Olmstead Law & Order Thursday

The Mental Health Crisis and better paradigms

11/7/2024

Val's Take/Conjecture

People with Neuro-Developmental and/or Psychiatric Disorders and an IQ over 70 have been at great risk of institutionalization or homelessness in this society and many societies.
"MIA [Maternal Immune Activation] induces widespread gene expression changes in neuronal and non-neuronal cells; importantly, these responses are abolished by selective genetic deletion of microglia."
- Fetal brain response to maternal inflammation requires microglia (2024)
These are big time paradigm shifts involving the Developmental Disorders of ADHD, Autism, Bipolar Disorder, Depression and Schizophrenia-- that are now seen as blurred as opposed to distinct.
- That would make a lot of sense if what we're talking about are IDIOSYNCRATIC activation of INFLAMMATORY CYTOKINES on most notably MICROGLIA during pregnancy.

The new paradigms often involve the 3 M's:

Maternal Immune Activation
Microglia, and
Mitochondria

Maternal Inflammation During Pregnancy and Offspring Brain Development: The Role of Mitochondria (2022)

Surprisingly, Suicidality involves dysfunctional mitochondria.

Moving towards biomarkers and Precision Medicine In Treating "Invisible Disabilities" ---To better avoid institutionalization

10/20/2024

Val's Take/Conjecture

The BLESSING and the CURSE of the Neuro-Developmental/Psychiatric Continuum is that most people on it do not have any visible MOBILITY issue.
However, many people with MOBILITY ISSUES do have PSYCHIATRIC SYMPTOMS.
- That includes Autoimmune Diseases such as Multiple Sclerosis, Cerebral Palsy, Cancer, Parkinson's, Dementia, etc.
People with Neuro-Developmental/Psychiatric Disorders and an IQ above 70 can be at risk of Incarceration and/or Homelessness.
- This is not a situation in which ignorance is bliss.

I think there can be a lot of fear of the "MEDICAL MODEL" --- but many people feel ill-served by the "NON-MEDICAL MODEL" or PRIMITIVE MODEL of SUBJECTIVE SYMPTOM CLUSTERS in the DSM.

Further, while many neuro-diverse people do not have obvious MOBILITY issues, many do have IDIOSYNCRATIC "FATIGUE" and/or ENERGY/OVER-EXCITABILITY issues that relate to MITOCHONDRIAL DYSFUNCTION, among other things.

Can lifestyle choices help this, I think it probably can but that is a lot more complicated than how we normally treat it.

We need to acknowledge the challenge of ACCELERATED AGING AT A CELLULAR LEVEL as a result of MATERNAL IMMUNE ACTIVATION.

BIOMARKERS can make that a lot clearer for everyone.

Mitochondrial dynamics and psychiatric disorders: The missing link (2024)

Accumulating data have underlined how mitochondrial bioenergetics affect major psychiatric disorders. However, how mitochondrial dynamics, a term addressing mitochondria quality control, including mitochondrial fission, fusion, biogenesis and mitophagy, is im …

Neurodivergent Rebel
Setting & Maintaining Healthy Boundaries

Val's Take: This is an interesting video and it goes in part to the difficulty of defining "Neurodivergence" from symptoms alone --- because those symptoms can be fairly idiosyncratic.

There are often processing differences --- but those too tend to be idiosyncratic.

To me, Neurodevelopmental Inflammation is a much better predictor of Neurodivergence --- at least in many to most cases.

Mitochondria: multifaceted regulators of aging (2019)

Metabolic processes, including nutrient sensing pathways and mitochondrial function, have emerged as prominent regulators of aging.

Mitochondria have been considered to play a key role largely due to their production of reactive oxygen species (ROS), resulting in DNA damage that accumulates over time and ultimately causes cellular failure.

EMPLOYMENT ACCOMMODATIONS for PEOPLE on the Neuro-Developmental/ Psychiatric Continuum

10/18/2024

Val's Take/Conjecture

For some of us, we found out we were on the Neuro-Developmental/Psychiatric Continuum by reaching STAGE 4 of that Continuum.
That is a PROFOUNDLY TRAUMATIC EXPERIENCE in and of itself.
AND it can be a dangerous experience.

