Blog Posts

Nebraska has an Olmstead Planning Law --- Colorado & Other States could use one

5/23/2021

Nebraska has an Olmstead Planning Law --- is it everything it should be --- probably not, BUT it is becoming MORE & MORE OBVIOUS that Colorado and Other States need a quick, easy reference within their own Statutes and Regulations to both comply with Federal Law and tailor Olmstead to their own needs.

Now if states don't include Federal Legal Requirements in their States' Laws ---- that doesn't mean those Federal Legal Requirements went away.

The 2011 US Department of Justice (DOJ) Olmstead Statement is meant to summarize the law on Olmstead ----- BUT most States are not aware of this "Statement" and if they do become aware of it ---- they are not sure whether they are bound by it ---- and they don't want to voice an opinion on it.

As of Feb. 25, 2020 --- DOJ did make clear that the 2011 Statement was NOT BINDING outside of Statute, Regulations and Judicial Precedent.

We've previously suggested that the DOJ Statement be incorporated into Regulations.

Measurable (specific) Goals are in the Caselaw --- BUT it's not helping that so much has to be PIECED TOGETHER.

(where might one find some caselaw on Measurable Goals (or not) --- the 2015 National Association of State Mental Health Program Directors --- Olmstead Risk Assessment & Planning Checklist --- ya gotta love it)

NOT A DIFFERENT BEAST------EXECUTIVE FUNCTIONING, DEVELOPMENTAL DIFFERENCES & "MENTAL ILLNESS"

5/22/2021

What I'm NOT Buying:

"Mental Illness" is a completely DIFFERENT BEAST than DEVELOPMENTAL DIFFERENCE involving Executive Functioning and Information and Sensory Processing.

Further, I'm not buying that "personality disorders" are somehow unrelated to HUMAN BIOLOGY even as they may be related to HUMAN ENVIRONMENTS.

Additionally I'm not buying that:
- "Gifted" emotional overexcitabilities, and
- Emotional Dysregulation, and
- "Reactivity"

-----are somehow unrelated

BUT I DO AGREE with "Gifted" Experts:

Often if you provide an environment that meets the person's intellectual and emotional needs ----
Many problematic behaviors will be greatly reduced.

Further, there is SELF INTEREST in "PRETENDING" that an ENVIRONMENT that works for the "MAJORITY" is going to work for everyone:

For people in which the CURRENT ENVIRONMENT is working ---
- The RISK of CHANGE --- is HIGH
For people in which the CURRENT ENVIRONMENT is NOT WORKING ----
- The RISK of CHANGE ---- is LESS

Executive Functioning & 5 "Disorders"

ADDITUDE Mag
Autism Speaks
Journal of Affective Disorders (Bipolar Disorder)
Expert Review Neurotherapeutics (Depression)
Frontiers in Psychiatry (Schizophrenia)

National Institute of Mental Health: 5 Disorders Share Common Genes (2013)

"Now that doesn't match with the idea that these are distinct."

In summary, calcium seems to play a central role in the activation of cells of the immune system. When the cells are stimulated, [Ca2+]i generally increases as a result of entry from the external medium, as well as mobilization of calcium from intracellular membrane-bound compartments.

Calcium homeostasis and the activation of calcium channels ...www.ncbi.nlm.nih.gov › pmc › articles › PMC1807782

Calcium channels are membrane-spanning proteins that regulate the intracellular concentration of calcium ions (Ca2+). After entering the cell, Ca2+ activates specific calcium receptor proteins, e.g., calmodulin, troponin-C, or calcium-activated calcium, potassium, and chloride channels.

Calcium Channel - an overview | ScienceDirect Topicswww.sciencedirect.com › topics › medicine-and-dentistry

Neuroinflammation and cognition across psychiatric conditions (2019)

Archive | Disorders Share Risk Gene Pathways for Immune, Epigenetic Regulation

The Lancet Psychiatry

Epigenetics: The missing link in understanding psychiatric disorders? (2018)

Psych Scene Hub

Epigenetic Mechanisms in Psychiatric Disorders – Major Depression, Psychosis and Addiction (March 2021)

Olmstead Legal Requirements and Co's 2018 Community Living Update

5/16/2021

There seems to be a FUNDAMENTAL MISUNDERSTANDING of the nature of the 2018 Community Living Update on the part of the Polis Administration.

The 2018 Update was NOT an Olmstead Plan or a REVISION of the 2014 Plan. The Hickenlooper Administration had rejected a Revision of the Olmstead Plan and a CONCILITORY UPDATE was the Consolation Prize.

