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Neuro-Developmental Disorders in the Criminal Justice System

9/13/2022

Warning: TRAUMATIC SUBJECT MATTER

Conjecture

Right now we've been "coming to terms" with the HIGH PERCENTAGE of people with serious and persistent mental illness in the Criminal Justice System.

It's on the EXTREMES and its EASIER TO SEE --- HOLMES, GLEN BURTON AKE in Oklahoma many years ago are EASIER TO SEE.

"Glen Burton Ake was arrested and charged with murdering a couple and wounding their two children in 1979. At his arraignment, his bizarre behavior prompted the judge to order a psychiatric competency evaluation."

Ake v. Oklahoma - Wikipedia

[I was a Sophomore in High School in Oklahoma in 1979 --- It was one of the most heinous crimes I think most people could imagine being committed.

It was at least one of the reasons why my father who was so forward thinking in so many areas --- was not for getting rid of the DEATH PENALTY.

As a young Assistant District Attorney, I remember seeing Glen Burton Ake on REMAND --- apparently shot up with THORAZINE, his head and long stringy hair hanging down as the JUDGE said there would be a special place in HELL for him.

Was it AKE or one of the many others --- I forget.

I remember thinking at the time(s) the JUDGE(S) was/were wasting his/her/their time.

BUT I as a young assistant DA --- nobody cared what I thought -- I wasn't trying death penalty cases --- and at time time I didn't really see the DEATH PENALTY as the BIG ISSUE in Criminal Justice.

The Death Penalty was a BIGGER KEY to CRIMINAL JUSTICE REFORM than I realized at the time because it was going to FOUNDATIONAL VALUES.

Importantly, heinous crimes that shock the conscience aren't just those resulting in death --- the Kidnapping of Elizabeth Smart certainly qualified. The Mental Health Problems of the Kidnappers of Elizabeth Smart --- were on the EXTREMES and EASIER TO SEE.

I remember hearing of a man in California who had sexually assaulted and cut off the arms of a young girl ---- and thinking I could kill him quite easily myself.

In the last few years, WESTWORD pointed out that NOT GUILTY BY REASON OF INSANITY isn't just for that axe murderer anymore --- which I think we all should take a moment to be GRATEFUL for.

Later, I would work for THE LEGAL CENTER FOR PEOPLE WITH DISABILITIES & OLDER PEOPLE ---- I think we both thought the other was quite NAIVE --- often in IRONIC WAYS.

BUT THE TRUTH IS WHILE A SIGNIFICANT PERCENTAGE OF PEOPLE IN THE CRIMINAL JUSTICE SYSTEM HAVE SEVERE & PERSISTENT MENTAL ILLNESS ---

NEURO-DEVELOPMENTAL DIFFERENCES such as ADHD, AUTISM and/or DYSLEXIA are ENDEMIC to the CRIMINAL JUSTICE POPULATION.
Those "SUBSTANCE ISSUES" are often an attempt to "MANAGE" a DYSREGULATED BIOLOGY that can absolutely be made worse by BAD SOCIAL CIRCUMSTANCES.
- EPIGENETICS

Poor Males and Males of Color with Neuro-Developmental Disorders are much more likely to find themselvs in the CRIMINAL JUSTICE SYSTEM.

We have I think let the BATTLE of the SEXES get OUT OF CONTROL and generally FAIL to RECOGNIZE CAUSES beyond the first link in the chain of causality.

To me this is similar to Henry the VIII blaming his wives for the problems he had in acquiring a male heir.
MALE BAD BEHAVIOR can be a BIG PROBLEM--- probably some of it --- is related in part to MATERNAL IMMUNE ACTIVATION during pregnancy which is associated with both NEURO-DEVELOPMENTAL & PSYCHIATRIC DISORDERS.
- That MATERNAL IMMUNE ACTIVATION is quite COMPLICATED and part of it could be in some cases attributed to a BAD SOCIAL ENVIRONMENT --- in other cases --- other factors might be more influentIal.
- Further, there are complicated GENERATIONAL & HISTORIC ISSUES.

Scientific Reality, A Kinder Gentler Nation --- & Making Our Piece with the State of Nature

Allan David Bloom (September 14, 1930 – October 7, 1992) was an American philosopher, classicist, and academician. --- Wikipedia

Breaking Things Down --Lowering the Burden of Proof for Safety--- Getting Rid of Punishment

9/5/2022

Conjecture

Below is information on a beneficial bacteria suicidal people may be missing. There's also work on a blood test for suicidality.