Medication

When most of us think of Mental Illness --- we think of Psychosis.
In many cases Medication can resolve a Psychosis. (not for everyone)
That is a MIRACLE.

BUT

the Neuro-Developmental/Psychiatric Continuum is a whole lot more than Psychosis.
People may have various "EXECUTIVE FUNCTIONING" Challenges.
They may literally be MORE SENSITIVE --- they may have MORE REACTIVE CELLS ---
- That may take more time and effort to manage, but
- It can also be a SUPER POWER of SORTS in the right circumstances and part of that is creating the right circumstances.
- It can seem like such a SUPER POWER that we, family members and employers often don't appreciate that the person needs more TIME to RECOVER to avoid a BURNOUT or BREAKDOWN.

Strengths

When we're talking about the Neuro-Developmental/Psychiatric Continuum we need to not only ACCOMMODATE WEAKNESSES, we also need to ACCOMMODATE STRENGTHS.
There are Savants on the Continuum, but most people aren't.
On the other hand, many people on the Continuum do have a WIDE RANGE of SPECIAL ABILITIES that could benefit an employer.

Addressing Developmental Inflammation could reduce institutionalization of people with disabilities

10/13/2024

Progress in Neuro-Psychopharmacology and Biological Psychiatry
Developmental neuroinflammation and schizophrenia (2013)

Val's Take/Conjecture

People on the Neuro-Developmental/Psychiatric Continuum --- millions of people--- are in essence contending with Pre-Mature Aging as a result of In Utero Inflammation.
- Inflammation acquired after birth is important too, but how that inflammation is processed by the body will be influenced by the Inflammation that was acquired prior to birth.

One of the things that CMS (the Centers for Medicare & Medicaid Services) did awhile back was it partnered with the National Institute of Mental Health (NIMH) to develop protocols for 1st Episode Psychosis.

Research is everybody's Business

States that want to Legally Control their MI Olmstead Compliance Costs Should Keep Up With the Science

The Feds and the States have a HUGE INTEREST in getting better treatments for a whole range of issues, including:

Autoimmune Disease
the Neuro-Developmental/Psychiatric Continuum
Endocrine Disorders
Cancer, and
Dementia

There are numerous researchers around the world in quest of the HOLY GRAIL of MICROGLIA (immune cells in the brain) REPLACEMENT, REPAIR and/or PROTECTION.

This could be a game-changer.

We need CMS and the National Institutes of Health to champion Public Education and Professional Education in this important area as well as other emerging research.

The Microglia focus has considerable potential to reduce Institutionalization of People with Disabilities

Olmstead and Institutionalization of People with Disabilities---the Need for Better Understandings & Treatments

9/21/2024

Val's Take

The primary institutions where people with Neuro-Developmental Disorders, Psychiatric Disorders and Brain Injuries find themselves are Jails and Prisons.
When the Criminal Law was developed over hundreds, thousands of years --- the question of "INTENT" or "MENS REA" was a sophisticated question.
It is still an important question,
In 2024, it is not the question we should end with.
What are the biological mechanisms that are causing this INTENT?
- If the person's Microglia are eating the person's brain synapses --- that might be important.

I do think there is a HARM REDUCTION component to Olmstead.

All secure placements are not created equal.

Feds step up with resources to address behavioral health in homelessness or at risk of homelessness

9/13/2024

United States Interagency Council on Homelessness Announces ---

New Federal Resources for Addressing Behavioral Health Needs of People Experiencing or At Risk of Homelessness

The need for olmstead compliance measures

9/11/2024

Val's Take

I had been of the opinion that the US Department of Justice guidance on Olmstead was sufficient.
It seems that after Chevron was struck down by the US Supreme Court this year, it would be better to have Congress address State non-compliance with Olmstead.
That could get a lot of issues out on the table and set some priorities.

HOUSING
The big challenge had been Housing and still is, but HUD has really stepped up with "Olmstead" housing vouchers.

