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THE HIGH COST OF SUPPORTIVE HOUSING ---$1.5 MILLION FOR 25 NEW APTS

1/31/2021

   Supportive Housing in General is different than Supportive Housing for Competency Restoration, BUT Supportive Housing is EXPENSIVE and that is probably the #1 Reason we don't have enough of it.

Further, the monetary cost / benefit analysis is COMPLICATED.

If people go to the ER and are on Medicaid --- that costs the State money. BUT a lot of people don't go to the ER -- they go to JAIL.

That JAIL is NOT funded by the STATE -- it's primarily funded by the MUNICIPALITY or the COUNTY.

That is why COUNTIES are the ones behind the STEPPING UP INITIATIVE to reduce incarceration of people with mental illness in "jails."

Now go to PRISON --- that is a state expense.

BUT OFTEN, many people unless it is a very serious offense do NOT go to PRISON --- they go back on the Streets and there is NOT ENOUGH SUPPORT.

So people keep coming back, get more and more convictions on their record and they often do go to PRISON.

  The likelihood that someone can get TAGGED with ANTI-SOCIAL PERSONALITY DISORDER at this point is pretty high.

   When I criticize the diagnosis of Anti-Social Personality Disorder, I am nonetheless saying:

the person may have committed anti-social acts,
the person is probably not psychotic,
BUT probably is extremely reactive and can be or is emotionally dysregulated
- Does it matter whether the reactivity or emotional dysregulation is the result of just being BAD or TRAUMA and/or INNATE IMMUNITY ?
  - How we think about these things DOES MATTER
Supportive Housing may or may not be sufficient,
Some people may need a secure placement
Any secure placement should be humane and NOT a jail or prison.

Supportive Housing for Individuals Ordered to Competency Restoration

OBH and the Colorado Coalition for the Homeless will spend $1.5 million to provide 25 additional supportive housing apartments for unhoused individuals who have been ordered to outpatient competency restoration services, bringing the program total to 53 Denver-based units. Read the press release to learn more.

--- from OBH UPDATES Jan. 2021
Colorado Office of Behavioral Health

I am Olmstead

Getting an Honest Accounting of Supportive Housing & Accessible Housing Needs & Supply

Developing Some Measurable Goals & Reasonable Time Frames

Now is a good time when the State Budget Expectations are Low ---

To get the numbers
Post them on a State website
Update them at least yearly
Provide the Current Cost Estimates for
- Individual Units
- Any cost savings that could be realized by purchasing more units
- Etc.
- What is the Current Cost Estimate to bring Supportive Housing & Accessible Housing to SCALE to meet the needs of people with disabilities?

WE NEED AI -- OR MORE SOPHISTICATED AUTOMATION ---TO GET MENTAL HEALTH PROFESSIONALS UP TO SPEED

1/30/2021

In some ways this TECHNOLOGICAL ADVICE is pretty funny because I'm NOT a Techie.

I got a little more on top of the research the early 21st Century way -- I searched PUBMED and put 2 & 2 together --- maybe.

But you know what? It takes time and energy and resources to do that -- especially if you are trying to INTEGRATE all that.

If you're not being paid to do that, it is hard to justify --- in our society.

SO WHY AM I DOING IT?

I'm FEELING it MORE
I'm More UPSET by the INJUSTICE
I"m MORE ANXIOUS by the fact that we're NOT getting to the ROOT CAUSES of these PROBLEMS
AND these 'feelings" are biological

Now somebody else is going to be more "passionate" about something else and it's all biologically individual and being shaped by our individual experiences and environments as well.

I AM ANXIOUS ABOUT THE APPARENT FACT THAT I KNOW MORE ABOUT THE RESEARCH THAN MUCH OF THE MENTAL HEALTH PROFESSION

My point is NOT --- HEY, I want to do this research for you ---
THE POINT IS: Mental Health Clinicians Need More Support in the form of a Better System to Stay on Top of This Research

RIFFING OFF AI and "TRADITIONAL INTELLIGENCE" and "EMOTIONAL INTELLIGENCE"

I have been pretty UNINTERESTED in AI and the many debates and scenarios that various people and entities have been discussing.
What I really began to recognize as a young adult was that OTHER PEOPLE'S "TRADITIONAL INTELLIGENCE" was a lot MORE COMPLICATED than the SOCIETY had led me to believe.
When we've thought about TRADITIONAL INTELLIGENCE -- it's been all about the BRAIN.
The idea that part of your "TRADITIONAL INTELLIGENCE" might relate to how many PARASITES you do or don't have and what they are -- is NOT SOMETHING we were thinking.
So that's the MICROBIOME --- and really relates to "MENTAL HEALTH" as well as IMMUNE DISEASE.
We have more genetic material from our MICROBIOME than we do "HUMAN" genetic material.
So we need pretty sophisticated ways to understand all these INTER-RELATIONSHIPS, which could also be thought of as EQUATIONS.
Our Biology is So Complicated --- can we fully understand it without AI or at the very least Super Computers?
Further, there do "seem" to be some built-in CATCH-22s for some people and "TRADITIONAL INTELLIGENCE" -- and part of that does seem to involve the IMMUNE SYSTEM.