That "Update" shouldn't be used as the BASIS for OLMSTEAD COMPLIANCE MEASURES in Colorado today, even if the Update is not totally ignored.

Maybe most of us do believe in the Rule of Law --- BUT when it's NOT CLEAR --- it causes CONFLICTS and Lawsuits People with Disabilities CAN'T AFFORD.

Colorado State Government has contracted with the Colorado Health Institute
------ "We are holding 25-minute interviews over the next two weeks and would appreciate if you would share your perspectives about the state’s progress towards accomplishing the goals of the 2018 Community Living Report Update. "

That sounds good right? EXCEPT the 2018 Update doesn't have Measurable Goals and doesn't comply with the LAW.

Is the State taking a POLL as to whether or not State Officials should comply with the LAW?

I haven't necessarily seen it necessary to insist the State say it is out of compliance with the LAW --- if it was CLEAR the State was going to comply in the immediate future.

States around the country have a FRUSTRATING HABIT of FAILING TO COMPLY on "MEASURABLE GOALS."

Federal Judge Donovan Frank threatened the State of Minnesota with Sanctions due to their DELAYS and INSUFFICIENT OLMSTEAD PLANS.

I'm not sure that is where we're at here BUT it seems the State is NOT CLEAR on the LEGAL REQUIREMENTS.

THE "BIG ROCKS" ARE OLMSTEAD LEGAL REQUIREMENTS

5/16/2021

The Polis Administration has refused to DIRECTLY address the LEGAL ISSUES around Olmstead Planning
- Are they in AGREEMENT or do they feel bound by ---- 2011 US Department of Justice Guidance?
  - Who knows, they refuse to answer DIRECT QUESTIONS on the matter.
- Are they in agreement or feel bound by subsequent CASELAW --
  - It's NOT CLEAR

The REALITY is there are plenty of POLITICAL CONCERNS that States can incorporate into OLMSTEAD PLANNING ---- if they are CLEAR & COMMITTED to the Big Legal Rocks.

BUT we have to start with a CLEAR UNDERSTANDING of the LEGAL FRAMEWORK because that should determine what else goes in ---- NOT the 2018 Update.

Now, Colorado can consider the 2018 Update as much as it wants to --- SO LONG AS --- the Legal Framework is CLEARLY IN PLACE.

The Legal Framework for Olmstead Planning in Colorado is NOT CLEARLY IN PLACE.

As of Feb. 25, 2020 --- DOJ did make clear that the 2011 Statement was NOT BINDING outside of Statute, Regulations and Judicial Precedent.

We've previously suggested that the DOJ Statement be incorporated into Regulations.

Measurable (specific) Goals are in the Caselaw --- BUT it's not helping that so much has to be PIECED TOGETHER.

(where might one find some caselaw on Measurable Goals --- the 2015 National Association of State Mental Health Program Directors --- Olmstead Risk Assessment & Planning Checklist --- ya gotta love it)

TRUSTED MESSENGERS

5/14/2021

It used to be that there was one trusted human messenger in "ADVANCED SOCIETIES" --- Pharaoh, the King.
- That didn't work out very well.
Then there were Royal Families and people connected with those royal families.
- That didn't work out very well.
In Europe and the US, a landed gentry.
- That didn't work out very well.

In the 19th Century, Napoleon instituted the "Meritocracy" in the French Military.
- This is a STEP UP.
- Why would anybody be against it?

I'm for VACCINES and I've gotten my Covid Vaccine BTW --- BUT why would anyone be against VACCINES recommended by an EXPERT who had risen through the "MERITOCRACY" ?

Most people have had the experience of dealing with "EXPERTS" who were demonstrably wrong or were afraid to admit they were wrong.

Further, many people have had the experience of being IGNORED and BLOWN OFF on matters that were important to them.

HIERARCHY has historically been a CORNER-STONE of ADVANCED SOCIETIES --- but it brings a lot of weaknesses and sometimes its own destruction.

SciShow (Jan. 2021)
The Untold Story of the First Vaccine

One of the things we are starting to appreciate is the VALUE of Everyone's Perspective to the Process of Problem Solving and Public Health.

Experts do have a role BUT it is OVER-VALUED in our society, and the role of LAY PEOPLE is UNDER-VALUED.

