Blog Archives

"COLLABORATION" IS DESIRED BY ALL SIDES-- WHAT IT'S NOT

4/16/2020

Hint: "Collaboration" is NOT Failing to COMPLY with Disability Civil Rights Laws

For a long time, I didn't watch "South Park" -- it seemed so INAPPROPRIATE.

Then one night I did watch it -- I did think it went over the line -- but there was a pretty sophisticated moral sense -- I really hadn't expected. I'm sure the creators wouldn't appreciate me saying that.

"South Park" is equal opportunity in its SATIRE -- and comedy can be one of the few places really open to us to acknowledge the ABSURDITY of our society.

The ADVERSARY SYSTEM and its declared goal of a SEARCH FOR TRUTH -- comes up short more often than it succeeds--- and that is complicated.

If we really are ALL IN THIS TOGETHER -- and we are -- we have to act like it.

That means at a minimum complying with Federal Disability Civil Rights laws:

Measurable Goals
Reasonable Time Frames
Funding to Support the Plan

In PBS's "The Definition of Insanity," Florida Judge Steven Leifman makes the startling and welcome claim that we are moving to a COLLABORATIVE SYSTEM as opposed to an ADVERSARY SYSTEM.

To us, this is a BIG STEP UP but it is going to require a lot of creative thinking & innovation & INTEGRATION to make IT work.

Ironically, to get out of the ADVERSARY SYSTEM -- we must be open to hearing when THINGS AREN'T WORKING -- and not only that -- TO WORK "COLLABORATIVELY" TO FIX THEM.

Eric Cartman from "South Park"

Who does this image of Eric Cartman refer to?

Most obviously, it does refer to Law Enforcement & the Legal System.

It also refers to me: I'm short and talk about legal authority a lot.

More broadly it refers to the DISABILITY COMMUNITY.

Maybe if we did "respect" each other's "AUTHORITAH" -- getting out of the ADVERSARY SYSTEM would be a lot easier.

Wizard of Oz: Pay No Attention to That Man Behind the Curtain.

What's the Point? Primarily, I'm referring to serious scientific problems within the Mental Health Profession.

However, it also refers to policymakers who put up a lot of BLUSTER and just gosh darn it --- won't comply with disability civil rights laws.

REACTION TO PBS' "Definition of Insanity" and "CrazytheFilm"

4/15/2020

Insanity

Colorado has begun the process of integrating Medicaid for Justice Involved People. That is a gargantuan task, and most states are probably behind Colorado. We'd like to see Colorado move a lot faster.
CASE MANAGEMENT was a huge issue in Miami-Dade County. It is a huge issue in Colorado and around the country.
A public health perspective in Criminal Justice needs to go beyond mental illness, and at the very least include brain injury and developmental disability.
That public health perspective needs to extend to all felonies.

Crazy

The problem of psychiatric medication for some people is quite real.
Our thinking is very confused when it equates psychiatric medication with treatment efficacy and safety: that might be the case and it might not.
If the State can show the person is a danger to himself or others, forced custodial care without forced medication may be necessary.
Peer Respite is a practical alternative for many, probably not all.

PBS' "The Definition of Insanity"

CrazytheFilm

PBS' "The Definition of Insanity"

OUR HUGELY PROBLEMATIC SITUATION

Violence &/or serious "anti-social" behavior among the 10s of Millions of People with some form of "Mental Illness" isn't the norm BUT it is not an inconsequential minority either.
It's not just a handful of mass shooters -- it's hundreds of thousands of people in this country.
Do we have good ways of telling who's violent or who's not? Not always and it is often after the fact. Further, then our judgments are often based inversely on the seriousness of the crime not the medical reality -- meaning the more serious the crime, the harder it is for society to recognize mental illness or really any biological explanation -- and the more likely such explanation exists.
Further, this really goes beyond debates regarding "bad intent." "Bad Intent" seems to be able to exist quite easily alongside mental illness, brain injury and/or developmental disability.
WHY DO WE HAVE SUCH DIFFICULTY? Many people don't trust the Mental Health profession to get it right enough--
- victims
- defendants
- families
- the Society
- the State
- the US National Institute of Mental Health
Even the MIami-Dade Program isn't available to people charged with the most serious crimes, although it does include some felonies. The Nathaniel Program in New York includes felonies and offers Assertive Community Treatment (ACT)
Florida was offering some type of diversion program for people with mental illness charged with low level misdemeanors, probably 30 years ago. Now, Miami-Dade is moving that to some lower class felonies -- it took a long time to get here -- some of the people who needed that are dead now. Further, it is not near enough.
WE WOULD GET THAT IF IT WAS CORONAVIRUS -- WE DON'T REALLY GET IT WHEN IT'S MENTAL ILLNESS or Brain Injury or Developmental Disability.

