Blog Posts

Inflammation: The Modern Equivalent of Learning to Control FIRE

2/9/2022

Inflammation is so confusing --- its like a BABY crying --- that baby maybe crying for the usual reasons:
- hungry
- tired
- needs a diaper change, BUT
- it could be something else

To me, inflammation is like that baby crying ---- maybe there are different types of cries and different types of inflammation --- but it's this kind of UNIVERSAL SIGNAL that something is needing to be addressed.

In some ways, that CRYING BABY is more IMMEDIATE and EASIER to UNDERSTAND.

INFLAMMATION can not only build up over a period of years in a SINGLE LIFETIME --- it can build up over GENERATIONS.

One of the things that has made it HARD to UNDERSTAND is that we have IDEAS that there is a STRICT SEPARATION between our SOCIAL ENVIRONMENTS, PHYSICAL ENVIRONMENTS and our BIOLOGY
- So we've SEPARATED THINGS OUT to UNDERSTAND them.
- We haven't really understood the MAGNITUDE of INFLAMMATION because to do that we would have to INTEGRATE an ENORMOUS AMOUNT of KNOWLEDGE from areas and expertise we consider DISTINCT and SEPARATE.

So when we talk about PSYCHIATRIC DISORDERS that involve the BRAIN, but other SYSTEMS of the BODY as well, including the IMMUNE SYSTEM --- there are a lot of things that can damage the BRAIN's IMMUNE SYSTEM:
- Maternal Immune Activation
- Trauma
- Intergenerational Trauma
- Infections
- Toxins
- Not getting enough oxygen
- COVID
- Genes that go to the Immune System and Epigenetics
- etc.

Human beings aren't necessarily just contending with 1 of those things -- but multiple factors that are playing out in INDIVIDUAL and IDIOSYNCRATIC ways.

We've started the PROCESS of UNDERSTANDING the role of DEVELOPMENTAL INFLAMMATION in many people with PSYCHIATRIC DISORDERS and the role of EPIGENETICS.

So this is MORE COMPLICATED than we're treating it in our HEALTHCARE PROFESSION and in our PUBLIC POLICY.

"First Do NO Harm" --- is easy to say --- but it has proven hard to put into practice when multiple systems of the body are DYSREGULATED --- we're kinda just figuring that out ---- and we're at the beginning stages of IDENTIFYING BIOMARKERS.

The Society is looking to the MEDICAL PROFESSION and the HEALTHCARE PROFESSION to help NAVIGATE what can be a challenging ETHICAL & MORAL LANDSCAPE.

You wouldn't be the first person or first group of people to feel compelled to take a step back and say: Maybe our current judgments aren't completely accurate or fair.

Touched with Fire --- Manic Depressive Illness and the Artistic Temperament (1996) by Kay Redfield Jamison

Hair Analysis, Psychological Analysis, the Criminal Law & the Ethical & Moral Imperative to Pull Back

The Importance of Addressing Executive Functioning ---- from ADMINISTRATIVE SUPPPORT to Assertive Community Treatment

2/2/2022

For a long time, Mental Health along with everyone just considered challenges in Executive Functioning as problems with LACK of RESPONSIBILITY.

Where do I personally get the best appointment reminders ---my upscale Suburban Dentists' office.
- I get reminded 2 weeks before the appointment.
- 1 week before the appointment
- And the day before
- In the manner --- I prefer
  - The "WHAT I PREFER" part is important
  - It is also challenging for any medical or health care provider
  - Some automated systems do provide for choice in manner of communication:
    - E-mail
    - Telephone
    - Text
    - Some people may need an actual in-person contact --- that Suburban Upscale Dentists' Office is providing a lot of personal contact just as a good business practice for the BOTTOM LINE.
That doesn't just happen --- it's a COST
At this point in my mental health journey, what ADMINISTRATIVE SUPPORT the psychiatrist has is MORE IMPORTANT to me --- than who the psychiatrist is.
I know this was a BIG ISSUE in Colorado Medicaid a few years ago and may have been at least partly resolved.
In Private Mental Health --- the Solos are sometimes trying to perform their own Administrative Support at the same time they are charging out of network.
- I know I felt ripped off --- and I probably wasn't the only one.

Group practices and Corporate Mental Health generally have more in the way of Administrative Support --- but it is still often falling short of what one can get in other areas of the Society.

Beyond that --- it is a telling indication that the profession doesn't really understand that they should be LEADING on matters of accommodating Executive Functioning Differences and Deficits.

