following criteria as assessed by an ACT team:

18 years old or older (Individuals ages 16 and 17 may be eligible upon approval by the commissioner)
Have a primary diagnosis of schizophrenia, schizoaffective disorder, major depressive disorder with psychotic features, other psychotic disorders or bipolar disorder
Have a significant functional impairment demonstrated by at least one of the following:
No indication that other available community-based services would be equally or more effective as evidenced by consistent and extensive efforts to treat the individual; or a
Written opinion of a licensed mental health professional that the recipient has the need for mental health services that cannot be met with other available community based services, or is likely to experience a mental health crisis or require more restrictive setting if assertive community treatment is not provided.

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_058151

We know that ACT has also been used with people experiencing substance issues. We haven't thoroughly researched that; although the principles would appear to be the same.

It certainly seems pretty clear to us that under Parity Colorado Medicaid should be covering Assertive Community Treatment for people with mental illness where there is:

No indication that other available community-based services would be equally or more effective as evidenced by consistent and extensive efforts to treat the individual; or a
Written opinion of a licensed mental health professional that the recipient has the need for mental health services that cannot be met with other available community based services, or is likely to experience a mental health crisis or require more restrictive setting if assertive community treatment is not provided

Boulder County Jail Inmate with Psychosis Gouges Out His Own Eyes: Possible Jail & County Liability for State Failures to Adequately Resource Mental Health

1/2/2018

Well, Colorado State Government is trying to address Mental Illness in Criminal Justice, BUT

The Scale of the Problem is HUGE.
The Lack of Inclusion of People with both mental illness & criminal justice involvement absolutely negatively impacts the effectiveness of policies; and
The refusal to address this through Olmstead Planning -- reasonable & measurable goals, reasonable time frames, and funds to support the plan -- make coming to terms with the Scale of the Problem almost impossible. --- AND Oh Yeah, it's the Law.
Last year, Colorado approved approximately $2.7 million for housing and supportive housing for inmates with mental illness leaving jails and prisons. That's great, but that's a drop in the bucket with respect to the need.
AND Colorado needs a lot more bed space and needs to implement Open Dialogue and the Soteria approach to mental health community treatment.

We're really seeing the tip of the Iceberg when we see these lawsuits filed against jails, prisons, or mental health facilities regarding inmates or patients with mental health issues.
With regard to private lawsuits, it really helps if you're dead or horribly maimed. Otherwise, most private attorneys are not going to take the case, and they probably can't afford to.
With regard to systemic public interest cases, they are hugely important and hugely resource intensive.
So a lot of stuff -- really bad human rights violations not amounting to death or maiming -- are allowed to fester -- leading to more horrible problems.
True compliance with Olmstead and Parity is in large measure the ANSWER.
Addressing the Scale of the Problem, rather than running from it ---- would help a lot, too.

The Tragic Highlands Ranch Officers Shooting Hits Close to Home -- If We Can't Predict These Things -- Don't We Need to Regulate Guns A Lot More

1/1/2018

Our family lives very close to where the Highlands Ranch Officers Shooting occurred. In fact, University, Colorado, County Line -- those are our Stomping Grounds.
This is not the first horrible shooting and it is probably not going to be the last that was NOT prevented by our current systems of:

Mental Health Provision; and/or
Gun Regulation

We sometimes like to "think" that serious mental health problems are the province of "those people." The scary reality is serious mental health problems are the province of human beings and the human condition and processes that are often little understood.
There may be a lot of warning signs and red flags, but they often get ignored. AND sometimes, it really wasn't clear to anybody.
Just to make it more interesting, most people with some type of mental health issue are not dangerous, and some are.
Further, mental health problems while they may have been building -- can appear to manifest rather suddenly.
We have way too little knowledge, and way too many problems with mental health to allow the level of gun ownership in the general public that we currently have in this Country and in Colorado.
We've been very critical of the Hickenlooper Administration on other matters, but they took a lot of hits to champion reasonable gun control in this State.
AND we think the reality is the State and Country need a lot more reasonable gun control measures to prevent the kind of tragedies that occurred in the Highland Ranch officers shooting.

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