Blog Archives

State Don't Let Embarrassment Prevent You from Doing What Needs to Be Done on CMHIP: An Emergency Request for Funds

7/21/2017

I think there is a little awkwardness in going to the Legislature on an emergency when the State did not inform the Legislature of the problems at the Colorado Mental Health Institute @ Pueblo during the legislative session.
Well, maybe that would have been preferred -- BUT it didn't happen. AND now the State needs to suck it up and put on its big boy and big girl pants and seek emergency funds to solve the staffing problems @ CMHIP.
That could get fixed in a wide variety of ways, BUT IT NEEDS TO GET DONE & IT NEEDS TO GET DONE NOW. Right now what we have is very much in line with the son suffering for the sins of the father, only here it is patients and staff suffering for the sins of the State -- that has to STOP.
Further, we have facilities all over this State serving vulnerable people some run by the State, some run by non-profits, and some run by private companies. One of the most serious issues for those facilities is staffing.
We would submit the way the State is handling CMHIP is a horrible example
The State has the perfect justification to really solve the problems at CMHIP:: a CMS investigation finding initially "immediate jeopardy." Maybe that immediate threat is over but the widespread concerns about staffing, burnout, and playing with the numbers are hardly over.
We have got to get CMHIP adequately staffed and if it is not an emergency for the State, we just bet is for staff and patients.

Pueblo Chieftain

CMHIP Struggling for Key Staff

(Still More Than 80 Vacancies)
http://www.chieftain.com/news/pueblo/cmhip-struggling-for-key-staff/article_cd7e0d50-ac88-5c65-b44c-7e15cb82fe03.html

Aggression As A Protection Against Depression In Bipolar Disorder & Sleep Apnea Does Affect One's Risk for Bipolar

7/20/2017

Any discussion about people in general and aggression, assertiveness, passivity, etc. is frought with peril. And one throws in mental illness and well it is hard to keep things rational.
My biggest concern is that I have seen this "aggressiveness" concern turned on its head to try to protect people in power from legitimate lawsuits. Hmmm . . . I don't think so.
On the other hand, threats of physically harming people -- that looks pretty crazy -- AND it probably is.
AND there maybe a lot of factors going into that craziness/insanity/etc.

childhood abuse
societal abuse
physical/mental health concerns
genetics
etc.

   AND the fact that we don't completely understand those factors BUT that is NOT stopping us from rendering all kinds of judgments about them -- well that's pretty frightening.
We absolutely have to protect the community, but we have also got to acknowledge that we don't know it all -- and that is becoming painfully obvious.
   AND THAT SHOULD MEAN SOMETHING TO OUR CRIMINAL JUSTICE SYSTEM.

bphope.com

May 1, 2017, PHILADELPHIA, PA--Aggression appears to keep the depressive phase of bipolar disorder at bay longer, a new study suggests.

American researchers noted a growing body of evidence that suggests bipolar disorder is associated with higher levels of aggressive behavior. They looked at about 120 young adults, checking in every four months for more than three years.

The team found that, overall, physical and verbal aggression predicted a longer time to major depressive episode onset even after controlling for depressive and manic symptoms at the start of the study, family history of mood disorder, treatment seeking for mood problems, and impulsivity.

Aggression did not, however, significantly predict the time to manic episodes.

The study, which appeared in the journal Behavior Therapy, was entitled “Aggression protects against the onset of major depressive episodes in individuals with bipolar spectrum disorder.”

Source: http://www.sciencedirect.com/science/article/pii/S0005789416300557

For those in Integrated Care & Everybody Else:

bphope.com

Sleep Apnea Linked With Bipolar Disorder

Recent research has presented a possible link between bipolar disorder and instances of sleep apnea.

May 1, 2017, TAINAN, Taiwan—Sleep apnea, or frequent halts in breathing while asleep, has been linked with bipolar disorder in a new study.

Taiwanese researchers looked at more than 5,000 people with sleep apnea and more than 27,000 people who did not have the condition.

They found that people with sleep apnea were two to three times more likely to get a bipolar disorder diagnosis as compared to people without sleep apnea.

The authors said their findings indicate that health professionals should carefully monitor the psychological health of individuals with sleep apnea.

The study, which appeared in the journal Sleep and Breathing, was entitled “Sleep apnea is associated with an increased risk of mood disorders: a population-based cohort study.”