I personally think we're going to find biomarkers for homicidality as well.

One of the things that is going on with Biomarkers is often not as simple as a SINGLE GENE ---

Additionally, there's the "BRAIN" --- but there's a lot going on outside the Central Nervous System --- including the Immune System, the Endocrine System, Metabolism, etc.
There's a lot of "DEVELOPMENTAL DIFFERENCE" out there related to ADHD and/or Autism that is related to MATERNAL IMMUNE ACTIVATION and SYSTEMIC DEVELOPMENTAL INFLAMMATION.
- For people with SYSTEMIC DEVELOPMENTAL INFLAMMATION and an IQ over 70 --- what's out there in terms of TREATMENT & "SUPPORT" is so INADEQUATE it is BURNING OUT and BREAKING DOWN many people.
  - PART OF "PRO-LIFE" is SUPPORTING PEOPLE (ALL PEOPLE) -- INCLUDING AFTER THEY ARE BORN.
There's Epigenetics
There's ENVIRONMENT and
There's the MICROBIOME which is NOT even technically "HUMAN."
All of these things and more have complicated inter-relationships.
When we think about "JUSTICE" --- those "IDEAS" have evolved.
"BURDEN OF PROOF" is one of the "IDEAS" that we came up with to address the EQUITIES of who should bear the BURDEN of bringing forth evidence.

Related Ideas include:PRIMA FACIE ---

Prima facie may be used as an adjective meaning "sufficient to establish a fact or raise a presumption unless disproved or rebutted." An example of this would be to use the term "prima facie evidence."

It may also be used as an adverb meaning "on first appearance but subject to further evidence or information." An example of this would be to use the term "prima facie valid."

A prima facie case is the establishment of a legally required rebuttable presumption. A prima facie case is a cause of action or defense that is sufficiently established by a party's evidence to justify a verdict in his or her favor, provided such evidence is not rebutted by the other party.

I think what has happened over the course of Centuries and currently at a very fast pace is the understanding of the BIOLOGICAL BASIS OF BEHAVIOR.

Stanford Professor Robert Sapolsky's book
Behave: The Biology of Humans at Our Best and Worst Selves makes that PRIMA FACIE CASE for the BIOLOGICAL BASIS OF BEHAVIOR.

Let's just say that the "BIOLOGICAL BASIS OF BEHAVIOR" was NOT the motivating force behind the Origins of the Criminal Law except in an indirect way.

I love this video with Professor Sapolsky --- I think he makes some excellent points with regard to the HISTORICAL TRAJECTORY of our Understanding of Behavior and its Biological Basis.

How Many Angels can dance on the head of a pin and The Free Will vs. Determinism Debate

I don't agree with Sapolsky's framing of the "FREE WILL vs. DETERMINISM DEBATE" and the reason I don't agree with it and really with the construction of the debate itself is because it is RUNNING IN THE WRONG DIRECTION CHRONICALLY and the "ABSOLUTIST" framing bears little relationship to "REALITY" and practical concerns.

I think people want "CONTROL" over their lives and Human Beings have been working to get that "CONTROL."

As we get more UNDERSTANDING of our BIOLOGY and the World Around US --- we can and do get more "CONTROL" --- we often also learn that things were not as they appear or more complicated than we thought.

There are an INFINITE NUMBER OF POINTS between "FREE WILL" and "DETERMINISM" and all around those two points that the DEBATE seems to miss.

BUT unless we someday become gods who are ALL-KNOWING --- WE NEED TO GET OUT OF THE PUNISHMENT BUSINESS.

So maybe Sapolsky is right insofar as our ideas going to "FREE WILL" are foundational to our systems of "PUNISHMENT" --- and we need to get out of PUNISHMENT.

Further, even "GOD" may not be in the PUNISHMENT BUSINESS.

Bishop Carlton Pearson says he received a religious message that there is No Hell.

Mental Health Courts --- Pro & Con

We've started to address biological issues in Criminal Justice much more DIRECTLY in the form of PROBLEM-SOLVING COURTS --- specifically, MENTAL HEALTH COURTS, DRUG COURTS and even VETERANS COURTS.

