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THE CLOCK IS TICKING . . . INDIVIDUALS WITH SERIOUS MENTAL ILLNESS & THEIR FAMILY MEMBERS NEED EMERGENCY RULE MAKING to address medicaid Provider resort to criminal Justice System

6/10/2019

So let's say, the Medicaid mental health provider of someone in a residential placement :

filed a restraining order
pursued criminal charges for "harassment"
the person with serious mental illness is now or is on the verge of becoming homeless

What kind of human resources must be allocated to avoid homelessness or incarceration @ this point: A LOT.

Even if the Medicaid provider or Regional Accountable Entity finally steps up to do the right thing, they are often NOT prepared for the HEAVY LIFTING that is required. -- and the CLOCK IS TICKING.

This week we will start work on a Draft Application for Emergency Order and post on the website focusing largely on a Medicaid mental health recipient who is facing lack of treatment and homelessness due to State inaction or action. The Mental Health Center and the Regional Accountable Entity will also likely be included as Defendants.

If the situation in question is resolved QUICKLY -- our Application may not be necessary. Unfortunately, this is NOT an isolated incident.

While it is true much work is going on @ the state level on Behavioral Health -- Medicaid recipients with serious mental illness & their families need EMERGENCY RULE MAKING to address their concerns.

In some situations, it may be appropriate for the State to provide Hotel Vouchers until permanent housing can be obtained and the Mental Health Center and Regional Accountable Entity can arrange intensive services, including Assertive Community Treatment if appropriate.

Getting the situation out of the EMERGENCY category reduces the Stress on EVERYONE and increases the likelihood of cooperation and better decisions going forward.

PART II: HOW COULD WE CUT CRIMINAL JUSTICE DOCKETS IN HALF OR MORE? THE "HORCRUX" OF THE PROBLEM IN CRIMINAL JUSTICE

6/8/2019

The "Horcrux" of the problem in Criminal Justice is NOT that we're concerned about SAFETY. It is that our concern for PUNISHMENT is preventing us from realizing our SAFETY objectives.
It has also created one of the most inefficient, ineffective & unjust systems in American Society & largely the Western World -- the American Criminal Justice System.
Those long criminal dockets are pretty darn unnecessary.
There are some cases in which everything is @ issue. That's not most cases.
The primary issue in most cases is the PUNISHMENT.
Well, the Criminal Justice System has been trying to include TREATMENT in its range of options for decades. The advent of Medicaid Managed Care has not made that easy. Of course, it wasn't easy to begin with.
Further, the Criminal Justice System is going to determine homelessness, discrimination, poverty, substance issues, & disability largely IRRELEVANT to their determinations, except in very narrowly prescribed circumstances.
SO we can never reduce the CRIMINAL JUSTICE DOCKETS because we can't, we think we can't or we won't deal with underlying ROOT CAUSES.

The DUE PROCESS people need is not in trips to the Courthouse for Arraignment and the many court dates set after that for DISPOSITION -- because the range of alternatives is INSUFFICIENT and can be HORRIFIC.

There are cases that DO NEED a lot of attention in order to DETERMINE THE FACTS -- but those cases/people can't get it because the SYSTEM is so overrun with cases that don't need to be there.

Further, if we try to work with people rather than against them we may find that in some cases it is THEY not US who are arguing for a HIGHER LEVEL of TREATMENT & PLACEMENT.

The more we base treatment & placement decisions on objective health & social determinant of health data and on an inclusive set of considerations rather than an exclusive set of considerations-- the more COMMON GROUND we'll find.

J.K. Rowling

A Horcrux is an object formed by dark magic that is used by a wizard or witch in the Harry Potter series. Horcruxes are created to achieve immortality by splitting a dark wizard's soul into separate pieces.

--dictionary.com

Legal Reform: How to Cut Criminal Justice Dockets in half or more?

6/7/2019

Photo Credit: US Chamber Institute for Legal Reform. Of course, people and organizations have different opinions on what constitutes "reform."

