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WHAT I KNOW FOR SURE & WHY ORCHID IS MORE A QUEST FOR KNOWLEDGE THAN A PURVEYOR OF A KNOWN CANON

7/14/2019

So if anyone knows the importance of environment I do -- I'm an ultra sensitive person [with all that implies -- the good & the bad] and I had challenges not unlike the challenges I have in late mid-life BUT I was able to console myself with a lot of institutional success.
Of course, then the goal was getting -- the "A." It is not anymore.
Further, "questioning authority" was something that my "gifted teachers" loved.
What I found as an adult was that the "legal problems" of my clients were "too complex" for me to solve with a heavy caseload.
Even now when I only have a few active cases -- it overwhelms my ability to really solve the problems that I'm observing and partially understand.
What I know for sure with regard to Mental Health and more broadly Cognitive Disability and our Critical Systems:

our Legal System
- it is unable to effectively enforce established Federal Disability Civil Rights Laws on a consistent basis across the States.
- Basic concepts in the Criminal Law such as Mens Rea/Criminal Intent are not sufficiently tied to the BIOLOGICAL REALITIES we are aware of much less the broader biological scheme those realities point to.
- The Legal System's expense and overly formalized mechanisms of communication make it -- not only one of the most inefficient systems in our society -- but also one of the most ineffective as well when viewed from the perspective of the people its trying to serve.

our Clinical Mental Health System
- It has been charged with doing a lot of heavy-lifting in our society -- and it hasn't really had the knowledge to do it.
- Our society has taken a Scarlett O'Hara approach to this: "I'll think about that tomorrow."
- Unfortunately, the unintended consequences are here NOW.

our Political System
- the Democratic Presidential Primary field really represents -- the Fly in the Ointment with Representative Democracy -- there is not just one person who is qualified to run for president -- or for that matter any elected office -- whether Democrat, Republican, Independent, whatever.
- We've got to have other means of inclusion and representation.
- Stakeholder groups are a BIG WAY to do that.
- I'm not going to pitch a fit because I wasn't included in the Governor's Behavioral Health Task Force -- because my claim for membership is actually pretty weak.
- I am going to pitch a fit that even Polis --who is trying to heal the world-- didn't do a very good job of including the people who are actually going to be subjected to the the bright ideas of this Task Force. Somehow those views need to be included and in a BIG WAY. It is NOT EASY and Stakeholder Groups are not the only way to do it.

the relationship between Research and Clinical Practice
- It is really important to understand that current research is not denying mental illness -- what it is saying is that mental illnesses are biological realities and current diagnostic criteria seem to bear little relationship to those biological realities.
- Do you think that creates a problem in Clinical Practice [& the Law] -- you bet it does.

So these represent some pretty FUNDAMENTAL FLAWS in our SYSTEMS that are hardly innocuous. Further, those problems do not exist in isolation -- they are intimately related.

Photo Credit: King Abdullah University of Science & Technology, Saudi Arabia

THE NEED FOR SYSTEMIC CHANGE IN CO MEDICAID LONG TERM CARE & THE CREATION OF NEW ENTITIES

7/10/2019

   Colorado has 1000s of people eligible for Medicaid who are or have been incarcerated or homeless, have mental illness & have a need for supervision sufficient to qualify for long term care under Colorado Medicaid.

The Mental Health Centers have never been up to this task -- and they have never really wanted it.  The responsibility necessary is traditionally something they didn't feel they could AFFORD to perform.

Further, the State has never really been up to this as evidenced by the change in targeting criteria for the Community Mental Health Supports Waiver in 2015 requiring a need for assistance with activities of daily living. SAY WHAT?!!

Well, this is a HUGE MESS.

Further, many intensive services under Colorado Medicaid are classified as "Alternative Services" meaning there is no requirement on the State to provide these services as "reasonably medically necessary." That includes residential services, assertive community treatment and intensive case management.

So Colorado really needs to figure out what a Community Mental Health Supports Waiver should look like for people primarily needing SUPERVISION. Further, if the STATE needs to seek WAIVERS from CMS [the Centers for Medicare & Medicaid Services] -- the STATE needs to do that.

Crucially, the duties for CO Medicaid Mental Health Long Term Care need to be removed from the Mental Health Centers and new entities need to be formed.

There is a lot of important work to be done in prevention and care not rising to the level of Medicaid Long Term Care and the Mental Health Centers are well positioned to do that work.