The BURDEN of PROOF in CRIMINAL LAW is SO HIGH --- PROOF BEYOND A REASONABLE DOUBT --- WHY?

Because we're talking about "PUNISHMENT" -- often SEVERE PUNISHMENT.

The "BIOLOGICAL BASIS of BEHAVIOR" undermines the RATIONALE for PUNISHMENT --It doesn't undermine the RATIONALE for SAFETY.

On the one hand, we've already developed "CERTIFICATION PROCEDURES" for danger to self or others or gravely disabled ---With a LOWER BURDEN of PROOF than in the Criminal Law.

On the other hand, we have a HEALTH CARE SYSTEM that was overwhelmed by various forms of "COGNITIVE DISABILITY" early on.

It got a lot WORSE with DE-INSTITUTIONALIZATION for many reasons.

Over-Reliance on the "MIRACLE" of psychotropic drugs being one of the issues.

Leading to a FAILURE to INVEST in INTENSIVE SUPPORTS in the COMMUNITY.

Understanding the CONNECTION between DEVELOPMENTAL DIFFERENCES such as ADHD and Autism and PSYCHIATRIC DISORDERS and persistent EXECUTIVE FUNCTIONING CHALLENGES ---

Could greatly INFORM NEEDED SUPPORTS in the COMMUNITY.
It could also potentially "MITIGATE" some of the COSTS.

University of Florida

Differences in Saliva Bacteria of Students With Recent Suicidal Thoughts (2022)

August 27, 2022

Neuroscience News

Summary:

Students who reported recent suicidal thoughts had different bacterial compositions in their saliva compared to those who did not report suicidal thoughts.

Significantly, suicidal students presented with lower levels of Alloprevotella rava, a bacteria associated with positive brain health, in their saliva samples.

"PERFECTIONISM" and the Failure to Address an Out of Date DSM ---- We Need Interim Procedures

8/24/2022

When we think of "PERFECTIONISM" we often think of young women and eating disorders -- we might think of Karen Carpenter.
But perfectionism and eating disorders impact young men, too.
Further, that "PERFECTIONISM" is very much to be found in our:
- Research Community
- Medical Community and
- Legal Community
That's not all a bad thing, right? It's not.
But especially with Mental Health and the "PRO SOCIAL COMPETENCY EXPERTS" --- there is a "TIMIDITY" to addressing obvious problems and stick your neck out.

The current OUT OF DATE DSM is just such a LARGE, LOOMING ISSUE that REVERBERATES in the Criminal Justice System and throughout the Society.

It can feel a lot "SAFER" to sit up in the BALCONY and pontificate on "NARCISSISM" or "ANTI-SOCIAL PERSONALITY DISORDER" --------Than it is to address the SERIOUS FOUNDATIONAL ISSUES in one's own profession.

Neuro-Developmental Differences and --What It Really Means to be PRO-LIFE

8/20/2022

Conjecture

When we think of "PRO-LIFE" we think of the Abortion Debate ----
But in so many ways --- LIFE is a "CIRCLE GAME."
We're "CONNECTED" to our parents, grandparents, family tree, society and the environment around us in COMPLICATED WAYS that we "kinda" understand.

We often are having to ADJUST OUR FOCUS from a "TIME PERSPECTIVE" and from a "MICRO to MACRO" Perspective and everything in between.

If we want to get out of the INCARCERATION CRISIS in the US -- we need to do something that feels COUNTER-INTUITIVE and even SCARY given our history of Genocide and Eugenics----

Recognize the Large Incidence of Neuro-Developmental Difference in People with an IQ over 70.
Without the proper SUPPORT, Work-Arounds and Accommodations ----
- A small percentage of this population make up a very large segment of the incarcerated and chronically homeless populations.

"WALKING CHAOS" and Diagnostic Manuals THAT ARE missing the "BIG ROCKS"

8/8/2022

cha·os the·o·ry
/ˈkeɪˌɑs ˌθɪəri/noun

1. the branch of mathematics that deals with complex systems whose behavior is highly sensitive to slight changes in conditions, so that small alterations can give rise to strikingly great consequences.

Powered by Oxford Dictionaries

Conjecture

I'm going to do some more "Riffing" off of Frank James' video to the right.