Source: http://link.springer.com/article/10.1007/s11325-016-1389-x

Childhood Trauma Affects Health Across A Lifetime

7/18/2017

At some point we just want people to get over it -- and when it is uncomfortably and painfully obvious that people are NOT over it -- well -- maybe if we IGNORE them -- they'll get over it.
   That works with DOGs doesn't it?
   Well, it doesn't work so well with traumatized children or adults or at least that's my experience.
Then people "escalate" to get people's attention -- "You must not have heard me" -- and may get threatening --
" Well, we're not going to respond to threats or if we do respond it's going to be with a Wellness Check or depending on the color of their skin just an arrest."
   Lots of times if we really dig down there often is something to the claims of injustice of people who are either in the Denver Detention Center or in the Community --- and they get written off because of the manner in which they are presented and because the people presenting them are greatly traumatized.
   If our response is to ignore them until those claims can be presented in a manner more suited to our liking, we may be waiting a long time and missing important and legitimate claims that need to be redressed.

Our Social Safety Nets are Ripping Under the Weight & Cost of Social Exclusion:

7/17/2017

The Criminal Justice System
Medicaid
Healthcare in General
Social Security Disability
Etc.

Blue Zones, Social Inclusion & Go With the Flow

New York Times Columnist and author Thomas Friedman has argued that we have to become radically more entrepreneurial and provide radically better safety nets for the ever-growing group of those who can't keep up.
   But is that sustainable? Probably not.
We are going to have to become radically more entrepreneurial BUT that has to be inclusive.
This society isn't working for a whole lot of people -- stagnant wages & sky high housing costs -- and marijuana tax money has its downsides in increased homelessness, addiction, arrests, etc.
[ I'm not for re-criminalizing marijuana -- & can that tax money even cover the costs that are being incurred? And is it really legalization or the fact that surrounding states have NOT legalized marijuana?]
   Are we perhaps called upon to become radically entrepreneurial & radically inclusive becoming strength-based & person-centered so that our weaknesses don't pull us down.

Go With The Flow

PBS NewsHour: Job Opportunity Lagging for People w/ Disabilities

TedxTalk: Addiction & Connection

Vlog Brothers: Mass Incarceration in the US

Washington Post: Stress of Poverty & Racism Raises Risk of Alzheimers in African Americans

Click Here

Hybrid Assertive Community Treatment Could Be More Desired, Be More Effective, & Save Money

7/16/2017

We're big proponents of Assertive Community Treatment -- the Gold Standard in Intensive Community Mental Health Treatment.
Intensive Case Management which is sometimes referred to as ACT Lite has been found not to be as effective as ACT in some circumstances.

   And yet if the truth be told and we have told it before on the Orchid website and in meetings with the State and Stakeholders --- There are probably a lot of people who would qualify for ACT who don't necessarily want the full panoply of ACT services {psychiatrist, psychologist, etc] or at least not on a 24/7 basis.

   Most people do want Housing & Employment Assistance.

Additionally most people really do want Intensive Case Management Maxxed OUT @ -- 24/7. Some, not necessarily all people receiving those services, want case management to serve as a safety valve between the landlord and themselves.

   Also, at least some of the need for the case management is our inefficient systems. It would be really helpful to build into the case management job description: Making Monthly Recommendations for Systems Reforms to make Housing, Services, Benefits, Etc. easier to navigate. Deliver those recommendations to the agencies involved and post to a website.

   So a lot of this is what we might do for Intensive Community Mental Health Treatment, BUT it's also an example of how we might actually save money if we listen to one another.

   Some people will want and need traditional ACT --- people are individuals -- it takes time to listen to one another -- we have to have a lot of options that are flexible.

  Currently, Colorado Medicaid defines Assertive Community Treatment (ACT) – Comprehensive, locally-based, individualized treatment for adults with serious behavioral health disorders, that is available 24 hours a day, 365 days a year. Services include case management, initial and ongoing behavioral health assessment, psychiatric services, employment and housing assistance, family support and education, and substance use disorders services, 8.212.4.B.2 (CO Medicaid Regulations)

     Intensive Case Management is defined as more than 1 hour of case management per week, 8.212.4.B..3 (CO Medicaid Regulations)

An Olmstead Plan is Really A Court Compromise Trying to Balance the Interests of States & People with Disabilities

