Addressing the failure of SYSTEMS to care for those with the greatest needs

This person who is "GRAVELY DISABLED" has REFUSED MEDICATION & TALK THERAPY

• there are no MENTAL HEALTH BEDS

WHATEVER SHALL WE DO?How does the person feel about:

• Hotel Vouchers 
• Assisted Living
• Nursing Homes 
  • ​Often Disfavored as Institutions
  • Often a Step-Down from the Mental Health Institutions 
  • Nursing Homes COULD BE a great place to do DISCHARGE Planning for 30 to 90 days--
  • BUT it is a TRAP if there is NOWHERE TO GO.

Medication

• Is the person open to genetic testing as a way to get quicker and better insight into some Medication selections?
• Medication is a complicated issue in Mental Health as it is in Cancer and other major illnesses.
• Further, many people with High IQ Neuro-Developmental Differences involving Executive Functioning and/or Psychiatric Disorders:
  • ​Have IDIOSYNCRATIC SYSTEMS --- and if they are on the Street or the Jail, etc.  --- they may be OUTLIERS in an OUTLIER POPULATION.

For most people with PSYCHIATRIC DISORDERS it has been an ALICE IN WONDERLAND experience of YEARS of TRIAL & ERROR --- that maybe turned up something that "worked and was better than nothing" and maybe didn't.

• ​Our Society needs the ability to deal with that COMPLEXITY both CONCEPTUALLY & PRACTICALLY.

Marshall Fire --- Photo Credit: AXIOS

The Researchers have been RINGING THE ALARM BELLS for the need for BETTER TREATMENTS for AWHILE --- and it is in their INTERESTS to do so.

• In this year's PBS Program on Mental Health funded by the AMERICAN PSYCHIATRIC ASSOCIATION FOUNDATION --- that need for BETTER TREATMENTS was acknowledged.
• BUT how many people in the SOCIETY understand the need for BETTER TREATMENTS as opposed to just the need to FORCE SOMETHING DOWN some RECALITRANT PATIENT'S THROAT?

MORE CONJECTURE --- EPIGENETICS

• ​It seems that we should be talking about Neuro-Developmental Disorders such as ADHD and AUTISM with PSYCHIATRIC DISORDERS --- and a lot of the research does that.
• What Neuro-Developmental and Psychiatric Disorders often have in common is EXECUTIVE FUNCTONING CHALLENGES.

MORE CONJECTURE:  The Epigenetics of the IMMUNE SYSTEM are SENSITIVE because they need to be for our SURVIVAL.

• ​BUT many factors are pushing our IMMUNE SYSTEMS TO THE LIMIT and we need better and more complete understandings of what's going on.
• We've tended to fill in the gaps with PRO SOCIAL COMPETENCY RELIGION for people "we judge harshly" 
  • ​​That "we judge harshly" comes from Stanford Neuro-Biologist Robert Sapolsky and his ADMONITION to be very careful in judging a behavior --- "ESPECIALLY IF IT IS A BEHAVIOR YOU JUDGE HARSHLY."  ​

Doing Therapies 

• ​Music Therapy & Something like Britain's Key Changes which provides opportunities for patients to perform and record musical tracks.
• Art Therapy
• Animal Therapy (Dog, Equine)

​Supported Employment 

• One of the insights of the Dartmouth Supported Employment Model was that if done in an INDIVIDUALIZED manner --- it could often improve Mental Health. 
• ​BUT Employment is tricky for people with Psychiatric Disorders or High IQ Neuro-Developmental Difference involving Executive Functioning
  • ​People need to be challenged in their STRENGTHS (which can be HIGHER than EXPECTED), and
  • SUPPORTED in areas of Executive Functioning such as Planning, Organization, Emotional Regulation and Short-Term Memory.

​The truth is most people want HELP --- BUT the options are meager, especially when what we're doing is in some cases not working and hospital beds haven't gotten any cheaper.   

SAMHSA.GOV

The National Registry of Evidence-Based Programs and Practices (NREPP) has been indefinitely suspended by federal health officials.

Since 1997, NREPP has listed effective, science-based interventions for behavioral health issues, including the prevention and treatment of mental illness and substance use disorders (SUD).

Programs included in NREPP were independently audited and regularly updated.

The registry included proven interventions as well as programs to avoid because they had not been shown to work sufficiently.

​The White House froze the public database in September 2017 and months later pulled federal funding for NREPP, which was a project of The Substance Abuse and Mental Health Services Administration (SAMHSA).  ​

​This defunding of NREPP is more COMPLICATED than it looks --- mainly because CMS, SAMHSA and the STATES have largely failed to address the needs of people with the most serious mental health needs.

So when the conservative organizations like the Mental Illness Policy Organization and the Treatment Advocacy Center saw things like NREPP --- it made their BLOOD BOIL -- these governmental subdivisions had so FAILED at what should be their primary mission --- serving those with the greatest needs.

So we absolutely have to hold CMS, SAMHSA and the STATES' FEET TO THE FIRE on providing for those with the GREATEST NEEDS -- which isn't being done --- and it is INFURIATING.

On the other hand, this is a CONTINUUM and we do need the National Registry of Evidenced-Based Practices and Programs.]

The CATCH-22 for HIGH IQ DEVELOPMENTAL DIFFERENCE --- nobody is expecting or prepared to deal with the need for EXECUTIVE FUNCTIONING SUPPORT.

​​CONJECTURE:  The FAILURE to address EXECUTIVE FUNCTIONING with REASONABLE ACCOMMODATIONS and WORKAROUNDS -- and even just some KNOWLEDGE -- is resulting in an EPIGENETIC CASCADE.

• So the person's IMMUNE SYSTEM and SENSORY PROCESSING is RAMPING UP to find PATTERNS to address this CHALLENGE 
• BUT there are LIMITS which our SOCIETY and our MENTAL HEALTH Profession largely think NEURO-PLASTICITY or COGNITIVE BEHAVIORAL THERAPY ARE going to solve.
• What's Happening --- you have a person with a NEURO-DEVELOPMENTAL DISORDER that now has a PSYCHIATRIC DISORDER and an even more HYPER-CONNECTED BRAIN.
  • ​and a Mental Health Profession that is by and large CLUELESS those people with DEVELOPMENTAL DISABILITIES that they didn't want to treat are their PRIMARY POPULATION --- but with HIGHER IQs.

MANY JOB DESCRIPTIONS today read like "NO BLACKS, ASIANS, HISPANICS, LGBTQ NEED APPLY" for people who may have those EXECUTIVE FUNCTIONING CHALLENGES.​

• Because the knowledge doesn't appear to be there to deal with that on the part of anybody --- certainly the ADULT MENTAL HEALTH SYSTEM.
• There are a HANDFUL of EDUCATIONAL PSYCHOLOGISTS and OCCUPATIONAL THERAPISTS who could add a lot to the discussion --- BUT we normally don't think of them for ADULTS.

If we can't discriminate against people because of their skin color or their sexual orientation or preference --

that ODDBALL in the corner who seems so EMOTIONAL or SPEAKING OUT of TURN, has BORING "SPECIAL INTERESTS," or is DISORGANIZED --- surely we can DISCRIMINATE AGAINST them --- that's OBJECTIVE CRITERIA, isn't it?