Blog Archives

Arapahoe High School Had Its 4th Suicide This Year--- Of Course, Everyone Is Heart-Broken and Grieving -- How Do We Stop This?

8/31/2017

Val's Take

Public High Schools have traditionally been an intersection of the nation's social problems.
   I love social media and primarily what I love about it is the ability to access and distribute large amounts of information -- BUT I'm a big time introvert, but not our daughter who is an extrovert.
   For her, it's all about who said what about whom and who is bullying whom -- and there's a lot of that going on.
   She was first cyber-bullied when she was in middle school, and that's not exactly unique.
I think it is certainly identifying problem areas and what we don't want -- but it also has to be identifying what we do want --- if we don't want kids glued to their cell phones -- what's the replacement?
   I "think" sometimes kids are expecting parents and teachers to "pick up on the signs" that something is wrong -- so kids don't actually have to tell us or somebody else that something is wrong.
   That's a risky gamble -- as parents and teachers we do our best to pick up on those "signs" and at the same time try to create an environment where our kids feel comfortable talking to us or somebody else about their concerns.
We've got to work with our kids to develop better strategies to prevent suicide.

Colorado Crisis Services

1-844-493-TALK(8255)
Espanól | Text TALK to 38255

USA Today

Youth suicide rates are rising. School and the Internet may be to blame.

www.usatoday.com/story/news/nation-now/2017/05/30/youth-suicide-rates-rising-school-and-internet-may-blame/356539001/

Psych Meds, Being Humble, & Looking To "Open the Dialogue" As Wide As We Can

8/29/2017

I used to think with respect to clients: "Why not just take the medication. You've got the "Expert," the "Psychiatrist" saying that's the thing to do -- That's sounds right, isn't it?!"
   We have to rely on arguments from authority all the time -- we don't have the the time and energy to research every area of knowledge or expertise, so if the heating guy tells us we need a new heater -- most of us say "oh okay, we must need a new heater" or we might get a second opinion.
   But if we come across information that the plumbers in our area are making some systemic mistakes -- well, that's kind of a different, larger issue.
   AND that's the kind of issue that people with "mental illness" in the United States and largely the West are faced with.
I wish it were as simple as Medications Good or Medications Bad --- it is a lot more complicated than that.
   I've noticed a similarity between trying to talk to people about some of the downsides of Marijuana and trying to talk to some mental health professionals about some of the downsides of Psych Meds --- there is NOT just a whole lot of openness to hearing it or a desire to have a dialogue.
   And yet there are a whole lot of people in the mental health community who want that openness and dialogue about Psych Meds and a lot of other things in the mental health system.
   We need people in the mental health profession not necessarily that we always agree with but that are:

Open to Dialogue
Open to Questions, Open To Hard Questions
Open to Shared Decision-Making, and

[Now if there is no Court Order the person can do whatever they want to about medication within the bounds of the law -- and ideally there is medical counsel maybe not just a psychiatrist, but in certain circumstances genetic testing]

Who Are Humble

Three of my big scientific heroes in this area are:

Dr. Thomas Insel, former head of the US National Institute of Mental Health,
Neuro-scientist Dr. David Anderson @ Caltech, and
Dr. Jaakko Seikkula, Director of the Institute for Dialogic Practice and a professor of psychotherapy at the University of Jyvaskyla, Finland. From 1981 to 1998, he served as the chief psychologist at Keropudas Hospital in Tornio, Finland. It was during this time that he became one of the main developers of Open Dialogue.

I don't know if David Anderson is humble, but he certainly asks tough questions. Insel and Seikkula both have specifically spoken about the importance of being "humble" in the context of mental health.

   In Finland, they also talk about this in terms of "democracy."   I suspect that makes a lot of Western doctors feel very nervous.

   But we lack "Open Dialogue" on a lot of fronts in the US and Colorado in the Mental Health System & it is desperately needed.

   Maybe, just sayin' -- the CU National Behavioral Health Innovation Center could help facilitate some of this. I've got a list and I'm checkin' it twice.

Kendrick Lamar, "Be Humble"

Humbleness
&
Psychiatrists

I think humbleness breeds cooperation in mental health. Most patients already know their mental professionals aren't perfect -- they are just waiting for the mental professional to recognize it -- so the patient can trust the professional.

Mental Health & the Rest of the Society have a lot to learn from Disability Education

8/28/2017

I know that Disability Education is not perfect, but it has been forced to deal with "accomodations" for students in way that Mental Health hasn't and the society hasn't or at least on the same personal level and scale, despite the Americans with Disabilities Act to the contrary..