The WHACKED OUT

4/14/2020

Val's Scary Whacked Out "Religious" Psychotic Episode AND
The Scary/Whacked Out Use of Anti-Social Personality Disorder in OK, CO & CDHS

The 2006 Psychotic Episode

BOTTOM LINE: I was going to help everyone get to heaven. Because my mind was racing unbelievably fast, that really saved me and anyone else -- I moved on to something else.

This was a helluva way to step into the psychotic realm in your mid-40s.

I think the one thing I knew was that this could never happen again. It was very unclear what that meant.

Did it mean I needed to commit suicide, turn myself in, go to an institution -- it was very scary.

Today almost 14 years later with no subsequent episode -- that seemed so far off in 2006.

I bitch continually about mental health, and I didn't get here without the help of a psychiatrist.

Val's Take on Criminal Justice & Psychiatry Today

State definitions of "Insanity" and "Incompetent to Proceed" and American Psychiatric Association "invalid" diagnoses contained in the DSM 5 represent an unintelligible linguistic morass that does play itself out in ARBITRARY & CAPRICIOUS ways in this Country every day.

  LATERAL PROBLEM SOLVING:
  GOING AROUND THE CRIMINAL JUSTICE SYSTEM --
  THEY'LL PROBABLY BE HAPPY WE DID

There is largely a way out that doesn't really require STRUCTURAL CHANGE:

It's largely State Compliance with already existing DISABILITY RIGHTS LAWS.
MORE Funding for Research & Translational Medicine for IMPROVED TREATMENTS & BIOMARKERS WE CAN USE.

The STRUCTURAL CHANGE is really attitudinal at the Federal & State Levels:

It can't continue to be: Wink, Wink, Nod, Nod -- to State Non-Compliance with Disability Rights Laws.
If States need more SUPPORT -- Technical, Financial, Whatever -- the Feds & the States need to have those HARD DISCUSSIONS. 
AND MOST OF ALL WE NEED AN END TO STATE "GASLIGHTING" -- you must be crazy if you think we're not complying with disability rights laws -- don't pay any attention to those thousands of people with cognitive disabilities who are homeless or incarcerated.

Oklahoma
NATHAN LOCKETT

Dr. Call told the jury that he had interviewed Mr. Lockett and tried to administer a personality test but that Mr. Lockett had refused to cooperate.

But even without the personality test, Dr. Call testified, he was able to conclude that Mr. Lockett did not suffer from any mental illness.

Dr. Call asserted that Mr. Lockett displayed no symptoms of post-traumatic stress disorder.

Dr. Call testified, however, that Mr. Lockett had anti-social personality disorder and was a psychopath.

APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF OKLAHOMA (D.C. No. 5:03-CV-00734-F)

Colorado/CDHS

Mr. Universe who is Black and in his 50s has a decades long history of homelessness and incarceration -- when not incarcerated on SSI for Schizophrenia.
During evaluation at the Colorado Mental Health Institute at Pueblo, Mr. Universe refused to meet with evaluator.
From my perspective, that was because of paranoia.
In any case, the evaluator determined that Mr. Universe had a long history of criminal involvement and drug use. Without meeting with Mr. Universe, the evaluator issued a report to the Court concluding that Mr. Universe had an "Anti-Social Personality Disorder."
Above: the sequence of events in the Nathan Lockett botched execution in Oklahoma -- the evaluation process is eerily similar.

LIMITED ANECDOTES or EVIDENCE of SYSTEMIC PROBLEMS ACROSS THE COUNTRY

The burden has to be on the STATE and that includes the burden of DATA COLLECTION.

HOW MANY PEOPLE in US JAILS & PRISONS have:

Brain Injury
Mental Illness
Developmental Disability
Substance Issues (A Serious Health Issue)

There's "PREJUDICIAL" AND "UNFAIRLY PREJUDICIAL."