I think if the Feds and the States can agree to consistently cover Housing for people with disabilities with Long Term Care Needs --- great.

Municipalities and Counties are generally in the mix, too and often on the front lines.

Recently, the Biden Administration issued new rules to address COMPLIANCE with the 2008 Mental Health Parity & Addiction Equity Act.

Were the private insurance companies doing nothing on mental health and addiction?--- No.

But there was not substantial compliance with the law.

The situation is similar with Olmstead and the States.

HEALTHCARE & EDUCATION--
NUMERIC STAFFING

Staffing problems exist throughout the society.
People are aware at least to some degree of staffing problems in Healthcare and Education.
I have my own take on this:
- I think some (not all) of these problems bleed over to Law Enforcement and the Court System.
- We're horrified and rightly so in some cases -- I think there's an argument to be made that Law Enforcement and the Court System are being "Scapegoated" for inadequate staffing in Healthcare and Education.

Staffing

EMPLOYMENT
Employment has to be included but there needs to be more support for Employers.

"Olmstead" Housing vouchers greatly improved

8/29/2024

with Waitlists and Admissions Preferences

Richard Cho

U.S. Department of Housing and Urban Development

Senior Advisor for Housing and Services

Val's Take:

THIS IS HUGE!

States have not substantially complied with the HOUSING component of Olmstead.

Olmstead is the 1999 US Supreme Court decision holding that the Americans with Disabilities Act prohibited the unnecessary institutionalization of people with disabilities.

Olmstead specifically assumed a State Plan for People with Disabilities, and required that plan to be:

Comprehensive
Effectively Working, and
Waitlists moving at a Reasonable Pace

Currently, Olmstead and subsequent caselaw are designed to prevent:

Unnecessary institutionalization of people with disabilities, or
The risk of institutionalization.

Housing is expensive! If you live in Colorado, you know that.

People with Disabilities and States have needed the FEDS to step up --- and they STEPPED UP.

We are grateful!

Hud takes action to Support Community Living for People with Disabilities

HUD’s Mainstream Voucher program is a special purpose voucher for people with disabilities.

I often think of them as “community living” vouchers or “Olmstead” vouchers.

But until now, there were challenges with using these vouchers to quickly connect people with disabilities leaving institutional settings or homelessness to community based housing and supportive services.

I’m excited that today [August 27, 2024] U.S. Department of Housing and Urban Development announced new requirements and flexibilities for Mainstream Vouchers that make them an even more effective tool for supporting community living.

First, public housing agencies that administer Mainstream Vouchers can now establish separate waiting lists and also establish admissions preferences that prioritize people referred by the services agencies that support community living or ending homelessness for people with disabilities.

Second, PHAs [Public Housing Authorities] must allow at least 120 days to help people find an accessible and affordable unit, along with 90-day extensions.

These flexibilities and new requirements open the door to new partnerships between PHAs [Public Housing Authorities] and Medicaid, Centers for Independent Living, Continuums of Care, and state mental health and IDD [Intellectual or Developmental Disability] agencies to help further the goals of Olmstead v. L.C.

Very proud of this!

[Why did the U.S. Supreme Court Justices in 1999 assume the States had a "State Plan" for People with Disabilities?

Georgia (and other States) told them that.

Further, that is why the Justices held that the States could not be required to make a "FUNDAMENTAL ALTERATION" to the STATE PLAN.

You can imagine that has been subject to considerable interpretation.

The big flies in the ointment: MOST STATES don't have a comprehensive, effectively working plan for people with disabilities or waitlists moving at a reasonable pace.]

Federal Housing Vouchers as a Key to STATE Olmstead Compliance

8/3/2024

Val's Take

Colorado's Nursing Home Transition Program was designed to transition nursing home residents to the community where appropriate.
I remember asking --- what about housing. They were flush with housing vouchers. That wasn't the most pressing issue.
In that situation, the Feds and the States were bearing very high nursing home costs and --- there was a clear financial benefit to the Feds and the States to transition people with disabilities out of nursing homes if they could safely live in the community.
In contrast, Chronic Homelessness often involves people with some type of Neuro-Developmental or Psychiatric difference/disability and an IQ over 70.

