Blog Archives

CMHIP: "Charm King"

3/27/2020

CMHIP had a heterosexual version of the "Tiger King" who I'm calling the "Charm King."

Black, super intelligent, polished, professional athlete athletic, wanted to be a motivational speaker.

Had seduced at least one staff member and there were the escapes from CMHIP and violent encounters on the outside.

I think it is very hard when our society sees people like "Joe Exotic" or the "Charm King" --- "just get your emotional life in order -- and you'll rocket to the TOP."

The problem is that those "super abilities" and that emotional dysregulation are often linked. Further, much more of "mental illness" is DEVELOPMENTAL than previously realized.

Neither the person NOR the society can wait to develop STRENGTHS or PROVIDE FOR SAFETY if that is necessary.

If Charm King could fill a STADIUM of 135,000 people giving a motivational speech while under 1 on 1 or more supervision -- Why not?

Dr. Gail Saltz in her book, "The Power of Different: The Link Between Disorder and Genius" argues that 80% of the time should be spent on development of strengths, and 20% on workarounds for weaknesses.

The more we understand some mental health issues as DEVELOPMENTAL --- the more we understand the importance of "WORKAROUNDS."

Both Charm King and Tiger King were DESPERATE to have an opportunity to use their considerable strengths and there was no easy way for them to do that in this Society.

There has to be a PATH & SUPPORT for the many Charm Kings and Tiger Kings across the US and the World.

Colorado Mental Health Institute @ Pueblo (CMHIP)

Joe Exotic -- "The Tiger King" -- convicted on Solicitation to Murder"

warning: some language issues

"Tiger King" -- Entrepreneurship, Drug Use, Sexual Exploitation, Animal Exploitation --

3/27/2020

the High-Jinks Never Stop -- but who IS the "Tiger King" -- We Are

First let me say I do think "Tiger King" is HILARIOUS -- and if there is anyone who is drawn like a moth to a flame to "TRUTH IS STRANGER THAN FICTION" cases -- it's me.
I've had a lot of time to think about them.
A lot of the characters in "Tiger King":

had been through the criminal justice system
were entrepreneurial
are relatively poor
have problems with emotional regulation, other cognitive problems
have drug problems

Often there is this ASSUMPTION that people in the CRIMINAL JUSTICE SYSTEM are "LAZY" or just have "ANTI-SOCIAL PERSONALITY DISORDERS."

The COMPLEX Social & Biological Reality they are living in is not only often BEYOND them -- it's OFTEN BEYOND "US."

To make matters even more challenging, we must deal with the AMBITION of people in the Criminal Justice System & people with Cognitive Issues -- that AMBITION currently doesn't have any easy LEGAL OUTLET.

Mental Illness as an Immune System Disorder(s)

3/27/2020

We mean this in BASIC TERMS -- Mental Illness involves the Immune System

 Physical Health, the Immune System, the Endocrine System & Mental Health

ADHD, Autism, Depression, Schizophrenia and Bipolar Disorder share common genes regulating epigenetic changes to the Immune System

 National Institute of Mental Health (NIMH): Disorders Share
Risk Gene Pathways for Immune, Epigenetic Regulation
Genome-wide findings add to evidence blurring traditional
psychiatric categories

Trauma Impacts the Immune System

The Brain, Immune, Gut Triangle

Oslo University Hospital/ University of Debrecen: The Brain- Immune-Gut Triangle: Innate Immunity in Psychiatric and
Neurological Disorders (2013)

"The communication between the immune and central nervous systems has been known for decades.

"Although the biological rules and complexity of the neuroimmune axis is yet to be clarified, in the modern era of immunology and clinical neurosciences it has become a dynamically evolving paradigm."

The Immune System MAY control Social Behavior in Mammals, according to the University of Virginia School of Medicine (see video below)

It is becoming more and more clear that we can't have effective Mental Health Systems without addressing the Immune System.

We understand that we have to support physical health professionals to address COVID-19 -- we must support mental health professionals with TRANSLATIONAL RESEARCH TO CLINICAL PRACTICE -- we can't afford to wait DECADES for that.