In the video, James makes a number of points:

People are "Walking Chaos"
- Yeah, you can predict what they are going to do a lot of the time --
- But they will throw you a CURVE BALL --- and then you have to revise your theories --
- But that will ultimately break down and you'll have to revise your theories again.

I want to bring actual "CHAOS THEORY" to this:

"CHAOS THEORY" isn't saying the world isn't ultimately understandable ---
BUT it is saying there are a lot more "VARIABLES" than what you thought and some of these seemingly "small variables" can have a big effect.

One of the reasons the FOUNDATIONS of MENTAL HEALTH as articulated in the Diagnostic and Statistical Manual are so "SHAKY" is because we're missing a lot of not only the small effects BUT a lot of the BIG ROCKS ---

MATERNAL IMMUNE ACTIVATION
GENETICS
EPIGENETICS
the IMMUNE SYSTEM
the ENDOCRINE SYSTEM
the MICROBIOME
the INTER-RELATIONSHIPS of these various SYSTEMS with the BRAIN

Frank James
How INFJ Ruins Relationships = "CONTROLLING"

See also Ramped Up Stress Responses Often Lead to Control Freaks

So we could just "PRETEND" what we're doing is sufficient and not LEGALLY, ETHICALLY and MORALLY CHALLENGED ---

and "GOD" knows that's what we are doing.

Or one option is to acknowledge the "COMPLEXITY" of HUMAN BEHAVIOR and that we don't have it all figured out and ----

THIS IS A PROCESS --- NOT AN EVENT.

I do think the more we can start meeting people where they really are in terms of STRENGTHS and WEAKNESSES ----

NOT where some IDEALIZED REASONABLE PERSON should be ---
While maintaining SAFETY ---
THE BETTER RESULTS WE'RE GONNA GET.

Developmental Difference with IQ over 70 in the Criminal Justice System

8/7/2022

(See addition on Brain Injury and ADHD below)

See also:

Missed & Misdiagnosed: The Importance Of Screening For Neurodiversity In The Criminal Justice System -- Different Brains (2021)

Neurodiversity in the criminal justice system: A review of evidence -- UK (2021)

This is going to focus mainly on the BLURRED Neuro-Developmental Differences of ADHD and Autism.

So some people do have a CLASSIC "presentation" --- BUT many don't --- and it can be very BLURRED.

Further, it is not just that OTHER PEOPLE don't understand --- it's that the person themselves and their families don't understand.

I think Developmental Difference cqn be a GIFT ---

BUT it can be a NIGHTMARE if you are trying to manage this in IGNORANCE.

The ATTITUDE of the study to the right is pretty standard --- the person with the Neuro-Developmental Difference is being measured on that person's "ADAPTABILITY" to a Neuro-Typical Society.

We are in desperate need of some DOUBLE EMPATHY --- this needs to be more of a TWO-WAY STREET.

I think if you bring together:

Neuro-Developmental Difference
Ignorance, and
Unconscious Bias
- You're basically going to get the CRIMINAL JUSTICE SYSTEM we have today.

Further, some of those folks with "BRAIN INJURY" --- may have started out with a DEVELOPMENTAL DIFFERENCE.

Do Toxic Synergies of Underlying Etiologies Predispose the Positive Association Between Traumatic Brain Injury and ADHD? (2020) --- Journal of Attention Disorders
Conclusion: The conclusion of this commentary is that the toxicological interdependence of the underlying etiologies for mTBI and ADHD may help to explain their association as found in the meta-analysis conducted by Adeyemo et al. This commentary explores this dynamic further and, in so doing, underscores the need for additional research to validate these important conclusions.

----Now are there people with Developmental Differences at the TOP of this SOCIETY behaving just badly as those in the CRIMINAL JUSTICE SYSTEM ----- THERE ABSOLUTELY ARE.

Asperger's from the Inside
High Functioning Autism --- It's NOT What You Think

The misnomer of 'high functioning autism': Intelligence is an imprecise predictor of functional abilities at diagnosis (2020)

Affiliations

1 Telethon Kids Institute, The University of Western Australia, Australia.
2 Stanford University, USA.
3 WA Department of Health, Australia.

Abstract

'High functioning autism' is a term often used for individuals with autism spectrum disorder without an intellectual disability. Over time, this term has become synonymous with expectations of greater functional skills and better long-term outcomes, despite contradictory clinical observations.