In Education, teachers are probably more familiar with the IDEA (Individuals with Disabilities Education Act) and Section 504 of the Rehabilitation Act.

So there is a real process that teachers, administrators, parents, and students go through identifying problem areas and how to address those.

It is probably pretty deceptively systematized but compared to Mental Health, at least we've:

got a form for issue spotting;
the school is taking some responsibility for doing some things -- making some accommodations
We're focusing on what the child can do -- not what the child can't do (theoretically) & there's room for improvement.

Okay now we're in Mental Health (but this isn't just a problem in Mental Health).

For the most part, there aren't systems in place to be strengths-based -- although I think people are in favor it by and large it's not particularly controversial.
BUT what does that mean if you don't have the systems in place -- well one can be a non-violent patient down at the Colorado Mental Health Institute @ Pueblo for over 5 years and nobody realizes the patient has a degree in computer science from a major university. -- That's what it can mean.
I think it is not uncommon for mental health professionals to have an idea of their patients' strengths which is often pretty fuzzy and not always accurate..
Of course in education, teachers are doing all kinds of testing -- I'm not really proposing that -- but I am proposing in-depth discussions with patients about strengths and how to capitalize on them -- or referrals to someone who can have those discussions.
With respect to weaknesses, really working with the patient to find those creative accommodations and work-arounds or referrals to someone who can have those discussions.

From my perspective, I think what is really not helpful is to focus on cultivating skills the person inherently lacks.

Think more "work-around" than transforming an elephant into a cat. Now, there's a limit to that philosophy -- and it won't always work -- BUT it will work a lot of the time if we follow the law and make "reasonable accommodations" for people with disabilities & I would say for everyone AND take a strength-based approach.

Job Accommodation Network
askjan.org

Neuro-Diversity, Mental Health -- & the Excruciating Need for Education & A Strengths-Based Approach

8/27/2017

   Growing up, nobody thought I had a disability. In elementary school, middle school, and high school -- I was identified as gifted.
   AND in college, I graduated Top 10 Seniors at a University of about 23,000 students.
But during that time, I was really encouraged to question and I followed my passions and that pretty much masked my ADHD and twice exceptionality.
I am well aware that announcing one's own giftedness is not generally the thing to do, but I think some of us in the mental health community are pretty desperate.
In the mental health system, you see lot of "patients' going from one treatment provider to another in an often futile attempt to find somebody who really "gets" them.
   Often "gets" them, understands them means sees their strengths.
    I really haven't provider shopped because I felt like I recognized pretty early on that the problem wasn't with the provider it was with the system.    From my perspective, the mental health system is not a person centered, strength-based system. And some of it is just ignorance, a lot of mental health providers have never even heard of 'twice exceptionality."
So there is education and there is backing up that education with processes and procedures.
With respect to a strength-based approach, Dr. Gail Saltz in her book the "Power of Different" talks about that in terms of a 80/20 split -- 80% of the time spent on strength development and 20% of the time spent on work-a-rounds for weaknesses.
   In some senses what makes it all the worse is that by and large, people in the mental health system are generally trying to help -- it's just often they aren't helping. That's hard for them to hear, it's hard for us to say.

I don't think the point is that everybody is a "genius" -- but most people do have "strengths" and "gifts" that need to be the focus of mental health treatment.

Helping Gifted Students with Learning Disability
http://www.psy-ed.com/wpblog/gifted-learning-disabled-child/

Some Thoughts Down On The Animal Farm: Criminal Justice Must Be Included In Our Draft Olmstead Bill

8/26/2017

One of the things I really liked about J.K. Rowling's Harry Potter series was that Rowling so brilliantly contrasted the sometimes monumental challenges people were facing in their lives with the often oblivious demands of the society.

"That's irrelevant." "No excuse."

Well, I don't think the point of recognizing Reality is so much an "excuse" as addressing and ameliorating that "Reality."

So what am I talking about:

Class
Poverty
Homelessness
Race, Racism, Discrimination
Ethinicity, Discrimination
Discrimination against People with Mental Illness, Traumatic Brain Injury, and other invisible disabilities.

  With respect to disabilities, the State has a legal obligation under the Americans with Disabilities Act and the 1999 US Supreme Court Olmstead decision to provide Housing and Services to meet the need or have a comprehensive, effectively working plan with measurable goals to bring housing and services to scale.