The Difference Between Doing "Something" & Understanding There's An "Emergency"

3/26/2020

Our Society & Politicians by & large STILL DON'T GET IT ON COGNITIVE DISABILITY

My BOTTOM LINE has been Governors who violate federal law and do not comply with OLMSTEAD are UNFIT FOR OFFICE.

The problem that I have and the Disability Community have is very similar to the one State & Federal authorities have had on MARIJUANA: THERE IS WIDESPREAD NON-COMPLIANCE.

Sometimes one might say -- "Hey, just legalize the non-compliance. The compliance efforts are worse than the violation."

Maybe that is true for MARIJUANA -- it is NOT TRUE FOR OLMSTEAD.

So even though we have the LAW -- most of us can't afford to ENFORCE it.

We need effective administrative enforcement that helps States provide:

Measurable Goals
Reasonable Time Frames, &
Funding to Support the Plan

COVID-19 -- will likely be over in a year and a half to 2 years.

It is very likely we will still be dealing with past and current state failure to bring cognitive disability:

Services
Housing, and
Placements

TO SCALE.

By John-Michel Basquait

Now
Our Society & Our Political Class are pretty oblivious to the fact that:

Health Care Rationing
Housing Rationing, and
Placement Rationing

have decimated HUNDREDS OF THOUSANDS of Americans with Cognitive Disability and landed them into Homelessness & the Criminal Justice System.

We're all for doing what we need to do on COVID-19 -- BUT let's wake the F' Up.

Public Health, Understanding & Cognitive Disability

3/23/2020

   We don't know anyone who begrudges the efforts on COVID-19.

On the other hand, the mishandling of our Mental Health/Cognitive Disability Crisis by both Republicans and Democrats over the last 60 years and currently -- is cause for REFLECTION.

Of course, concerns for HUMAN HEALTH go far beyond the last 60 years.

In the SCHEME OF THINGS, we've often had a MIXED BAG of approaches to health problems that were beyond our SKILL SET.

    In the US in 2020, one is unlikely to be burned as a witch -- BUT the Society is VERY LIKELY to determine Jails or Prisons are a regrettable alternative for people with cognitive disabilities-- on ECONOMIC GROUNDS.

How many people -- HUNDREDS of THOUSANDS.

Another little inconvenient fact -- a lot of those people have suffered much more from an ABUSIVE SOCIETY than an ABUSIVE FAMILY.

Overwhelming the health care
system is NOT the ONLY criterion for a perceived PUBLIC HEALTH CRISIS.

Some baseline understanding of the nature of the sickness/condition is essential, and
Some baseline understanding of the ENDGAME is essential as well.

Housing & Infrastructure

3/23/2020

While the Senate coronavirus Stimulus Plan does not address housing -- this is still in the early days of the emergency and there will likely need to be multiple ECONOMIC STIMULUS PACKAGES.

Supportive Housing is a FUNDAMENTAL aspect of our ECONOMY and SOCIETY.

It is crucial that DEMOCRATS and REPUBLICANS take this MOMENT to bring SUPPORTIVE HOUSING to SCALE.

Housing

Absent comprehensive and bold investment in our nation's housing infrastructure, the inequities in access to affordable, healthy housing will continue to grow.

[ Orchid: Further, housing is a primary SOCIAL DETERMINANT of HEALTH and lack of housing is a primary source of HEALTH INEQUITY.]

Infrastructure Equity

Council of Large Public Health Authorities

Public Housing IS Infrastructure

A Basic Need: American Infrastructure Must Include Housing

Document from Oregon Housing & Community Services.

Housing, Placements as INFRASTRUCTURE

3/22/2020

There has been and is a conceptual challenge in the US and around the world regarding funding of Disability Housing & Placements.

A lot of countries and the US are doing "something."

In the US, Disability Housing and Placements are the ultimate legal responsibility of the State under Olmstead, but other governmental subdivisions such as the Feds and Municipalities are often big players in providing disability housing.

With all these "players" -- there is PLENTY of disability housing & placements in the US, right? Of course, anyone familiar with the situation knows that is far from the TRUTH.

