Blog Posts

Beyond the dsm 5 to new paradigms

4/27/2024

Val's Take

Attempted suicide is not a crime in most Western Countries, but it can serve as the basis for a Mental Health Certification.
Homicidality is a much more complicated issue -- and I suspect we will find bio-markers for that as well.
Dangerousness can also serve as a basis for a Mental Health Certification --- but what is mental health and what's not is very subjective in 2024.
If "Anti-Social Personality Disorder" is really a form of ADHD according to some academics and researchers--- that matters.
We're at a little bit different place than just saying logically the DSM 5 doesn't hold up --- some stronger, biologically based paradigms seem to be emerging.

Decriminalization of attempted suicide law: Journey of Fifteen Decades (2015)

Internationally, Germany, in 1751, was the first country to decriminalize attempted suicide.

After the French revolution, all countries of Europe and North America subsequently decriminalized suicide.

n 1983, the Roman Catholic Church reversed the canon law that prohibited proper funeral rites and burial in church cemeteries for those who had committed suicide.

All of these developments have been instrumental in shifting attitudes about suicide in modern society.

Some countries like Scotland never considered suicide a crime and had no law for the same.

India recently announced the decriminalization of suicide, but its neighboring countries Pakistan, Bangladesh, Malaysia, and Singapore among others still continue to consider suicide a crime.

How Many Angels Can Dance on the Head of a Pin and the Free Will vs. Determinism Debate

What is it going to take to get Mental Health Clinicians (and other clinicians) on top of the research?

the current general estimate to get new understandings from the researcher to clinician is 17 years.
that wasn't good enough for Covid
we don't have a SYSTEM of TRANSLATIONAL RESEARCH in this country that can bring clinicians up to speed in 6 months to a year.
further, so many mental health professionals are busy chopping in the wrong forest with an unabated Mental Health Crisis--- they don't have time to incorporate significant new understandings.
It is easy enough to say that Researchers are far ahead of the Clinicians --- BUT THE RESEARCHERS ARE BEING PAID TO DO IT.
- and that is a huge issue in this society.
- Further, information overload is such a big issue and such a problematic issue in medical research that we can't expect Clinicians to solve this on their own.

Mitochondria Dysfunction --- is a hot topic for several complicated health issues, including the Neuro-Developmental/Psychiatric Continuum. See video below.

See also Val's Tables.

Douglas C. Wallace, Ph.D.
Director, Center for Mitochondrial and Epigenomic Medicine (CMEM) Professor, Department of Pathology & Laboratory Medicine
The Children's Hospital of Philadelphia

A Mitochondrial Etiology of Common Complex Diseases

Disability Law Colorado and an Important settlement

4/20/2024

Val's Take: Building out the high end of the Continuum of Care in Medicaid Mental Health has been a fraught process.

D.J. Jaffe of the Mental Illness Policy Organization documented that in his book "Insane Consequences: How the Mental Health Industry Fails the Mentally Ill." I think advocates see a lot more common ground than they did 10 years ago.

Right now the scientific understandings are evolving quickly and they don't quite look like the DSM 5. In another 10 years, Mental Health could be a much more standard medical discipline in which patients, families, Medicaid, private insurance, and the community at large would pay for medical care that included metabolomic biomarkers.

Settlement expected to significantly improve intensive behavioral health services for Colorado youth receiving Medicaid

Pollution, damage to mitochondria and mental Ill Health

4/18/2024

The lung microbiome regulates brain autoimmunity (2022)

"Our data demonstrate the existence of a lung-brain axis in which the pulmonary microbiome regulates the immune reactivity of the central nervous tissue and thereby influences its susceptibility to autoimmune disease development.

P erspective: Cell danger response Biology-

The new science that connects environmental health with mitochondria and the rising tide of chronic illness (2020)

PBS NewHour
Why air quality is getting worse in many places and how it puts human health at risk

2:24: Ultra Fine Particles able to penetrate cell mitochondria.