A COMMON PRESCRIPTION: Let's try to turn this person into a NEURO-TYPICAL often doesn't work and it can EXACERBATE things. WHY IS THAT?

Those EXECUTIVE FUNCTIONING DIFFERENCES are at least in part often DEVELOPMENTAL.
The BRAINS of People with Neuro-Developmental Disorders do become HYPER-CONNECTED as a way to try to COPE with various DIFFERENCES and DYSREGULATIONS.
By the time one gets to the MENTAL HEALTH PROFESSIONAL --- that's needing to be CALMED DOWN.

For some people with neurodevelopmental and psychiatric disorders, the Executive Functioning Support they need goes beyond APPOINTMENT REMINDERS which are really going to MEMORY and some other challenges related to DOPAMINE DYSREGULATION and other issues.

Part of EXECUTIVE FUNCTIONING is EMOTIONAL REGULATION.

This is also an issue where it is NOT FEASIBLE for the Psychiatrist or Counselor to try to bear the ENTIRE LOAD of that.

PEER SUPPORT can be an EQUIVALENT of ESSENTIAL ADMINISTRATIVE SUPPORT when it comes to providing EMOTIONAL SUPPORT.

This does get to why serving people with Executive Functioning Differences can be so CHALLENGING --- we don't want to burn anybody out and we don't want to BANKRUPT our SYSTEMS either.

That's why having a SOCIETY that is EXECUTIVE FUNCTIONING INFORMED is important.

In many cases, if we're providing A LITTLE BIT to MEDIUM SUPPORT --- IN MULTIPLE AREAS --- we can avoid the need for that total breakdown of functioning that is so costly PERSONALLY and FINANCIALLY FOR INDIVIDUALS, FAMILIES and THE SOCIETY --- to say "Hey, something isn't working here."

Further, we can't put this on just one segment of the society --- or they can breakdown too --- and that is part of what has happened with Mental Health.

On the FLIP SIDE ---- we not only have to engage others ---- we have to develop, reward and employ those UNEXPECTED STRENGTHS that often come with NEURO-DIVERSITY.

One of the reasons ASSERTIVE COMMUNITY TREATMENT is the gold standard of Intensive Mental Health Care:

It's addressing those MULTIPLE NEEDS that EXECUTIVE FUNCTIONING Differences and Challenges can present.

I love this video. It is from Canada and it's on Housing and Assertive Community Treatment.

One of the points the psychiatrist makes is --- You don't just get people better by seeing a PSYCHIATRIST --- you need this whole system of support.

I would submit the reason you need that whole system of support is to address DIFFERENCES and DEFICITS in EXECUTIVE FUNCTIONING.

If we are combining TRAUMA-INFORMED CARE with EXECUTIVE FUNCTIONING INFORMED CARE ---- we probably could do this more COST EFFECTIVELY.

Case in Point: The Biology of Substance Issues Meets "Us vs. Them Thinking" --- & A modern take on Loyalty & Fealty

1/22/2022

We're going to be looking at Substance Abuse and its relationship to Neuro-Endocrine and Neuro-Immune Pathways.

Also, the DISPARITIES with regard to DRUG ENFORCEMENT are fairly well established..

It's hard if not next to impossible to understand what is going on in this Country with regard not only to Criminal Justice BUT ALSO the Society At Large --- if you don't start addressing:

UNCONSCIOUS BIAS
US vs. THEM Thinking
and a Society of Lawyers, Advocates, and At Will Employees in which everyone has taken an OATH of LOYALTY & FEALTY --- and few are really free to speak their minds without fear of losing their jobs.
Further, educated professions such as LAW & Mental Health are making rudimentary logical mistakes --- but it is difficult to address if we're unwilling to address UNDERLYING ASSUMPTIONS that don't look so good anymore.

Tolstoy had an interesting REMEDY for US vs. Them Thinking and it was that God was on the SIDE of the UNDERDOG.

As soon as the UNDERDOG got the upper hand, it switched --- and God was on the SIDE of the NEW UNDERDOG.

I think one of the ways this is borne out in a way is that we are UNAWARE of our UNCONSCIOUS BIASES --- but those on the receiving end are AWARE --- and sooner or later that KNOWLEDGE is going to turn into POWER.

What Is the "Us Against Them" Mentality?

Effects of prenatal immune activation on amphetamine-induced addictive behaviors: Contributions from animal models (2021)

Abstract

Background: Prenatal environmental adversities may affect brain development and are associated with increased risk for schizophrenia, an illness with 50% comorbidity with addiction.

Maternal immune activation by poly-inosinic-citidilic acid (Poly(I:C)) exposure can promote behavioral alterations consistent with schizophrenia symptoms in rodents.