In fact, Colorado and most States are in PERPETUAL CRISIS regarding LACK of Disability Housing & Placements.

The State funds prisons which often serve as a kind of long-term placement for some people with cognitive disabilities.

Counties typically fund jails which serve as a kind of typically short-term placement for some people with cognitive disabilities.

With understanding of how appropriate disability housing and placements could be economically stimulative -- we could transform our society and come out even stronger economically from COVID 19.

Image Credit: People with Disabilities Australia

Using a Univ. of Penn. Law Review article as a Springboard to Discuss Major Reform

3/21/2020

This Law Review article --

Recognizes that "virtually all doctrines and practices would benefit from substantial reform to further justice, humanitarian and systemic goals."

We don't agree with all the recommendations BUT recognition of the need for SUBSTANTIAL REFORM is a monumental step in the right direction.

Below very limited comments on the 33 Recommendations.

Criminal Justice & Mental Health (2018)

Stephen J. Morse

IV. CONCLUSION

Mental disorder plays a very large role in criminal justice at every step in the process. Virtually all doctrines and practices would benefit from substantial reforms to further justice, humanitarian and systemic goals.

This chapter has made an enormous number of recommendations. I hope that some begin serious discussion and come to fruition.

Most importantly, however, better mental-health services, including addiction treatment, should be more widely available in the community and in the criminal justice system.

RECOMMENDATIONS

To reiterate, here are my policy recommendations to promote greater justice and humanity in the law’s treatment of criminal offenders who suffer from mental disorders.

1. Readers interested in the role of mental disorder in the criminal justice system should also consult the ABA Criminal Justice Mental Health Standards.  [We're really concerned about those standards because they are tied to the DSM]

2. When predicting future behavior, the most accurate type of prediction method available should be used. If actuarial or structured clinical judgment methods are available for the type of prediction in question, they should always be preferred to purely clinical prediction.  [This hits the nail on the head: we don't always have the best methods to determine dangerousness and that's really why a lot of punishment is tied to INTENT + ACT.

Some/Most of those criminal sentences are pretty arbitrary and capricious.

Most if not all of these sentences or orders need to be regularly reviewed with an eye towards RISK ASSESSMENT best practice.]

3. Race should not be considered as a variable when predicting future behavior. [This is very controversial but more people of color may have experienced more TRAUMA or Inter-Generational Trauma than others -- the important thing is to provide appropriate Treatment and Housing and/or Placements as necessary]

4. Non-physician health-care providers in jails and prisons, especially psychologists, psychiatric social workers, and psychiatric nurses, who have received adequate training in prescribing psychotropic medication should be permitted to prescribe psychotropic medication and medication for substance use disorders. [Hmmm. . . This is hard for psychiatrists -- and a lot of the people in criminal justice have idiosyncratic nervous systems -- in some cases it is a part of why they are there -- that's our take.]

5. Until rigorous data support the effectiveness of various psychological treatment methods for prisoners, including special populations such as addicts and sexual offenders, large-scale resource allocation for such methods should be limited, especially for methods focused on individual cases.

6. Jail and prison mental-health services need to be dramatically improved. [Are jails and prisons the right place for people with mental health or cognitive issues -- NO.]

7. Mentally disordered people arrested for nonviolent or minimally violent offenses should be diverted from the criminal justice system to the mental health system.

Adequate methods for effective and efficient triggering of diversion must be devised, and adequate treatment must be provided in the community to the people diverted. Law-enforcement officers should receive special training in dealing with mentally disordered people to enhance diversion and to deal with such people humanely.

8. Competence determinations should be fully adversarial, with experts representing both sides.

9. A mental-health expert should be appointed to assist a defendant with any potential claim based on mental disorder that bears on culpability and punishment.

10. Defendants with a mental health-based claim should be entitled to a genuinely independent mental-health expert of his own choosing retained for the defense team, and the results of the evaluation should be confidential work product and not disclosed to the prosecution unless the defendant intends to use the evaluation to support a claim.

11. Clinical forensic evaluation interviews should be videotaped, and the raw scores of psychological tests should be provided to the opposing side.