7/15/2017

From the perspective of people with disabilities -- States should already be providing all the housing and services necessary to prevent unnecessary institutionalization and great risk of institutionalization that is inherent in homelessness as a requirement of Title II of the Americans with Disabilities Act (ADA).
In the US Supreme Court's 1999 Olmstead decision --- the Court cut the States a break and basically said that if the States have:

Comprehensive
Effective Working Plans

to provide housing and services in the community for people with disabilities, then that is a defense to an ADA claim.
Since then, subsequent caselaw has required that such "Olmstead Plans" have specific measurable goals. Additionally, US Department of Justice guidance has indicated that housing and services need to be brought to scale to meet the need.
   Well, the thing is most States don't have compliant plans -- Colorado doesn't. Minnesota does, but only after a Court Order.
   And now here we are in the middle of a federal Healthcare debate, and as painful and ridiculous as it is -- it is NOT a legal excuse Not to have a compliant Olmstead Plan.
When Olmstead/Olmstead Plans are treated as Ad Hoc it never gets done or it doesn't get done right -- this isn't a one off exercise -- It's A Continuing Process.
   Because It is A Continuing Process -- with Continuous Improvement & Modification Built In (or should be) -- we don't need to fear or loathe it.

Diversity, Will Power, Blue Zones & Olmstead Compliance -- Social Inclusion is Required for Health, & in a Diverse Society It Requires Some Will Power to Make That Happen

7/14/2017

Diversity: Our Greatest Strength Can Be Our Greatest Weakness.

This is not surprising or unusual -- whether something is a strength or a weakness largely depends on:

the environment,
the context
the skill of the individuals involved to leverage a quality as a strength as opposed to a weakness

This can be HUGELY problematic in a society that is as diverse as the US is.

   When we talk about Will Power, our supply of it is limited -- according to the New York Times Bestseller, "Rediscovering the Greatest Human Strength: WILLPOWER."

   I would submit that it takes some "will power," some energy to deal with people in general [of course, this is coming from an introvert]-- and the more different from us in appearance, outlook, etc. they may be -- the more "will power" or energy it may take depending on the context.

We don't really budget the time necessary to really understand the diverse needs of individuals in our society, and it causes a lot of problems.

We MANDATE it such as in the Americans with Disabilities Act and various other Civil Rights Laws -- and then at least in some circumstances we have problems with fairly widespread non-compliance.

We've got to make complying with our Civil Rights Laws easy to do and at the same time we have to slow down and talk to one another.

   Our fast pace is not good for our physical or mental health, according to the research by "Blue Zones" author Dan Buettner. Further, according to Buettner, SOCIAL INCLUSION is good for our physical and mental health.

   It may very well take some "will power" or "energy" for the State to engage the marginalized people with mental illness who are incarcerated or homeless, but we think it is so important to both those people and the State officials to do just that..

It could be a healing experience for both.

Medicaid & Olmstead: The Good, The Bad, & The Ugly

7/13/2017

The issue of Medicaid & State Olmstead Compliance is not a new one.
Often it has come up in the context of State obligations to fund housing or services for people with disabilities when that is not covered by Medicaid.
The US Dept. of Justice Interpretative Guidance on the Americans with Disabilities Act and the US Supreme Court's 1999 Olmstead decision make clear that a State's obligations under Olmstead are NOT limited by what is covered by the Medicaid Program.
In general, housing has never been covered by Medicaid and States are legally obligated to provide housing to people with disabilities to prevent institutionalization and the great risk of institutionalization inherent in homeless.
  With respect to the current Healthcare debate at the Federal Level, this country has been trying to deal with healthcare for decades and it is a controversial issue -- there is nothing in the Americans with Disabilities Act or Olmstead decision that says a radical change in Medicaid is grounds for failing to comply with Title II of the ADA or the Olmstead decision.
   If a radical change in Medicaid were to happen after specific measurable goals were set in an Olmstead Plan, that can be taken into account with respect to "reasonableness" and various other factors going to the issue of reasonableness.
   The Olmstead Plan really comes in as a recognition by the US Supreme Court and subsequent courts that States can't provide those Housing units and Services overnight.
     In return for not requiring States to come into immediate compliance with Housing and Services, there are some requirements --which Colorado BTW isn't complying with -- an Olmstead Plan which is:

Comprehensive
Effectively Working
With Specific Measurable Goals
That will bring Housing & Services to Scale to Meet the Needs of People with Disabilities to Prevent Unnecessary Institutionalization and the Great Risk of Institutionalization Inherent in Homelessness

Additionally, people with disabilities need to be "included" [hence, inclusion -- or "Nothing About Us, Without Us"] in the decision-making process for the "Olmstead Plan."