"[I]t will take a combination of technological improvements, procedural simplifications and maybe even 'breaking down the lawyer cartel' for the access to justice problem to be mitigated."

---LAW360, Access to Justice

The Access to Justice article referenced above is about DIVORCE -- but it could also be about -- GASP! -- CRIMINAL JUSTICE.

What drives Criminal Justice Dockets is failure to provide appropriate and humane placements & services over the long term.

Our Society does NEED the skills lawyers & judges possess -- but those skills are often being wasted in not only grossly inefficient legal systems but also grossly ineffective legal systems as well.

Part I: Get Rid of Probation, Jail & Prison -- Provide for Weaknesses & Strengths

PART II: HOW COULD WE CUT CRIMINAL JUSTICE DOCKETS IN HALF OR MORE? THE "HORCRUX" OF THE PROBLEM IN CRIMINAL JUSTICE

PART I: HOW COULD WE CUT CRIMINAL DOCKETS IN HALF OR MORE? GET RID OF PROBATION, JAIL & PRISON-- PROVIDE FOR WEAKNESSES & STRENGTHS

6/6/2019

[The policy prescriptions below may not sound very much in the "middle" -- BUT from our perspective they really are]

Provide a menu of individualized services & housing, placements that are available based on demonstrated need, including:

Supported Employment
Vocational Rehabilitation, including access to educational supports
Placement determinations in which victims, if any, do have a voice
Access to appropriate level of treatment and/or placements for:
- Brain Injury
- Mental Illness
- Developmental Disability, including HIGH IQ ADHD or Autism
- Substance Use Issues
- Sex Offending Behavior
Strength-Based Development of talents, abilities, hopes, aspirations & goals.

One of the places we really get into trouble is we UNDER-ESTIMATE the level of difficulty of RE-INTEGRATING somebody SAFELY back into SOCIETY -- both for the person and for the Society.

So we're NOT for:

Understating the Risk or Difficulty the situation presents, BUT
We're NOT for overstating the Risk or Difficulty either.

Some people may be truly dangerous, SOME people are EMOTIONALLY OVEREXCITABLE --- & when that EMOTIONAL OVEREXCITABILITY is MISINTERPRETED -- Some [maybe most] of those People become even more EMOTIONALLY OVEREXCITABLE.

Well, now we're really OFF TO THE RACES. We think this "overexcitability" is really @ the heart of what the "GIFTED" Community is complaining about with regard to "misdiagnosis." The problem-- it appears these "overexcitabilities" can damage the immune system and ultimately the brain.

Our Society is going through some growing pains with regard to the NATURE of Intelligence. It is pretty clearly NOT what we thought it was. In fact, the disconnect between what we "thought" and "reality" has become so pronounced that the industry that has grown up around "Emotional Intelligence" is BOOMING.

Well, unfortunately many of the people the "emotional intelligent" people would label as TOXIC are in fact "gifted" people with "overexcitabilities" that the "emotionally intelligent" people don't like.

AND that is one of the reasons it is so important to NOT only provide accommodations for weaknesses, BUT also provide access to opportunities to develop strengths & talents.

High IQ & Psycho-Neuro-Immunology

The "Epidemic" of "Misdiagnosis" in the "Gifted" Community

Bringing "Giftedness" Down To Earth So We Could Recognize It In Unlikely Places

When We Don't Tackle Complex System Issues like Guns & Mental Health -- We Almost Always SCAPEGOAT Individuals

6/6/2019

The mishandling of the Arapahoe High School Shooting was every bit as bad as that of Parkland.

But the problem wasn't with security it was with administration officials -- including the firing of security officers for TELLING THE TRUTH.

The Arapahoe High School Community is STILL dealing with the fallout, BUT it recently rejected a bid to SCAPEGOAT Principal Pramenko even though some of the actions of Pramenko & Littleton Public School District officials were pretty bad.

If we are NOT for SCAPEGOATING -- & we're NOT -- what are we for -- dealing with the TOUGH SYSTEMIC PROBLEMS these TRAGEDIES EXPOSE -- the BAD JUDGMENT CALLS are CLUES.