This study investigated the relationship between adaptive behaviour, cognitive estimates (intelligence quotient) and age at diagnosis in autism spectrum disorder.

Participants (n = 2225, 1-18 years of age) were notified at diagnosis to a prospective register and grouped by presence (n = 1041) or absence (n = 1184) of intellectual disability.

Functional abilities were reported using the Vineland Adaptive Behaviour Scales.

Regression models suggested that intelligence quotient was a weak predictor of Vineland Adaptive Behaviour Scales after controlling for sex.

Whereas the intellectual disability group's adaptive behaviour estimates were close to reported intelligence quotients, Vineland Adaptive Behaviour Scales scores fell significantly below intelligence quotients for children without intellectual disability.

The gap between intelligence quotient and Vineland Adaptive Behaviour Scales scores remained large with increasing age at diagnosis for all children.

These data indicate that estimates from intelligence quotient alone are an imprecise proxy for functional abilities when diagnosing autism spectrum disorder, particularly for those without intellectual disability.

We argue that 'high functioning autism' is an inaccurate clinical descriptor when based solely on intelligence quotient demarcations and this term should be abandoned in research and clinical practice.

Executive Functioning: Looking for a Strength-Based & Equitable Approach

Criminal Justice Index

Criminal Justice and Invisible Disabilities Index

Neuro-Behavioral Disability in the Criminal Justice System

"ANTI-SOCIAL ---PERSONALITY--- DISORDER"

7/31/2022

The Immune System, Neuro-Developmental Differences/ Disorders, Ramped Stress Responses, the Challenge of Double Empathy, Social Behavior, Ramped Up Sensory Processing, Epigenetic Changes and ---

SOCIAL ENVIRONMENTS &
INACCURATE MAPS

Conjecture

Neuro-Developmental Differences/Disorders, Psychiatric Disorders, and "Personality Disorders" [now starting to be CONCEPTUALIZED as Neuro-Developmental Disorders] are often papering over DEEPER INDIVIDUAL & GENERATIONAL IMMUNE ISSUES.
- Further, this is also occurring in the CONTEXT of CHRONIC DISEASE PROBLEMS --- CANCER and AUTO-IMMUNE DISORDERS ---
  - Those PHYSICAL PROBLEMS may be more ACCEPTED by the SOCIETY in 2022 (they weren't always accepted) --
  - BUT they too OFTEN come with their own PSYCHIATRIC DISORDERS.

How that SHAKES OUT can REVEAL a lot of UNCONSCIOUS BIAS.

And how HIERARCHY was maybe a PRAGMATIC APPROACH to dealing with the CHALLENGE of COMPLEX INDIVIDUAL DIFFERENCES in COMPLEX SOCIETIES.
- You didn't necessarily have the BANDWIDTH to UNDERSTAND or ACCOMMODATE everyone --
- So you did your best to UNDERSTAND & ACCOMMODATE the KING & HIS CRONIES.
- Or whoever is in POWER.
- In MODERN DEMOCRACIES -- your POLITICAL GROUP.

Einstein: You CAN'T SOLVE PROBLEMS at the SAME LEVEL THEY WERE CREATED.

"I think everybody's crazy, and if I'm the one being a little direct about it, that's fine by me."

----------Ezra Miller, American actor

Professor Daniel Davis, University of Manchester
The Greatest Human Diversity is Within the Immune System

CO Medicaid & Homeless Coloradans w/ Mental Illness

7/20/2022

Issues of Harm Reduction, Level of Care, Choice and Economics

THE ISSUE

Some Coloradans with Mental Illness who are HOMELESS meet the criteria for CO MEDICAID Long Term Care
BUT they don't need assistance with activities of daily living. This requirement for the CMHS (Community Mental Health Supports) Waiver was put in rule at 8.509.15.A.2

There has been a lot of PLAYING GAMES in Colorado Medicaid Mental Health because it is SO POLITICAL, SO EXPENSIVE & the NEED IS SO GREAT..

There are a lot of moving parts --- BUT this doesn't look like PARITY to us.

We would like to see a STATE STAKEHOLDER GROUP that specifically addressed the needs of Coloradans with Mental Illness who meet the LEVEL OF CARE for Medicaid Long Term Care BUT don't need help with activities of daily living.

