Blog Posts

In Praise of SB 20-181 -- Measures to Improve Outcomes for Incompetent to Proceed (ITP)

7/12/2020

AND
* CMHIP VOLUNTARY Patient Collaboration with CU Boulder on Microbiome Issues
*Olmstead Compliance as Lateral Problem Solving for Archaic ITP Laws

SB20-181

Really deals with the HARD REALITY of Current Long Term Disability as evidenced by:
- More than one finding of Incompetent to Proceed;
- MODERATE TO SEVERE INTELLECTUAL OR DEVELOPMENTAL DISABILITY, ACQUIRED OR
  TRAUMATIC BRAIN INJURY, OR DEMENTIA, WHICH EITHER ALONE OR TOGETHER WITH A CO-OCCURRING MENTAL ILLNESS AFFECTS THE DEFENDANT'S ABILITY TO GAIN OR MAINTAIN COMPETENCY, THE EVALUATOR
  SHALL PROVIDE AN OPINION AS TO WHETHER THERE IS A SUBSTANTIAL PROBABILITY THAT THE DEFENDANT WITH RESTORATION SERVICES WILL ATTAIN COMPETENCY WITHIN THE REASONABLY FORESEEABLE FUTURE.

Voluntary Collaboration with Microbiome Researchers @ CU Boulder or Elsewhere

There are literally Trillions of VARIABLES when it comes to Cognitive Disability -- so it's no wonder this has taken awhile to tease out.
The current research model of the Brain-Immune-Gut Triangle with the MICROBIOME in the middle gives us an idea of just how COMPLEX many of these issues are.
Some of the people at CMHIP or Ft. Logan are pretty IDIOSYNCRATIC and have fallen through the MENTAL SYSTEM as it is currently constructed NUMEROUS TIMES.
The ANNA KARENINA PRINCIPLE put forth by Oregon State University is that the HUMAN MIcrobiome is largely HEALTHY in the same way, but it can go off track in a MULTITUDE of WAYS impacting Mental Health.
Some of the most important RESEARCH -- some of which is going on right here in Colorado -- involves that MICROBIOME and that it can be much more complicated to STABILIZE than one would expect.

SB20-181 -- Is A BIG STEP UP for Colorado Incompetent to Proceed Law

The Imagine Microbiome Program in Canada

The Microbiome is in Our Guts, and it appears to be in Our BrainsButton Text

Our SCARY ITP System: Implicit Bias + Pathologizing Conflict = Structural Discrimination at CMHIP

Click Here

Getting Out of the Nightmare of Archaic Laws & an Out-of-Date DSM 5 is in part About Olmstead Compliance

In some ways this is similar to the debates about the Civil Commitment Statutes -- is the REAL issue the Civil Commitment Statute or the State's failure to provide:
- Housing
- Intensive Services,
- Placements to SCALE, and
- INCLUSION
IT"S THE STATE's FAILURE to provide Housing, Intensive Services and Placements to SCALE and Radical Inclusion that is the REAL issue.
A lot of Law Enforcement, Prosecutors and Judges would like to see RESOURCES for the Long Term so people don't just keep coming back.
A lot of Individuals and Families desperately NEED those RESOURCES.
Figuring out how to fund it has always been the issue.
To paraphrase Senate candidate John Hickenlooper, let's stop arguing over COGNITIVE DISABILITY HEALTHCARE and figure out how to fund it and drive down costs.
For many reasons, including to comply with FEDERAL LAW -- Title II of the ADA and Olmstead.

Seeing Things In a New Light

7/10/2020

There is something about hearing an idea expressed in another language or context that gives it new meaning, richness and dimension.

By and large, I haven't been one of those people who is offended by "All Lives Matter" -- even as I'm supportive of BLACK LIVES MATTER.

It was only after seeing Lone Bannana's picture to the right that I realized how HOLLOW that "All Lives Matter" seems to many people, especially when espoused by white people.

When we think about SLAVERY/Jim Crow REPARATIONS or addressing TREATY OBLIGATIONS with Indigenous People ---- that's very complicated, and it does go to the diminished health of those populations.

Mental Health/Activism and Law are different sides of the same coin. Sometimes you do just have to get through a terrible situation and cope as best you can.

On the other hand, we're almost always called upon to change those situations for others.

The idea of a SOCIAL CONTRACT has been around for a LONG TIME. Some SPIRITUAL IDEAS regarding obligations to the community have been around EVEN LONGER.