SCAPEGOATS, SACRIFICIAL LAMBS &

AMERICAN
CRIMINAL JUSTICE

America's Justice Problems are NOT limited to the Criminal Justice System -- BUT they are worse there than anywhere else.
There are some pretty FUNDAMENTAL, STRUCTURAL Problems that are driving this:

The US Bill of Rights includes some pretty BROAD protections that are meant to protect Individuals and Minorities.
However, the American Judiciary has never quite lived up to its promise of being an INDEPENDENT CO-EQUAL BRANCH of Government. Yes, it will on highly selected occasions declare something unconstitutional or illegal -- but there are A LOT of POLITICAL CALCULATIONS that go into that.
Long Time ideas of CAUSATION going back to English Common Law -- and before that ---govern HIGHLY COMPLEX HUMAN BEHAVIOR in HIGHLY COMPLEX SOCIAL ORDERS. Do we need to know who did it? -- Yeah, BUT we need to know A LOT more, too.
Much of what is most critical to know: the Justice System will determine as IRRELEVANT.
So the ROOT CAUSES of our problems OFTEN don't get SOLVED -- BUT if we PUNISH somebody-- we call it GOOD.
IT'S NOT GOOD and it has led to the replacement of the US as the protector of AMERICAN VALUES. Remember those values are IDEAS and some countries are implementing those IDEAS much better than we are.

Image Credit: economictimes.indiatimes.com

Organizations need scapegoats to take responsibility for failures

THE VERY LARGE INTERSECTION BETWEEN PERSON-CENTERED, STRENGTH-BASED CARE AND SAFETY

6/5/2019

   Throughout most of human history including modern history, we've generally thought we needed to get the community's CONSENSUS to HATE on BAD PEOPLE to protect ourselves.
I remember one of the GREAT attorneys I knew, and I have known many, was fond of saying:  "Well, the DEATH PENALTY will deter this person."
   We're generally pretty far past the "BLOOD FEUD" -- although some gang violence looks a lot like it.
  Far from being complicit in most horrible crimes, today it's concerned family members and friends who may be contacting law enforcement.
   If you're a social worker, or a public interest attorney or in public health--you probably already know, that when SOCIETY washes its hands of people-- people tend to get worse.
   On the other hand, we can't ask the Community or Providers or Law Enforcement to be in unsafe or perceived unsafe situations.
Now, sometimes folks, including providers, will say: THE PERSON WON'T ACCEPT TREATMENT.
This is where the skills of creative lawyers & advocates can really be of great use. BUT the truth is we DON"T need & there aren't enough lawyers & advocates for every person who needs to NEGOTIATE "TREATMENT."
    Some people might consider our good friend, colleague, psychiatric survivor and nationally known mental advocate Amy Smith as a "radical" mental heath advocate -- BUT even she would tell you that people are "begging for help" and they can't get it.
  Well, what are those skills of creative lawyers and advocates that we could probably transfer into an interactive questionnaire -- @ least to begin with:

finely parsing the treatment options that are available: CBT [Cognitive Behavioral Therapy] , DBT [Dialectical Behavioral Therapy], EDMR [Eye Movement Desensitization and Reprocessing], nutritional support, exercise, dog therapy, equine therapy, cooking therapy, horticulture therapy, etc.
what's available for -- medication, etc.
- what types of medication
- has the person already tried some types of medication, what was the experience -- good/bad/side effects
- would genetic testing be appropriate
- would advice of a neuro-pharmacologist be appropriate
- are there relevant clinical trials that the person might be interested in participating in or monitoring.
what "reasonable accommodations" -might be made to treatment options --are there ways of thinking about those "reasonable accommodations" in general "categories."
an opportunity for the person to propose an accommodation
an opportunity for the person to propose what they would see as most helpful -- again -- are there ways of thinking about this in general "categories" --
it's very hard to get information if people are provided a blank piece of paper or a blank screen -- but if people are given relevant prompts -- we generally get a lot of information. Also, if we just say "treatment" that's a whole lot of things and if someone has had a BAD EXPERIENCE -- there may be a BLANKET REFUSAL.
Where appropriate ask about the persons feelings about institutionalization & various forms of it --- many people are adamantly opposed some people aren't. --WHAT MAKES PEOPLE FEEL BETTER IS AGENCY, NOT NECESSARILY THE FORM OF THE TREATMENT. If there is a CHOICE to be made, be sure the person gets to make it where possible.
Good lawyers and advocates are generally trying to find that INTERSECTION between the person's wants and needs and that of AUTHORITY FIGURES. That intersection is actually much bigger than what we think -- in fact we think it is HUGE.