With special attention to Coloradans who are Homeless and or being released from Jail or Prison.

Further

Medicaid Long Term Care generally opens up the possibility of:
- Nursing Home Care
- Assisted Living Care
- In Home Care

Medicaid Home & Community Based Services "Waivers" such as the Colorado Community Mental Health Supports (CMHS) Waiver are designed for people who meet the level of care for a "nursing home" but can be served in the community.

There are many younger people with mental illness in Nursing Homes because there are insufficient services in the Community -- both on locked wards and open wards.

There are even more younger people with mental illness who are homeless and/or incarcerated because there are insufficient services in the Community.

What a Tangled Web We Weave --- What Was Really Going On In HCPF's Change of Targeting Criteria

CO's Mental Health Continuum of Care Hell

Fixing HCPF's Fair Housing Problem

Nursing Homes & Housing

8.509.15 ELIGIBLE PERSONS

A. HCBS-CMHS services shall be offered to persons who meet all of the eligibility requirements
below: . . .

2. Level of Care AND Target Group.
Clients who have been determined to meet the level of care AND target group criteria
shall be certified by the Utilization Review Contractor (URC) as functionally eligible for
HCBS-CMHS. The URC shall only certify HCBS-CMHS eligibility for those Clients:
a. Determined to meet the target group definition, defined as a person experiencing
a severe and persistent mental health need that requires assistance with one or
more Activities of Daily Living (ADL);

i. A person experiencing a severe and persistent mental health need is
defined as someone who:

1) Is 18 years of age or older with a severe and persistent mental
health need; and

2) Currently has or at any time during the past year leading up to
assessment has a diagnosable mental, behavioral, or emotional
disorder of sufficient duration to meet diagnostic criteria specified
within the Diagnostic and Statistical Manual of Mental Disorders
(DSM -5); and
a) Has a disorder that is episodic, recurrent, or has
persistent features, but may vary in terms of severity and
disabling effects; and
b) Has resulted in functional impairment which substantially
interferes with or limits one or more major life activities.

ii. A severe and persistent mental health need does not include:
1) Intellectual or developmental disorders; or
2) Substance use disorder without a co-occurring diagnosis of a
severe and persistent mental health need.

b. Determined by a formal level of care assessment to require the level of care
available in a nursing facility, according to Section 8.401.11-15; and

c. A length of stay shall be assigned by the URC for approved admissions,
according to guidelines at Section 8.402.50.

Our backward debates & Justice

7/11/2022

In Mental Health and Criminal Justice --- there is enough to know our Diagnostic Categories are WRONG or at the very least RESEARCHERS have raised "REASONABLE DOUBT" about them.

As hard as it is to accept, those INACCURATE DIAGNOSTIC CATEGORIES are RELEVANT to the LEGAL CATEGORIES we've set up in Criminal Justice.

Further, this isn't about going back to the FREE WILL vs. DETERMINISM DEBATE.

This requires a much more sophisticated PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE than what we've got.

Over 600 Research Institutions Question DSM Categories

The US "Mental Health" Debate --- Where it "IS" and Where We'd Like to See It Go

PBS NewsHour July 8, 2022
Brooks & Capehart

This is an analysis of the National Debates on Abortion & Gun Rights.

I'm posting this for the troubling discussion of "MENTAL ILLNESS" in the context of the Gun Debate.

What's troubling to me is the DISMISSIVE nature of "MENTAL ILLNESS" and more broadly "COGNITIVE DISABILITY" in the context of GUN VIOLENCE ----

Unfortunately that dismissiveness appears to be based on discussions with "MENTAL HEALTH EXPERTS."

What do we mean by "MENTAL ILLNESS"?
- The DSM according to NIMH (the National Institute in Mental Health) in 2013 isn't a valid diagnostic manual ---
- And more and more PSYCHIATRIC DISORDERS are being associated with NEURO-DEVELOPMENTAL DISORDERS.

Additionally, it is well documented that BRAIN INJURY is prominent in criminal justice populations around the world, including the US.

I'm sorry BUT this GUN VIOLENCE is NOT just the result of EVIL PEOPLE even though the acts are EVIL.

