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Why D.J. Jaffe is Such A Hero -- States Must Have Community Mental Health Systems that Can Serve People Coming Out of Prisons, Jails, Nursing Homes, Homeless Shelters/Streets & Hospitals

9/17/2017

An Emerging Consensus Mental Health Policy for Citizens with Intensive Mental Health Needs After Decades of Gross Neglect

If one wins the debate, one may feel comfortable to start moderating -- and that seems to us to be the case with conservative D.J. Jaffe and the Mental Illness Policy Organization.
  Jaffe had to take on pretty much the entire mental health advocacy world including Bazelon and the National Protection and Advocacy System for People with Disabilities to make what now seems the obvious case that the sites of greatest institutionalization for people with mental illness in the US are jails and prisons.
  But even if you weren't in DENIAL, it seemed like Jaffe's policy prescriptions left something to be desired: GO BACK TO INSTITUTIONALIZATION and/or FORCED TREATMENT.
   Now, of course, Colorado has Assisted Outpatient Treatment [Outpatient Certification] -- what that really means without resources is pretty questionable and even Jaffe would acknowledge that.
  Of course, certification, inpatient or outpatient -- is really treatment failure -- and in this environment you have to look @ the paucity of resources as a potential factor -- and the paucity of resources for treatment of people with INTENSIVE MENTAL HEALTH NEEDS such that they would otherwise be in the:

Prison
Jail
Nursing Home,
Hospital. or
Homeless Shelter/Street

still shocks the conscience even with all the good things that have been done.
    In 2017, Jaffe is arguing for 50 psych beds for every 100,000 people.  That doesn't strike us as grossly unreasonable -- especially, in Colorado's case which has a very large and growing transient and homeless population which includes some people with serious mental health needs. It may especially be needed to stabilize people before more permanent placements.
      Colorado has a population of roughly 5.5 million people -- that would be about 2,750 psych beds. The mental health institutes have less than 600.
   Additionally, our understanding is that CMHIP is pretty much forensic at this point and they still don't have enough beds.
   As our understanding grows of some of these mental health issues in the criminal justice context we should anticipate more not less need for both inpatient and intensive community care.
   Of course, community care is less expensive than hospital care generally BUT INTENSIVE COMMUNITY MENTAL HEALTH SERVICES ARE NOT INEXPENSIVE --

THAT IS WHY Evidenced-Based Gold Standard in Community Mental Health Treatment --ASSERTIVE COMMUNITY TREATMENT --- IS NOT AVAILABLE TO ALL WHERE REASONABLE MEDICALLY NECESSARY

     That is BIG Time Discrimination CO Department of Health Care Policy & Financing / Hickenlooper Administration.

   And this brings us to where Jaffe really surprised us -- the call to FUND Community Mental Health Care for those with the most intensive mental health needs.

   We don't think you can just write off people with less intensive mental health needs ---- and maybe this is the beginning of a Beautiful Friendship.

D.J. Jaffe, CMHIP, Our Olmstead Planning Bill & TABOR: It Is Long Past Time To Have A Come To Jesus or More To The Point -- A Come To Reality

9/16/2017

Colorado Hasn't Allocated the Resources for the Inpatient Care or Community Care Colorado Citizens with the Most Intensive Mental Needs --- Need. That Has and Is Leading to in the words of Conservative Mental Health Advocate D.J. Jaffe "Insane Consequences." And that is true even in economically prosperous Colorado.

D.J. Jaffe is hardly a darling of the Left, in fact he is generally embraced by the Right, and we don't necessarily agree with all the prescriptions -- BUT he has pretty accurately described the problem in the US that people with the most intensive mental health needs have been written off as too expensive and cost shifted to the criminal justice system and the homeless shelter.

How can we have:

an evidenced based community mental health treatment such as Assertive Community Treatment that is the gold standard in intensive community mental health treatment
a major component of many MI US Dept. of Justice Olmstead Settlement Agreements, and
Yet not systematically required to be provided where reasonably medically necessary and desired --- politics? this is insane & life-destroying.