. . .

Conclusions: Prenatal administration of Poly(I:C) is able to potentiate vulnerability to addiction in two animal models, without however modulating stereotyped behavior.

Neuroendocrine and immune pathways from pre- and perinatal stress to substance abuse (2018)

Neuroimmune Mechanisms as Novel Treatment Targets for Substance Use Disorders and Associated Comorbidities (2021)

Do we have the right profession to address the "Neuro-developmental continuum"---?

1/16/2022

Genetic research supports the hypothesis that ID (Intellectual Disability), ASD (Autism Spectrum Disorder), ADHD, schizophrenia, and bipolar disorder lie on a neurodevelopmental continuum

There's a lot of "INTEGRATIVE COMPLEXITY" in the statement above from Dialogues in Clinical Neuroscience, and I suspect we will be UN-PACKING IT for the next century if not far beyond.

Much of how we REASON is to take the CAUSAL LINK we've come upon in the MOMENT and try to make sense of it and create a STORY and a NARRATIVE until we can't anymore --- the ANOMALIES have built up to such a degree that we know this STORY --- can't be "RIGHT."

The STORY the MENTAL HEALTH PROFESSION is telling themselves and others regarding PSYCHIATRIC DISORDERS is "NOT RIGHT" in FUNDAMENTAL WAYS that are preventing us from MORE EFFECTIVELY addressing the MENTAL HEALTH CRISIS that we see in most DEVELOPED COUNTRIES and DEVELOPING COUNTRIES.

Is the STORY "WRONG" --- well, it is MISSING KEY ELEMENTS that would DRAMATICALLY CHANGE TREATMENT STRATEGIES in MANY CASES.

On the other hand --- DON'T THROW THE BABY OUT WITH THE BATH WATER --- it is not as if there is nothing of value in our current approaches to treating "PSYCHIATRIC DISORDERS."

Further, many of our current approaches have SAVED LIVES --- even as those approaches are NOT SUFFICIENT to address the CRISIS we're currently facing.

WORK has to be a TWO-WAY STREET and it may be most easily seen in the "EXTREME" of people with NEURO-DEVELOPMENTAL DIFFERENCES and SERVICE PROVIDERS.

You can't just RAM Neuro-Diverse people into any old WORK Environment and think it is going to "work out"
- they often have BIG STRENGTHS that aren't getting SUFFICIENTLY CHALLENGED, and
- EXECUTIVE FUNCTIONING Differences or Deficits that are not receiving SUFFICIENT SUPPORT.

"My New Job Isn't What I Signed Up For" --- Inc.com

It has been HARD to understand how the Profession could:

Blow off the significance of a scientifically invalid DSM, and
Compelling Research of the last 5 to 10 years regarding the relationship between Neuro-Developmental & Psychiatric DIsorders BUT
This isn't necessarily APPEALING to the people who are currently in the Profession.

You can't just add FUNDAMENTAL ELEMENTS to the JOB Description of treating PSYCHIATRIC DISORDERS --- and think everyone who is currently working under the title MENTAL HEALTH PROVIDER --- wants to do or is even well-suited to incorporate those FUNDAMENTAL NEW ELEMENTS.

Are neurodevelopmental disorders discrete conditions? (2018)

There is abundant evidence to indicate that neurodevelopmental disorders tend to co-occur, rather than existing as individual conditions.

Could this ‘comorbidity’ reflect an overall atypical course of neural development, which manifests in various ways?

The NEW PARADIGMS from the RESEARCH view:

Neuro-Developmental Disorders as BLURRED
Psychiatric Disorders as BLURRED, and
Psychiatric Disorders as DISORDERS of the NEURO-DEVELOPMENTAL CONTINUUM

That's a far cry from the DSM and goes a long way to explaining why we are having such a hard time addressing our MENTAL HEALTH CRISIS ---

We've got a bigger problem than we realize, and
Our Systems are not set up to deal with it.
Further, a lot of people who went into Mental Health wanted to do "Mental Health Therapy" --- NOT work with people with DEVELOPMENTAL DISORDERS --- but that is their primary population
- THIS IS A PROBLEM.
- There is a role for therapy, but much of what is needed is DIFFERENT than what is being offered.
- Now, a lot of Mental Health Professionals if they had the TRAINING would be interested in working with people with DEVELOPMENTAL DISORDERS involving EXECUTIVE FUNCTIONING.
- Further, it is not as if Mental Health Professionals don't have some general knowledge, but by and large they are NOT the EXPERTS we need them to be, even if there are EXPERTS within their ranks, not surprisingly in EDUCATIONAL PSYCHOLOGY --- which is focused on more DEVELOPMENTAL ISSUES.

