The need for Intensive treatments, Olmstead & MISMATCHED FINANCIAL INCENTIVES

SEEMINGLY MISMATCHED FINANCIAL INCENTIVES

Some of the "unspoken logic" behind Olmstead and Mental Health Community Services was that:

• Intensive Community Services would be so much LESS EXPENSIVE than large MENTAL HEALTH INSTITUTIONS.
• The problem was that we severely limited our BED SPACE and didn't adequately INCREASE ACCESS to those INTENSIVE COMMUNITY SERVICES ---
  • those INTENSIVE SERVICES may be less expensive than the HOSPITAL, BUT
  • those INTENSIVE MENTAL HEALTH SERVICES aren't  CHEAP either.
    

So in Colorado and most States ---

• There isn't adequate BED SPACE, AND
• There isn't adequate access to INTENSIVE COMMUNITY TREATMENT such as ASSERTIVE COMMUNITY TREATMENT
  • MEANING those TREATMENTS/ SERVICES are not AVAILABLE where "REASONABLY MEDICALLY NECESSARY."
  • There is generally an ARTIFICIAL LIMIT not based on NEED.
    

The SERVICE PROVIDERS and INSTITUTIONS who are really taking the FINANCIAL HIT are LAW ENFORCEMENT & JAILS --

• Generally, NOT funded by the STATE but by MUNICIPALITIES & COUNTIES.
• This has turned into a POLITICAL FIASCO and a NIGHTMARE for People with Serious Cognitive Disabilities and their Families.

 
Yeah, we're STARTING to address this ---

• BUT Mental Health Providers riding-- with COPS is just the TIP OF THE ICEBERG.

 
SCREENING the PRISON POPULATIONS for:

• BRAIN INJURY
• Neuro-Developmental Differences/Disorders such as ADHD & Autism
• PSYCHIATRIC DISORDERS, and
• SUBTANCE ISSUES (that are often CO-MORBID with one or more of the above)

--- could be an important step in not only understanding but acquiring CRITICAL DATA to address a HUMAN RIGHTS TRAGEDY of MODERN TIMES.

Colorado State Government in the past has taken a position that is probably a position that many States take:

• "Hey, Olmstead/the ADA don't require that any PARTICULAR or SPECIFIC TREATMENT be AVAILABLE."
• With respect to ASSERTIVE COMMUNITY TREATMENT (the GOLD STANDARD in more ways than one for Intensive Community Treatment) ----
  • "We provide that as FUNDS  and our OUTDATED SYSTEMS allow."

 

• This ATTITUDE is what generally leads to "ASSERTIVE COMMUNITY TREATMENT" being included as a COMPONENT of many if not most US Department of Justice Olmstead Settlement Agreements with States involving people with "MENTAL ILLNESS."

 
What Olmstead is about is preventing the "UNNECESSARY INSTITUTIONALIZATION" of people with disabilities.When we're talking about people with Neuro-Developmental Differences that can make them more vulnerable to various forms of SENSORY OVERLOAD, STRESS & PSYCHIATRIC DISORDERS that impact a wide and idiosyncratic range of EXECUTIVE FUNCTIONING ----

Rain City
Housing First & Assertive Community Treatment
(Acknowledges what many people probably in Canada & the US already know --- HOUSING ALONE is not always going to be enough)

At 6:27:  Canadian Psychiatrist tells it like it is:

• Complex Needs
• Flawed Systems, and
• People who don't get "BETTER"

As the CANADIAN PSYCHIATRIST above so honestly distills:

• You don't get people "BETTER" with COMPLEX NEEDS if the "SYSTEM THAT IS SUPPORTING YOU ISN'T VERY GOOD." 
• The SYSTEM is flawed in BC (British Columbia) probably in most of Canada [in Colorado, and in most of the US].

We're often talking about needing a "SYSTEM" that can address a WIDE RANGE of NEEDS.

I would submit the underlying drivers of those WIDE RANGES OF NEEDS are IDIOSYNCRATIC EXECUTIVE FUNCTIONING CHALLENGES that are impacting every area of life.

AND if we do provide that SUPPORT and really LISTEN to the person's GOALS and DEVELOP & EMPLOY their STRENGTHS---Things start to look a lot "BETTER."

In some ways, this is our RESIDENTIAL SCHOOLS for INDIGENOUS PEOPLE ----

• It is not going to be easy to come to terms with what we've done and what we're currently doing.
• BUT if we start collecting HONEST DATA and do our best to FUND REASONABLY MEDICALLY NECESSARY Placements, Housing & Intensive Services ---
• AND COMPLY WITH CURRENT LAW ---
• That would be a BIG STEP IN THE RIGHT DIRECTION.
  

A Common Issue in the US with regard to INDIGENOUS PEOPLE and PEOPLE with DISABILITIES ---

• It's not that the LAWS or TREATIES weren't there --
• They were just IGNORED when it was INCONVENIENT.
• That is certainly true for Olmstead and it's true in Colorado.