AN ASIDE

There is a lot of "CONJECTURE" on Orchid --- there's a lot of playing with IDEAS, mainly because I see the VALUE of that, and
I see it as CRITICAL to PROBLEM-SOLVING
We have inadvertently and sometimes purposefully shut a lot of that down in this SOCIETY --- in the name of EFFICIENCY
BUT we're often NOT EFFECTIVE
If there is anything that is NOT being handled EFFECTIVELY on MULTIPLE LEVELS -- it's "MENTAL HEALTH" and Cognitive Disability

RESEARCH --- THE SYNDROME VS. THE DISTINCT ILLNESS

1/30/2021

ADHD, AUTISM AND MENTAL ILLNESS --- AND THE IMMUNE SYSTEM

The DSM has looked at clusters of symptoms and said this is a particular type of "mental illness" --- one could also say a particular type of "mental syndrome"
What research seems to be saying is that many developmental disorders and "mental illnesses" share clusters of symptoms.
Further -- the IMMUNE SYSTEM keeps coming up.

We want Olmstead Planning for Cognitive Disability and we want every bit that is necessary and legally required.

BUT we are never going to be able to afford the unsupported low bar of our current mental health profession.

AND they can't afford it, either.

Click Medpage logo for Jan. 19, 2021 article referenced below.

"Study IDs Puzzling Risk Factor for ADHD— Strong statistical association but biological connection remains a mystery" (hmmm . . .)

Moms with auto-immune disorder more likely to have children with ADHD

(I'm not sure this is very puzzling if you've been paying attention to the research)

DRAFT: Innate & Adaptive Immunity in Cognitive Disorders

National Institute of Mental Health: 5 Disorders Share Common Genes (2013)

"Now that doesn't match with the idea that these are distinct."

In summary, calcium seems to play a central role in the activation of cells of the immune system. When the cells are stimulated, [Ca2+]i generally increases as a result of entry from the external medium, as well as mobilization of calcium from intracellular membrane-bound compartments.

Calcium homeostasis and the activation of calcium channels ...www.ncbi.nlm.nih.gov › pmc › articles › PMC1807782

Calcium channels are membrane-spanning proteins that regulate the intracellular concentration of calcium ions (Ca2+). After entering the cell, Ca2+ activates specific calcium receptor proteins, e.g., calmodulin, troponin-C, or calcium-activated calcium, potassium, and chloride channels.

Calcium Channel - an overview | ScienceDirect Topics www.sciencedirect.com › topics › medicine-and-dentistry

Archive | Disorders Share Risk Gene Pathways for Immune, Epigenetic Regulation

Click Image to go to 2015 article

FORM & SUBSTANCE---- MINNESOTA'S HOUSING OLMSTEAD GOALS

1/28/2021

Two incorrect assumptions that make Olmstead Planning so scary to policymakers are:

Olmstead Planning is a one-time event-- often a 5 to 10 year Soviet-style plan that has to be PERFECT.
- In fact, while a legally sufficient Olmstead Plan may go out 5 or 10 years -- it's constantly being REVIEWED.
That Olmstead Plan is NON-MODIFIABLE --- it is like an IRREVOCABLE TRUST -- so let's make this as vague as possible.
- Olmstead Plans are MODIFIABLE and generally changed circumstances or new information are common bases for MODIFICATIONS.

Minnesota's on-going Olmstead Planning came out of the Jensen case in which Federal Judge Donovan Frank insisted on Measurable Goals even as Minnesota state officials kept trying to feed him plans without "measurable goals."

Minnesota has been providing an UPDATED OLMSTEAD PLAN with MEASURABLE NUMERIC GOALS now since 2015 and they did make modifications based on COVID.

We feel strongly that people with disabilities would be a lot better off if the FEDS make a FIRMER COMMITMENT to DISABILITY HOUSING.

BUT maybe the FEDS won't do that.

"Measurable goals" are still legally required in State Olmstead Planning.