   The institutions where most people with mental health disabilities are in Colorado and around the country are jails and prisons. THIS IS AN OUTRAGE.

   There has been a lot of change -- BUT NOT NEAR ENOUGH.

   That is why we want to specifically list Criminal Justice and jails and prisons in our draft Olmstead bill.

We don't think J.K. Rowling is talking about "inferiors" and people not one's equal in any absolute sense but rather in the context of often damaging self-serving human hierarchies and social classes. In the US we sometimes like to think we're beyond all that -- but you really just have to visit the Criminal Justice System to realize that is not the case. Difference whether race, ethnicity, real or perceived disability, sexual orientation, and many others we use to categorize and rank each other and the results are often not pretty.

George Orwell's "Animal Farm"

US Supreme Court: "Equal Justice Under Law"

Reality, Diversity & the Need to Change Systems to Fit

8/23/2017

The Dominant Group(s) tends to think -- they're the best, they're #1 -- what could be more obvious.
   (Or maybe that's just because I come from Oklahoma and an OU family -- Sooners #1)
Anyway, not everyone shares their opinion, and often that usually includes people who for one reason or another are not in the dominant group(s).
Often we value the strengths we ourselves possess the most, and minimize the weaknesses that we possess.
   That is probably not a totally bad thing, especially if it keeps us from becoming depressed or despondent.
But we often tend to minimize the strengths of others especially if we can't relate to them easily, and exacerbate their weaknesses sometimes through bad social environments (social determinants of health) and systems they couldn't possibly fit into.
   Well, how are we going to find out what works for other people not in the middle of the distribution map and the scale of their needs -- well we could talk to professionals and attorneys -- and policymakers and officials probably should --- BUT ultimately we've got to talk to the people themselves and collect the necessary data.
   The challenge of democracy and life is recognizing reality and diversity -- we all want to be # 1 and ultimately we are the one -- the person, individual that needs a society and system we can ALL fit into.
   I don't mean # 1 in terms of a "participation certificate" -- I mean #1 in terms of being able to fully maximize our "strengths" and compensate for our "weaknesses" -- and of course so much of that is a matter of perspective.
   That demands inclusion and is part of what Olmstead Planning is all about.

I want to thank Scott Durairaj PGC, MBA with the NHS (National Health Service) England for posting this on Linkedin.

Where There Is A Will There's A Way -- Our Draft Olmstead Planning Bill

8/23/2017

I don't know if our draft Olmstead Planning Bill will be successful or not this year.
I do know that Specific Measurable Goals are now legally required for viable Olmstead Plans per various cases, specifically the Minnesota Court-Ordered Olmstead Plan. Colorado doesn't have that.
We're going to be getting a draft bill to the Governor's Office probably within a week.
We'd like to work with the Governor's Office to address their concerns and objections in a substantive way so that we could move forward together on this if possible.

Moving Forward With Open Dialogue

8/22/2017

Psychiatry has historically had a lot of problems, primarily because it doesn't have enough knowledge to fully address the problems it is tasked with addressing.
   But what are you going to do -- there are the problems and you have to go with what you've got.
   When things aren't working -- who is going to know that? The person with the "mental illness'? Who has the least credibility in this process or system -- the person with the "mental illness."
   So that makes reform exceedingly difficult and it is one of many reasons mental health is lagging more than 50 years behind physical health in innovation according to the Guardian.
https://www.theguardian.com/social-care-network/2016/jun/09/what-service-users-change-mental-health-policy
   I'm an avid follower of:

Neuroscience,
the National Institute of Mental Health's Research Domain Criteria Program
Physical Causes of Mental Distress, and
Open Dialogue

I think in the West especially --- Open Dialogue really implicates psychiatric medication. There are a lot of very difficult questions for clinicians, patients, and Policy Makers when it comes to psychiatric medication:

In general, Americans don't have a problem taking drugs -- legal or illegal. For some people with "mental illness," the medications have objectionable side effects and/or the person just doesn't like them.
Genetic testing and the assistance of a neuro-pharmacologist might help in some of these cases. In fact, the science is probably evolving to ethically require it.
With Open Dialogue and the intensive community support which is a part of the model, the need for medication may be eliminated or significantly reduced.
"Open Dialogue" has already been piloted in Massachusetts and Georgia.
People within the Mental Health System have an interest in an Open Dialogue approach in Colorado. That may need to be specifically authorized for inclusive evaluation, planning, and implementation.
None of our current efforts would have been possible without the work and advocacy of Mental Health Advocate Amy Smith.