   We need new entities that can FOCUS on LONG TERM CARE as a result of a need for SUPERVISION. This is the CRYING & MOST URGENT NEED of CO Medicaid's Mental Health System.

  It goes directly to the SAFETY of the Community & the SAFETY of Individuals with Mental Illness with the most serious needs. The SCALE of those concerns are what community members and policymakers must face honestly and courageously.

Colorado's Mental Health Continuum of Care Hell

2015 CMHS Waiver Targeting Criteria

DECLARING INDEPENDENCE FROM THE POOR CARE OF MEDICAID MENTAL HEALTH CENTERS

7/5/2019

One of the most difficult lessons we learn in this life is just because we're good @ one thing or maybe many things -- that doesn't mean we're good @ everything. I have plenty of PAINFUL experience with this. This isn't just true of individuals --- it is true of organizations, too.

It is amazing to watch talented Mental Health CEOs like Sharon Raggio and Carl Clark [I'm sorry Carl -- you're still over paid].

BUT they are not good @ everything -- none of us are. A lot has been made of the fact that the Crisis Contract was taken from MindSprings -- Sharon Raggio's baby.

Sharon is probably the most entreprenurial of all the Mental Health Center CEOs and did an absolutely FANTASTIC job of raising funds and executing to bring more psych beds to the Western Slope.

On the other hand, the Orchid Facebook page gets a lot of complaints about MindSprings -- and some people from that area were HAPPY to see the crisis contract taken from them.

Carl Clark is doing all kinds of things with technology -- and that's interesting and maybe somebody should be doing it.  However, the HUGE CRYING NEED in Medicaid Mental Health is serving people with INTENSIVE MENTAL HEALTH NEEDS.

The Mental Health Centers are pretty much focused on FINANCIAL SURVIVAL because over many years -- they've had to be.

For a long time in the Aging Community there has been discussion about what the society is going to do when all those Baby Boomers get Alzheimer's.

The Mental Health Crisis in Western Countries is here NOW. Criminal Justice knows it can't solve this -- BUT it can't create the services either.

The Legal System -- our intended refuge for minorities -- has been pressed into service quite a lot in Colorado to address our NIGHTMARE of a MENTAL HEALTH SYSTEM. Even with that, the expense and Byzantine nature of the legal system -- mean justice is out of reach for most people with mental illness and their families.

  In Modern Society -- DATA IS A CIVIL RIGHTS ISSUE. Fair-Minded Data Collection and Innovative & Creative Problem Solving are what is going to get us out of this crisis.

Medicaid Mental Health Centers may not be the best place for people with intensive community mental health needs. Historically, they haven't been.

   That model never really got developed to SCALE after de-institutionalization -- and it is A LOT MORE THAN CRISIS CENTERS.

  Further, our need for Crisis Centers is directly related to our FAILURE to Develop a COMPREHENSIVE MENTAL HEALTH CONTINUUM OF CARE, including HOUSING.

We've been living in Denial for Decades

7/5/2019

Today we have thousands of Coloradans with serious mental illness--many who are already on Medicaid & on SSI -- who cannot get the Housing & Services they need.

Further, Colorado is not somehow unique in this problem.

There are a lot of ways to solve this.

One way would be for Medicaid which is a jointly federally & state funded program to:

provide housing for people with disabilities who need long term care as a mandatory service.
and provide specific criteria for Medicaid Network Adequacy with regard to serious mental illness, require data to ensure compliance.
In the meantime, with respect to Housing -- Colorado could seek a "WAIVER" to cover Housing for people with disabilities needing long term care.