If States are updating plans on a yearly basis, there are a lot of benefits -- two of which are:

Continuous Improvement, and
Responsiveness

It's unclear whether Colorado and most other States will get LEGALLY REGUIRED MEASURABLE OLMSTEAD GOALS in the next 5 years.

Minnesota's 2020 Revision to its Olmstead Plan

Housing and Services (DHS, MHFA)

GOAL ONE: By June 30, 2020, the number of people with disabilities who live in the most integrated
housing of their choice where they have a signed lease and receive financial support to pay for the cost
of their housing will increase by 5,569 (from 5,995 to 11,564 or about a 92% increase).

Annual Goals to increase the number living in the most integrated housing:

• By June 30, 2019 the number will increase by 5,569 over baseline

• By June 30, 2020 the number will increase by 5,569 over baseline

Minnesota Olmstead Plan Section on the Minnesota DHS Website

CAN THE FEDS GET US TO "MEASURABLE GOALS"

1/27/2021

    One of the reasons there is so much pressure on government to do something about cognitive disability -- there is so much pressure on families --- and a lot of that pressure is FINANCIAL PRESSURE.

We've made the point before that Cognitive Disability has already EXHAUSTED the Healthcare System.

    While the researchers and the National Institute of Mental Health may be self-interested, it is hard to get away from their argument that we're in desperate need of better understandings and better treatments.

    We are in a Behavioral Health Crisis in large part because we can't or won't afford the current remedies to SCALE --- Supportive Housing being right at the top of the list.

The call from Black Lives Matter to DEFUND THE POLICE may not be considered the right "messaging" --- BUT it is hard to see how we are going to get out of this without RE-ALLOCATING RESOURCES.

   Another way to think about this is DON'T COST SHIFT TO THE POLICE.

Colorado's Behavioral Health Task Force Blueprint for Reform

Colorado needs Federal Guidance (& mainly RESOURCES) and so do most States.

States "maybe" more receptive to that "GUIDANCE" with new proposed federal policy initiatives on Social Determinants of Health (including Housing) and already proposals for infrastructure housing that includes Disability & Elder Housing.

We need to get States to Measurable Goals --- and to me that's a role for Olmstead Planning & the FEDERAL GOVERNMENT with technical assistance and administrative enforcement by executive agencies with the US Department of Justice as the backup --- and private enforcement a last resort..

I think the reason the FEDS haven't been more UNIFORM in their ENFORCEMENT over the past over 20 years since Olmstead-- they didn't want to have that LARGE SCALE CONVERSATION ABOUT RESOURCES --- maybe they are ready to have that RESOURCE CONVERSATION.

If the FEDS are ready to have that conversation with real results, a lot of that passive resistance from the STATES to OLMSTEAD -- may go away.

That would be an excellent thing for people with disabilities in this country.

"PLANNING" FOR SCALE: THE TENSIONS IN OLMSTEAD

1/25/2021

There are many tensions in Olmstead, 3 Big Tensions are:

The US Supreme Court decided Olmstead in 1999 and most states still aren't in compliance.
- According to the US Department of Justice the further out States are from 1999 -- the more that is expected.

With respect to mental health and other cognitive disabilities, some of the high end of the continuum got cost shifted to the Streets and Law Enforcement -- so some of this isn't currently on the State's books--it's on the books of the Counties and Municipalities.

In 2021, there are lot more people with "cognitive disabilities" who are "institutionalized" or "at great risk of institutionalization" than were recognized in 1999.
- In cognitive disability, the primary institutions are jails and prisons. In 1999, most disability advocates were focused on large disability institutions such as mental institutes, and later nursing homes. Those are still important, but they are not as large as jails and prisons as the cognitive disability providers of last resort.
  - Further, "mental illness" is just one of a number of significant cognitive disabilities that can put one at risk of incarceration..
  - A lot of people in jails and prisons have brain injury, substance issues, ADHD or Autism and may also have traditional "mental illness."

COVID provides States a legitimate reason why they can't fund everything that would have been expected pre-COVID.

At the same time, it provides an opportunity to do that PLANNING and to press the Federal Government for COVID Stimulus and Economic Relief in various forms, including:

Supportive Housing, and
Accessible Housing

Orchid is primarily a GADFLY.

We see a lot of HYPOCRISY that is preventing Olmstead Compliance.

Further, we see Olmstead Compliance as Legally Required and such an obvious SOLUTION to Disability Housing Issues and a significant part of Criminal Justice Reform.