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.14 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.1

More DOJ Guidance

The 2010 DOJ/Georgia Olmstead Settlement Agreement -- It Was Supposed To Be A Template for the Nation & It Did Include Criminal Justice -- What Did It Require?

7/12/2017

Selected Provisions of the Georgia/DOJ Settlement Agreement

The target population for the community services described in this Section (III.B) shall be approximately 9,000 individuals by July 1, 2015, with SPMI [Serious Persistent Mental Illness] who are currently being served in the State Hospitals, who are frequently readmitted to the State Hospitals, who are frequently seen in Emergency Rooms, who are chronically homeless, and/or who are being released from jails or prisons.

ACT services shall be available 24 hours per day, 7 days per week. The number of individuals served by an ACT team shall be no more than 10 individuals per ACT team member. ACT teams shall be comprised of 7 to 10 team members, with at least one member being a peer specialist.

Intensive Case Management (“ICM”) (A) ICM teams provide coordination of treatment and support services for individuals in the target population. Oversight of paraprofessionals delivering ICM is provided by a licensed mental health professional. ICM teams assist individuals with SPMI in accessing community resources. ICM teams will have a staff to client ration of 1 to 20 in rural areas and 1 to 30 in urban areas.

By July 1, 2015, the State will have capacity to provide Supported Housing to any of the 9,000 persons in the target population who need such support. The Supported Housing required by this provision may be in the form of assistance from the Georgia Department of Community Affairs, the federal Department of Housing and Urban Development, and from any other governmental or private source.

Supported Employment will be operated according to an evidence-based supported employment model, and it will be assessed by an established fidelity scale such as the scale included in the Substance Abuse and Mental Health Administration (“SAMHSA”) supported employment tool kit.

Orchid's Take

Colorado's doing a lot of these things -- we just have a long way to go to bring them to scale.
That's really the need for an Olmstead Plan, especially in Criminal Justice these little groups tend to be pretty heavily dominated by institutional and professional interests.
Those interests have every right to be heard -- but so do people who are going to be impacted by these decisions, especially if they are conveniently in State custody.
Also, the concerns go beyond mental illness and criminal justice to traumatic brain injury and developmental disability as well.
The 2010 DOJ/Georgia Settlement occurred prior to the 2015 Court Ordered Minnesota Olmstead Plan finding a previous Minnesota Olmstead Plan too vague and lacking specific measurable goals. We would note that the Minnesota Dept. of Corrections was part of the Minnesota Olmstead Sub-Cabinet. Our concern is that the Colorado Department of Corrections is NOT included in the Executive Departments the State has listed as included in this Olmstead "Task Force".
We need an Olmstead Plan for everyone with disabilities and we are certainly forcused on one for people with disabilities:

* Leaving Prisons & Jails
* Who Are Chronically Homeless
   *Leaving Emergency Rooms
* Who Desire To Leave Nursing Homes
   *State Hospitals

Bottom Line:  It Is going to require Thousands of Units of Housing & Services in the Community for Colorado to comply with the Americans with Disabilities Act (ADA) & the Olmstead decision:

Supportive Housing:

Peer Services
Assertive Community Treatment
Supported Employment
Etc.

As for Medicaid Uncertainty & Planning:

We need to do the best we can; if something has to be modified based on a material & substantial change in condition -- OK
BUT COLORADO NEEDS TO STOP VIOLATING THE AMERICANS WITH DISABILITIES ACT AND OLMSTEAD DECISION
It is great that we have the Equitas Foundation BUT the State needs to be willing to deal with the people & comply with the LAW.

If We Can Do A Statewide Plan to Improve Behavioral Health Outcomes for People In the Criminal Justice System -- We Can Do An Olmstead Plan

7/11/2017

We Would Like to See A Statewide Behavioral Health/Criminal Justice Plan with Significant Inclusion of People with Lived Experience with Mental Illness/Substance Issues & the Justice System and Included in a Statewide Olmstead Plan

    In a July 5, 2017, letter from Governor Hickenlooper to "Task Force Members" shared by the Equitas Foundation, Gov. Hickenlooper asked the members to make recommendations for a statewide strategic plan to improve behavioral health outcomes for individuals involved in our criminal justice system.