"Anti-Social Personality Disorder Diagnoses" are "UNFAIRLY PREJUDICIAL" -- if the Mental Health Profession can't recognize that -- somebody needs to recognize it for them.

Selected Links

Part II: My Experience with Mental Health Professionals, Personally

4/13/2020

There are a lot of factors that go into my assessment of the Mental Health Profession, generally it's not about individual professionals being uncaring or "stupid" - it's about a Profession that does know it doesn't know it all -- BUT they don't quite appreciate how off the mark they can be.

My experience with Mental Health professionals:

a couple of appointments with a psychologist when I was in 4th Grade (nice older gentleman who determined my mother needed to let me be me)
mid 30s a handful of appointments for depression
mid 40s potentially very dangerous psychotic episode and hospitalization
at 50 -- self diagnosed ADHD -- psychiatrist "confirmed"

MY BOTTOM LINE: I really can't TRUST (in terms of competence) the Mental Health Profession to:

correctly & systematically identify issues
correctly & systematically treat them, and
correctly & systematically prevent further deterioration

A lot of the SCIENCE I put here is not to say Val's the Researcher -- It's to say this stuff is HUGELY RELEVANT -- you don't seem to be AWARE of it MENTAL HEALTH PROFESSION -- and you can't possibly be COMPETENT without this knowledge.

After all is said and done, my ranting against the Mental Health Profession is not that different from the ranting of Judges against the behavior of Defendants.

Mental Health Professionals want to be competent and if they are not -- we really have to look to Research & Translational Medicine.

We also have to be HUMBLE.

Photo Credit: AB Staffing Solutions

Religion, Science & Mental Health Part I: My Background & My Deep Concerns

4/12/2020

I grew up in a non-traditional religious family, in an extremely conservative religious state.
I was never rebelling against my family's religious beliefs -- because I was pretty free to believe whatever I wanted -- although I was certainly giving people "what for" from an early age.
Further, REBELLING is an interesting thing --some people I knew did rebel against their conservative upbringing -- one of the few people I knew raised in the Unitarian Church -- rebelled and went to an Evangelical Church.
But my family definitely saw the PROS and CONS of organized religion and the importance of respect even if it wasn't something they felt they fit into -- even the most liberal incarnations -- it was mainly beliefs -- but it was partly they weren't interested in large groups of people.
Further, both my parents were pretty big INTROVERTS. They often joked that no one else would put up with them -- and that is probably true.

    Basically at home, my Dad read a lot of history, science and current affairs and liked to play chess, my Mom read a lot of Science Fiction, they cleaned the House, they worked in the Yard, played cards or board games with us, took the Grandmothers shopping -- and that was pretty much it.

   In my family, I read a lot of history, science, and current affairs, my husband reads a lot about neuro-monitoring and history, our daughter wants to become a history teacher, and our son is a personal trainer who works out several hours a day.

    My Husband was raised in the Catholic Church and left the Catholic Church after the divorce from his first wife -- he goes intermittently to the Episcopal Church -- he is ABSOLUTELY NOT interested in Religious Discussions and likes the Ritual of It -- "You Unitarians take Religion too seriously -- LEAVE ME ALONE."

Cleaning the House, Working in the Yard -- well, my husband and I have pretty much created our own ADHD NUCLEAR FAMILY and that brings with it its own challenges. We've gotten a lot better.

   I have intermittently engaged the Unitarian Church, BUT it has never really stuck.

Ultimately my point will be that there is more than Science & Religion: There are a lot of ways to parse REALITY -- and ultimately there is the HARD WORK of trying to INTEGRATE all that.

Stanford Professor Robert Sapolsky in his statement on the importance of caution in judging people harshly -- for me echoed my father's statements regarding judging religion harshly -- EVEN IF Sapolsky judges religion harshly and a lot of, although not all, Science Types do judge religion harshly.

My father's statement: Before you tear down somebody's religion, you better be awfully sure you have something better to replace it with.

PHILOSOPHICAL PRINCIPAL OF CHARITY
    In philosophy and rhetoric, the principle of charity or charitable interpretation requires interpreting a speaker's statements in the most rational way possible and, in the case of any argument, considering its best, strongest possible interpretation.

  In its narrowest sense, the goal of this methodological principle is to avoid attributing irrationality, logical fallacies, or falsehoods to the others' statements, when a coherent, rational interpretation of the statements is available.