Harvard
How Air Pollution Affects Our Brains

Beefing up biomarkers and Continuums of care to address public concerns

4/6/2024

George Brauchler

‘Incompetence’ as a cover for criminals to walk free

Val's Take

Well, Brauchler has a very provocative title to his opinion piece.
I don't agree with it AND I'm glad he wrote it.
Mental Health generally and Forensic Psychiatry specifically need to move to BIOMARKERS where possible --- and more and more are available.
Additionally, "incompetence" should not be a cover for someone walking free ---
- We have to have a robust CONTINUUM of CARE, especially at the higher end.
  - If the State isn't providing that and the State is not ---
  - That needs to be addressed directly and FUNDED.

Metabolomic Biomarker Signatures for Bipolar and Unipolar Depression (2023)

Counties are the ones who are bearing the burden of people with mental illness in jails.

On the other hand it is States like Colorado who never caught up after DE-INSTITUTIONALIZATION in the 1960s and 1970s that need to FULLY FUND the Continuum of Care.

Now in 2024 and many more people, we don't have the bed space, housing or intensive services that we need --- although we have some bed space, housing and intensive services.

saying goodbye to the non-biological mental illness

Coming to terms with not only biologically based mental illness, but human behavior

Neuro-Diversity in Justice

4/6/2024

Val's Take

My observation has been that there is a lot of Neuro-Diversity in Criminal Justice on all sides.
Certainly in Brittain, this is being openly talked about and there have been some government reports issued with respect to criminal defendants.
Getting this out on the table so we can learn from one another is important.

ADHD Chatter Podcast
The Shocking Link Between ADHD And Crime. 2 Policemen Open Up! - Carl Mumford & Daley Jones

The Bizarre Intersection between Law & Giftedness --- Adulting with Exceptionalities In the Criminal Justice System

Dyslexia, HoMelessness & Justice-Involvement

3/29/2024

Val's Take/Conjecture

Maternal Immune Activation and Neuro-Diversity are not that new.
Our appreciation of what is going on is linking back to 'Aristotle.
There are a lot of different aspects to neuro-diversity
- It may come in the guise of Dyslexia, Dyspraxia, Dysgraphia, ADHD, Autism, Giftedness, OCD, etc.
My experience is that a great deal of human suffering is wrapped in having that "Genius" but often struggling in ways that do not seem "REASONABLE."

Getting a MORE BALANCED VIEW of these STRENGTHS & CHALLENGES might be something the Ancient Greeks could appreciate.

Having PARADIGMS that ACTUALLY REFLECT REALITY--- is also CALMING.

I can't pretend anymore that I don't know more than most people "in some respects."

BUT I also can't pretend anymore that the CHALLENGES that I have (that many people don't have) --- don't exist --- THOSE CHALLENGES DO EXIST.

“Too Far Gone”: Dyslexia, Homelessness, and
Pathways to Drug Use and Dependency (2016)

Strength-Based Approach

Common challenges for many neuro-diverse people across wide swathes of the "SPECTRUM," include:

Fatigue
Emotional Responses that are Greater than the Norm
And Pain Responses that are greater than the Norm.

This is fairly problematic, especially if these challenges are not perceived as "REASONABLE" --- which they often are not.And people push themselves and other people, and are getting pushed beyond their limits, and the consequences can be quite disastrous.

Neurodivergent Rebel
Setting and Maintaining Healthy Boundaries

High IQ and Psycho-Neuro-Immunology

Overcoming the Challenges & Realizing the Gifts of Dyslexia

Reading Disorders and Psychiatric Co-Morbidity

I think there are a lot of Neuro-Diverse people who wouldn't necessarily see themselves as having a problem with READING, BUT they might be somebody in which VISUAL-SPATIAL thinking is difficult or auditory processing----

or something else

An important point is that who gets to STRUCTURE THE ENVIRONMENT has been very important and people typically structure it to suit themselves.

I've been in environments in which I've THRIVED and I've been in environments in which I've WITHERED and there was A LOT MORE TO THAT than I appreciated at the time and that the people around me appreciated.