12. In quasi-criminal proceedings, such as those involving the civil commitment of mentally abnormal, sexually violent predators, the person facing commitment should be entitled to a genuinely independent mental-health professional to assist him.

13. Defendants who are incompetent to stand trial should be permitted without exception to raise pretrial motions that might end the prosecution.

14. Long-term inpatient commitments to restore trial competence are unnecessary. Short-term commitments are adequate to either restore

Reforming Criminal Justice the defendant or to determine that the defendant cannot be restored. In appropriate cases, restoration should be performed in the community.

15. Forcible medication to restore trial competence should be justified in the case of all felony prosecutions.

16. The test for competence to plead guilty and to waive counsel should be a context-dependent assessment of whether the defendant has the rational skills necessary to meet a generally low standard for competence.

17. Defendants should be permitted to introduce evidence of mental disorder without limitation to negate any subjective mens rea but should not be permitted to use such evidence to negate negligence. [Hmmm . . . the LAW has developed a lot of PARSING of CULPABILITY -- mental health can and does implicate negligence and brain injury and other cognitive issues do as well]

18. All jurisdictions should adopt a cognitive test for legal insanity but should not adopt a control test.

[There is a HUGE problem of DENIAL regarding cognitive issues, human beings and the criminal justice system.

It is NOT just that most states have a generally indefensible definition of INSANITY -- certainly Colorado does -- it is that our most basic paradigms in criminal justice don't reflect REALITY.

That REALITY is very hard to acknowledge if we're not providing SAFETY and it is hard for us to conceptualize that HUMAN INTENT is a matter of HUMAN BIOLOGY.

Now all those issues aren't classic mental health issues -- HOW ARE WE GOING TO DEAL WITH THAT?]

19.  All jurisdictions should adopt an insanity defense to ensure that justice is done in appropriate cases and no alternative will equally achieve this result.  [Well, the Insanity Defense is a mess]

20. Legislatures should adopt a generic verdict of “guilty but partially responsible” that would reduce the defendant’s sentence in cases in which the defendant’s rationality was substantially compromised. [Hmmm . . . This seems to us like PARTIALLY getting biologically based HUMAN Behavior]

21. Prisoners should be forcibly medicated under a Harper rationale only if the prisoner’s dangerousness is a result of his disordered state of mind.

[Forced Medication is very complicated --- individuals need access to genetic testing and other means to additional information. Colorado really looks to "EMERGENCY" -- that seems reasonable.]

22. Prisoners facing a Harper hearing should be represented by an adviser, preferably an attorney, who is independent of the prison or mental-health system in the jurisdiction.

23. In all capital and noncapital sentencing proceedings in which the defendant has a colorable mitigation claim based on mental disorder, the defendant should have the right to an independent mental-health professional retained for the defense to assist him with the claim.

24. Legislatures should adopt a mandated scheme of mitigation if the sentencing judge finds that substantial diminished rationality existed at the time of the crime.

[Orchid: a lot of the problem is that Human Intent is not quite what we think is -- although BAD INTENT is a part of reality.

As a Society we will probably deal with this in a piecemeal fashion -- and for much of that the LAW probably won't be leading. Safety is the BIG ISSUE]

The amount of reduction could be a uniform percentage or might vary by crime to adjust for social-safety concerns, but the sentencing judge should have no power to individualize beyond the mandated reduction.

25. In non-capital cases, mental disorder may be used as an enhancement factor but only if the most accurate methods of predicting future behavior have been used and indicate a very substantial risk, but the amount of enhancement should be limited.

[Hmmm . . . this needs a lot of work. This reveals the fundamental problem of using a system based on "punishment" to deal with bad even horrific human behavior. That bad behavior/ bad intent is a result of HUMAN BIOLOGY. A lot of our reluctance to acknowledge that is fear we can't protect ourselves under the current system.]

26. The standard for competence to be executed should be very high.

[Other States and Colorado are getting rid of the Death Penalty -- "Competence" as it has historically played out is grossly insufficient]

27. Competence to be executed should be decided by a judicial hearing.

[We think RISK ASSESSMENT should be decided by judicial hearing.]