According to Simon Blackburn "it constrains the interpreter to maximize the truth or rationality in the subject's sayings."

   ---Wikipedia

OTHER KINDS OF INTELLECTUAL CHARITY: Recognizing Complex and Interconnected "ROOT CAUSES" & the NEED FOR SUPPORT

If there is anybody who is CRITICAL & JUDGING of the Mental Health Profession -- it is me.

There are people who have gotten the DEATH PENALTY or LENGTHY TERMS OF YEARS in no small measure because of SIMPLISTIC & GROSSLY INCOMPETENT ANTI-SOCIAL PERSONALITY DIAGNOSES contained in an INVALID DIAGNOSTIC MANUAL.

In my weaker moments, would I like to give those "get along" mental health professionals the death penalty or a lengthy terms of years -- YES I WOULD.

Really rather fortunately, that type of "fairness" & "equity" really isn't available to me -- AND, of course, it wouldn't solve the problems I want to solve.

It is MASSIVE SUPPORT in RESEARCH & TRANSLATIONAL MEDICINE that both the Mental Health Profession and many people in the Criminal Justice System need.

Further, NONE OF THIS WORKS without services, housing & placements to SCALE.

State Olmstead Non-Compliance Increases Homelessness & Criminal Justice Involvement-- There are Opportunities in COVID-19 Economic Recovery

4/10/2020

Some of the places that represent the greatest COVID-19 danger are our nation's jails and prisons.
Jails and prisons in the US are generally terrible environments to begin with -- BUT it may be COVID-19 that helps us to further recognize that.
   The BIG CHALLENGE for Homeless Advocates and Criminal Justice Reform Advocates: MANY/MOST/ALMOST ALL of the people who find themselves homeless or in the criminal justice system have EXTREMELY COMPLEX NEEDS.
We've recognized that for awhile and we're doing "some things."
We say this a lot: THE PROOF IS IN THE PUDDING.  If people with cognitive disabilities are still winding up homeless or incarcerated -- STATES ARE NOT DOING ENOUGH.
What must States provide?

Intensive Services where necessary
Housing where necessary
Placements where necessary
Secure Therapeutic Placements where necessary
- If we don't provide for SAFETY where necessary -- it is going to be very hard to get people to go along with this.
- It's easy enough to say we don't need Secure Placements -- if we're in denial about the incidence of cognitive disability in violent crime. Now much of that can be addressed in other ways, especially if there has been an opportunity to have a secure placement and comprehensive discharge planning to an appropriate step-down.
- To do appropriate DISCHARGE PLANNING -- providers, individuals and families need someplace to discharge the person to. STATES if you are NOT providing those placements & housing --- THERE IS NOT GOING TO BE APPROPRIATE DISCHARGE PLANNING.
There is a big intersection among: SAFETY, Homeless Reform, Criminal Justice Reform & Olmstead.

Newsy: Covid-19 outbreak @ Cook County Jail. Additionally, Sheriff Dart @ the Jail has been an outspoken critic of the number of people with mental illness in the nation's jails.

Medicaid & Housing Related Activities

Olmstead Planning can be covered by Medicaid.

We'd like to see the Colorado's Behavioral Health Task Force recommend legislation for On-Going Comprehensive Olmstead Planning in Colorado.

That would go beyond Behavioral Health and is greatly needed across Colorado's Disability Community.

INNOVATIVE FUNDING STRATEGIES

Housing Trusts
Social Impact Bonds

The Challenge to Provide Housing, Services & Placements to Society's Disfavored "OUT-GROUPS"

4/8/2020

Landmark Minnesota Olmstead Complaint (2011):

AMENDED CLASS ACTION COMPLAINT AND REQUEST FOR INJUNCTIVE AND DECLARATORY RELIEF

Minnesota's Jensen Case -- Enforcing Olmstead

PBS: The Brain with David Eagleman

We literally don't feel the pain of people in our "out-groups" as much as we feel the pain of people in our "in-groups."

Those "out-groups" and "in-groups" can literally be based on any real or perceived differentiating factor.

We think that has a lot to do with the Coronavirus Response which is appropriate although maybe not adequate -- and the inadequate response to Cognitive Disability which is not appropriate or adequate.