THE NEWLY DISCOVERED WORLD OF NEURO-DEVELOPMENTAL INFLAMMATION & EXECUTIVE FUNCTIONING DIFFERENCES

5/12/2021

Conjecture

It's looking like PSYCHIATRIC DISORDERS are starting out as NEURO-DEVELOPMENTAL DIFFERENCES affecting EXECUTIVE FUNCTIONING:
- I would submit that some of these DIFFERENCES are NOT ALL "BAD" and many have CONSIDERABLE STRENGTHS.
- On the other hand, there are some REAL CHALLENGES that are not necessarily best addressed by CONVENTIONAL THERAPY.
  - Why would that be? We're talking about Developmental Differences.
    - We need a systematic assessment of executive functioning;
    - We need workarounds and accommodations

Also we need a STRENGTH-BASED APPROACH --- for that to mean anything --- it needs to be FORMALIZED and SYSTEMATIZED
- How many Mental Health Professionals are against that? Probably none.
- How many Mental Health Professionals are implementing a SYSTEMATIZED STRENGTHS-BASED Approach ----- not many.

This NEW WORLD of COGNITIVE DIFFERENCE / DISABILITY

The "EQUATION" got a lot more COMPLICATED
It's NOT just the BRAIN as COMPLICATED as that is:
- It's the IMMUNE SYSTEM
- The ENDOCRINE SYSTEM, and
- The MICROBIOME

Who first told me they thought "Mental Illness" was "SYSTEMIC" throughout the body ---

Internationally known Colorado Based Mental Health Visionary --- Amy Smith.

FOREWARNED IS FOREARMED

5/11/2021

My mother told me, "You won't make my mistakes, you'll make your own."
I've told my children the same thing.

Tolstoy lamented that the values of CHILDHOOD were often not reflected in ADULTHOOD.

I think there are a lot of reasons for that. One of the reasons is that CHILDHOOD involves EDUCATION and the ASSIMILATION of HUMAN KNOWLEDGE that was often gained the HARD WAY.

There's a certain amount of being the "SACRIFICIAL LAMB" and adding to the HUMAN KNOWLEDGE BASE of which you may never benefit, and the hope is POSTERITY does benefit.

One of the things that seems sorta understood and sorta not understood --- We're often talking about a CONTINUUM between DEVELOPMENTAL DISABILITY/ DIFFERENCE and MENTAL ILLNESS.

See: Evolving Notions of Schizophrenia as a Developmental Neurocognitive Disorder (2017)----

Affiliations

Harvard Medical School, Department of Psychiatry
Massachusetts Mental Health Center Division of Public Psychiatry
Beth Israel Deaconess Medical Center,Boston,Massachusetts.

Walter Reed National Military Medical Center,Bethesda,Maryland.

Further, it's often the DEVELOPMENTAL DIFFERENCE that is PRIMARY.

It often involves the IMMUNE SYSTEM and MATERNAL IMMUNE ACTIVATION.

Additionally, the Immune System has been identified with mating.

Recent research on Neuroscience News is that 50% of partners of a person with Schizophrenia or Bipolar Disorder have their own mental health issues.

The IDEA is that this is NOT A RANDOM PAIRING.

GIFTEDNESS, ADHD, AUTISM --- Those are SPECIAL NEEDS POPULATIONS in our Society BECAUSE they are coming with EXECUTIVE FUNCTIONING DIFFERENCES, and the Individuals and the Society are often not well prepared for those differences.

C-STAT, CMS' 2015 GUIDANCE ON HOUSING RELATED ACTIVITIES & ------OLMSTEAD DATA COLLECTION

5/10/2021

Data Collection is a BIG PART of Successful Olmstead Planning
Perhaps most importantly DATA COLLECTION is CRITICAL to making the case for FUNDING to:
- State Legislatures
- Philanthropic Organizations and Efforts, and
- the FEDS

CMS' 2015 Housing Related Guidance
When CMS (Centers for Medicare & Medicaid Services) came out with this "Informational Bulletin" on "Housing Related Activities" ----- It was a disappointment to many advocates.

There had been a great hope that Medicaid would fund "HOUSING AS HEALTHCARE."
BUT there are IMPORTANT NUGGETS to drive REFORM in this document ---
- FUNDING OF OLMSTEAD ACTIVITIES

We need to confront the FINANCING OF DISABILITY HOUSING in this Country.

Additional Data beyond HUD's yearly POINT-IN-TIME COUNT could help us do that.

One IDEA is to FAVORABLY ADJUST the State's Medicaid Financial Percentage in return for commitments to provide SUPPORTIVE HOUSING (not just the services, but the HOUSING too).