COMING TO TERMS WITH "THE TOTALITY OF THE CIRCUMSTANCES" IN BEHAVIORAL HEALTH

1/23/2021

"Totality of the Circumstances" feels very EQUITABLE as opposed to a BRIGHT LINE legal test.

Two driving factors in our current Criminal Justice Crisis are:

Bright Line Competency Standards, and
A Bgillion Factors regarding Cognitive Disability, some of which (many of which) mental health professionals are not even competent to assess.

What are some big areas in which mental health professionals may need to be supplemented with other heath care professionals to deal with:

Brain Injury,
Developmental Differences (At least the University of Michigan considers Bipolar Disorder a Developmental Disorder)
Maybe an occupational therapist to address executive functioning issues
Etc.

This is also about getting HONEST about the EQUATION. What do I mean by the EQUATION?

Basically, I mean what Robert Sapolsky means in the video to the right when he says: we've found all these Biological Explanations for Behavior over the last 500 years, you really have to ignore the whole TRAJECTORY OF SCIENCE to think this is going to stop.

What are some of the things that drive Human Intent that we didn't understand a 100 years ago:

Developmental Difference
Brain Injury
Substance Issues
Environmental Toxins
Societal Trauma
Childhood Trauma
Etc.

Now to me, we can satisfy the PERSONAL RESPONSIBILITY WARRIORS --- if we will just focus on SAFETY and HUMANE TREATMENT.

We post this video a lot. It is Stanford Neuro-Biologist and acclaimed Author Robert Sapolsky on "Free Will."

To us, the important thing is that Absolute Free Will is NOT in the past or in the present --- it is something we are trying to get, we make fitful progress, and the more we learn the more we realize we don't know.

BUT it is hard to get away from Sapolsky's basic point that we must understand the underlying BIOLOGY.

OLMSTEAD & DISABILITY HOUSING

1/22/2021

AT LEAST TODAY -- OLMSTEAD GETS TO HOUSING WHERE PARITY & MEDICAID NETWORK ADEQUACY DON'T

A lot of people might ask --- isn't the timing off in trying to push Olmstead during a pandemic?

My response is this may be the BEST TIME --- since the financial pressure on a State may be less, in fact a lot less --- than it would normally be.

And that really allows States to focus on "THE BONES OF THE HOUSE" ---- "THE BONES OF OLMSTEAD."

In a lot of ways, "The Bones of Olmstead" are:

Measurable Goals
Reasonable Time Frames and
Funding to Support the Plan

To bring:

Supported Housing
Home & Community Based Service (HCBS) waivers
Crisis Services
Assertive Community Treatment (ACT) teams
Case Management
Respite
Personal Care Services
Peer Support Services, and
Supported Employment

TO SCALE TO MEET THE NEED.
Colorado and most states are providing pretty much all of the services listed above --- but far below scale and it's costing states a lot of money to provide what they are providing.

Olmstead provides a LEGALLY REQUIRED FRAMEWORK to deal with some difficult issues. Some very difficult issues.

Olmstead provides a level of accountability and breadth that is certainly beyond the Ad Hoc Stakeholder Group and because Olmstead gets to HOUSING -- it is beyond Parity and Medicaid Network Adequacy as well.

Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C.
7. May the ADA and Olmstead require states to provide additional services, or services to additional individuals, than are provided for in their Medicaid programs?

A: A state’s obligations under the ADA are independent from the requirements of the Medicaid program.

Providing services beyond what a state currently provides under Medicaid may not cause a fundamental alteration, and the ADA may require states to provide those services, under certain circumstances.

For example, the fact that a state is permitted to “cap” the number of individuals it serves in a particular waiver program under the Medicaid Act does not exempt the state from serving additional people in the community to comply with the ADA or other laws.

15. What types of remedies address violations of the ADA’s integration mandate?

Olmstead remedies should include, depending on the population at issue: supported housing, Home and Community Based Services (“HCBS”) waivers,crisis services, Assertive Community Treatment (“ACT”) teams, case management, respite, personal care services, peer support services, and supported employment.
Our understanding is that Colorado State Government and the Behavioral Health Task Force are making an enhanced commitment to Parity.

When it comes to Olmstead, we would like to see Colorado put in "THE BONES of the HOUSE" for a Housing Olmstead Plan that gets to:

Supportive Housing, and
Accessible Housing

for People with Disabilities who are Institutionalized or at Great Risk of Institutionalization.