The Immune System Revolution (which is really a Biological Revolution)

4/2/2020

Stanford Neurobiology professor Robert Sapolsky in his book "Behave: Biology of Humans at Our Best & Worst Selves" really is making the argument that Biology controls Behavior wherever one is on that Behavioral Spectrum.
He is also saying that people can be all over that Behavioral Spectrum depending on the current biology.
Further, he is saying that it is NOT just one thing -- it is a multitude of "things" --- AND IT'S EXTREMELY COMPLICATED.
So the new paradigm that is developing -- the Immune System controls Social Behavior and it may control Endocrinology and Hormones as well -- isn't that too SIMPLISTIC?
Well, it probably is -- BUT the Brain and nervous system are likely 1/3 of the puzzle at best. The already emerged paradigm of the Brain-Immune-Gut Triangle begins to recognize a large role for the Immune System.
That role for the Immune System is getting Bigger and BIGGER.
Our parsing of Human Intent in the LAW was the best we could do -- IT'S NOT GOOD ENOUGH ANYMORE.
The CATCHALL category of 'ANTI-SOCIAL PERSONALITY DISORDER" for Bad Behavior when we don't know what's going on -- ISN'T GOOD ENOUGH ANYMORE.

University of Virginia School of Medicine:

• Researchers determine that the immune system affects – and even controls – social behavior (in mice). (2016)

What about the Endocrine System?

Pituitary Network Association (2010)

Pituitary patients may recognize that the first signals of something being wrong with their system and/or body is when they find their sexual health and/or mental health deteriorating.

"The Brothers Karamazov isn't good enough anymore."

-----Slaughterhouse Five (1969)

Slaughter House 5 (the movie -- 1972)

WHAT'S THE POINT???

What did Vonnegut mean? We think he meant that the argument that there is EVIL in the World because God granted Human Beings "Free Will" -- isn't good enough anymore.

What we think is that the FREE WILL vs. DETERMINISM DEBATE isn't good enough anymore.

That old SIMPLISTIC debate gets in the way of rational Criminal Justice Reform in both obvious and covert ways.

It's time to move on to GREATER SAFETY and MORE HUMANE TREATMENT with a Public Health approach to Criminal Justice.

The Immune System, the Brain, Ability and Mental Illness

4/1/2020

This is the 50,000 feet overview-- like a lot of what we do.

There is a lot going on with mental health problems, they often involve problems with:

the Gut
the Immune System
the Brain
Epigenetic predispositions to changes to the Immune System
Other Genetic Factors
Etc.

That's A LOT -- and it's probably not all of it. That is why our current systems are so challenged and why we have a "Criminal Justice Crisis" and a "Mental Health" crisis -- and we have an ETHICAL CRISIS in the Mental Health Profession and the Criminal Justice System that ripples throughout the Society.

Unlike Victor Hugo's 19th Century France, it's been awhile since modern prosecutors were interested in prosecuting people for stealing a loaf of bread to feed their families, but I'm sure there are exceptions.

We often have pretty fuzzy ideas about how the:

actions,
artistic endeavors or
business schemes (legal or illegal)

of people with significant emotional dysregulation are connected to the brain and the immune system.

AND let's be clear -- our ideas aren't CRYSTAL CLEAR -- and that is part of the point.

BUT there is scientific backing for connecting:

the immune system to mental illness
the immune system to social behavior
the immune system to positive benefits of music
professional musicians having a high rate of mental illness
entrepreneurship being associated with some forms of mental illness
etc.

This gets back to our LIFE-SAVING & SOCIETY-SAVING POINT -- a Strength-Based Approach is NOT just something nice to do.

People are contending with COMPLEX BIOLOGIES that even in 2020 are only fractionally understood.

We've developed some coping skills over the past few thousand years that aren't perfect BUT often help.

Every person in this society needs a PATH & SUPPORT to EXERCISE THEIR STRENGTHS -- not just as something nice to do, but for their survival and ours.

What's The Point? Many people with emotional dysregulation have profound abilities (not perfect abilities) and they need to exercise those abilities not just because they want to (although they do want to).

Exercise of those abilities often helps them function (although not perfectly).

And for many of us it is as ESSENTIAL as WATER.

What's The Point? The Point is that much of our current system of justice is as Cruel as Victor Hugo's "Les Miserable" in 19th Century France -- given current knowledge and knowledge of lack of knowledge.

The Point is NOT that people with behavioral issues and bad intent may not present a SAFETY THREAT -- but much of what we do EXACERBATES that.

Strength-Based Approach

Forward>>

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