Loneliness can literally kill you, and it's a bigger health risk than obesity

We’re more socially isolated than ever — and it can harm our health.

http://www.metro.us/body-and-mind/health/health-risks-loneliness

Jerry Lewis Telethon Confessions & More

8/21/2017

Growing up I was captivated by the Labor Day Muscular Dystrophy Telethons.
   I would watch with tears streaming down my face and then go out and collect money for MDA throughout my neighborhood and take the money to the local mall where the local television station was holding its local version of the telethon.
   It was many, many years later that I was to learn Jerry Lewis and the Telethon were not well thought of in the Disability Community, and the pitch was really relying on pity.
   As the sign in Atlantis Independent Living Center says, "Piss On Pity."
   I think there were a lot of things going on with the Telethon. I think it was set up to find a "CURE" like finding a cure or vaccine for polio.
   AND when that didn't happen early on, and I think there were a lot of reasons for that, the Telethon never really became inclusive of people with disabilities or not enough.
   It really comes back to "NOTHING ABOUT US WITHOUT US."
   It takes a lot of time and energy to REALLY include people -- Lewis was extremely successful. Why should he include the disability community?
   But the Telethon was ultimately shut down & nobody took it over.
You know who else is really successful and has a problem with inclusion -- The Hickenlooper Administration.

Crying Need for "Open Dialogue" in Colorado

8/19/2017

First, a lot of people in the mental health communities in the US and Colorado were really drawn to "Open Dialogue" -- because it dramatically reduced medication use.
In the pilot in Massachusetts of Open Dialogue, it did reduce medication use --- it did not eliminate it.
When we think about somebody perhaps needing significant assistance we think:

Crisis Unit
Hospital

Of course, most people don't want that even though the assistance they may need and even want (with a lot of caveats) is pretty intensive.
   "Open Dialogue" is significant not only because it reduces medication use, but because of extremely intensive support services in the first year after psychosis.
   We tend to have the hospital -- which many people don't like -- and the community -- that doesn't have the services people want and need [others include Peer Run Services, Assertive Community Treatment -- if its done right, etc.]-- at the level of intensity that is needed.
   And so we just let things get so bad that we certify somebody, maybe we grumble about the certification statutes -- BUT THE REAL PROBLEM IS THE LACK OF ADEQUATE COMMUNITY SERVICES PEOPLE WANT -- and have been asking for, in the case of OPEN DIALOGUE -- for over a decade (THANK YOU AMY SMITH!)
One of the things that one of the psychologists from the Open Dialogue project in Finland talks about is "psychosis" as a form of "meaning making."
   I'd never really heard that before and that is an interesting take. I think one of things that the US and Colorado could really do to build on the Open Dialogue approach is to put it in the context of an Integrated Care Model that Colorado is already trying to lead on.
I think sometimes (NOT ALWAYS) people are trying to make sense of their physical health breaking down which is (sometimes unbeknowst to them their mental health as well) and that is having mental health consequences in multiple respects which can include psychosis.
"Open Dialogue" had been in our Draft Measurable Goals we sent to the State. This may not be something we want to specify in a draft Olmstead Bill -- and we need to get moving on it.
   We may be looking at fleshing out the "Services" Topic to require Specific Measurable Goals in the State's Analysis and Consideration of Peer Generated Service Category Requests -- such as Open Dialogue & Peer Run Services.
   We are not satisfied with respect to how the State has handled such requests.

‘OPEN DIALOGUE’
IN THE TREATMENT OF
MENTAL ILLNESS

The focus in this approach to the treatment of mental illness and maintaining mental health is on keeping patients in the community as long as possible.

To achieve this local community centres are scattered around the region. Teams visit patients at home. All staff participating in the treatment are highly qualified and have additional three-year training in family therapy.

There is enough staff to meet the demand for team meetings with the patients and their social network as frequently as needed to help patients to live at home in their normal surroundings. Hospital admissions are used only as on outreach from the community services when the crisis cannot be handled in the community.

In all meetings there are preferably at least two staff members familiar with the patient present. Any staff member can be given the ongoing responsibility for the new patient and of organising the team for the first crisis meeting with the patient and the social network as well as the follow up.

The continuity is seen as important. Because the treatment team always consists of several people it is not too difficult to have at least one familiar staff member in every meeting.

The first meeting, usually in crisis, has to take place as soon as possible within 24 hours of the initial contact. In most cases it takes place at the patient’s home. Depending on the needs, there may be several treatment meetings with the patient and social network people in a day.