WHAT WE WANT FROM THE BIDEN ADMINISTRATION

1/21/2021

The Most Obvious --- Disability Housing as COVID Economic Stimulus and Infrastructure

Translational Research & Medicine for better means of keeping informed
- Medical Disciplines addressing Cognitive Disability and
- Criminal Justice which is often serving as the Disability Provider of Last Resort

We would submit that "NOT KNOWING" or "KNOWING ENOUGH TO KNOW THIS IS MORE COMPLICATED THAN WE THOUGHT" ----
- is LEGALLY SIGNIFICANT

We'd like to see the new US Department of Justice team incorporate the 2011 DOJ Statement on Title II of the Americans with Disabilities Act and Olmstead into the Code of Federal Regulations

We need COMPREHENSIVE admini-strative technical assistance to the States on Complying with Olmstead.

The Feds, the States and the Disability Community need to have some FRANK DISCUSSIONS regarding how States are going to meet their OLMSTEAD OBLIGATIONS for:
- Supportive Housing,
- Community Placements, and
- Services at the High End of the Continuum of Care

Scattered Site Supportive Housing is often considered the Gold Standard in integrated disability housing and services.

Having said that, there are at least some people with disabilities who are homeless or incarcerated who would prefer a "Supportive Housing Community" or Congregate Living Situation over homelessness or incarceration.

THE VA AND MEDICAID COGNITIVE DISABILITY

1/20/2021

[P.S. OLMSTEAD ISN'T LIMITED TO MEDICAID]

In 2021, a lot of Americans have someone in their family or know someone or are someone with:

Mental Illness
Brain Injury
Substance Issues
ADHD, and/or
Autism

Some or all of those issues are also seen in the military.
When we think about the budget for the VA or Medicaid Services for people with cognitive disability --- IT'S HUGE and it's often not adequate.
Ultimately, Research is going to be the answer.

Meanwhile . . .
We need some re-allocation of financial and human resources.

We need a huge investment in Translational Research & Medicine
- This is an issue for Medicine across the board but it is a huge, ethical and moral issue in cognitive disability
- This is an issue for Criminal Justice which in the US and many countries is the Cognitive Disability Provider of Last Resort

We must get HONEST about the NEED and bring housing, placements and services to SCALE.

Whether we want to call it "DEFUNDING THE POLICE" or "RE-ALLOCATING THE POLICE" those LAW ENFORCEMENT ROLES are in need of MAJOR TRANSFORMATION.

US Department of Justice

13. What must a public entity show to establish a fundamental alteration defense based on an Olmstead plan?

A: A public entity raising a fundamental alteration defense based on an Olmstead plan must show that it has developed a comprehensive, effectively working Olmstead plan that meets the standards described above, and that it is implementing the plan.

A public entity that cannot show it has and is implementing a working plan will not be able to prove that it is already making sufficient progress in complying with the integration mandate and that the requested relief would so disrupt the implementation of the plan as to cause a fundamental alteration.

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Val's Blog

THE HIGH COST OF SUPPORTIVE HOUSING ---$1.5 MILLION FOR 25 NEW APTS

WE NEED AI -- OR MORE SOPHISTICATED AUTOMATION ---TO GET MENTAL HEALTH PROFESSIONALS UP TO SPEED

RESEARCH --- THE SYNDROME VS. THE DISTINCT ILLNESS

ADHD, AUTISM AND MENTAL ILLNESS --- AND THE IMMUNE SYSTEM

DRAFT: Innate & Adaptive Immunity in Cognitive Disorders

FORM & SUBSTANCE---- MINNESOTA'S HOUSING OLMSTEAD GOALS

CAN THE FEDS GET US TO "MEASURABLE GOALS"

"PLANNING" FOR SCALE: THE TENSIONS IN OLMSTEAD

COMING TO TERMS WITH "THE TOTALITY OF THE CIRCUMSTANCES" IN BEHAVIORAL HEALTH

OLMSTEAD & DISABILITY HOUSING

AT LEAST TODAY -- OLMSTEAD GETS TO HOUSING WHERE PARITY & MEDICAID NETWORK ADEQUACY DON'T

WHAT WE WANT FROM THE BIDEN ADMINISTRATION

THE VA AND MEDICAID COGNITIVE DISABILITY

Author

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Val's Blog

ADHD, AUTISM AND MENTAL ILLNESS --- AND THE IMMUNE SYSTEM

​DRAFT: Innate & Adaptive Immunity in Cognitive Disorders

AT LEAST TODAY -- OLMSTEAD GETS TO HOUSING WHERE PARITY & MEDICAID NETWORK ADEQUACY DON'T

Author

Archives

Categories

DRAFT: Innate & Adaptive Immunity in Cognitive Disorders