AND We Do Need More Beds & Sufficient Salaries for Staff.

We're asking the Hickenlooper Administration, Colorado Attorney General Coffman's Office, and the Colorado Legislature to look at the State's obligations under Federal Law as falling outside of TABOR restrictions based on the Supremacy Clause to the US Constitution.

Specifically, for our purposes that would mean:

State obligations to meet Federal Safety and Staffing requirements of facilities, etc.
Obligations under the federal Americans with Disabilities Act and the 1999 Olmstead decision and subsequent caselaw and federal guidance, etc.

National Review
By D.J. Jaffe
Price's War On Mental Illness
http://www.nationalreview.com/article/451039/mental-health-spending-serious-illnesses-should-get-bulk-spending

Democracy, Representative Government, & Inclusion -- We've Got To Change -- Our Governments Don't Work for a LOT of PEOPLE

9/13/2017

     We trace our democratic roots to ancient Greece, and yet even there democracy had a bad rap among some -- Mob Rule basically.
It is certainly not easy, and generally in modern times we agree with Churchill -- it is the worst form of government -- except for everything else.
Of course, we don't have "direct democracy" and direct democracy's manifestations in the US -- think especially California, but Colorado too, the referendum process -- has its critics.
   AND yet the US-form of democracy is in a lot of trouble folks. To the untrained eye, it looks a whole lot like an oligarchy.
   Even with all the good things the Hickenlooper Administration has going for it -- AND there are a LOT -- there have been A LOT of problems with LACK OF INCLUSION & NULLIFYING COMMUNITY DECISIONS in the case of the choice of the Crisis Center Providers, never really having the diverse input that is necessary for the mess that is CMHIP (Colorado Mental Health Institute @ Pueblo), etc.
     In fairness, some of this may be (likely be):

unconscious bias (they are not even aware of any bias)
lack of capacity and a protective reaction (it takes time and energy to include people)
etc.

It is critically important that our government officials have the "capacities" -- in time, money, and processes to substantively engage with people who are perceived as significantly different from themselves or marginalized.

Those reasons as well as many others are why we are supporting a CO Olmstead Planning Bill. We believe its potential as a model could go beyond the disability community.

We Need Real Inclusion On CMHIP & Olmstead

9/11/2017

I don't have a problem with "empathizing" with state officials who are charged with the difficult duty of addressing the CMS initial "immediate jeopardy" determination and the larger long-standing staffing problems at the Colorado Mental Health Institute @ Pueblo.

   In fact, such empathy and understanding is no doubt essential.

   Having said that, it does not appear that Colorado State Government has the processes in place to successfully address the scope of this problem.

   The State does not appear to be empowered to do what it needs to do, or does not "think" it is empowered to do what it needs to do to address this crisis -- and large scale staffing problems at a large institute of vulnerable individuals is a crisis.

   No doubt in the midst of crisis it is hard to figure out how to include people -- but that lack of inclusion is part of the reason for the current crisis @ CMHIP.

   We don't know whether to laugh or cry or both when the Hickenhooper Administration sets up what come off as pretty bogus "listening sessions" around state -- and they can't talk about Olmstead or CMHIP with the diverse Mental Health Community that wants to talk them about those issues..

   BTW Olmstead Compliance is required by federal law and NOT subject to a poll taken by the State.

Telephone Conferences on CMHIP Staffing Issues & Olmstead Planning Bill

9/11/2017

1. CMHIP Staffing Issues Telephone Conference

   We will be having a brief telephone conference on CMHIP Staffing Issues on Friday, September 15, 2017 from 2 -2:30 p.m.

2. Olmstead Planning Bill Telephone Conference

I have been contacted by folks about next steps specifically regarding the Olmstead Planning Bill. We will be have a brief telephone conference from 2:45-3:30p.m.

I'll get out a draft agenda Tues. along with the specifics on the calling information. If you would like to be on the e-mail list, e-mail val -- [email protected]

Anybody is welcome whether individuals, advocates, providers, or people with government.

