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Waitlists, Evolving Treatments & Olmstead

12/25/2021

The "process" as laid out by the Olmstead Decision to get to Olmstead Compliance is "WAITLISTS MOVING AT A REASONABLE PACE."

The Olmstead Decision doesn't talk about "WAITLISTS" in terms of SPECIFIC HOUSING, PLACEMENTS, SERVICES or EMPLOYMENT.

Those kinds of things change over time with better and more effective TREATMENTS and MODELS.

What the Olmstead Decision talks about are WAITLISTS of PEOPLE who could move into the COMMUNITY or I would say a less restrictive or less harmful setting with known treatments or modalities such as SUPPORTIVE HOUSING ---

But that SUPPORTIVE HOUSING or other Known Evidenced-Based Treatment or Modality isn't available.

So that includes Assertive Community Treatment, Models of Supported Employment, and Strength-Based Approaches.

I do think there is a HARM REDUCTION COMPONENT to OLMSTEAD. So a therapeutic placement could be a LESS RESTRICTIVE ENVIRONMENT than a Jail or Prison and may be desired by the person.

HOMELESSNESS does theoretically offer "MORE FREEDOM" but what some people find is that it comes at a HIGH COST to their PERSONAL SAFETY and WELL BEING.

Most people would be more interested in SUPPORTED HOUSING.

One of the ways to get there would be to RAMP UP INVESTMENT in HOTEL VOUCHERS.

But if the CHOICE at the MOMENT is a THERAPEUTIC PLACEMENT over HOMELESSNESS (such as an Assisted Living, Nursing Home, Group Home or some New Model)--- some people (not all) would choose a THERAPEUTIC PLACEMENT.

See HORROR STORY -- It Doesn't Have To BE THIS WAY.

So far this has sounded a lot more like Translational Justice than Translational Medicine.

BUT the TREATMENTS and MODALITIES we need are NOT those of 1999 (when the US Supreme Court decided Olmstead) they are the EVIDENCED-BASED TREATMENTS and MODALITIES of 2021 and the PRESENT DAY going forward.

Before you can IDENTIFY who could successfully live in the community with KNOWN, EVIDENCED-BASED TREATMENTS and MODALITIES --- you IDENTIFY those KNOWN, EVIDENCED-BASED TREATMENTS and MODALITIES.

Further, that requires CONSTANT REVISION and UPDATING --- because those TREATMENTS and MODALITIES are CONSTANTLY EVOLVING.

So ideally this is done at the FEDERAL LEVEL and in fact it is being done at the FEDERAL LEVEL at SAMHSA.

BUT the efforts of SAMHSA and CMS need to be more INTEGRATED generally, but especially for people needing LONG TERM CARE.

States need SAMHSA/CMS/HUD/DEPT. of LABOR to provide updated MODIFIABLE TEMPLATES for the STATES for people with COGNITIVE DISABILITY NEEDING LONG TERM CARE incorporating KNOWN EVIDENCED-BASED TREATMENTS and MODALITIES and EMPLOYMENT for PEOPLE with COGNITIVE DISABILITY.

States need to provide AGGREGATE WAITLIST DATA to the FEDS, their STATE LEGISLATURES, and the GENERAL PUBLIC.

That AGGREGATE DATA should show not only how many people could transition SUCCESSFULLY to the Community from the Institute, the Nursing Home or the Jail or Prison with Proper Supports.

It should show in the AGGREGATE what SPECIFIC TREATMENTS, HOUSING, PLACEMENTS and MODALITIES are needed and not currently available.

The Americans with Disabilities Act and the Olmstead Decision are all about "REASONABLENESS."

We can't make REASONABLE DECISIONS if we are AFRAID OF THE DATA.

D.J. Jaffe was what I consider to be a "CONSERVATIVE" Mental Health Advocate --- although I don't think he saw himself that way.

There were a lot of things I didn't agree with regarding Jaffe's policy prescriptions -- although he did become an advocate for SUPPORTIVE HOUSING.

But Jaffe was far ahead of most Mental Health Advocates in understanding the "INSANE CONSEQUENCES" of failing to provide for people with the most serious mental illness who are often Homeless or Incarcerated.

Internationally recognized Mental Health Advocate --- Colorado's own Amy Smith -- is about 25 years ahead of the curve in her thinking on Mental Health Policy, Peer Services and Peer Respite.

There's a CRYING NEED to INTEGRATE the INSIGHTS of the Jaffes and Amy Smiths of the Mental Health Policy World.

A BIG CAVEAT: Brain Injury may be more common in Criminal Justice than some Traditional Notion of Schizophrenia or Bipolar Disorder.

But Brain Injury and Mental Health Issues often go together.

Further the Developmental Issues coming from Maternal Immune Activation and broadly understood in OVERLAPPING CATEGORIES of ADHD and AUTISM --- are OVERWHELMING in Criminal Justice.

One of the PRIMARY INSIGHTS of ORCHID is ---- it is NOT just our traditional distinct boxes of MENTAL HEALTH DISORDERS in the DSM --- it is INDIVIDUAL combinations of Cognitive Disability and often more than one CATEGORY of COGNITIVE DISABILITY --- especially in Criminal Justice.