The five year research to the patients in this program shows outcomes that have not been achieved by any other program in the western world, eg:

Number of relapse cases         17 %
Studying or working               76 %
Unemployed                           10 %
Disability allowance               14 %

It is claimed that the program is not more expensive than traditional mental health programs in Finland. Taking everything in consideration it may even result in savings.
This may be due to lesser need for hospital beds, less medication, fewer people on disability pension and more people returning to work force. The program is fully functional in Western Lapland where it was developed over the last two and half decades.

Open Dialogue approach has now been built into the state psychiatric system. Many western countries including other Scandinavian countries, Germany and the USA are also showing interest in the program.

In view of my personal experience and the glowing research findings of the program over 2- and 5-year periods of follow-up as well as the fact that the schizophrenia is disappearing from the Western Lapland I am convinced that this is the approach that should be adopt[ed] in NSW mental health system.

. . .
Satu Beverley 2.9.2011

www.arafmi.org/wp-content/uploads/2016/.../Introduction-to-OPEN-DIALOGUE.doc

[Mental Health Carers for New South Wales -- Australia]

Univ. of Mass. Dept. Of Psychiatry Open Dialogue

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Val's Blog

Arapahoe High School Had Its 4th Suicide This Year--- Of Course, Everyone Is Heart-Broken and Grieving -- How Do We Stop This?

USA Today

Youth suicide rates are rising. School and the Internet may be to blame.

www.usatoday.com/story/news/nation-now/2017/05/30/youth-suicide-rates-rising-school-and-internet-may-blame/356539001/

Psych Meds, Being Humble, & Looking To "Open the Dialogue" As Wide As We Can

Humbleness
&
Psychiatrists

I think humbleness breeds cooperation in mental health. Most patients already know their mental professionals aren't perfect -- they are just waiting for the mental professional to recognize it -- so the patient can trust the professional.

Mental Health & the Rest of the Society have a lot to learn from Disability Education

Job Accommodation Network
askjan.org

Neuro-Diversity, Mental Health -- & the Excruciating Need for Education & A Strengths-Based Approach

Helping Gifted Students with Learning Disability
http://www.psy-ed.com/wpblog/gifted-learning-disabled-child/

Some Thoughts Down On The Animal Farm: Criminal Justice Must Be Included In Our Draft Olmstead Bill

Reality, Diversity & the Need to Change Systems to Fit

Where There Is A Will There's A Way -- Our Draft Olmstead Planning Bill

Moving Forward With Open Dialogue

Loneliness can literally kill you, and it's a bigger health risk than obesity

We’re more socially isolated than ever — and it can harm our health.

http://www.metro.us/body-and-mind/health/health-risks-loneliness

Jerry Lewis Telethon Confessions & More

Crying Need for "Open Dialogue" in Colorado

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Val's Blog

USA Today Youth suicide rates are rising. School and the Internet may be to blame.​www.usatoday.com/story/news/nation-now/2017/05/30/youth-suicide-rates-rising-school-and-internet-may-blame/356539001/

Humbleness ​& Psychiatrists I think humbleness breeds cooperation in mental health. Most patients already know their mental professionals aren't perfect -- they are just waiting for the mental professional to recognize it -- so the patient can trust the professional.

Job Accommodation Networkaskjan.org

Helping Gifted Students with Learning Disabilityhttp://www.psy-ed.com/wpblog/gifted-learning-disabled-child/

Loneliness can literally kill you, and it's a bigger health risk than obesity We’re more socially isolated than ever — and it can harm our health.http://www.metro.us/body-and-mind/health/health-risks-loneliness

Author

Archives

Categories

USA Today

Youth suicide rates are rising. School and the Internet may be to blame.

www.usatoday.com/story/news/nation-now/2017/05/30/youth-suicide-rates-rising-school-and-internet-may-blame/356539001/

Humbleness
&
Psychiatrists

I think humbleness breeds cooperation in mental health. Most patients already know their mental professionals aren't perfect -- they are just waiting for the mental professional to recognize it -- so the patient can trust the professional.

Job Accommodation Network
askjan.org

Helping Gifted Students with Learning Disability
http://www.psy-ed.com/wpblog/gifted-learning-disabled-child/

Loneliness can literally kill you, and it's a bigger health risk than obesity

We’re more socially isolated than ever — and it can harm our health.

http://www.metro.us/body-and-mind/health/health-risks-loneliness