Blog Posts

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.

Genetic Testing, the Standard of Care & Individual Rights to Privacy & Access to Care

12/11/2023

Our societies are called on to Solve Some WICKED PROBLEMS involving Auto-Immune Disease, Cancer, Neuro-Developmental Differences, Psychiatric Disorders & Neurological Diseases

Val's Take/Conjecture

A lot of the problems we're facing are "WICKED PROBLEMS" of our own BIOLOGIES ---
It doesn't breakdown NEATLY into GOOD & BAD -- it's a POSITIVE in some ENVIRONMENTS --- a NEGATIVE in others.
AND WE'VE really got to UNDERSTAND what we're doing on BOTH the LARGE SCALE and the INDIVIDUAL SCALE.
SURVIVAL OF THE FITTEST --- is a pretty BLUNT INSTRUMENT ---
Further --- we all have pretty much the same genes and the greatest diversity is in the IMMUNE SYSTEM.
In the form we're in now --- the HUMAN BEING --- we're ALL OF THE BELOW:
- TOP PREDATOR
- A RATIONAL ANIMAL
- Destroying the Planet ---
- As we COMPETE against each other
It is BOTH an INSPIRING and DEEPLY TROUBLING PICTURE.

I remember a brilliant guy I knew who was also pretty weird and could be a jerk --- said, "I don't think my genes are that special."
- I think that's true.

US vs. THEM THINKING is all around us and in many ways it may be LESS than what it was HISTORICALLY---
- Further, there's a MUSICAL CHAIRS quality to "US vs. THEM THINKING"
- Our "BALANCING ACT" is very much DEPENDENT on PUSHING "SOMEONE" to the BOTTOM
  - In the long run, that's not good for anyone ---
  - BUT it is especially not good in the short term for the person or group(s) -- that get pushed to the BOTTOM.

When it comes to NEURO-DIVERSITY --- at least in some cases what we're talking about is MORE REACTIVE CELLS.

Is that Good or Bad?
Well, it DEPENDS ---
- On the Physical Environment
- On the Diversity in our Microbiomes
  - One of the great insights of the 21st Century is that HUMAN REASONING & FUNCTIONING is DEPENDENT on NON-HUMAN "ACTORS"
- On the Emotional Environment
- On the Social Environment
- A lot of what we think it is to be HUMAN is seen in the EXTREMES with Neuro-Diversity and Maternal Immune Activation.
  - A lot of the INDIVIDUALITY we see among HUMANS is the result of ---
    - GENETIC DIVERSITY in the IMMUNE SYSTEM, and
    - MATERNAL IMMUNE ACTIVATION

Much of what the FREEWILL vs. DETERMINISM DEBATE gets WRONG is it is ROOTED IN THE PAST rather than LOOKING TO THE FUTURE.

We're all just BORN INTO THIS --- and if OUR SOCIETIES --- Don't KNOW or Don't have all the answers --- and they usually don't ---That's often putting a HEAVY BURDEN on the INDIVIDUAL or GROUPS of INDIVIDUALS to FIGURE THINGS OUT.

University of Manchester Professor Daniel Davis

BIOLOGY: Genes & Immunity

According to Davis, the Greatest Diversity of Human Genes is in Our Immune Systems --- and it's Essential we have that Diversity.

How The Black Death Shaped the Evolution of Immunity and Led to a Rise In Auto-Immunity (2022)

Science X: Phys.org, Medical Xpress, Tech Xplore

Neanderthal DNA has Subtle but Significant Impact (2016)

Vanderbilt University

Those impacts can be both positive and negative for mental health.

University of Michigan

The Study of Bipolar Disorder is the Study of Humanity

People with Bipolar Disorder have MORE REACTIVE CELLS.

CONFIDENTIALITY is a BAROMETER of whether we have things FIGURED OUT ---

IF WE'VE GOT THIS --- there's generally not a lot of ANXIETY about DISCUSSING a particular issue ---
IF We don't have this --- there's going to be a lot of anxiety about a particular issue
- If we don't have this and there's a lot of anxiety --- SOME NEURO-DIVERSE PEOPLE are going to start pushing the ENVELOPE ---
  - Because they know IGNORANCE WON'T SOLVE THE ISSUE.
  - They may also know that we need to "SCRUB IDENTIFYING INFORMATION" ---
  - Provide UNIVERSAL ACCESS to the CARE we do have, and
  - SLOWLY COME OUT OF THE NEURO-DIVERSE CLOSET ---
    - For our own Mental Health and that of others.

Rules of Evidence and the mess in Mental Health

10/26/2023

Federal Rule of Evidence 702.

Testimony by Expert Witnesses

A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if:

(a) the expert’s scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue;

(b) the testimony is based on sufficient facts or data;

(c) the testimony is the product of reliable principles and methods; and

(d) the expert has reliably applied the principles and methods to the facts of the case.

The Issue in 2022 (& Still in 2023)*

Often mental health providers are "reliably applying" the principles and methods to the Defendant.
BUT --- those methods are NOT:
- Based on sufficient facts or data,
- The principles and methods are NOT RELIABLE.

If someone is getting an ANTI-SOCIAL PERSONALITY DISORDER DIAGNOSIS based on criteria from the DSM 5:

That is scientifically suspect.
Now, many of these categories are now being conceptualized as "BLURRED", and
Often related to Neuro-Developmental Differences or Disorders.
- THAT SHOULD MATTER.

Further, it is muddy and messy:

our Legal System is currently not well structured to deal with the FALLOUT ---
- If we raise legitimate questions about the reliability of "ANTI-SOCIAL PERSONALITY DISORDER" in the context of Criminal Justice and the ASSUMPTIONS we're making under MENS REA ---
  - Where does that leave us?