The Mental Health Crisis and Incorporating New Understandings

12/19/2021

It's hard to see how we get out of our current mental health crisis without incorporating the new understandings of "Immuno-Neuro-Psychiatry."

Further, researchers haven't quite settled on a TERM for this new Age in Psychiatry. Contenders:

Immunoneuropsychiatry
Immunopsychiatry
Psychoneuroendocrin-ology
Psychoneuroimmunology
etc.

But these NEW UNDERSTANDINGS are GAME CHANGERS.

Under the current regime of Translational Research and Medicine in the US: Clinicians will be on top of these new understandings in 10 to 20 years.

But the US has Hundreds of Thousands of People who are Incarcerated and Homeless and/or Punished in Other Ways for Neuro-Developmental and Psychiatric Disorders.

We need to continue our move to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE while maintaining safety.

Further, we need greater investments in Translational Research and Medicine for the benefit of Clinicians, Patients and Policy Makers.

Immunoneuropsychiatry -
novel perspectives on brain disorders (2019)

Affiliations
1Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
2Inserm, U955, Institut Mondor de la Recherche Biomédicale, Créteil, France.
3Fondation FondaMental, Créteil, France.
4AP-HP, Department of Psychiatry of Mondor University Hospital, DHU PePsy, University of Paris-Est-Créteil, Créteil, France.
5Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. [email protected].

Abstract
Immune processes have a vital role in CNS homeostasis, resilience and brain reserve. Our cognitive and social abilities rely on a highly sensitive and fine-tuned equilibrium of immune responses that involve both innate and adaptive immunity.

Autoimmunity, chronic inflammation, infection and psychosocial stress can tip the scales towards disruption of higher-order networks.

However, not only classical neuroinflammatory diseases, such as multiple sclerosis and autoimmune encephalitis, are caused by immune dysregulation that affects CNS function.

Recent insight indicates that similar processes are involved in psychiatric diseases such as schizophrenia, autism spectrum disorder, bipolar disorder and depression.

Pathways that are common to these disorders include microglial activation, pro-inflammatory cytokines, molecular mimicry, anti-neuronal autoantibodies, self-reactive T cells and disturbance of the blood-brain barrier.

These discoveries challenge our traditional classification of neurological and psychiatric diseases. New clinical paths are required to identify subgroups of neuropsychiatric disorders that are phenotypically distinct but pathogenically related and to pave the way for mechanism-based immune treatments.

Combined expertise from neurologists and psychiatrists will foster translation of these paths into clinical practice.

The aim of this Review is to highlight outstanding findings that have transformed our understanding of neuropsychiatric diseases and to suggest new diagnostic and therapeutic criteria for the emerging field of immunoneuropsychiatry.

Neuro-Developmental and Psychiatric Disorders ----- Improving Systems of Translational Medicine

12/16/2021

Cancer Medicine is probably providing the GOLD STANDARD today in Translational Medicine -- bringing research to the clinician and the patient --- But efforts on the mental health front are increasing.

Division of Translational Research (DTR)

Utah

$90 million approved for first-of-its-kind translational research building for mental health (Sept. 2021)

Developing mental health policy in Sweden:

a policy analysis exploring how a complex societal challenge was consigned to individual citizens to solve (April 2021)

Colorado Clinical and Translational Sciences Institute (CCTSI)

part of the UK's National Institute of Health Research

"QUESTIONING" in a COMPLEX SOCIETY

12/2/2021

Battle of the psychiatric experts has been a tradition in American Criminal Justice at least since Ake v. Oklahoma (1986)

the US Supreme Court held that the Due Process Clause of the Fourteenth Amendment required the state to provide a psychiatric evaluation to be used on behalf of an indigent criminal defendant if he needed it.

In 2021, I would say that most criminal defendants have some form of brain injury, substance use, developmental difference / disability, psychiatric disorder --- and many of them "intended" the crime.

Problem-Solving Courts have emerged as a MIDDLE WAY to deal with some of these COMPLEX PROBLEMS.

BUT for this to work, PROBLEM-SOLVING COURTS need access to the FULL RANGE of the CONTINUUM of CARE --- which Colorado and most states are struggling to provide.

The BOTTOM LINE: The better the "TREATMENTS" --- the more "successful" this is going to be. There's a BIG INCENTIVE to invest in TRANSLATIONAL RESEARCH and MEDICINE.

IN THE MEANTIME: Building on Strengths and Providing Work-Arounds for Executive Functioning Differences / Deficits is CRITICAL to enable a growing percentage of the population with NEURO-DEVELOPMENTAL INFLAMMATION ---- TO THRIVE.

Problem-Solving Courts

At least one paper has identified SUPPORTIVE HOUSING and SUPPORTIVE EMPLOYMENT as potential important tools of PROBLEM-SOLVING COURTS.

Mental Health Courts: Pro & Con

Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review

(Jan. 2021)

Neuroendocrine and immune pathways from pre- and perinatal stress to substance abuse

(2018)

Translational Medicine Friday

Waitlists, Evolving Treatments & Olmstead

The Mental Health Crisis and Incorporating New Understandings

Neuro-Developmental and Psychiatric Disorders ----- Improving Systems of Translational Medicine

"QUESTIONING" in a COMPLEX SOCIETY

Translational Medicine Friday

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