Waitlists, Evolving Treatments & Olmstead

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.