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DAMN IT -- WE NEED PEOPLE OUT OF THE CRIMINAL JUSTICE SYSTEM -- WITH ALL APPROPRIATE SERVICES & SAFETY PROTOCOLS --- NOW ---- & AS FAR AS I KNOW THAT MEANS MEDICAID

11/1/2014

We can't wait any longer, people are dying AND saying we're now not going to subject people with mental illness to "administrative segregation" is NOT near enough.
The misguided idea that we can subject people with "mental illness," brain injury, neurological disease or developmental disability to further emotional trauma to obtain some penological goal is in itself delusional and not based on any evidence that I am aware of.
We need to be able to ramp up the CO Medicaid Community Mental Health Services Waiver that has struggled and struggled to be relevant to the actual needs of people with "mental illness."
( For more "insight" see our Instructive Comparison of the HCBS-EBD Waiver & the HCBS-CMHS Waiver)
At the top of the list --- Assertive Community Treatment (ACT) and ULTRA Intensive Case Management -- on a daily basis if necessary. And if we are really smart "housing as healthcare."
WE CAN DO THIS & WE NEED TO DO IT NOW!

Let's Start Costing It Out NOW for this Upcoming Legislative Session.
Some of the Intended Benefits:

Terminating the practice of putting people with bad behaviors in torture chambers (aka modern prisons & jails) to "teach them a lesson."
Terminating the practice of scapegoating people from jailors to judges in impossible positions with inadequate alternatives and training.
Achieving greater community safety than what we currently have.

Research reveals that get-tough tactics may worsen rates of juvenile delinquency
http://www.scientificamerican.com/article/how-to-turn-around-troubled-teens/

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I'm Gonna Cry Me A River BUT First We've Gotta Continue To Build Better Systems

10/20/2014

I'll never forget watching the closing argument in one particular Oklahoma County death penalty case.
The Defendant was a young man who committed a murder and the defense's argument was that a mitigating factor was that the man had been sexually abused as a child beginning at age two.
The sexual abuse was uncontroverted, and my boss at the time Oklahoma County DA Bob Macy argued that such sexual abuse was no excuse. The man received the death penalty.
From my perspective, I did not feel comfortable morally judging that man (or anyone for that matter) although I felt perfectly comfortable saying he was very dangerous and the community needed to be protected.
Which brings me to my experience today in a Colorado courthouse many years later, in a different state (in more ways than one), presumably and in actuality more progressive, and observing the disposition of much less dramatic and primarily non-violent offenses.
It was all there-- the impatience, the system's unrealistic expectations regarding the abilities of people with mental illness, developmental disabilities, substance abuse issues, brain injuries, trauma, etc. to comply with "Court Orders" and "Terms of
Probation."
And these weren't trials, so the familiar long dockets, attorneys with more than they could possibly handle given the complexity of the people and problems they were presented.
A lot has been and is being done for community corrections and attempts at Mental Health Court -- from my perspective these efforts still seem punitive and disconnected from the realities (both known and unknown) of the people with whom the system is dealing. Perhaps the punitive component is to make it politically palatable.
In any case, before I cry my river I'm going to work with any person and organization I can to build something new. Luckily, many people have been and are still hard at work.
Maybe if we stop putting unrealistic demands on the criminal justice system, it will stop putting unrealistic demands on the people before it.

Oklahoma County Courthouse

Socrates

“The secret of change is to focus all of your energy, not on fighting the old, but on building the new.”

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Invisible Abilities, Invisible Disabilities, & Wicked Positive Feedback Loops or Where's A "Strengths-Based" Recovery System When You Really Need it?

10/5/2014

Val's Invisible Abilities:

High Level of Compassion
High language skills
Persistent
Associational Thinker

Val

Well, I'm sure you picked up on the hammerhead symbolism --- I have emphasized my "invisible disabilities" much more than my "invisible abilities."
The point, of course, is that that is exactly what we do in society. And the consequences are quite disastrous.
One of the reasons for this is folks such as my self with mental health diagnoses are often EXTREMELY SENSITIVE to perceived rejection or criticism.
Further, if we are to have any hope of making it in society we are of necessity going to need to concentrate on our strengths.
Unfortunately, concentrating on one's weaknesses often leads to EXTREMELY UNPLEASANT "positive feedback loops" which tend to destabilize one and cause one to go to extremes even more.
Strengths-Based Recovery is not a new idea AND once again we are struggling with the "HOW." See:

Excellent Document on Scottish Model

Walsh Trust: New Zealand

American Psychological Association Recovery Principles

There's a lot here & and much of it is "associational". If you need additional explanation or information, it is NOT a problem.