Hammering out the DETAILS of that -- is a BIG PART of the work of SOCIETY.

When we IGNORE TREATIES or LAWS it has a BIG IMPACT on the lives of Individuals, their Families and Communities.

Some of these OBLIGATIONS are NOT EASY -- like the ADA and Olmstead and their relationship to the needs of People with Cognitive Disabilities.

But if you don't honor those obligations-- you wind up with the modern day horror of MASS INCARCERATION.

Trail of Tears: 21st Century Edition
by
Lone Bannana

Val's Note: If you would have asked me a week ago if Oklahoma had any "reservations" -- I would have said no. Indian Land -- yes, reservations -- no.

That was before the US Supreme Court's ruling July 9, 2020 that almost half of Oklahoma is Creek and other Indian Reservations for purposes of Criminal Court Jurisdiction.

The diagram above shows a relatively close proportion of Native Americans in Oklahoma and as Defendants in Federal Court.

But that is because most Native American defendants in Oklahoma are prosecuted in STATE COURT.

That is not going to be true anymore for almost half the State.

Native Americans refer to -- the RESERVATION TO PRISON PIPELINE.

With --

A Lot of Inclusion
Honoring Existing Obligations, and
Bringing in a Public Health Approach

MAYBE WE COULD GET OUT OF THIS NIGHTMARE.

Cronkite News (2019)

Native Americans have the highest suicide rates in the nation and young Native Americans face an even greater risk.

Here in the Southwest, efforts are under way to overcome the stigma of talking about mental health issues, and to help native youth build resiliency and connect with their culture.

The NEED for Resources and BOLD Stands

7/10/2020

The calls of Black Lives Matter to DeFund the Police and Re-Allocate Resources to Services People Need and UCDavis' Dr. Shem's courageous challenge of the American Psychiatric Association over Structural Racism put in high relief what is at stake and how hard it is to reform entrenched systems.

INADEQUATE FUNDING
The FAILURE of STATE LEGISLATURES to adequately fund Housing, Intensive Services and Placements for people with Cognitive Disabilities is a primary reason and root cause for MASS INCARCERATION..
Many if not most Courts and Prosecutors would go along with a SAFE CARE PLAN with HOUSING or PLACEMENT.

INADEQUATE SCIENTIFIC RIGOR AT THE CLINICAL LEVEL
On the other hand, Clinical and Forensic Mental Health seem OBLIVIOUS to the problems of a scientifically invalid classification system in the DSM 5 or the need for BIOMARKERS.
There's a BIG DIFFERENCE between doing the best you can with what you have and ARROGANTLY and INCOMPETENTLY refusing to limit actions based on SIGNIFICANT KNOWLEDGE GAPS.
An invalid classification of "ANTI-SOCIAL PERSONALITY DISORDER" -- could get the book thrown at a person -- and a lot of states haven't repealed the death penalty -- so the person could wind up incarcerated for a long time or dead based on an invalid classification.
For many of us this isn't THEORETICAL -- we've seen it with our own eyes.
The Forensic Psychiatrists & Psychologists of the world need to STEP UP and stop allowing themselves to be used for purposes of punishment.

If there was ever a TIME to make this BOLD STAND -- NOW IS THE TIME.

Dr. Thomas Insel, former Head of the US National Institute of Mental Health, on the DSM 5

Income Inequality, Supportive Housing and BIG DATA

7/9/2020

What's the POINT of the Oliver Twist clip?

19th Century England was marked by HUGE Income Inequality and HUGE Social Problems
There were attempts to deal with the Social Problems -- to do "SOMETHING"
Those ATTEMPTS generally fell FAR, FAR SHORT of the NEED
We are now in an ERA of BIG DATA -- if we want the information -- we can largely get it.
Many STATES are AFRAID to get the DATA on the NEED for SUPPORTIVE HOUSING of People with Disabilities in their States -- including those being released from Incarceration.

Oliver! is a 1968 British musical drama film directed by Carol Reed, written by Vernon Harris, and based on the 1960 stage musical of the same name.

Both the film and play are based on Charles Dickens's 1838 novel Oliver Twist. --- Wikipedia

Data Collection, the Root Causes of Problems and Funding SUPPORTIVE HOUSING

7/9/2020

    Data Collection and Planning have the possibility of CALMING THINGS DOWN --- but it is all in how you CONCEPTUALIZE it --- and that has to be continually REVISED based on new information and new understandings.

