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The Ethical Issues in Mental Health & Law --- Greatly Exacerbated by BIG SHORTAGES & Failure to Provide Self-Determination in Evidence-Based Treatments

12/30/2021

Generally when we say someone is REFUSING Treatment -- it is a narrow slice of what is actually considered EVIDENCED-BASED TREATMENT.

Further, one could just go with what is on the SAMHSA website and that is much more than is available to most patients.

This argument is NOT going to solve all the issues out there BUT --- it could solve more than we're acknowledging.

So ethical conundrums of Healthcare Professionals and Lawyers are CHEAPER than ADDRESSING the BIG SHORTAGES in Housing & Intensive Services for People Experiencing Significant Cognitive Disability.

But those ETHICAL CONUNDRUMS are also NEVER ENDING if we fail to deal with the REAL ISSUES:
- The need to address BIG SHORTAGES,
- Provide rights of Self-Determination in selecting Evidenced-Based Treatments where possible, and
- Provide STRENGTH-BASED Approaches for Neuro-Diverse People who often struggle with Executive Functioning, but often have ATYPICAL STRENGTHS that go INSUFFICIENTLY RECOGNIZED, DEVELOPED and EMPLOYED.

Image Credit: Study.com

Conjecture: It seems that there is a lot more going on with DYSREGULATION of the IMMUNE SYSTEM in NEURO-DEVELOPMENTAL and PSYCHIATRIC DISORDERS than one would expect.

Most significantly, according to Top Researchers the Immune System implicates --- SOCIAL BEHAVIOR.

Further, this isn't just "IMPLICATES" --- this is being conceptualized as the IMMUNE SYSTEM CONTROLS SOCIAL BEHAVIOR.

University of Virginia School of Medicine

Shocking New Role Found for Immune System: Controlling Social Interactions (2016)

This seems to fit into:

Rejection Sensitive Dysphoria --- emotions often normal in every way except INTENSITY
Blurred Neuro-Developmental and Psychiatric Disorders
Common Sensory Processing Problems and Loss of Control of Inputs, and
The Old Friends Hypothesis --- modern Immune Systems with lack of diversity of microbiota have become in some cases ULTRA SENSITIVE.

Stephen Covey & Temple Grandin:
Sometimes Great Minds Do Think Alike

All Kinds of Minds, Executive Functioning & Criminal Justice

12/25/2021

Temple Grandin is talking about:

All Kinds of Minds, and
Spectrums

I used to think and I think a lot of people still do think that people in the Criminal Justice System have Lower Intelligence --- in some kind of ABSOLUTE SENSE.

A big part of our Criminal Justice Problem is that ASSUMPTION is not true.

BUT it is true that people have EXECUTIVE FUNCTIONING DIFFERENCES that are making it difficult for the person to survive in society.

Further, as more and more of our arbitrary and racist, sexist, politically incorrect filters are having to be discarded --- Traditional Executive Functioning and "Emotional Intelligence" SEEM LIKE OBJECTIVE MEASURES --- but they are not.

The "ASYNCHRONOUS" Packages people are coming in are not only making it hard to ECONOMICALLY SURVIVE --- it is making it hard to EMOTIONALLY SURVIVE.

I would submit that Temple Grandin is much more "EMOTIONALLY INTELLIGENT" than much of what I have seen on "Emotionally Intelligent People" and the "Toxic People."

For some Neuro-Diverse People with Executive Functioning Differences, the HIGH SKILLS in some areas are never getting sufficiently challenged ----
that is leading to mental health problems.

On the other hand, the SOCIETY for all intents and purposes is NOT PREPARED to accept that intelligent people could have EXECUTIVE FUNCTIONING DIFFERENCES.

Ted-Ed -- Temple Grandin
The World Needs All Kinds of Minds

A lot of people in Criminal Justice fall into a broad category of ADHD that is in fact quite BLURRED with Autism.

Further, these DSM boxes are having more and more difficulty corresponding to empirical research.

Lex Morningstar @ 6:50: "People with ADHD receive 20,000 more criticisms by the time they reach the age 12 than Neurotypicals. That's a lot."
A lot of times you do have highly intelligent people, who are highly sensitive, and have executive functioning differences and a SOCIETY that is ABUSING them.

The RESULTS are not pretty.

Medicaid, Supported Employment and getting up to speed on the research

12/18/2021

Integrating MEDICAID and SUPPORTED EMPLOYMENT with Criminal Justice --- It's NOT just our traditional ideas of MENTAL HEALTH.

There are 2 Ideas included here:

By and large we are talking about "COGNITIVE DISABILITIES" in the Criminal Justice System and that is not limited to traditional ideas of "mental illness."
On the other hand, these "COGNITIVE DISABILITIES" are often involving multiple systems of the body. They are involving the brain and central nervous system, but they are involving other systems of the body as well.