One of the points we've tried to make on this website is that CRIMINAL JUSTICE REFORM often FAILS because what's needed is so UNDER-ESTIMATED.

At least in part, that can be traced to Medical and Educational Under-Estimations of what it actually takes to address DIFFERENCES or DEFICITS in EXECUTIVE FUNCTIONING.

To say this is DISASTROUS sounds like hyperbole --- UNTIL you realize:

Most people with psychiatric disorders started out as people with neuro-developmental disorders involving EXECUTIVE FUNCTIONING, and
Graduated to people with psychiatric disorders and HYPER-CONNECTED BRAINS at least in part I would submit trying to manage those EXECUTIVE FUNCTIONING DIFFERENCES in a largely clueless if not PUNISHING SOCIAL ENVIRONMENT.

Those super sensitive / reactive people are becoming more sensitive and more reactive in attempts to address EXECUTIVE FUNCTIONING and that is DYSREGULATING SYSTEMS of the BODY even more.
Finding BALANCE and SUSTAINABILITY is a much more CHALLENGING PROPOSITION than we've been willing to recognize as a society ---- the more ASYNCHRONOUS the PERSON --- the more of a challenge that can be.

We somehow have this IDEA that DEVELOPMENTAL DIFFERENCE doesn't have any consequences if one has an AVERAGE or ABOVE-AVERAGE IQ.

Of course, our MENTAL HEALTH CRISIS and who it is affecting is telling quite a different story.
Further, that population of NEURO-DIVERSE people is steadily increasing as inflammation in the society and MATERNAL IMMUNE ACTIVATION increase.

It is not fair to say that the SOCIETY is causing ALL the CHALLENGES --- but it is FAIR to say the SOCIETY is EXACERBATING the CHALLENGES by FAILING TO ADEQUATELY APPRECIATE THEM.

Image Credit: VIA Institute on Character

Those NEURO-DIVERSE STRENGTHS that are a NATURAL ATTEMPT to BALANCE what may be MULTIPLE DYREGULATIONS of BODILY SYSTEMS by conventional standards --- may prove INSUFFICIENT ---

but those NEURO-DIVERSE STRENGTHS are still an IMPORTANT COMPONENT to MENTAL & PHYSICAL WELL BEING.

Maternal Immune Activation, DYSREGULATION INCLUDING Metabolic Dysregulation & the Tree of Knowledge

1/14/2022

Psychiatric Disorders appear to be in some to many cases a progression of Neuro-Developmental Disorders.

Further, those Neuro-Developmental disorders often bring with them DYSREGULATIONS of MULTIPLE SYSTEMS of the BODY.

Such DYSREGULATIONS "appear" to be IDIOSYNCRATIC and can tend toward one extreme or another.

Metabolic Dysregulations from Maternal Immune Activation are associated with Neuro-Developmental and Psychiatric Disorders.

This is above and beyond Professor Graham Rook's concerns of the lack of diversity in the HUMAN MICROBIOME that is causing the IMMUNE SYSTEM to be TOO SENSITIVE which might be considered a SOFTWARE CONCERN.

The issues with MATERNAL IMMUNE ACTIVATION --- appear to go to HARDWARE and perhaps more difficult to address.

Do these METABOLIC ABNORMALITES / DYSREGULATIONS represent another type of EXECUTIVE or UNCONSCIOUS FUNCTIONING that now has to be managed more CONSCIOUSLY with ADDITIONAL CHALLENGES?

Interestingly, "BIPOLAR DISORDER":

Bipolar Disorder is being conceptualized by the University of Michigan as a DEVELOPMENTAL DISORDER that includes
Cells that are MORE REACTIIVE
Further, Bipolar Disorder appears to involve DSYREGULATIONS of MULTIPLE SYSTEMS OF THE BODY
And those INTER-CONNECTED DYSREGULATIONS have a LIFE OF THEIR OWN

Tree of Knowledge --- The Art of DionJa'Y

Metabolic Disorders May Contribute to Anorexia
(2019)

Researchers say these metabolic abnormalities may not be symptoms of the eating disorder. They may be part of the cause.

Metabolic abnormalities associated with obesity in children and adolescents in Jordan (2011)

"Obesity was significantly associated with increased odds of individual metabolic abnormalities and their clustering."