We need experts who understand there is an UNDERLYING BIOLOGY to these violent acts even if we don't call it --- "MENTAL ILLNESS."

We're Encouraged by this Legislative Session ---BUT There are Some Scary Reminders About How Far We Have To Go

6/20/2022

FEDS: WHERE ARE YOU?

In March 2022, the US Department of Justice issued a "FINDINGS LETTER" to COLORADO re: people with physical disabilities and nursing homes.

There are more "FINDINGS LETTERS" that need to be issued to Colorado and most States.
We are on the 100-YEAR PLAN to COMPLIANCE with EXISTING FEDERAL DISABILITY CIVIL RIGHTS LAWS.

What we really need is COMPREHENSIVE TECHNICAL ASSISTANCE and EFFECTIVE UNIFORM ADMINISTRATIVE ENFORCEMENT.

I am for INDIVIDUAL STATE INNOVATION, CREATIVITY and Tailoring.
- There is NOT just ONE RIGHT WAY to comply with:
  - The Americans with Disabilities Act (ADA)
  - Section 504 of the Rehabilitation Act
  - Mental Health Parity & Addiction Equity
  - Medicaid Network Adequacy
  - Etc.
- The PROBLEM is there is NOT JUST ONE WAY to NON-COMPLIANCE either.

We NEED the FEDS to provide more in the way of CONTINUOUSLY IMPROVED DEFAULT TEMPLATES.

CMS and others are providing "GUIDANCE" sort of BUT Compliance is:
- TECHNICALLY COMPLICATED, and
- POLITICALLY COMPLICATED, and
- ENFORCEMENT is PATCHY.

We do need STATES to push to bring down COSTS, BUT Ironically 2 of the things that are going to bring down costs are:
- BETTER TREATMENTS, and
- BREAKING DOWN BARRIERS to realizing the INTEGRATION MANDATE in the ADA

Especially for Cognitive Disability, Developmental Difference with Average or Above Average IQ --- the CURRENT PATHS TO INCLUSION are more difficult than the MAJORITY appreciates.
- Further, those people with Developmental Differences involving Sensory Processing and Executive Functioning are more VULNERABLE TO PSYCHIATRIC DISORDERS.
- THEIR Strengths and Weaknesses are DIFFERENT ENOUGH that the NEURO-TYPICAL MOLD won't fit.
- If we really put some CONSCIOUS EFFORT into MAXIMIZING the STRENGTHS and WORKING AROUND the "WEAKNESSES" ---
  - We probably can realize some COST SAVINGS.

Many people are not going to get into a HOUSE without a 30-YEAR MORTGAGE ---
- BUT EVERYONE understands that the more YEARS you add to that MORTGAGE --
  - The more you are ULTIMATELY going to pay.

Well, the INTEREST RATE for SOCIAL EXCLUSION, INADEQUATE TREATMENTS, HOUSING & PLACEMENTS for Cognitive Disability/Difference is MANY TIMES that of the average 3O-year mortgage---
- BOTH in TREASURE and HUMAN SUFFERING.

Further, we don't seem poised to REACH COMPLIANCE with EXISTING DISABILITY CIVIL RIGHTS LAWS in 30 YEARS or 60 YEARS.

In fact, it's not clear when we will reach COMPLIANCE.

We need a Plan -- like an Olmstead Plan with:

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

In the meantime, we would like to see ON-GOING ENGAGEMENT and Yearly Reports of State Protection & Advocacy Offices with States on:

Olmstead
Parity
Network Adequacy

Further, State Lawyers Committees and Pro Bono Efforts should PARTNER with State P&A Offices conduct "INVESTIGATIONS" in COORDINATION with the US Department of Justice.

Some of that is being done in States like Colorado and others.

If we are NOT going to FUND UNIFORM and EFFECTIVE ADMINISTRATIVE ENFORCEMENT --- we need to FUND P&A, Pro Bono & DOJ INVESTIGATIONS and Enforcement Efforts.

As encouraged as we all are by a new Colorado Behavioral Health Administration ---

the most DIFFICULT CONVERSATIONS have yet to be had, and
HCPF's 809.15.A.2 on Target Criteria for Colorado's MI Waiver requiring needing assistance with activities of daily living ----
- Speaks VOLUMES about where we've been, where we still are and how far we have to go.

Cloudy Valley Morning --- photo.net

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