"The Heroic/Tragic Stereotype" -- Dare We Say This Refers to Physical Disability NOT Mental Disability or Neurodiversity

Val's Invisible Disabilities

ADD
Bipolar Disorder
Autism-like Stereotyppies -- nobody really knows what it is
Have had unwanted OCD type thoughts

Example of Positive Feedback Loop -- Cattle Stampede: Creative Commons

Positive Feedback Loops

"When a change occurs in the system, a positive feedback loop acts to exacerbate and amplify it. If your thermostat worked on a positive feedback loop, for example, as the temperature increased, the thermostat would respond by turning on the heater, boosting the temperature even more and causing the thermostat to respond by turning the heater higher still. Positive feedback loops tend to destabilize a system by causing it to go to an extreme."

http://www.livestrong.com/article/535270-how-do-feedback-loops-in-the-body-work/

Rejection Sensitive Dysphoria
http://www.dodsonadhdcenter.com/rejection-sensitive-dysphoria/

Hazards of Looking Like
Everyone Else

When a black person presented a dissenting perspective to a group of whites, the perspective was perceived as more novel and led to broader thinking and consideration of alternatives than when a white person introduced that same dissenting perspective. The lesson: when we hear dissent from someone who is different from us, it provokes more thought than when it comes from someone who looks like us.

http://www.scientificamerican.com/article/how-diversity-makes-us-smarter/?wt.mc_id=SA_MindFacebook
Query: What about a jail or prison population where a large percentage of the population is Black?

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Neurodiversity: "A Mind Is A Terrible Thing To Waste"

9/28/2014

People who are "neurally diverse" sometimes find that they don't fit in well with traditional employment schemes. The double-edged sword to that is that it doesn't mean they aren't smart, talented, and capable.
If these folks do manage to get on social security disability after perhaps years of trying, they may be viewed by the public as slackers.
The reality is that society AND various laws and regulations define what "disability" is -- AND if you can't get a job because of issues arising out of a "mental health diagnosis" then you NEED social security disability benefits to survive.
This blog post is NOT about traditional "reasonable accommodations" in the workplace.
Rather this is about re-vamping our employment programs so that people who are neurally diverse can tap into emerging economies of scale with respect to office space, administrative assistance, mental health support, etc.
The obstacle usually isn't "Why" to do the "right thing." It's "How" to do it.
William & Mary and the Job Accommodation Network (see below) are showing us "How."
We need to upgrade our educational & employment systems to reflect new knowledge and insights.
Because -- "A mind is a terrible thing to waste."

Job Accommodation Network: JAN On-Demand for Self-Employment

http://askjan.org/entre/index.htm

William & Mary -- The Neurodiversity Initiative

The College of William & Mary Campus

At the College of William and Mary we are committed to educating our campus community about brain differences, and to supporting and cultivating an appreciation of the many kinds of diversity we can nurture at our historic institution.

http://www.wm.edu/sites/
neurodiversity/index.php

JAN cont. . . .

JAN consultants handle each inquiry on a case-by-case basis offering self-employment and small business development expertise and referrals regarding business planning, financing strategies, marketing research, disability-specific programs, income supports and benefits planning, e-commerce, independent contracting, home-based business options, and small business initiatives for disabled veterans.

JAN customers can expect to receive a resource packet tailored to their specific entrepreneurial goals with consultants available throughout all stages of the process who can provide ongoing supports. If you have a question about starting your own small business, send it directly to a self-employment Consultant by using JAN on Demand for Self-Employment.

