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Simplicity on the Near Side of Complexity --- PRISON BUDGETS

1/15/2023

Polis' $1 Billion State Prison Budget Isn't the Answer Anymore than A NARROW VIEW of "DE-INSTITUTIONALIZATION" was "THE ANSWER" for Mental Health

Olmstead is about preventing the "UNNECESSARY INSTITUTIONALIZATION" of people with Disabilities.

If we don't have any sense of a CONTINUUM --- you can end up where the DISABILITY COMMUNITY was 10 years ago --

We want people out of the Mental Institutes and
There are very few people with disabilities in the Criminal Justice System.

In the span of a DECADE --- that has CHANGED IN A BIG WAY.

Now most disability advocates would say the primary INSTITUTIONS for people with "MENTAL ILLNESS" are JAILS & PRISONS.

Our go to expert is often Former Director of the National Institute of Mental Health Thomas Insel who says Psychiatric Disorders are some of the most complicated problems in Medicine.

RAISING THE COMPLEXITY ANTE IN CRIMINAL JUSTICE

One of the other things that happened in the last decade was --- we started to realize how many people with BRAIN INJURY are in the Criminal Justice System
Statistics on BRAIN INJURY in CRIMINAL JUSTICE often run higher than PSYCHIATRIC DISORDERS --

RAISING THE COMPLEXITY ANTE EXPONENTIALLY in CRIMINAL JUSTICE

Developmental Disability (sometimes with IQ under 70, often with an IQ over 70),
Psychiatric Disorders
Brain Injury, and
Substance Issues

Well -- that sounds really complicated --- BUT these are often DISTINCT ISSUES that are well understood and we have great treatments for:

NOT SO MUCH
These are often BLURRED
Our TREATMENTS can be Medications that affect the BRAIN GLOBALLY --- and the precision medicine that's needed isn't there.

New Yorker: A New Hemingway Documentary Peeks Behind the Myth

One of the things that I appreciated about Ken Burns and Lynn Novick's documentary on Hemingway was Burns & Novick showed all the COMPLEXITY of Hemingway who was a talented guy AND who was often a NUT CASE ---He had mental illness, brain injury, substance issues (and I would say probably developmental issues)

Complex Patterns

Not an insignificant percentage of people in the Criminal Justice System are dealing with MULTIPLE COGNITIVE ISSUES.

So we're often dealing with the MOST COMPLEX ISSUES in MEDICINE in MULTIPLE in COMPLEX PATTERNS ---If we want to use $1 Billion Dollars to further the transition to a PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE --- that is probably not a bad thingBUT trying to placate a frustrated PUBLIC with more stuff that doesn't work isn't the way to go.

Jerry Lewis Telethon for Muscular Dystrophy

A lot of DISABILITY ADVOCACY is what to do when you DON'T HAVE THE "CURE" ---It's often an EXPLICIT REJECTION of the Jerry Lewis Telethon approach to DISABILITY ADVOCACY.

CNN: The AIDS activists of the past have more to teach us (2021)

Having said that --- AIDS ACTIVISTS did understand the importance of SCIENCE to their CAUSE and spent a lot of time ADVOCATING at the FEDERAL RESEARCH LEVEL.

When it comes to people with disabilities in the Criminal Justice System:

We need a Comprehensive Continuum of Care, and
- To me that is the States, Medicaid & HUD -- and we get rid of the well-intentioned Medicaid Institute of Mental Disease Exclusionary Rule that is making it hard for States to fund that Continuum of Care at higher levels of need.

UCHealth -- the picture is associated with a story on Covid --- but the University of Colorado and others are doing important work on PSYCHO-NEURO-IMMUNOLOGY

We need BETTER TREATMENTS ---

In a PBS Special funded by the American Psychiatric Foundation --- there was an acknowledgment that BETTER TREATMENTS are needed.
Research is probably primarily a FEDERAL ISSUE although Colorado has leading researchers and we should be CAPITALIZING on that to the MAXIMUM EXTENT POSSIBLE.

Making Society Neuro-Diversity FRIENDLY Is an OLMSTEAD ISSUE

1/15/2023

When we talk about Olmstead --- we're talking about:

Title II of the Americans with Disabilities Act and the ----- INTEGRATION MANDATE, and
The 1999 US Supreme Court Decision that the UNNECESSARY INSTITUTIONALIZATION of People with Disabilities VIOLATES THE INTEGRATION MANDATE.

Most people with Brain Injury, Neuro-Developmental Disorders, and classic PSYCHIATRIC DISORDERS who are "INSTITUTIONALIZED" (many are not) ----

Are Institutionalized in Jails and Prisons
At great risk of institutionalization as a result of "Criminal Justice Involvement"
Or at great risk of institutionalization as a result of HOMELESSNESS.

What many of the people with BRAIN INJURIES and PSYCHIATRIC DISORDERS have IN COMMON is some type of NEURO-DEVELOPMENTAL DIFFERENCE such as:

ADHD
Autism
Dyslexia
Etc.

Lived Experience Educator

In one sense, the Society is REFUSING or CAN'T BE BOTHERED to accommodate COMPLEX EXECUTIVE FUNCTIONING DIFFERENCES ----

On the other hand --- they really don't know HOW.

Further, the Society is in the PROCESS of LEARNING THIS ---

So there is going to be some TRIAL & ERROR.

The Criminal Justice System and Law Enforcement have to be a part of OLMSTEAD PLANNING.

AND Justice Involved and Homeless people with disabilities ---- HAVE TO BE PART OF THE OLMSTEAD PLANNING PROCESS --- TOO.

Cognitive Disability and Mobility

1/10/2023

I think this is an important issue because it highlights the POLICY CHALLENGES for the people with Cognitive Disabilities who are MOBILE.

There are care challenges for people with cognitive disabilities who are in some way physically incapacitated --- BUT the SAFETY CONCERNS for others often goes way down and we're often more concerned about the SAFETY of the PERSON -- pressure sores, neglect, abuse, etc.

Mobile people with Dementia can present challenges in care and they are sometimes placed on locked nursing home wards to prevent not only wandering --- but so-called "BEHAVIORS."

One of the points I want to make is that Cognitive Disability rising to a level of danger to self or others or gravely disabled can occur at any point in someone's life --- but when that occurs with MOBILITY -- the Society is often trying to get it's OXYGEN MASK ON before it can even think about this person with a COGNITIVE DISABILITY who is MOBILE and STRUGGLING.

That "SOCIETY" includes Family Members, Health Care Professionals, Law Enforcement and the Broader Community.

All of those STAKEHOLDERS have an interest in seeing COMPREHENSIVE and EFFECTIVE OLMSTEAD PLANNING for all people with disabilities and ESPECIALLY THOSE WITH THE GREATEST NEED.

This typically does not work out well for anyone if we haven't done the HARD PLANNING & IMPLEMENTATION -- before the crisis hits.

Further, if we do that PLANNING & IMPLEMENTATION --- we will likely see a lot fewer crises.

Simplicity on the Near Side of Complexity --- PRISON BUDGETS

Making Society Neuro-Diversity FRIENDLY Is an OLMSTEAD ISSUE

Cognitive Disability and Mobility

Olmstead Law & Order Thursday

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