When we talk about ROOT CAUSES of PROBLEMS -- we're often talking about FUNDAMENTAL ERRORS in how we CONCEPTUALIZE the problem.

When we start talking about problems in HUMAN BEHAVIOR --- we're talking about the biology/environment of the person and the society.

  The other day I heard an interview with the Flint Michigan doctor who exposed the High Lead levels in Flint, Michigan children. One of the points she made was that we don't have good, reversing treatments for LEAD EXPOSURE -- and it has long-term, life-long consequences.

   Further, those kids may likely need a lot of SUPPORT over their lifetimes.

  When we talk about "MENTAL ILLNESS" that is sometimes looking a whole lot more like DEVELOPMENTAL DISABILITY for people with higher IQs -- and CUMULATIVE DAMAGE to an overly sensitive immune system -- and that ultimately damages the brain.

We throw a lot of ideas and conjecture out regarding "Mental Illness" -- not necessarily because we're the most formally qualified people to do it --- but we do have enough personal, professional and research knowledge to know --- what we're doing NOW is based on a FUNDAMENTALLY INACCURATE CONCEPTUALIZATION of "Mental Illness" -- and THAT MATTERS, it MATTERS A LOT.

Re-working that CONCEPTUALIZATION of "Mental Illness" in 2020 is a lot about not only recognizing the importance of the BRAIN BUT also:

common genes among "mental disorders"
common epigenetic changes to the immune system
the Immune System itself and it's pipeline to the brain -- that was only DISCOVERED less than 10 years ago
the Endocrine System
the Gut, and
the HUMAN MICROBIOME -- which does more metabolizing and has more genetic material than we have human genetic material -- and we're just beginning to unravel that.

That's a lot.

When we talk about COVID-19 one of the great concerns is OVERWHELMING THE HEALTHCARE SYSTEM. That Healthcare System and Public Support System is more than OVERWHELMED with the needs of people with Cognitive Disabilities.

We would submit there is a lot of HOPE when it comes to ameliorating the challenges of Cognitive Disability -- especially if we can build on the natural strengths of creativity, divergent thinking, and entrepreneurship that often come with an overly sensitive system while providing innovative workarounds for emotional dys-regulation and other executive functioning issues.

All of this is a very long way of saying we need to fund MUCH MORE SUPPORTIVE HOUSING until we have better TREATMENTS.

Further, we need to fund more RESEARCH and MUCH MORE TRANSLATIONAL MEDICINE (bringing research to CLINICIANS in ways they can use).

With respect to FUNDING -- what people are against largely is just throwing money at a problem with lack of specificity in how the PLAN is going to ameliorate the problem.

When we think about a Plan for Cognitive Disability that has to include 2 Elements:

Housing, Services, & Placements NOW or a Comprehensive, Effectively Working Plan to get them -- Olmstead, Title II of the ADA
A Comprehensive and Effectively Working Plan for Research and Translational Medicine

When we focus on the first element, one of the most expensive aspects of this is SUPPORTIVE HOUSING -- yet this is also something that the ENTIRE SOCIETY could get behind in funding:

State and Federal Government
Municipalities and Counties
Philanthropic Interests
Businesses
Religious Charitable Efforts
Social Services Organizations
Youth
Etc.

The COORDINATION of that effort could come through funding for Medicaid Housing-Related Activities which includes funding for Olmstead Planning.

It's a lot easier for people to believe we're all in this together -- when we act like it.

CMS -- Medicaid Housing Related Activities

Law Enforcement, Criminal Justice & Mental Health are a MESS -- We NEED Real Reform

7/7/2020

In democracies, minorities often bear the brunt of reducing societal ideas and assumptions to the ABSURD in practice.
AND because we don't really feel the pain of our OUT-GROUPS -- it can take a long time for the MAJORITY to clue in that some type of CHANGE is NEEDED.
Right now our SYSTEMS of:

LAW ENFORCEMENT
CRIMINAL JUSTICE, and
MENTAL HEALTH

are a MESS.

BLACK LIVES MATTER and others are posed to make some BIG CHANGES.

Almost all of this is NOT NIHILISM or ANARCHY, but rather a RE-IMAGINING and RE-ALLOCATION and RE-PRIORITIZATION of RESOURCES.

Did we need PROTESTERS in the Streets for weeks DEMANDING CHANGE---- you're DAMN RIGHT WE DID.

These SYSTEMS are so out of touch, expensive, cumbersome and FAILED -- there really wasn't a lot of choice.