As some may recall one of our big objections to Colorado's Community Living Plan & why we maintained it wasn't "comprehensive" was that it did not include Criminal Justice.

       The State isn't tackling mental illness and criminal justice through the lens of Olmstead but it's tackling it in its "own way." There has been a lot of resistance to considering Criminal Justice through an Olmstead Lens which has been very frustrating to us because we don't necessarily have a problem with the other Lens.

   Our point is not so much that the other Lens are de-legitimate as the Olmstead Lens is legitimate and in fact the Law.

     Again interestingly, the State is wanting to "set reasonable and measurable performance and outcome metrics."   Well, of course, we've been screaming for that in an Olmstead Plan--specific & measurable goals. as required by law

Maybe we really can get that Olmstead Plan Colorado desperately needs with "reasonable and measurable performance and outcome metrics."

One thing we would note, "metrics" is not a common word and most people don't know what it means. Most people know what "specific measurable goals" are and that is the language of Olmstead caselaw so we prefer it.

Ideas for Inclusion

Seek volunteer stakeholders from people w/ MH or Substance Issues who are currently in community corrections;
Consider "skyping in" or telephone conferencing in people who are currently incarcerated w/ MH or Substance issues to participate as regular stakeholders.

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Val's Blog

State Don't Let Embarrassment Prevent You from Doing What Needs to Be Done on CMHIP: An Emergency Request for Funds

Pueblo Chieftain

CMHIP Struggling for Key Staff

(Still More Than 80 Vacancies)
http://www.chieftain.com/news/pueblo/cmhip-struggling-for-key-staff/article_cd7e0d50-ac88-5c65-b44c-7e15cb82fe03.html

Aggression As A Protection Against Depression In Bipolar Disorder & Sleep Apnea Does Affect One's Risk for Bipolar

Childhood Trauma Affects Health Across A Lifetime

Our Social Safety Nets are Ripping Under the Weight & Cost of Social Exclusion:

PBS NewsHour: Job Opportunity Lagging for People w/ Disabilities

TedxTalk: Addiction & Connection

Vlog Brothers: Mass Incarceration in the US

Washington Post: Stress of Poverty & Racism Raises Risk of Alzheimers in African Americans

Hybrid Assertive Community Treatment Could Be More Desired, Be More Effective, & Save Money

An Olmstead Plan is Really A Court Compromise Trying to Balance the Interests of States & People with Disabilities

Diversity, Will Power, Blue Zones & Olmstead Compliance -- Social Inclusion is Required for Health, & in a Diverse Society It Requires Some Will Power to Make That Happen

Medicaid & Olmstead: The Good, The Bad, & The Ugly

Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C.

See Also:

Housing -- A Conundrum for the States -- A Nightmare for People with Mental Illness

The 2010 DOJ/Georgia Olmstead Settlement Agreement -- It Was Supposed To Be A Template for the Nation & It Did Include Criminal Justice -- What Did It Require?

If We Can Do A Statewide Plan to Improve Behavioral Health Outcomes for People In the Criminal Justice System -- We Can Do An Olmstead Plan

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Val's Blog

​Pueblo ChieftainCMHIP Struggling for Key Staff(Still More Than 80 Vacancies)http://www.chieftain.com/news/pueblo/cmhip-struggling-for-key-staff/article_cd7e0d50-ac88-5c65-b44c-7e15cb82fe03.html

PBS NewsHour: Job Opportunity Lagging for People w/ Disabilities

TedxTalk: Addiction & Connection

​

Vlog Brothers: Mass Incarceration in the US

Washington Post: Stress of Poverty & Racism Raises Risk of Alzheimers in African Americans

​ ​Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. ​

​See Also: Housing -- A Conundrum for the States -- A Nightmare for People with Mental Illness

Author

Archives

Categories

Pueblo Chieftain

CMHIP Struggling for Key Staff

(Still More Than 80 Vacancies)
http://www.chieftain.com/news/pueblo/cmhip-struggling-for-key-staff/article_cd7e0d50-ac88-5c65-b44c-7e15cb82fe03.html

Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C.

See Also:

Housing -- A Conundrum for the States -- A Nightmare for People with Mental Illness