As an adult, I saw that in my own children who have their own DIFFERENCES and need ENVIRONMENTS that work for them.

To me, this is a JUSTICE ISSUE.

Imperfect Knowledge, Proof Beyond a Reasonable Doubt & Punishment

3/26/2024

Val's Take/Conjecture

Certainly Christianity historically struggled with the image of Jesus as a harsh Judge or a loving Judge providing Salvation.
With the advent of the Modern Age ---- the "Meritocracy" has largely taken over as the "Judge" today ----
- For those who have lived through it, it's flaws are rarely acknowledged.
- Another big fly in the ointment is recognizing that DEVELOPMENTAL ISSUES of the Neuro-Developmental/Psychiatric Continuum as well as "Brain Injuries" are HIGHLY RELEVANT to:
  - Metabolism
  - the Endocrine System
  - the Microbiome
  - the Immune System
  - the Nervous System, and
  - Behavior

Conservatives and Liberals often have radically different views of Criminal Justice and some of them do seem to go back to dueling ideas of Jesus as Judge.

One of the BIG CONCERNS that I have is that we seem to be unable to deal ethically with our own IGNORANCE.

"Come back to me when you've got this all figured out."

The problem is that kind of CERTAINTY is often quite "BRITTLE" and that it seems to me is where we are at with the Mental Health Profession and Criminal Justice.

Smarthistory
"The Harrowing of Hell" --- 1440-70

The BETTER THE SCIENCE is the BETTER THE SYSTEM OF JUSTICE.

Beyond "the Innocence Project"

2/12/2024

So "SCIENCE" has helped a lot in criminal law, both in solving crimes and helping us get better understandings of the basis of crime.

In some ways it is a tribute to "SCIENCE" that some of us recognize that what passes for "SCIENCE" in the Criminal Justice System is DANGEROUS.

When I began my legal career in Oklahoma at the Oklahoma County D.A.'s Office in the late 80s--- they were heavily relying on "HAIR ANALYSIS" to solve capital murder cases.

Until that was upended in a big way in the McCarty Case by defense attorney David Autry --- who was not far out of law school at that time.

What it takes to do something like that --- is pretty HERCULEAN and the TIME, ENERGY and RESOURCES are hard to come by.

The ADVERSARY SYSTEM ITSELF ---- multiplies many times the amount of TIME, ENERGY and RESOURCES one needs to address some of these issues.

The Second Chance Center is an important part of the CONTINUUM OF CARE in Colorado and there is plenty of UNMET NEED to justify expanding it's capacity.

Further, we need that INDIVIDUALIZED APPROACH that is going to pick up the stray case of Huntington's Disease or something else and provide for proper treatment and placement.

Rocky Mountain PBS
The Gang of 19 --- ADA Movement

The Innocence Project

Rocky Mountain PBS: The Second Chance Center in Aurora.

One of the reasons why we sometimes convict INNOCENT PEOPLE --- is the SYSTEM is SO CROWDED with "GUILTY PEOPLE" ---- we're not allocating resources EFFECTIVELY or EFFICIENTLY.

Many of those "GUILTY PEOPLE" have the "ANTI-SOCIAL PERSONALITY DISORDER" Label from the DSM.

How that Label plays out in the Criminal Justice System is pretty WICKED.

One of the issues the Criminal Justice System has struggled with is "RECIDIVISM."

A significant number of people in the Criminal Justice System need LONG TERM CARE or SUPPORTS.

BUT Human Beings in general need Long Term Care and Support that changes across the LIFESPAN.

Many "GUILTY PEOPLE" within the Criminal Justice System are struggling with idiosyncratic combinations of:

Brain Injury
Neuro-Developmental Disorders
Psychiatric Disorders, and
Substance Use Issues

Mr. Universe: What Must We Do To Prove We Are Humans

Science Up

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

Psychiatry & the Criminal Justice System: Simplicity on the Near Side of Complexity

3 Big needed reforms in Medicaid

1/25/2024

Val's Take

Funding of "Housing" for those needing "Long Term Care"
Repeal of the IMD Rule prohibiting funding of Institutes of Mental Disease
Transitioning to a Public Health Approach to Criminal Justice using Medicaid monies to fund "Therapeutic Secure Placements" as PART of a CONTINUUM OF CARE

This is one of my favorite quotes of Daniel Patrick Moynihan --- I would go beyond this and say it is an endeavor that includes one's own life but expands exponentially and ultimately beyond one's own lifespan.