Integrating Physical Health, Mental Health & the Law: Trying To Shore Up Our Incompetent Mental Health & Legal Systems

9/10/2017

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/

Val's Take

It is not just our model of Healthcare that is outdated -- our model of Justice is outdated and not just a little bit -- It Shocks the Conscience.
We have Legal Systems in place that purport to make determinations in which the scientific knowledge to make such determinations does not exist -- and saying they're just Legal Concepts is a Legal Fiction I'm not willing to go along with.
Amazingly, these determinations are made everyday.
How did this happen? Well, I think actually for initially benevolent purposes and at the behest of defendants and their counsel to address the situation of someone who at the time of the crime was "insane. "
Well, this hardly ever happens -- except it happens a lot -- things turned out to be a lot more complicated than we thought.
Right now (subject to change):

One of the leading theories regarding mental health is the Immune-Gut-Brain Triad
Former National Institute of Mental Health Director Thomas Insel says we don't even have a parts list for the Brain and this is a time of "discovery" -- we have to be "humble."
Further, Insel maintained that the DSM 5 lacked scientific validity and that's one of the reasons for the Research Domain Criteria Program (RDoC).

The Law treats the criminal law and "punishment" differently than other determinations with higher burdens of proof.

When we punish someone we're theoretically punishing both the bad act and the bad intent.

Reality is presenting us a very messy picture not only with the Immune System and the Microbiome but with Social Determinants of Health.

It is long past time for us to let go of punishment, and focus on:

safety
evidence-based treatment, and
addressing the "root causes" of problems.

Missing the Boat on the Staffing Problems @ the CO Mental Health Institute @ Pueblo

9/8/2017

CMHIP Staffing-- Is This A Math Problem?

Partly, BUT The Problem Is Much More Complicated Than That:

It is failing to treat adequate staffing as the "emergency" issue it really is
It is decades of politicizing the placement and growth of mental health and other care facilities regardless of what is in the best interests of patients or whether we can adequately staff the facilities.

Yeah, staffing is a problem all over the Country, all over Colorado -- BUT if we don't "get" that some places are particularly difficult to staff and that leads to consistently substandard and sometimes horrific conditions in patient care --- we've missed it -- we've missed the proverbial BOAT.

AND anybody in good faith can miss it:

the public
advocates
policymakers
officials

These are the people who have said to me personally that it is a problem to staff the Colorado Mental Health Institute @ Pueblo because of its location:

Former CMHIP Superintendent Bill May
Some CMHIP Staff
Many CMHIP Patients who related that Staff told them it was hard to staff because of the location.

Further, a long term complaint of patients has been lack of staff.

This is very much a political problem and people with mental illness are getting the short end of the stick and they have been for decades.

We need to get to the "root cause" and get specific -- not just staffing problems in the nation -- BUT deal with the highly politically charged problem of "location."

In the blog immediately preceding this, I listed some things we think can calm things down:

Dialogue
Data
Inclusion
Process

We desperately need those things when it comes to CMHIP.

How Quickly We Forget . . .

Dialogue, Data, Inclusion, & Olmstead -- Something Old & Something New

9/8/2017

I remember being in a Comedy Club in College and the comic asking some of us what our majors were.
   I said I was a Letters Major -- it's a broad liberal arts major concentrating on Literature, History {Including History of Science], & Philosophy with Ancient and Modern Language.
"What are you going to do -- open up a philosophy shop?" he asked.
   Well, of course, not. I was much more practical than that -- I was going to go to Law School -- and Change the World.
   Well, unbeknowst to me and a lot people I had ADD and didn't get diagnosed until I was 50. I picked a helluva career for someone with ADD, but like a lot of things maybe it's a blessing in disguise.

So this is a very long introduction to my relationship to philosophy and DIALOGUE and mental health and our Olmstead Planning Bill.