MORE INTEGRATION:MEDICAID'S INNOVATION CENTER, NIMH & OUR DESPERATE NEED FOR CLINICIAN-SCIENTISTS

7/4/2019

Medicaid is the country's largest provider of mental health care and mental health is a HUGE COST DRIVER in Federal Medicaid Budgets and State Medicaid Budgets around the country.
The reality is MEDICAID should be paying for SUPPORTIVE HOUSING [ALL OF IT -- INCLUDING THE HOUSING]for individuals with disabilities, and the people who often need the most expensive SUPPORT are people with cognitive disabilities.
    Why are services for people with cognitive disabilities so expensive? Well, there are a lot of factors BUT not having good treatments is right up there.
It is one thing to pay a load of dough for a MANSION and it is quite another to pay beaucoup bucks for a SHACK. Unfortunately, that's what the FEDS & STATES have been doing -- paying millions, billions of dollars for inadequate mental health care -- essentially, a shack.
  Is this some kind of intentional ripoff? YES & NO. Medicaid Mental Health Centers have tended to go where the money is -- and that is NOT treating people with very complex, difficult mental health problems -- unfortunately, Medicaid is the primary provider of intensive community mental health services.
BUT it is NOT just the mercenary nature of the Medicaid Mental Health Centers-- which they might accurately describe as a means to ECONOMIC SURVIVAL---{Of course, they have all those overpaid CEOs -- MHCD CEO Carl Clark -- we're talkin' about you -- and underpaid staff members.]
    BUT even with all that --- the treatments just aren't as good as they need to be -- and that is NOT by design.
It is ultimately the treatments that must be improved, and by happy coincidence there is an enormous amount of research going on around the world to do just that.
We need Medicaid to partner with NIMH to get some of the current research from around the world to people who need it NOW.

The National Institute of Mental Health (NIMH) is the lead federal agency for research on mental disorders.

"Transforming the understanding and treatment of mental illnesses."

IAP selected, in consultation with states and stakeholders, four program areas in which to offer technical support:

In addition, IAP also works with states through its functional areas, or levers, for

Medicaid delivery system reform:
data analytics,
performance improvement,
quality measurement, and
value-based payment and financial simulations.

WE NEED TO CATCH UP WITH THE SCIENCE OR @ THE VERY LEAST ADMIT OUR IGNORANCE

7/1/2019

Below:

Parkinson's starts in the gut
A substance in many toothpastes & cosmetics can increase the risk of thyroid problems in women
Antibiotics appear to be related to an increase in auto-immune disease & mental illness
Some anti-psychotics appear to increase the risk of dementia.
Many people with mental illness already have an increased risk of dementia.

Illness affects ALL of US and we all have an interest in improved treatments regardless of our political party. Many if not most "Mental Illnesses" are appearing to be much more PHYSICAL ILLNESSES than we have previously appreciated -- involving inflammation, the immune system and the microbiome among other things. Further, TRAUMA can affect those physical processes as well as numerous other factors.

Mental Health patients and Clincians are in critical need of much better SYSTEMS of TRANSLATING CURRENT EVIDENCED-BASED RESEARCH into CLINICAL PRACTICE.

THE POINT:
Mental Illnesses and cognitive disabilities are more complicated than we treat them-- and certainly than we treat the casual & damning toss off of labels of:

"anti-social" behavior
or in the criminal justice system: the person is just bad or evil.

Severe Psychiatric Disorders in Mid-Life and Risk of Dementia in Late-Life (Age 65-84 Years): A Population Based Case-Control Study

Conclusion: Severe depression, anxiety disorder, bipolar disorder, schizophrenia and alcoholic dependency disorder treated by specialists in psychiatric facilities in mid-life are important risk factors for late-life dementia. These psychiatric conditions need to be considered in future studies of the risk and prevention of late-life dementia.

Current Alzheimer's Research (2014)

University of Nottingham

"The increased risk [of dementia] was linked to anticholinergic antidepressants, antipsychotics, bladder control, epilepsy and Parkinson's disease medications."

Neuroscience News -- June 24, 2019

Summary: A new study adds to the growing body of evidence that Parkinson’s disease may start in the gut. Researchers found gut-to-brain propagation of alpha-synuclein spread via the vagus nerve. The study provides a more accurate model of Parkinson’s progression and could lead to new treatments to halt or prevent this neurodegenerative disease.

Click Here

Manic Psychiatric Patients Have Higher Incidence of Infection, Antibiotic Use

Physical Health Issues, the Immune System & Mental Health

Forward>>

Val's Blog

WHAT I KNOW FOR SURE & WHY ORCHID IS MORE A QUEST FOR KNOWLEDGE THAN A PURVEYOR OF A KNOWN CANON

THE NEED FOR SYSTEMIC CHANGE IN CO MEDICAID LONG TERM CARE & THE CREATION OF NEW ENTITIES

DECLARING INDEPENDENCE FROM THE POOR CARE OF MEDICAID MENTAL HEALTH CENTERS

We've been living in Denial for Decades

MORE INTEGRATION:MEDICAID'S INNOVATION CENTER, NIMH & OUR DESPERATE NEED FOR CLINICIAN-SCIENTISTS

WE NEED TO CATCH UP WITH THE SCIENCE OR @ THE VERY LEAST ADMIT OUR IGNORANCE

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