Honestly, we have a system that is about 1/2 way there to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE but doesn't have the PUBLIC HEALTH PRACTITIONERS to SEAL THE DEAL.

*This blog was originally written in 2022 and was on the homepage for over a year.

There are LOGICAL & ETHICAL PROBLEMS associated with trying to use a scientifically invalid diagnostic manual as our DICTIONARY.

Over 600 Research Institutions Find Shared Heritability In Common Disorders of the Brain (2018) --- Contradicting DSM 5 Categories

In 2022 (& 2023)*, the BIG QUESTION is who can live:

In the community, with some supports
In the community, with intensive supports
In a structured placement
In a secure placement.

Further, these questions are NOT somehow divorced from what COMMUNITY INTEGRATION is being provided for people with:

Neuro-Developmental Disorders
Psychiatric Disorders
Brain Injuries, and
Substance Issues that are often related to one or more of the above.

Do we even know what to provide in 2022?

Supportive Housing, and
Supportive Employment

could help a lot of people.

The INTEGRATION MANDATE of Title II of the ADA which also served as the RATIONALE for the US Supreme Court's 1999 Olmstead decision could provide the LEGAL BASIS.

Science Up

“So what this is doing — is it’s starting to kind of shed light on the specific biological pathways that might be shared across these disorders; namely, these specific neurons that are sort of critical and just brain signaling pathways,” Grotzinger said.

With these findings, Grotzinger hopes to be able to identify what the specific genetic risk pathways are so an individual can be diagnosed and treated more efficiently.

The goal is to be able to give an individual one diagnosis and treatment for the disorders they have instead of multiple, if possible.

Currently, an individual cannot be diagnosed with bipolar and schizophrenia disorder.

However, these two disorders have an overlap in their genetic makeup — meaning that an individual can experience symptoms from both disorders.

Grotzinger hopes in the future diagnoses can be made “a little less sort of by the book.”

In addition, there also may be a possibility of treating certain diagnoses with psychotherapy versus prescription medicines.

The research team only analyzed the genetic variation that showed up in at least 1% of the population.

“That really rare stuff might be really important.

And it’s something that we’re just now getting to the point that we can start to look at,” Grotzinger said.

Daily Camera Article --- CU Research

The CURRENT NECESSITY AND Trap of "Confidentiality"

10/17/2023

If We Get Out of Punishment --- and Move to

Safety
Health, and
Problem Solving

[which we are doing as we are able]

We can further "MODIFY" some of the more PROBLEMATIC aspects of the ADVERSARY SYSTEM.

Ironically, that ADVERSARY SYSTEM according to Judge Leifman in Florida is moving to a COLLABORATIVE SYSTEM.

"CONFIDENTIALITY" is a strangely problematic aspect of both Mental Health and Criminal Justice.

The perceived need for "CONFIDENTIALITY" --- is at the ROOT of much Mental Health Stigma.

Now, confidentiality ungirds healthcare as well --- but the perceived NEED FOR CONFIDENTIALITY is often a BAROMETER of whether the SOCIETY "HAS GOT THIS" or Society's understanding is SHAKY.

This is a very complicated dance --- we don't want to subject anyone to PUNISHMENT, EMBARRASSMENT or RIDICULE.

People are coming out of the MENTAL HEALTH CLOSET and our UNDERSTANDINGS and TREATMENTS are getting better.

Coincidence & Remembrance on this Veteran's Day

The World War II Veteran I spoke to wanted to be FORGIVEN by God and as many people as possible.

Further, if one person is struggling with something --- it's pretty likely there are others.

It's not necessary to have identifying information --- BUT some people do want to be seen, provided help as available and their challenges to be treated for what they are --- HEALTH CHALLENGES.

We have created some very expensive systems that are not addressing the underlying problems as well as they might --- and sometimes they are EXACERBATING those problems.

Maria Bamford --- at the Psych Ward
and the strange mix of feelings raised in some patients by professionals who promise they would never tell anyone.

It really gives the message that this is so SHAMEFUL that the patient shouldn't tell either.

Bamford has also said that she openly talks about mental illness in her acts and interviews --- because --
"IT MAKES IT LESS OF A FREAK SHOW."

We're currently not putting people in prison for SUICIDE ---- so Bamford's SUICIDAL IDEATION is NOT THE HARD CASE.

HOMICIDAL IDEATION is the HARD CASE --- BUT we can address that if the person is on the EXTREMES --- IF WE'RE BEING HONEST ---

Incompetent to Proceed and Insanity are already there in US Law and many other Countries.

The harder case is the PERSON with a NEURO-DEVELOPMENTAL DISORDER, no obvious PSYCHOSIS, ramped STRESS & PAIN RESPONSES who seems to be EXACTLY the person the CRIMINAL LAW was meant to address

---WITH OUT OF PROPORTION BAD INTENT & BAD ACTS.

ADHD, Reciprocity, Rejection Sensitive Dysphoria & Differences in Intensity

BUT going deeper than MORE OBVIOUS bad acts and bad intent ---

We can start to move more to PREVENTION by SCREENING for not only problematic mental states but also:

SLEEP DISTURBANCES
PERIODONTAL DISEASE
MIGRAINE
BRAIN INJURY
AUTO-IMMUNE DISORDERS
CANCER
etc.

Stroke & ADHD

<<Previous

Forward>>

Transitional/ Translational Justice Monday

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

Genetic Testing, the Standard of Care & Individual Rights to Privacy & Access to Care

Rules of Evidence and the mess in Mental Health

The CURRENT NECESSITY AND Trap of "Confidentiality"

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