State Waivers List

CMS' 2015 Housing Related Guidance

3. State-level Housing Related Collaborative Activities

Several strategic, collaborative activities to assist in identifying and securing housing resources are:

Developing formal and informal agreements and working relationships with state and local housing and community development agencies to facilitate access to existing and new housing resources.

Participating and contributing to the planning processes of state and local housing and community development agencies, for example, by providing demographic, housing need, and other relevant data for the populations served by the LTSS agencies, among other planning activities.

Working with housing partners to create and identify opportunities for additional housing options for people wishing to transition to community-based housing.

This may include coordinating available housing locator systems and developing and/or coordinating data tracking systems to include housing.

Racism in Psychiatry: Questioning the Expertise of the "EXPERTS"

5/10/2021

New York Times (April 2021): Psychiatry Confronts Its Racist Past, and Tries to Make Amends ----But there is a lot to apologize for — from Reconstruction to today.

Temple Grandin

Psychiatry's confrontation of its racist past is important for a number of reasons --- one of them being that it runs HEAD-LONG into one of the FAULT-LINES in our society --- EXPERTS and LAY PEOPLE.

What we all want to do is just rely on the EXPERT.

Further, addressing errors of "EXPERTS," is a long and time consuming process.

Additionally, I do not think we can expect critical professionals in our society such as Law Enforcement, Teachers and Mental Health Professionals to be some type of SUPER HUMAN that doesn't have any flaws.

A lot of STRENGTHS come with their own WEAKNESSES.

This gets to Temple Grandin's point of the importance of DIFFERENT MINDS and INCLUSION.

Doing that with EXPERTS and LAY PEOPLE is not easy, but we need to do it.

THE DEFINITIONAL ARGUMENT IN MENTAL HEALTH & CRIMINAL JUSTICE POLICY

5/9/2021

Despite the obvious fun of telling MDs and PhDs that something is flying over their heads --- why are we as a SOCIETY and EXPERTS missing the DEFINITIONAL ARGUMENT in Mental Health and Criminal Justice Policy?
This isn't ROCKET SCIENCE.
This is High School Debate or Introduction to Philosophy.

Yeah, but "Mental Health" isn't High School Debate or Philosophy -- it's Medicine (sort of).

What does the NATIONAL INSTITUTE OF MENTAL HEALTH think about the Diagnostic Manual and the DEFINITIONAL ASPECTS of Mental Illness?

"The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.

"In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.

"Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.

"Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system."

https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

Mental disorders are among the most complex problems in medicine, with challenges at every level from neurons to neighborhoods.

Yet, we know so little about mechanisms at each level. Too often, we have been guided more by religion than science.

That is, so much of mental health care is based on faith and intuition, not science and evidence.

On the plus side, we put a premium on listening and compassion. We help people to change through understanding.

But not enough of our care has been standardized to a high level of quality, as expected in the rest of medicine.

------------Dr. Tom Insel, Director of the National Institute of Mental Health from his October 2014 Blog Atonement

When NIMH took the POLITICALLY RISKY step of questioning DSM Definitions and Diagnostics in 2013 --- it doesn't appear they were thinking about CRIMINAL JUSTICE.

BUT the problems with these "invalid" definitions and diagnostics are even more pronounced in CRIMINAL JUSTICE.

Further, we have long historical LEGAL TRADITIONS regarding BURDEN OF PROOF and MENS REA (the mental element of crime) ---- those Foundational Principles are showing some significant wear given the MULITITUDE of BIOLOGICAL EXPLANATIONS for Behavior Problems.

A Biological Problem such as Neuro-Inflammation no longer seems to be the EXCEPTION -- but rather the RULE.

BUT that doesn't make anybody less of a risk.

And this is where we get to why our SOCIETY and our EXPERTS are MISSING ---- the Definitional Argument.

THEY ARE NOT "MISSING" IT --- they do understand the CONSEQUENCES and they are rejecting them.

A PUBLIC HEALTH APROACH to CRIMINAL JUSTICE is the PEARL of GREAT PRICE ---- many countries are turning to after years of PAINFUL THINKING.

History of Philosophy with Prof. Footy
Socrates, Knowledge & Ethics

What is "Mental Illness?"
What is a Non-Biological Personality Disorder?

Definition Argument

"The definition argument focuses on clarifying a definition for a controversial term or concept.

"In other words, a definition argument is one that asserts we cannot make clear assertions or possess a clear understanding of an issue until we understand exactly what the terms mean."

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