Of course at this point, BLACK LIVES MATTER holds the HOPE of many people in the MAJORITY as well as various MINORITIES that REAL CHANGE & REFORM will happen.

Individual "ACCOUNTABILITY" is NOT the PANACEA We'd Hoped

7/6/2020

This really isn't an argument to minimize BAD BEHAVIOR -- It's really an argument to take it SERIOUSLY:

Take necessary and humane steps to provide for SAFETY;
Recognize this is likely NOT the only person in the Society exhibiting this unwanted behavior;
"ACCOUNTABILITY" and PUNISHMENT are likely to DISCOURAGE people from seeking whatever TREATMENT or SANCTIONED SOLACE that is available;
Encourage engagement with the PUBLIC HEALTH SYSTEM and privacy-protecting PUBLIC HEALTH DATA COLLECTION ACTIVITIES.
The PUBLIC HEALTH NEEDS that Bad Behavior often exposes can sometimes be LONG TERM and beyond any ARBITRARY & CAPRICIOUS term of years.

The Criminal Justice System spends a lot of time trying to MAINTAIN THE FICTION that VAST AMOUNTS of REALITY are IRRELEVANT -- so it can "HOLD PEOPLE ACCOUNTABLE."

We can provide for SAFETY, open this up to REALITY, and BUILD ON the HARD WORK of getting to the ROOT CAUSES of the problems in our Criminal Justice System.

Florida Judge Steven Leifman maintains we are moving to a COLLABORATIVE APPROACH in Criminal Justice -- that is so needed for everyone involved.

The BLACK LIVES MATTER Movement could really speed that up.

It is hard to overstate how important it is for us to get on the SAME TEAM while maintaining our integrity. BIOLOGICALLY, we are wired to feel EMPATHY for those on our side, and not really register the PAIN of those in our OUT-GROUPS.

Anybody who has read Orchid for any length of time knows we do NOT practice EMPATHY perfectly -- and if you're living in the US in 2020 you're also living in a Society with FAILED SYSTEMS and FAILED EMPATHY.

God of the Gaps, Criminal Liability of the Gaps

Crap Justice and Crap Services: They Often Go Togethr

We're in the midst of a Scientific Revolution -- Our Moral Duties don't begin after it's over -- They are Here Right Now

"Collaboration" is Desired by All Sides: What it's NOT

Mental Health's Profound Problems and Defunding Jails and Prisons

7/5/2020

The Scientific problems in the Mental Health profession were vocally addressed by the US National Institute of Mental Health as early as 2013.
After a lot of push back from the American Psychiatric Association, NIMH now says it is "AGNOSTIC" on the DSM 5 -- other researchers are not and are more blunt in their assessments of the DSM 5 as a meaningless classification system..
Because of this special moment in history, Dr. Shim with UCDavis FINALLY got the APA to act on Structural Racism -- this week -- after publicly quitting organized psychiatry.
This is a profoundly troubled profession that has very little INSIGHT into the facts that:

Forensic Experts are in way over their heads in the Criminal Justice System, and
Some policymakers are starting to ask some very tough questions regarding what they are getting for all the money they are spending on Mental Health.

One of the things our Society needs to do is acknowledge the reality that we don't know it all -- and we need to stop putting that burden on often poor people with cognitive disabilities.

On the other hand, we have to have the COURAGE to acknowledge what we do know -- JAILS and PRISONS are often the treatment provider of last resort for people with cognitive disabilities.

One of the reasons why our system is so ineffective is it wants to PUNISH individual bad acts and intent RATHER THAN address the often COMPLEX and LONG TERM cognitive and behavioral issues the person is facing---which can implicate COMPLEX and LONG TERM Systemic Problems in the Society such as:

INADEQUATE HEALTHCARE, especially for Cognitive Disability,
STRUCTURAL RACISM
etc.

There are plenty of people who are arrested on a low level charge -- and really need LONG TERM CARE for the foreseeable future.

This gets to a BIG MORAL ISSUE for the Society: we do have enough information or we could get it to determine that the person has some type of cognitive disability, but we often DON'T HAVE that perfect treatment waiting in the wings.

What's needed is often a LIFETIME COMMITMENT -- not necessarily to a secure placement (although in some cases -- yes) -- but to Supportive Housing and Intensive Services, including Supportive Employment.