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What A Frickin' Mess -- A Tale of 3 Drug Regulatory Systems (Psychotropics, Marijuana, & Illegal Drugs)-- Let's Be Careful Out There

9/20/2014

What a frickin' mess.
Colorado's new campaign against teen marijuana use is entitled "Don't Be A Lab Rat." I couldn't agree more.
And whether you agree with the campaign or not, from my standpoint the Colorado Department of Public Health & Environment strikes a desperately welcome attitude in their openness and encouragement of dialogue.
Well, as some studies are now suggesting, people with schizophrenia are drawn to marijuana use. And people with other mental illnesses are drawn to other types of drugs. (See ADHD--Crime & Prison Issues).
Dual Diagnosis -- in this case mental illness and substance abuse -- are very common.
That's why criminalizing illegal drug use is so often criminalizing mental illness.
That doesn't mean that marijuana or illegal drugs are good.
I can only speak for my myself AND I don't want any drugs "criminalized" AND I want these issues handled medically -- with medical professionals who are open & encourage dialogue and questions AND are willing to say when they or the medical/psychiatric systems don't know.
From my perspective, so much of the current misery created by our criminal justice system & the mental health system is a result of assuming we know when we don't.
That brings me to forced medication which generally are anti-psychotics. I used to think, "What kind of frickin' idiot wouldn't take medication if it would help them function safely in society."
Well, there are side effects -- but hey -- this is important AND massive weight gain, cognitive dulling, dyskinesia, over-sleeping -- YOU can live with it.
BUT what about this:

"Indirect evidence suggests that antipsychotic medications may have adverse effects on brain anatomy and function.

Persistent adverse effects of antipsychotics on some cognitive processes supported by frontostriatal brain systems are well established in preclinical models. Studies using similar cognitive paradigms with schizophrenia patients show similar adverse effects.

Reduced prefrontal connectivity in resting-state fMRI studies has also been demonstrated after initiation of antipsychotic treatment . Thus, evidence for potential adverse effects of antipsychotics outside the domain of motor systems has grown in recent years.

The greatest reason for concern about adverse neuroanatomic effects of antipsychotic treatment stems from data showing a robust reduction in brain volume in monkeys treated with clinically relevant dosages of conventional and atypical antipsychotics .

Editorial above with supporting citations was written by Dr. John Sweeney, Ph.D who has served on advisory boards for Bristol-Myers Squibb, Eli Lilly, Pfizer, Roche, and Takeda and has received grant support from Janssen.

Dr. Sweeney serves in the Departments of Psychiatry and Pediatrics, University of Texas Southwestern Medical Center, Dallas.

To see even more of our argument against forced medication -- click here.

King's College London, Library

"Genes, cannabis and schizophrenia:
A puff of logic
Correlation is not necessarily causation"
-----The Economist
http://www.economist.com/news/science-and-technology/21605870-correlation-not-necessarily-causation-puff-logic

Schizophrenia and cannabis use may share common genes
http://www.kcl.ac.uk/ioppn/news/records/2014/June/Schizophrenia-and-cannabis-use-may-share-common-genes.aspx

We are forwarding a link to this column to Dr. Wolk with the Colorado Department of Public Health & Environment & spokesperson for the "Don't Be A Lab Rat" campaign.

We would very much like an expanded dialogue & one that includes anti-psychotics.

In Closing --" Let's Be Careful Out There."

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Secrecy, Mental Health, & the Struggle for Authenticity

9/7/2014

I never struggled more in my life than when I felt I could not responsibly be honest about the potentially dangerous psychotic episode and hospitalization I had been through. That was in 2006.
Then as now I'm an attorney and a suburban, middle class mom.
I think the perceived need for secrecy whether the LGBT closet or the mental health closet is such an enemy to integrity, authenticity, wellness and wholeness.

Further, it is also a budget nightmare. Most people are not going to have the money & I can assure you Medicaid doesn't have the money to pay for mental health services so people can have a few moments of authenticity during the month.
I don't want to shock anyone -- AND we need a society in which people can pretty much live with authenticity and integrity all the time AND no matter what.
In my opinion, one of the ways we do that is by sharing our own experience if we feel comfortable to do that AND by demanding a therapeutic jurisprudence that isn't afraid of reality.

Gilbert Parker, British-Canadian Author (1862 - 1932)

In all secrets there is a kind of guilt, however beautiful or joyful they may be, or for what good end they may be set to serve. Secrecy means evasion, and evasion means a problem to the moral mind.