CMS and states like Colorado have already started the process of INTEGRATING Physical and Mental Health Care.

The Research does continue to support this direction in care with more and more physical and mental diseases and disorders linked to CHRONIC INFLAMMATION.

[See Inflammation–Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing “the Epidemic” of Chronic Diseases --- Frontiers in Medicine, 2018]

In the case of "psychiatric disorders," this CHRONIC INFLAMMATION is often beginning DEVELOPMENTALLY with MATERNAL IMMUNE ACTIVATION.

Further, many people in the Criminal Justice System have developmental issues such as ADHD and Dyslexia.

Care needs to be provided, but also more sophisticated SUPPORTIVE EMPLOYMENT. We have a number of people who have AVERAGE or HIGH IQ and DIFFERENT EXECUTIVE FUNCTIONING.

[Further, it seems to me that less controlled "INPUT" is often what is leading to BOTH a perception of HIGH IQ and a perception of LOW EXECUTIVE FUNCTIONING.]

It is only recently that we have separated out these notions of "IQ" and "EXECUTIVE FUNCTIONING" and there is very much a bias to say, "Well, if you don't have traditional executive functioning -- your HIGH IQ can't be worth very much."

BOTTOM LINE: In 2021, that means a HIGH NEED for SUPPORTED EMPLOYMENT among people in the Criminal Justice System who are often struggling with EXECUTIVE FUNCTIONING DIFFERENCES but have average or above average intelligence.

Further, EMPLOYMENT is a big part of our lives and our mental health. This DISCONNECT between "IQ" and "Executive Functioning" is going to require some modified approaches if we're to maintain the mental health of the people we're trying to help.

[What's the POINT of the Research to the right? If we don't get up to speed with the RESEARCH that psychiatric disorders are DYSREGULATIONS of MULTIPLE SYSTEMS of the BODY --- we're going to have a hard time getting out of our MENTAL HEALTH CRISIS.

It is the Brain and the Central Nervous System ---BUT it's also other SYSTEMS of the BODY as well.]

Dr. Garnet Cummings is the Executive Director of Brain Care Centre in Edmonton, Alberta. He was the Chief of Emergency at the Royal Alexandra Hospital until an accident left him with a brain injury. Here he discusses the “unhappy triad” of brain injury, mental illness and addiction. (2015)

Why is ADHD linked with Addiction (2021)

Val's Note / Conjecture: ADHD is associated with "IMPULSIVITY" and the brain. I think it is important to note that neuro-developmental and psychiatric disorders are being recognized more and more as DYSREGULATIONS of MULTIPLE SYSTEMS of the BODY --- not just the Brain and the Central Nervous System.

Also this HEIGHTENED SENSITIVITY is not just going to REWARD but sometimes to ENVIRONMENT in general--- is the IMPULSIVITY a CAUSE or an EFFECT or BOTH.

Also what are people with ADHD RE-ACTING to -- is it just a DYSREGULATION of DOPAMINE or does it also include DYSREGULATIONS of other SYSTEMS of the BODY?

See:

Dopamine and Cortisol

[Dopamine is a neurotransmitter in the Brain and is part of the Nervous System, Cortisol is the primary stress hormone which is part of the ENDOCRINE SYSTEM.]

The microbiome: A key regulator of stress and neuroinflammation

MIA (Maternal Immune Activation) and the Human Microbiome When the maternal immune system is activated during pregnancy, the inflammatory cytokines released affect the offspring's vagal system and consequently their CNS regulation. MIA activation also affects maternal gut bacteria, which in turn can affect the microbiome of offspring.Jun 28, 2019
Maternal Immune Activation and Related Factors in the Risk of ...
Results from a new study suggest a pathway of communication between certain gut bacteria and brain metabolites, by way of a compound in the blood known as cortisol. And unexpectedly, the finding provides a potential mechanism to explain the characteristics of autism. Gut microbes have been in the news a lot lately.Aug 21, 2017
Gut microbes may talk to the brain through cortisol

Cortisol and the Immune Response

Is psychosis a multisystem disorder? A meta-review of central nervous system, immune, cardiometabolic, and endocrine alterations in first-episode psychosis and perspective on potential models (Molecular Psychiatry, 2018)

Transitional/ Translational Justice Monday

The Ethical Issues in Mental Health & Law --- Greatly Exacerbated by BIG SHORTAGES & Failure to Provide Self-Determination in Evidence-Based Treatments

All Kinds of Minds, Executive Functioning & Criminal Justice

Medicaid, Supported Employment and getting up to speed on the research

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