When it comes to homelessness, it's Municipalities and Counties that are bearing the brunt of the costs --- as it relates to governmental entities.
The people themselves, their families and the communities are bearing large costs as well.
The Feds, including CMS (Centers for Medicare and Medicaid Services), US Interagency Council on Homelessness, etc. and scattered disability advocates may appreciate the responsibility of States to provide Housing under Olmstead.
Outside the initiated, most people are not going to know much about Olmstead.
It appears that Denver is getting Housing Vouchers.
It is important that the Feds make available Housing Vouchers and Housing + Care Vouchers to meet the need to address Chronic Homelessness.
In Denver, Mayor Mike Johnston and his staff learned the hard way (as so many of us have), of the importance of Case Management.
The State has also identified Case Management as a Critical Issue.

Chevron, the ADA & Olmstead and the need for State Statutes & ReGulations

7/11/2024

Val's Take:

I don't know that there is anyone "gunning" for Olmstead the way conservatives targeted Roe v. Wade and Chevron.
Disability services have often enjoyed bipartisan support.
Olmstead was not decided on constitutional grounds, but on statutory grounds and associated regulations, specifically Title II of the Americans with Disabilities Act and the Integration Mandate.
The "balancing of equities" of people with disabilities and the State in the Olmstead decision is Solomon-like.
Further, the decision announced by Justice Ruth Bader Ginsburg in 1999 is a landmark decision in disability law, but it actually is extremely deferential to States.
The US Department of Justice provided "Guidance" not even regulations regarding enforcement of Olmstead.
Agency "Guidance" didn't go through a formal rule-making process as regulations do.
That "Guidance" is not particularly prescriptive, but does say that Olmstead Plans should provide measurable goals, reasonable time frames and funding to support the plan.
The "Olmstead Plan" is the State's defense to a lawsuit under Title II of the ADA alleging unnecessary institutionalization of people with disabilities.

Further, when talking about Olmstead Plans there are many Stakeholders, including:

Providers,
Taxpayers,
Family Members,
Community Organizations,
Law Enforcement,
Municipalities and Counties,
Etc.

in addition to the State and People with Disabilities.

Code of Federal Regulations -- Title 28
PART 35—NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES
Authority:5 U.S.C. 301; 28 U.S.C. 509, 510; 42 U.S.C. 12134, 12131, and 12205a.

We need State Statutes and regulations to provide the specificity sufficient to address process issues, provide transparency and accountability.

Olmstead Plans can be thought of as a Portfolio of several Projects:

Housing
Employment
Education
Transportation accessibility
Service Provision
Etc.

Historically, many states did not create an Olmstead Plan and if they did it was vague and almost always lacked "measurable goals."

Further, the plan was not modifiable often because it wasn't really doing anything.

To me, Olmstead Planning needs fair time frames to occomplish specific objectives with measurable goals and CONTINUOUS FEEDBACK on accomplishing those goals that is posted on a State Public Website.

Further, the Olmstead Plan or Sub-Project Plans need to be relatively easy to modify.

<<Previous

The Mental Health Crisis and better paradigms

Moving towards biomarkers and Precision Medicine In Treating "Invisible Disabilities" ---To better avoid institutionalization

EMPLOYMENT ACCOMMODATIONS for PEOPLE on the Neuro-Developmental/ Psychiatric Continuum

Addressing Developmental Inflammation could reduce institutionalization of people with disabilities

Olmstead and Institutionalization of People with Disabilities---the Need for Better Understandings & Treatments

Feds step up with resources to address behavioral health in homelessness or at risk of homelessness

The need for olmstead compliance measures

"Olmstead" Housing vouchers greatly improved

Federal Housing Vouchers as a Key to STATE Olmstead Compliance

Chevron, the ADA & Olmstead and the need for State Statutes & ReGulations

Olmstead Law & Order Thursday

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