   Classically, we think of Socrates asking impertinent questions about the meaning of common words such as "virtue" and revealing that our understanding of those "common" words isn't as good as we think it is.

   On the Orchid website, we try to ask difficult questions about the State of the Science regarding psychiatry and psychology.

   With "Open Dialogue," I did notice that the Finnish practitioners were linking this up to "democracy."

   Initially, I thought "Yeah, yeah -- that's really going to freak some people out in the US."

   BUT it was really only after seeing the UK Psychiatrist and Psychiatric Leader promoting "Open Dialogue" as a means of general political reform -- that I realized the full meaning & importance of this.

All around the world, people are viewing their circumstances and those of others through a "mental health" lens.

More and more, people want "Open Dialogue."

   "Change" is messy and stressful. My experience is that DATA, A PROCESS, & INCLUSION can calm things down.

One of the things I loved about going to a University was the many different colleges -- AND how they all saw the world and the universe through their own lens.

"Open Dialogue" by itself is not enough
Data by itself is not enough
A Process by itself is not enough
Inclusion by itself is not enough
Etc.

Those are some of the many reasons we are asking everyone to help make our Draft CO Olmstead Planning Bill the best it can possibly be and so that it may serve as a National Model.

^Change Around The World
We're NOT big fans of "chaos" & there is no getting around that change can be messy & stressful.

BUT It can certainly be worth it. Our efforts are about Olmstead Planning, disability rights, mental health rights -- it is also about Inclusion & Democracy..

Complexity: One of the Biggest Reasons We Need An Olmstead Planning Bill

9/7/2017

It is both very complex for States to comply with Olmstead and very complex for people with disabilities to enforce Olmstead.
From our perspective that has lead to widespread non-compliance. That doesn't mean that tremendous life-changing progress hasn't been made -- it has.
But if we want to realize the promise of Olmstead -- we must embrace the complexity of a:

Comprehensive
Effectively working Olmstead Plan

Well what does that mean? Federal Courts & the US Department of Justice have been fleshing that out.
We know it means:

Specific Measurable Goals (the Goals under Colorado's Community Living Plan are Too Vague & Lack Accountability)

We also know from the 2010 US Department of Justice Delaware Findings Letter, general Public Health principles, and common sense that we need to link these specific measurable goals with the overall need.

Bringing Housing & Services to Scale to Meet the Need [for people with disabilities who are institutionalized or are at great risk of institutionalization such as in homelessness]

We need to build the Olmstead Planning Process into Statute because we want to specify what it looks like and we know it is going to span administrations.

This is a LONG TERM PROCESS and IT IS GOING TO SPAN ADMINISTRATIONS

We want to:

Comply with Federal Law,
Build In Some Certainty & Predictability, &
Tailor Our Olmstead Planning Process to Colorado

"Emotional Intelligence," Conformity, Unconscious Bias -- & Taking It To The Next Level

9/6/2017

I do appreciate the work on "Emotional Intelligence" but I can get really frustrated and angry about it too.
   At least as presented in some of these recent incarnations, it is a whole lot about learning how to conform to get ahead.
   Now I'm pretty sure the "Emotional Intelligence" folks would dispute that or at least in large measure -- but that's my take.
   I don't see a problem with:

Learning about common human responses; or
Using that for mutual benefit

What I do have a problem with is dividing the world into the:

The Emotionally Intelligent People, and
The Toxic People

   And the "Toxic People" are pretty much people who express their emotions in ways that the "Emotionally Intelligent" people don't like.
Now I'm not arguing for being mean to people.
   What I am saying is that there is a much wider range of healthy human emotional expression than is approved by "Emotional Intelligence" proponents.
   But what they are really about is conforming and getting ahead -- and their "Emotional Intelligence" -- isn't really that healthy.
Now they will throw in the occasional nod to "authenticity," but that is not the primary focus -- it's reading other people and acting accordingly so you can make more money.
I'm not against people making money or learning about emotions -- but a big part of that has to be diversity -- not just a nod to it -- and that means diversity in expressing emotion.

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