Metabolic and behavioral features of acute hyperpurinergia and the maternal immune activation mouse model of autism spectrum disorder (2021)

Tree of Knowledge by Lucas Cranach the Elder

BUT all of those DYSREGULATIONS MAY FORCE a certain partaking of the TREE of KNOWLEDGE --- because you can't rely to the same EXTENT on AUTOMATIC FUNCTIONING.

So you MAY have to develop other skills including LOGIC SKILLS and other ABILILITIES much more than someone else -----

and what you're finding is what a lot of theologians and philosophers and artists found before you ---- YOU DON'T HAVE AN UNLIMITED ABILITY TO DO THAT.
The HYPER-CONNECTED BRAINS and DYSREGULATED SYSTEMS associated with NEURO-DEVELOPMENTAL and PSYCHIATRIC DISODERS are a kind of FORENSIC EVIDENCE that are telling a COMPLICATED TALE --- full of INTEGRATIVE COMPLEXITY.
- Just the kind of Tale that someone who was into the HUMANITIES would understand.

Addressing the failure of SYSTEMS to care for those with the greatest needs

1/4/2022

This person who is "GRAVELY DISABLED" has REFUSED MEDICATION & TALK THERAPY

there are no MENTAL HEALTH BEDS

WHATEVER SHALL WE DO?How does the person feel about:

Hotel Vouchers
Assisted Living
Nursing Homes
- Often Disfavored as Institutions
- Often a Step-Down from the Mental Health Institutions
- Nursing Homes COULD BE a great place to do DISCHARGE Planning for 30 to 90 days--
- BUT it is a TRAP if there is NOWHERE TO GO.

Medication

Is the person open to genetic testing as a way to get quicker and better insight into some Medication selections?
Medication is a complicated issue in Mental Health as it is in Cancer and other major illnesses.
Further, many people with High IQ Neuro-Developmental Differences involving Executive Functioning and/or Psychiatric Disorders:
- Have IDIOSYNCRATIC SYSTEMS --- and if they are on the Street or the Jail, etc. --- they may be OUTLIERS in an OUTLIER POPULATION.

For most people with PSYCHIATRIC DISORDERS it has been an ALICE IN WONDERLAND experience of YEARS of TRIAL & ERROR --- that maybe turned up something that "worked and was better than nothing" and maybe didn't.

Our Society needs the ability to deal with that COMPLEXITY both CONCEPTUALLY & PRACTICALLY.

Marshall Fire --- Photo Credit: AXIOS

The Researchers have been RINGING THE ALARM BELLS for the need for BETTER TREATMENTS for AWHILE --- and it is in their INTERESTS to do so.

In this year's PBS Program on Mental Health funded by the AMERICAN PSYCHIATRIC ASSOCIATION FOUNDATION --- that need for BETTER TREATMENTS was acknowledged.
BUT how many people in the SOCIETY understand the need for BETTER TREATMENTS as opposed to just the need to FORCE SOMETHING DOWN some RECALITRANT PATIENT'S THROAT?

MORE CONJECTURE --- EPIGENETICS

It seems that we should be talking about Neuro-Developmental Disorders such as ADHD and AUTISM with PSYCHIATRIC DISORDERS --- and a lot of the research does that.
What Neuro-Developmental and Psychiatric Disorders often have in common is EXECUTIVE FUNCTONING CHALLENGES.

MORE CONJECTURE: The Epigenetics of the IMMUNE SYSTEM are SENSITIVE because they need to be for our SURVIVAL.

BUT many factors are pushing our IMMUNE SYSTEMS TO THE LIMIT and we need better and more complete understandings of what's going on.
We've tended to fill in the gaps with PRO SOCIAL COMPETENCY RELIGION for people "we judge harshly"
- That "we judge harshly" comes from Stanford Neuro-Biologist Robert Sapolsky and his ADMONITION to be very careful in judging a behavior --- "ESPECIALLY IF IT IS A BEHAVIOR YOU JUDGE HARSHLY."

Doing Therapies

Music Therapy & Something like Britain's Key Changes which provides opportunities for patients to perform and record musical tracks.
Art Therapy
Animal Therapy (Dog, Equine)

Supported Employment

One of the insights of the Dartmouth Supported Employment Model was that if done in an INDIVIDUALIZED manner --- it could often improve Mental Health.
BUT Employment is tricky for people with Psychiatric Disorders or High IQ Neuro-Developmental Difference involving Executive Functioning
- People need to be challenged in their STRENGTHS (which can be HIGHER than EXPECTED), and
- SUPPORTED in areas of Executive Functioning such as Planning, Organization, Emotional Regulation and Short-Term Memory.