28. Competence to be executed that is achieved by forcible medication administered under a Harper rationale should not be sufficient.

The state should be compelled to decide whether forcible medication solely to restore competence is justifiable independent of a Harper rationale.

29. The state should provide an independent mental-health professional to help indigent people subject to a mentally abnormal sexual-predator commitment oppose the commitment.

30. Mentally abnormal sexual-predator commitment laws should be repealed.

[The issue of Sexual Predators is huge and needs a lot of consideration on HUMANITARIAN and SAFETY grounds]

31. Post-insanity acquittal commitments should be subject to the least restrictive means principle, including compelled treatment in the community.

32. An insanity acquittal should be followed by a brief evaluation period rather than by involuntary commitment to determine if the acquittee is still dangerous because his mental disorder continues.

If the state then wishes to commit the acquittee, there should be a judicial hearing and the acquittee should have the right to an independent mental-health professional to assist him to contest the commitment.

33. Expert witnesses at any stage of the criminal justice process should be prohibited from offering an opinion on the ultimate legal issue in question.

[Orchid is looking for some FUNDAMENTAL CHANGES -- our Society is already in the process of doing that and Problem Solving Courts while insufficient in themselves are a part of that.

Most of the dramatic change is coming from LEGISLATURES and that is not surprising.

The Legal System is unlikely to make the reforms necessary without State and Federal Funding of services, housing and placements to SCALE]

The DSM -- May Have Been Great 40 Years Ago -- Today It Is Holding Us Back

3/20/2020

A lot of people in the US are outraged about the slow response on COVID 19 which has been a matter of months.

The National Institute of Mental Health (NIMH) announced its concerns that the DSM 5 was not scientifically "valid" by 2013 and maybe before.  OMG.

Enormous POLITICAL CONSIDERATIONS from Mental Health Professional Organizations such as the American Psychiatric Association provided A LOT OF PUSHBACK.

The FIX was going to be NIMH's Research Domain Criteria Program and may be it ultimately will be.

In the Meantime, NIMH advised mental health professionals to just use the DSM like a Dictionary so they could have a common language on symptoms.

   Well, that's kinda like advising countries just to go about their normal business with COVID 19 and we'll provide further direction several years from now.

   The BIG PROBLEM is that DEFINITIONS are DEFINITIONAL and they are some primary filters that people use to understand the WORLD -- those definitions are never perfect and the more not perfect they are -- the more problems they cause because they do not reflect "REALITY."

The DSM gets criticism from all sides, but a HUGE problem is that it is not tied to:

biomarkers, and
it doesn't recognize that is a huge problem.

  The DSM does provide an incredibly ineffective disclaimer about use in court proceedings -- but those definitions and categories are in reports and testimony in criminal and civil cases across the US and across the world.

    Around the world, it may be the ICD 10 (International Statistical Classification of Diseases and Related Health Problems, a medical classification list by the World Health Organization.)

  The ICD 10 is pretty close to the DSM 5 on mental health-- and the concerns about the DSM 5 are relevant to the ICD 10 as well.

   THE BOTTOM LINE: We need to do A LOT MORE "Social Distancing" from the DSM 5 and move closer to Stanford Professor Robert Sapolsky's understanding of the FOUNDATIONAL NATURE of BIOLOGY to HUMAN BEHAVIOR.

International Journal of Forensic Mental Health (2019)

Some Ethical Considerations About the Use of Biomarkers for the Classification of Adult Antisocial Individuals

It has been argued that a biomarker-informed classification system for antisocial individuals has the potential to overcome many obstacles in current conceptualizations of forensic and psychiatric constructs and promises better targeted treatments.

However, some have expressed ethical worries about the social impact of the use of biological information for classification.

Many have discussed the ethical and legal issues related to possibilities of using biomarkers for predicting antisocial behavior.

We argue that prediction should not raise the most pressing ethical worries. Instead, issues connected with “biologization”, such as stigmatization and negative effects on self-image, need more consideration.