Venn Diagram

Lateral Thinking/Problem Solving (Disregarding "Implied" Rules)-- BTW Politicians Do This All The Time
[politicians also sometimes disregard actual LAWS ---we don't want that]

I want to thank Scott Durairaj PGC, MBA with the NHS (National Health Service) England for posting this on Linkedin.

WRONG TRACK/RIGHT TRACK? CLINICAL MENTAL HEALTH EDITION

6/5/2019

Wouldn't it be LOVERLY if all we had to tackle were GOSH AWFUL Government Mental Health Funding Policies such as those of CMS, State Medicaid Agencies -- including Colorado's Dept. of Health Care Policy & Financing -- and it's not like that's easy to fix.

BUT what government funders like to say in their defense even as they are NOT complying with parity -- "Hey, we're spending millions, billions of dollars on mental health and Medicaid is the largest funder of mental health services in the US."

The Conservative Mental Health Movement represented by D.J. Jaffe, the Mental Illness Policy Organization & Treatment Advocacy Center ----and the Disability Community ----are probably CLOSER than they have ever been before.

One of Jaffe's latest opinion pieces [this one in the New York Post] argued that New York should put mental health money for NYC's Thrive Program into SUPPORTIVE HOUSING for people with the most intensive mental health needs. Well, that's pretty much a lot of what Disability Advocates want.

While sometimes Jaffe & the Mental illness Policy Organization do recognize that mental health treatment is less than perfect -- they are often lock step with the Treatment Advocacy Center and Dr. E. Fuller Torrey.

We've picked on the Disability Community quite a lot. We're going to be turning our attention back to Jaffe, the Conservative Mental Health Movement & the Failures of Clinical Mental Health Practice that are related to a patchy and sometimes incorrect knowledge base.

Quite frankly those failures are in the process of being remedied by Research Institutions around the World -- BUT we're not there yet. Further, clinicians are not up on the SCIENCE we do have and multiply that by a factor of 1000 for the US Criminal Justice System.

We've said it before and we'll be saying it AGAIN, & AGAIN & AGAIN -- we didn't get into this Mental Health Crisis because of one system failure -- but because of MANY.

How to fix New York’s mental health crisis without spending more money

ANATOMY OF A "FIASCO"

6/3/2019

Most people in Medicaid Mental Health Residential Services or the equivalent:

Would meet the certification criteria for "gravely disabled" IF they are NOT provided those services, or a more intensive level or combination of services.
When Mental Health Centers wash their hands of a person that has A LOT of downstream effects for:
- the person, &
- for ill-trained or ill-equipped providers or "PROPERTY MANAGERS" coming down the pike.
- the result is a pretty predictable FIASCO

UPDATED

MAKING THE SUCCESSFUL HANDOFF FROM THE CRIMINAL JUSTICE SYSTEM TO INTEGRATED PHYSICAL & BEHAVIORAL HEALTH AND PUBLIC HOUSING OR RESIDENTIAL SERVICES

FEDERAL & STATE DISABILITY POLICY Runs through reform of County Jails

6/3/2019

When we take into account -- the people within our prisons & jails with:

Brain Injury
Mental Illness
Substance Issues, and/or
Developmental Disabilities, including High IQ Autism & ADHD

That is the vast, vast majority of the Criminal Justice population.

County Jails and State Prisons are NOT appropriate places to keep people with these issues. There are the traditional arguments for HUMANE TREATMENT.