The truth is most people want HELP --- BUT the options are meager, especially when what we're doing is in some cases not working and hospital beds haven't gotten any cheaper.

SAMHSA.GOV

The National Registry of Evidence-Based Programs and Practices (NREPP) has been indefinitely suspended by federal health officials.

Since 1997, NREPP has listed effective, science-based interventions for behavioral health issues, including the prevention and treatment of mental illness and substance use disorders (SUD).

Programs included in NREPP were independently audited and regularly updated.

The registry included proven interventions as well as programs to avoid because they had not been shown to work sufficiently.

The White House froze the public database in September 2017 and months later pulled federal funding for NREPP, which was a project of The Substance Abuse and Mental Health Services Administration (SAMHSA).

This defunding of NREPP is more COMPLICATED than it looks --- mainly because CMS, SAMHSA and the STATES have largely failed to address the needs of people with the most serious mental health needs.

So when the conservative organizations like the Mental Illness Policy Organization and the Treatment Advocacy Center saw things like NREPP --- it made their BLOOD BOIL -- these governmental subdivisions had so FAILED at what should be their primary mission --- serving those with the greatest needs.

So we absolutely have to hold CMS, SAMHSA and the STATES' FEET TO THE FIRE on providing for those with the GREATEST NEEDS -- which isn't being done --- and it is INFURIATING.

On the other hand, this is a CONTINUUM and we do need the National Registry of Evidenced-Based Practices and Programs.]

The CATCH-22 for HIGH IQ DEVELOPMENTAL DIFFERENCE --- nobody is expecting or prepared to deal with the need for EXECUTIVE FUNCTIONING SUPPORT.

CONJECTURE: The FAILURE to address EXECUTIVE FUNCTIONING with REASONABLE ACCOMMODATIONS and WORKAROUNDS -- and even just some KNOWLEDGE -- is resulting in an EPIGENETIC CASCADE.

So the person's IMMUNE SYSTEM and SENSORY PROCESSING is RAMPING UP to find PATTERNS to address this CHALLENGE
BUT there are LIMITS which our SOCIETY and our MENTAL HEALTH Profession largely think NEURO-PLASTICITY or COGNITIVE BEHAVIORAL THERAPY ARE going to solve.
What's Happening --- you have a person with a NEURO-DEVELOPMENTAL DISORDER that now has a PSYCHIATRIC DISORDER and an even more HYPER-CONNECTED BRAIN.
- and a Mental Health Profession that is by and large CLUELESS those people with DEVELOPMENTAL DISABILITIES that they didn't want to treat are their PRIMARY POPULATION --- but with HIGHER IQs.

MANY JOB DESCRIPTIONS today read like "NO BLACKS, ASIANS, HISPANICS, LGBTQ NEED APPLY" for people who may have those EXECUTIVE FUNCTIONING CHALLENGES.

Because the knowledge doesn't appear to be there to deal with that on the part of anybody --- certainly the ADULT MENTAL HEALTH SYSTEM.
There are a HANDFUL of EDUCATIONAL PSYCHOLOGISTS and OCCUPATIONAL THERAPISTS who could add a lot to the discussion --- BUT we normally don't think of them for ADULTS.

If we can't discriminate against people because of their skin color or their sexual orientation or preference --

that ODDBALL in the corner who seems so EMOTIONAL or SPEAKING OUT of TURN, has BORING "SPECIAL INTERESTS," or is DISORGANIZED --- surely we can DISCRIMINATE AGAINST them --- that's OBJECTIVE CRITERIA, isn't it?

Waitlists, Evolving Treatments & Olmstead

12/25/2021

The "process" as laid out by the Olmstead Decision to get to Olmstead Compliance is "WAITLISTS MOVING AT A REASONABLE PACE."

The Olmstead Decision doesn't talk about "WAITLISTS" in terms of SPECIFIC HOUSING, PLACEMENTS, SERVICES or EMPLOYMENT.

Those kinds of things change over time with better and more effective TREATMENTS and MODELS.

What the Olmstead Decision talks about are WAITLISTS of PEOPLE who could move into the COMMUNITY or I would say a less restrictive or less harmful setting with known treatments or modalities such as SUPPORTIVE HOUSING ---

But that SUPPORTIVE HOUSING or other Known Evidenced-Based Treatment or Modality isn't available.

So that includes Assertive Community Treatment, Models of Supported Employment, and Strength-Based Approaches.

I do think there is a HARM REDUCTION COMPONENT to OLMSTEAD. So a therapeutic placement could be a LESS RESTRICTIVE ENVIRONMENT than a Jail or Prison and may be desired by the person.