Dr. Shim at UCDavis takes on the APA for Structural Racism-- All of Us should have such COURAGE

7/4/2020

Val's Note: The Mental Health Profession is a floundering profession very much out of control that is hurting a lot of people in Colorado and around the country with its lack of competence.

Attempts at REFORM by the National Institute of Mental Health (NIMH) and Academic/Practitioners such as Dr. Shim have been resisted and rebuffed.

THIS IS NOT OKAY.

A day after Dr. Shim's scathing public article -- the APA (American Psychiatric Assn.) announced that a Presidential Task Force is to Address Structural Racism Throughout Psychiatry -- July 2, 2020

EXCERPT

"Although the discrimination I have personally experienced is a problem, the real issue is structural racism, which the Aspen Institute defines as 'a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity.' ”

"Organized psychiatry has repeatedly refused to examine its contributions to this system.

"It has not prioritized the needs of minority patients, especially Black patients.

"In our mental health system, people of color are overrepresented, misdiagnosed, and mistreated, and organized psychiatry has no plan to guide the correction of these well-studied and long-standing inequities."

When People Complain to me of the Medical Model -- I usually say ---What Medical Model? It's a Sham Medical Model at Best

No Good Deed Goes Unpunished

Hair Analysis, Psychological Analysis and the Moral and Ethical Imperative to Pull Back

Dr. Ruth S. Shim, M.D., M.P.H. @ UCDavis

Structural racism is why I’m leaving organized psychiatry

July 1, 2020

Excerpt

The killings of George Floyd, Ahmaud Arbery, Breonna Taylor, and so many others are leading many Americans to reflect on structural racism in society and resolve to do things differently. They have led me to make the difficult decision to end my membership with organized psychiatry, specifically the American Psychiatric Association.

After years of committing myself to the APA and believing that organized psychiatry was an effective vehicle by which progress could be made, racism is driving me and other Black physician leaders out of organized psychiatry, just as it has pushed Black physician leaders out of academic medicine.

. . .

At that meeting I learned that Black psychiatrists had stormed the APA board of trustees meeting in 1969, demanding racial equity.

One year later, a collection of seven articles on racism appeared in the American Journal of Psychiatry (pages 787 to 818) and included clear recommendations for white psychiatrists “to become increasingly aware of how their everyday practices continue to perpetuate institutional white racism in psychiatry and to support the search for realistic solutions,” and to make available “the necessary resources of money, manpower, and authority — and not just in the current token amounts.”

Unfortunately, these recommendations were not followed in any significant way, despite the fact that they are still as relevant today as they were 50 years ago.

I left the APA’s 2007 meeting vowing to continue to fight for racial equity from within the organization.

Over the next few years, as a junior faculty member, I dedicated myself to this effort. I submitted abstracts on topics related to improving outcomes for minority populations with serious mental illnesses.

I was careful, though, in how I presented these issues in submissions to the APA’s annual meeting scientific program committee. I hid my interest in “minority issues” through coded language such as health disparities and social determinants of mental health.

Many times, despite my great efforts to make my interests more “palatable” to a wide audience, these submissions were rejected.

I found acceptance with the Institute on Psychiatric Services (IPS), APA’s smaller fall meeting, which is marketed for public-sector psychiatrists — those who primarily care for poor patients of color. I began to incorporate discussions about discrimination in psychiatry into my submissions for this meeting.

Presentations that were routinely rejected for the APA’s annual meetings were often accepted and well-received at IPS meetings.

I was grateful to have the IPS as an outlet to grapple with complex issues of structural racism in psychiatry.

Sadly, prominent APA leaders have expressed concern that IPS unfairly caters to one group of the APA — public-sector psychiatrists — and have explored the financial viability of continuing the IPS meeting.

Full Article on STAT

Carl Reiner, a Psychotic Episode -- and the Need for More Comic Relief

7/3/2020

How many people can say Carl Reiner was in their Psychotic Episode? -- Well, I can --
There was almost a conscious desire to lighten that up --

Comic Relief --- is vastly under-appreciated in 2020.

While Carl Reiner never really came off as "tortured" -- plenty of comedians have.

An ability to synthesize and distill what's going on in the society or one's personal life -- into a short funny bit -- does take a comic genius -- someone with a lot of creativity and divergent thinking.

We need a bigger market for future Carl Reiners, comics, actors and artists.

Further, this is one way to lower the ranks of unemployed or under-employed individuals with "mental illness."

Today Show: Al Roker Looks Back At His Interview with Comedy Legend Carl Reiner

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