However, we conclude that also in this respect there are no principled ethical objections against the use of biomarkers to guide classification and treatment of adult antisocial individuals.

Stanford Professor Robert Sapolsky

DR. ROBERT SAPOLSKY IS A PROFESSOR OF BIOLOGY, NEUROLOGY AND NEUROLOGICAL SCIENCES, AND NEUROSURGERY @ STANFORD UNIVERSITY: "You are never really going to understand what is going on if you get it into your head that you're going to be able to explain everything with this is--

the part of the brain
the childhood experience
the hormone
the gene
or the evolutionary mechanism

---That explains everything.

"It doesn't work that way. Instead any behavior is the result of biology that occurred a second ago, hours ago, days ago -- a million years ago."
. . . .

"O000h it's complicated. Well, that's very useful.

"How 'bout, 'OOOh it's complicated and you better be really careful and really cautious before you think you understand the causes of a behavior, especially if it's a behavior you judge harshly.' "
.
------Prof. Robert Sapolsky Stanford

PsychCentral: Drawbacks of DSM-5
Therapists Marie Hartwell-Walker, Ed.D. and Daniel J. Tomasulo, Ph.D., TEP, MFA

We saw a personality disorder video @ the end of this -- and we're really concerned about how personality disorder diagnoses play out in the Criminal Justice System and serve as an EASY OUT for practitioners with respect to the most difficult patients.

That's why we really need biomarkers and we're starting to get them. The HUGE ETHICAL CHALLENGE is what to do before full blown replacement of the DSM.

"Networld" and Orchid

3/18/2020

Some Thoughts on Niall Ferguson's PBS program "Networld"

We believe strongly in a MARKETPLACE of IDEAS and our current SOCIAL NETWORKS & WEBSITES do present challenges.

We're a tiny non-profit with some non-traditional ideas about current paradigms regarding mental health specifically and cognitive disability, generally.

It's hard to get those ideas out.

On the other hand, we do want to be open to people and professionals who view things differently.

I'm pretty sensitive to the "FAKE NEWS" challenge -- I recognize the problems of:

manipulation on a small scale or a grand scale
"emotion & reason" and insufficient processing time, and
disgusted charges of "FAKE NEWS" when we may just disagree with the "NEWS" or we need to present an ALTERNATIVE VIEW or VIEWS.

Orchid was slammed pretty hard on FACEBOOK awhile back for posting a news article on a particular mental health medication.

A lot of the criticism surrounded the fact that I said we don't independently FACT CHECK the articles we post. We don't have the resources to do that.

We try to use reliable sources and we're open to substantive criticism of the information or even just venting.

Even though arguments from AUTHORITY are pretty problematic -- most of us rely on them to a great degree because we don't have the time and energy to independently verify the vast amount of information out there.

A lot of the strategy of Orchid is to go up a level of AUTHORITY in presenting our arguments, whether it's quoting:

researchers
the US Department of Justice
the World Health Organization
people with lived experience
my own lived experience

  A lot of UNDERSTANDING is about taking DISPARATE VIEWS and trying to figure out how they are all true at the same time -- that INCLUDES dealing with bad motives, misinformation, and stuff that just isn't right.

  INFORMATION is NEVER perfectly right -- it is in a constant state of revision -- and that process is speeding up exponentially every year, every few months, every day.

We do need better systems to control that -- the AUTHORITARIANS aren't totally wrong.

    On the other hand, the MARKETPLACE of IDEAS is NOT out of date.

<<Previous

Val's Blog

CMHIP: "Charm King"

"Tiger King" -- Entrepreneurship, Drug Use, Sexual Exploitation, Animal Exploitation --

Mental Illness as an Immune System Disorder(s)

The Difference Between Doing "Something" & Understanding There's An "Emergency"

Public Health, Understanding & Cognitive Disability

Housing & Infrastructure

Housing, Placements as INFRASTRUCTURE

Using a Univ. of Penn. Law Review article as a Springboard to Discuss Major Reform

The DSM -- May Have Been Great 40 Years Ago -- Today It Is Holding Us Back

"Networld" and Orchid

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