HOMELESSNESS does theoretically offer "MORE FREEDOM" but what some people find is that it comes at a HIGH COST to their PERSONAL SAFETY and WELL BEING.

Most people would be more interested in SUPPORTED HOUSING.

One of the ways to get there would be to RAMP UP INVESTMENT in HOTEL VOUCHERS.

But if the CHOICE at the MOMENT is a THERAPEUTIC PLACEMENT over HOMELESSNESS (such as an Assisted Living, Nursing Home, Group Home or some New Model)--- some people (not all) would choose a THERAPEUTIC PLACEMENT.

See HORROR STORY -- It Doesn't Have To BE THIS WAY.

So far this has sounded a lot more like Translational Justice than Translational Medicine.

BUT the TREATMENTS and MODALITIES we need are NOT those of 1999 (when the US Supreme Court decided Olmstead) they are the EVIDENCED-BASED TREATMENTS and MODALITIES of 2021 and the PRESENT DAY going forward.

Before you can IDENTIFY who could successfully live in the community with KNOWN, EVIDENCED-BASED TREATMENTS and MODALITIES --- you IDENTIFY those KNOWN, EVIDENCED-BASED TREATMENTS and MODALITIES.

Further, that requires CONSTANT REVISION and UPDATING --- because those TREATMENTS and MODALITIES are CONSTANTLY EVOLVING.

So ideally this is done at the FEDERAL LEVEL and in fact it is being done at the FEDERAL LEVEL at SAMHSA.

BUT the efforts of SAMHSA and CMS need to be more INTEGRATED generally, but especially for people needing LONG TERM CARE.

States need SAMHSA/CMS/HUD/DEPT. of LABOR to provide updated MODIFIABLE TEMPLATES for the STATES for people with COGNITIVE DISABILITY NEEDING LONG TERM CARE incorporating KNOWN EVIDENCED-BASED TREATMENTS and MODALITIES and EMPLOYMENT for PEOPLE with COGNITIVE DISABILITY.

States need to provide AGGREGATE WAITLIST DATA to the FEDS, their STATE LEGISLATURES, and the GENERAL PUBLIC.

That AGGREGATE DATA should show not only how many people could transition SUCCESSFULLY to the Community from the Institute, the Nursing Home or the Jail or Prison with Proper Supports.

It should show in the AGGREGATE what SPECIFIC TREATMENTS, HOUSING, PLACEMENTS and MODALITIES are needed and not currently available.

The Americans with Disabilities Act and the Olmstead Decision are all about "REASONABLENESS."

We can't make REASONABLE DECISIONS if we are AFRAID OF THE DATA.

D.J. Jaffe was what I consider to be a "CONSERVATIVE" Mental Health Advocate --- although I don't think he saw himself that way.

There were a lot of things I didn't agree with regarding Jaffe's policy prescriptions -- although he did become an advocate for SUPPORTIVE HOUSING.

But Jaffe was far ahead of most Mental Health Advocates in understanding the "INSANE CONSEQUENCES" of failing to provide for people with the most serious mental illness who are often Homeless or Incarcerated.

Internationally recognized Mental Health Advocate --- Colorado's own Amy Smith -- is about 25 years ahead of the curve in her thinking on Mental Health Policy, Peer Services and Peer Respite.

There's a CRYING NEED to INTEGRATE the INSIGHTS of the Jaffes and Amy Smiths of the Mental Health Policy World.

A BIG CAVEAT: Brain Injury may be more common in Criminal Justice than some Traditional Notion of Schizophrenia or Bipolar Disorder.

But Brain Injury and Mental Health Issues often go together.

Further the Developmental Issues coming from Maternal Immune Activation and broadly understood in OVERLAPPING CATEGORIES of ADHD and AUTISM --- are OVERWHELMING in Criminal Justice.

One of the PRIMARY INSIGHTS of ORCHID is ---- it is NOT just our traditional distinct boxes of MENTAL HEALTH DISORDERS in the DSM --- it is INDIVIDUAL combinations of Cognitive Disability and often more than one CATEGORY of COGNITIVE DISABILITY --- especially in Criminal Justice.

The Mental Health Crisis and Incorporating New Understandings

12/19/2021

It's hard to see how we get out of our current mental health crisis without incorporating the new understandings of "Immuno-Neuro-Psychiatry."

Further, researchers haven't quite settled on a TERM for this new Age in Psychiatry. Contenders:

Immunoneuropsychiatry
Immunopsychiatry
Psychoneuroendocrin-ology
Psychoneuroimmunology
etc.