Alanis Morissette, Canadian-American singer-songwriter, guitarist, record producer, and actress. Creative Commons

Then I realized that secrecy is actually to the detriment of my own peace of mind and self, and that I could still sustain my belief in privacy and be authentic and transparent at the same time. It was a pretty revelatory moment, and there's been a liberating force that's come from it.

Author Joyce Carol Oates, Creative Commons

When I wrote 'We Were The Mulvaneys,' I was just old enough to look back upon my own family life and the lies of certain individuals close to me, with the detachment of time. I wanted to tell the truth about secrets: How much pain they give, yet how much relief, even happiness we may feel when at last the motive for secrecy has passed.

Mental Health, Money, & Morality

9/1/2014

Mental health advocates have sold de-institutionalization and community mental health services for decades now as the far cheaper alternative to mental hospitals.
You have to know your audience right -- and the public and policy-makers are always concerned about cost.
Well, we made our case AND the unintended consequences are pretty horrific. In Colorado as in many states, the Department of Corrections along with county jails are the largest providers of mental health services and many people with mental illness are homeless.
D.J. Jaffee with the Mental Illness Policy Organization along with the Treatment Advocacy Center are arguing hard that what we need to do is to go back to institutionalization in mental hospitals -- Hey, it's better than prison, jails, and homelessness, right?
According to a 2007 CMS (Centers for Medicare & Medicaid Services) Audit, Colorado was only spending $12 a day per person on home and community-based services under the state's Medicaid mental illness waiver for long term care.
The fact is that many people on Medicaid don't need intensive mental health services -- AND there are some people who do, and there may be thousands of people in Colorado's prisons, jails, and streets who need intensive mental health services.
Further, the fact is -- "managing" people with mental illness in prisons, jails, and on the streets can seem "cost effective." There are studies saying otherwise. We could debate it.
But is it morally right?

Scanned Copy of 2007 CMS Audit of CO MI Waiver -- with some handwritten notes. CMS Region 8 advises the audit is not otherwise available on the internet.

"Everybody's Crazy" or The Art of Reasonable Accommodations

8/25/2014

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

I'm not sure I would say "everybody's crazy" --- and I would say people are all over the place in terms of talents and weaknesses AND we are all doing the best we can-- "and if I'm the one being a little direct about it, that's fine by me."
One of the challenges in Employment "Reasonable Accommodation" Cases especially in the mental health context is:
1. It is often not clear to anyone what accommodations need to be made. For help on this thorny question see the Job Accommodation Network; and
2. Sometimes the relationship between the parties is strained, and that's putting it mildly; and
3. None of us fit neatly into "crazy" or "sane" or "reasonable" or "unreasonable."
Just to put a finer point on it, I have always thought it was pretty ridiculous that we need a law mandating that we make "reasonable accommodations" for people with socially recognized "disabilities." And there is no question we NEED the ADA (Americans with Disabilities Act)!
And I think we ALL need "reasonable accommodations."
From my perspective, if we want the benefits of diversity -- a stronger economy, a more inclusive, more caring society -- we will all need to become experts to the best of our abilities at the art of "reasonable accommodations" both with respect to ourselves and with regard to others.

Ezra Miller, American Actor

Creative Commons

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The Structure of Legal Revolutions

8/20/2014

The findings in this initial exploration of the impact of genetic attributions for criminal behavior suggest limited direct effect on decisions regarding verdicts and sentencing. . . .Although confirmatory studies are needed, our data to date are consistent with the conclusion that both the hopes and concerns that have been expressed of the potential impact of behavioral genetic data in the criminal courts are overstated.

----- Paul S. Appelbaum, M.D. and Nicholas Scurich, Ph.D
"Impact of Behavioral Genetic Evidence on the Adjudication of Criminal Behavior,"
Journal of the Academy of Psychiatry and Law (2014)

This may not be a totally fair critique -- and if it's not I apologize -- AND from my perspective these kinds of studies so miss the point. We know that there are all kinds of complicated factors that effect behavior -- genetics, past history of abuse, etc. AND we know that we don't know it all. So who do we put the burden on in a competency proceeding or mitigating defense proceeding, an indigent defendant.
WTF.
I'm sorry -- that is beyond "arbitrary and capricious," -- that "shocks the conscience."
So why do we do it? I think it is because that we're afraid we won't be able to protect the community if we acknowledge reality -- there are very complicated reasons, including genetics, past history of abuse, bad environment, something we haven't discovered yet, etc. for much of human behavior, including bad behavior.
As for some ultra-conclusive evidence one way or the other to settle the old free will v. determinism debate -- in the words of a currently popular Disney song ---- "Let It Go."
We need a humane system that respects human rights right now and that does a better job of protecting the community right now -- acknowledging the reality of what we know, and that we don't know everything.
We can do that -- I feel a Structure of Legal Revolutions coming in the air tonight.
At least it's pretty to think so.