BUT we largely ignore the very REAL SAFETY ISSUES CREATED by inhumane treatment and exacerbation of existing cognitive disabilities.

  Further, our cognitive well-being is tethered to that of others. If LAW ENFORCEMENT & FIRST RESPONDERS and VICTIMS are struggling with their own Mental Health Issues we have to SUPPORT them but we also must look honestly for SYSTEMIC SOLUTIONS -- because the real message is NONE OF US ARE IMMUNE.

While the ultimate solution may lie in RESEARCH --- we can't afford to be making our problems worse.

What does that mean:

We can't be arresting individuals multiple times and not getting them the housing, placements and/or services they need.
That is NOT safe for the person -- it is NOT safe for the COMMUNITY.

Jails are really triaging stations -- BUT we must have someplace to triage people to -- & if we do have someplace -- we probably won't be taking them to the jail in the first place.

This does go to reform of Medicaid's Institute for Mental Disease Exclusion Rule and Medicaid Community Mental Health. BUT it goes beyond that to Brain Injury and Developmental Disability -- and the recognition that for many people with cognitive disability -- that is NOT experienced in nice, neat categories.

Photo Credit: The Colorado Independent

Veterans, the rest of us & Cognitive disability

5/28/2019

There are MANY FORMS of Cognitive Disability contributing to the Cognitive Disability Crisis in the World today--- right up there is BRAIN INJURY.

When this [that there are multiple sources of cognitive disability] we rightly know -- through the world we SAFELY go.

Further, some veterans may be experiencing multiple forms of cognitive disability.

Further, while our Healthcare & Legal Systems may consider health concerns such as:

Brain Injury
Mental Illness
Substance Issues &
Developmental Disability -- including High IQ ADHD & Autism

---As relatively distinct issues [that is starting to change @ least in Healthcare] --- THE REALITY FOR THE PERSON is that the issues can be and often are very inter-related -- in unique & individual ways.

The issues many people in the military are confronting do stem from many things -- including our own societal failures -- they also stem from BRAIN INJURY -- and it is forcing a re-examination of the old calculations regarding military engagement --

maybe forcing just as much if not more re-thinking & re-calculation than did the dawning of the Nuclear Era.

CO Springs Veterans Trauma Court

Christopher Lowry, Associate Professor in the Department of Integrative Physiology @ CU

Gut Bacteria, PTSD & Cutting Edge Research @ CU

DU's Dr. Kim Gorgens: The Surprising Connection between Brain Injury & Crime

Sebastian Junger: In the end, could it actually be "the opposite of war" that soldiers miss?

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Val's Blog

THE CLOCK IS TICKING . . . INDIVIDUALS WITH SERIOUS MENTAL ILLNESS & THEIR FAMILY MEMBERS NEED EMERGENCY RULE MAKING to address medicaid Provider resort to criminal Justice System

PART II: HOW COULD WE CUT CRIMINAL JUSTICE DOCKETS IN HALF OR MORE? THE "HORCRUX" OF THE PROBLEM IN CRIMINAL JUSTICE

Legal Reform: How to Cut Criminal Justice Dockets in half or more?

PART I: HOW COULD WE CUT CRIMINAL DOCKETS IN HALF OR MORE? GET RID OF PROBATION, JAIL & PRISON-- PROVIDE FOR WEAKNESSES & STRENGTHS

When We Don't Tackle Complex System Issues like Guns & Mental Health -- We Almost Always SCAPEGOAT Individuals

THE VERY LARGE INTERSECTION BETWEEN PERSON-CENTERED, STRENGTH-BASED CARE AND SAFETY

WRONG TRACK/RIGHT TRACK? CLINICAL MENTAL HEALTH EDITION

ANATOMY OF A "FIASCO"

FEDERAL & STATE DISABILITY POLICY Runs through reform of County Jails

Veterans, the rest of us & Cognitive disability

CO Springs Veterans Trauma Court

DU's Dr. Kim Gorgens: The Surprising Connection between Brain Injury & Crime

Sebastian Junger: In the end, could it actually be "the opposite of war" that soldiers miss?

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