But these NEW UNDERSTANDINGS are GAME CHANGERS.

Under the current regime of Translational Research and Medicine in the US: Clinicians will be on top of these new understandings in 10 to 20 years.

But the US has Hundreds of Thousands of People who are Incarcerated and Homeless and/or Punished in Other Ways for Neuro-Developmental and Psychiatric Disorders.

We need to continue our move to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE while maintaining safety.

Further, we need greater investments in Translational Research and Medicine for the benefit of Clinicians, Patients and Policy Makers.

Immunoneuropsychiatry -
novel perspectives on brain disorders (2019)

Affiliations
1Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
2Inserm, U955, Institut Mondor de la Recherche Biomédicale, Créteil, France.
3Fondation FondaMental, Créteil, France.
4AP-HP, Department of Psychiatry of Mondor University Hospital, DHU PePsy, University of Paris-Est-Créteil, Créteil, France.
5Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. [email protected].

Abstract
Immune processes have a vital role in CNS homeostasis, resilience and brain reserve. Our cognitive and social abilities rely on a highly sensitive and fine-tuned equilibrium of immune responses that involve both innate and adaptive immunity.

Autoimmunity, chronic inflammation, infection and psychosocial stress can tip the scales towards disruption of higher-order networks.

However, not only classical neuroinflammatory diseases, such as multiple sclerosis and autoimmune encephalitis, are caused by immune dysregulation that affects CNS function.

Recent insight indicates that similar processes are involved in psychiatric diseases such as schizophrenia, autism spectrum disorder, bipolar disorder and depression.

Pathways that are common to these disorders include microglial activation, pro-inflammatory cytokines, molecular mimicry, anti-neuronal autoantibodies, self-reactive T cells and disturbance of the blood-brain barrier.

These discoveries challenge our traditional classification of neurological and psychiatric diseases. New clinical paths are required to identify subgroups of neuropsychiatric disorders that are phenotypically distinct but pathogenically related and to pave the way for mechanism-based immune treatments.

Combined expertise from neurologists and psychiatrists will foster translation of these paths into clinical practice.

The aim of this Review is to highlight outstanding findings that have transformed our understanding of neuropsychiatric diseases and to suggest new diagnostic and therapeutic criteria for the emerging field of immunoneuropsychiatry.

Neuro-Developmental and Psychiatric Disorders ----- Improving Systems of Translational Medicine

12/16/2021

Cancer Medicine is probably providing the GOLD STANDARD today in Translational Medicine -- bringing research to the clinician and the patient --- But efforts on the mental health front are increasing.

Division of Translational Research (DTR)

Utah

$90 million approved for first-of-its-kind translational research building for mental health (Sept. 2021)

Developing mental health policy in Sweden:

a policy analysis exploring how a complex societal challenge was consigned to individual citizens to solve (April 2021)

Colorado Clinical and Translational Sciences Institute (CCTSI)

part of the UK's National Institute of Health Research

"QUESTIONING" in a COMPLEX SOCIETY

12/2/2021

Battle of the psychiatric experts has been a tradition in American Criminal Justice at least since Ake v. Oklahoma (1986)

the US Supreme Court held that the Due Process Clause of the Fourteenth Amendment required the state to provide a psychiatric evaluation to be used on behalf of an indigent criminal defendant if he needed it.

In 2021, I would say that most criminal defendants have some form of brain injury, substance use, developmental difference / disability, psychiatric disorder --- and many of them "intended" the crime.

Problem-Solving Courts have emerged as a MIDDLE WAY to deal with some of these COMPLEX PROBLEMS.

BUT for this to work, PROBLEM-SOLVING COURTS need access to the FULL RANGE of the CONTINUUM of CARE --- which Colorado and most states are struggling to provide.

The BOTTOM LINE: The better the "TREATMENTS" --- the more "successful" this is going to be. There's a BIG INCENTIVE to invest in TRANSLATIONAL RESEARCH and MEDICINE.

IN THE MEANTIME: Building on Strengths and Providing Work-Arounds for Executive Functioning Differences / Deficits is CRITICAL to enable a growing percentage of the population with NEURO-DEVELOPMENTAL INFLAMMATION ---- TO THRIVE.

Problem-Solving Courts

At least one paper has identified SUPPORTIVE HOUSING and SUPPORTIVE EMPLOYMENT as potential important tools of PROBLEM-SOLVING COURTS.

Mental Health Courts: Pro & Con

Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review

(Jan. 2021)

Neuroendocrine and immune pathways from pre- and perinatal stress to substance abuse

(2018)

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