Press Release from the Karolinska Institutet in Sweden:

"The conference will focus on the development of the brain from conception, in utero to the early post natal stages.

"If something goes wrong during this time, it may have major consequences, and many known psychiatric illnesses can be traced back to this period.

"Schizophrenia, autism, ADHD, bipolar disorder and anxiety syndrome are just a few examples. "

Socrates

"The more you know, the more you realize you don't know"

Dr. Elias Zerhouni, Director of the National Institutes of Health

“The explosion of data about the brain is overwhelming conventional ways of making sense of it," said Elias A. Zerhouni, M.D., Director of the National Institutes of Health. "Like the Human Genome Project, the Human Brain Project is building shared databases in standardized digital form, integrating information from the level of the gene to the level of behavior. These resources will ultimately help us better understand the connection between brain function and human health.”

Thomas Kuhn, The Structure of Scientific Revolutions

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When You Don't Know Whether to Sue or Comfort the State: Maybe It's Both -- "It's A Process"

8/15/2014

It's always difficult criticizing people who are doing more than you are to serve the serious human needs in the state. That's why I always try to make clear that my concern is with the "System." Not that that really helps, but it makes me feel better.
I've spoken about "my guy" in a previous blog -- "Why Working in Colorado's Mental Health Un-Systems Feels LIke the Diner Scene From Five Easy Pieces."
I had really hoped that going to the top of various executive agencies was going to get this ridiculous discharge to homelessness from CMHIP (Colorado Mental Health Institute @ Pueblo) rapidly resolved.
It hasn't. It appears not so much because people aren't willing to help, but because these systems are so diffuse and complicated -- nobody really understands all of it well enough to make it sing. And goodness knows, I'm sure there are plenty of other grass fires to put out.
In my opinion, there are all kinds of legal liability issues surrounding this discharge to homelessness AND I will be focusing on, as I have been focusing on, an Olmstead lawsuit.
Colorado Lawyers Committee Mental Health Task Force AND Big Firms, I'll be knocking on your doors.
State and all the good people who work for you -- if and when you come up for air -- I'm willing to talk.

Richard Titmuss, Professor of Social Administration at the London School of Economics (1950-1973), (1907 - 1973)

"He was fascinated by the problem of making large social service bureaucracies humane and sensitive to individual human need. He acted as a kind of bridge between government and academic life helping each to understand the other’s perspective. It was this which lay at the root of his influence on policy and gave his whole department that unique mixture of reforming zeal and practicality."

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Val's Blog

DAMN IT -- WE NEED PEOPLE OUT OF THE CRIMINAL JUSTICE SYSTEM -- WITH ALL APPROPRIATE SERVICES & SAFETY PROTOCOLS --- NOW ---- & AS FAR AS I KNOW THAT MEANS MEDICAID

I'm Gonna Cry Me A River BUT First We've Gotta Continue To Build Better Systems

Invisible Abilities, Invisible Disabilities, & Wicked Positive Feedback Loops or Where's A "Strengths-Based" Recovery System When You Really Need it?

Val's Invisible Disabilities

Neurodiversity: "A Mind Is A Terrible Thing To Waste"

What A Frickin' Mess -- A Tale of 3 Drug Regulatory Systems (Psychotropics, Marijuana, & Illegal Drugs)-- Let's Be Careful Out There

Secrecy, Mental Health, & the Struggle for Authenticity

Mental Health, Money, & Morality

"Everybody's Crazy" or The Art of Reasonable Accommodations

The Structure of Legal Revolutions

When You Don't Know Whether to Sue or Comfort the State: Maybe It's Both -- "It's A Process"

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