George Will --- Statecraft as Soulcraft

Prison Health Care is Broken Under the Medicaid Inmate Exclusion Policy

Oregon's 1115 Medicaid Waiver

"Social Determinants of Health" are now often being referred to as "Health Related Social Needs" (HRSN)--- Housing is a BIG HEALTH RELATED SOCIAL NEED.

What CMS seems to be prepared to do beyond their 2015 Guidance --- is to EXTEND the kind of Housing Supports that were provided to people TRANSITIONING FROM THE NURSING HOME --- to other people making significant transitions such as:

from Homelessness to Housing

from Incarceration to Housing

etc.

This is something that I was calling for over 10 years ago --- and it is a "LOGICAL" extension of the work on Nursing Home Transition and there are EQUAL PROTECTION issues.

Obviously, a whole lot of other people saw this, too.

Getting rid of the IMD RULE to build out the High end of the continuum of care

1/24/2024

Opinion

Mayors Coffman, Mobolade and Johnston: Mental health services lacking across Colorado

What’s needed is a historic investment in more inpatient beds and additional inpatient facilities.

Guest Column

January 9, 2024

Val's Take

Colorado Law Enforcement, District Attorneys and Mayors seem to be largely in agreement with regard to the need for more Residential and Inpatient Options.
This has been a really hard issue for the Mental Health Community in Colorado and Nationally and by extension the larger Disability Advocacy Community.
The Medicaid Rule prohibiting the funding of "INSTITUTES of MENTAL DISEASE" has been a disaster.
- The IMD Rule was supposed to serve as an INCENTIVE for the creation of housing and services in the community --
  - BUT YOU KNOW WHAT --- it's been cheaper for STATES not to provide any of the above or not at the scale needed: beds, housing and intensive community services.
  - But those COSTS don't go away --- they are SHIFTED to Cities and Counties. --- That is not just true in Colorado.
    - Further the costs can be horrific.
- The IMD Rule has undergone relaxation over the last few years --- and we probably do just need to get rid of it.
- It would cost the FEDS about $4 Billion Dollars to get rid of the IMD Rule per year, according to a Congressional Budget Office Analysis.
  - This is from Open Minds Executive Briefings-- April 2023

Reference: Medicaid: IMD Exclusion | NAMI: National Alliance on Mental ...

Currently, the law prohibits states from using Medicaid to pay for care provided in “institutions for mental disease” (IMDs), which are psychiatric hospitals or other residential treatment facilities that have more than 16 beds.

The Mayors also recognized the importance of Community Mental Health Services as a STEP DOWN from facilities and to provide a more complete CONTINUUM OF CARE.

That is really a wonderful thing --- because this debate has too often been about Hospitals and Facilities versus Community Care.

The DEVIL IS IN THE DETAILS --- but it is encouraging that so many political and community leaders are calling for greater investments on the HIGH END OF THE CONTINUUM OF CARE.

<<Previous

Forward>>

Transitional/ Translational Justice Monday

Beyond the dsm 5 to new paradigms

Disability Law Colorado and an Important settlement

Pollution, damage to mitochondria and mental Ill Health

Beefing up biomarkers and Continuums of care to address public concerns

‘Incompetence’ as a cover for criminals to walk free

Neuro-Diversity in Justice

Dyslexia, HoMelessness & Justice-Involvement

Imperfect Knowledge, Proof Beyond a Reasonable Doubt & Punishment

Beyond "the Innocence Project"

3 Big needed reforms in Medicaid

Getting rid of the IMD RULE to build out the High end of the continuum of care

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