Blog Archives

Sufficiency of Knowledge, the Criminal Justice System, People with Disabilities and the Human Rights Issue of Our Time

9/27/2017

So what are we trying to say with regard to the sufficiency of the body of knowledge in mental health as it relates to the criminal justice system?

We're NOT saying ----there is NO knowledge in the mental health profession. In fact, there is a lot of knowledge.
What we are saying is that whether knowledge is sufficient depends on the task @ hand. One may be a whiz @ engineering and not be able to get a rocket out of the Milky Way Galaxy.
Because of the historical nature of "mens rea" or mental element in the criminal law, mental health professionals have been pressed into service by desperate defense attorneys to provide "expert" testimony as to whether their client was "insane" and prosecutors have engaged their own "experts."
No other area of medicine [mental health] is so implicated in punishment and no other is so struggling in lack of sufficient scientific grounding.
The Criminal Justice System really can't just reform itself, or not easily. It will likely take a combination of Legislation and Court decisions to reform the fairly routine human rights violations that are committed against people with disabilities, especially invisible, largely cognitive disabilities, that occur on really a daily, hourly basis.
Of course, what we really need to do is get people with disabilities -- mental illness, brain injury, developmental disability, etc. --- out of the criminal justice system and provide the housing and services, including intensive services if necessary, that they will need to remain outside of the Criminal Justice System and other institutions.
This truly is the Human Rights and Civil Rights Issue of Our Time.
We Hope You Will Support Our Draft CO Olmstead Planning Bill

Mary Robinson was an Irish Independent politican who served as the 7th, and first female, President of Ireland from December 1990 to September 1997, and the United Nations High Commissioner for Human Rights from 1997 to 2002. -- Wikipedia

New Science Is Amazing AND It Has HUGE Moral Implications for Our Society: NOW

Continuum of Care Mental Health Planning: The Olmstead Planning Bill and the Need for Inclusion in Mental Health Bed Expansion Planning

9/26/2017

The above may seem like an oxymoron but we have long recognized that a strong continuum of care is essential for older people: If someone breaks his or her hip, he or she may need to go to the nursing home for rehab, but with an anticipated return to home.

That need for a strong continuum of care is
even greater in mental health --- where people are bouncing between homelessness, incarceration, the mental institute, the nursing home, etc.

Of course, we don't really want people bouncing around -- and we think that:

complying with Federal law and Olmstead will help,;
increasing the inclusion of people with disabilities in the planning of disability services will help, including mental health bed expansion;
going to a Strength-based, person-centered recovery system will help;
Housing will help;
increasing availability of intensive mental health services in the community will help.

We are at a very exciting point in Colorado history. The State and the Hickenlooper Administration realize the challenge of mental health in the criminal justice system and are doing a lot to try to address it.

Eagle County is putting a measure to the voters for a local marijuana tax to fund mental health care.

Mental health is a widespread need the county needs to focus on, said Kathy Chandler-Henry, county commissioner.

“The need is clear, the will to do something is clear. What remained was how to do it. Now we’re asking the voters what they think,” Chandler-Henry said.

http://www.parkrecord.com/news/colorado-voters-to-decide-if-marijuana-taxes-will-fund-mental-health-care/

We think our Olmstead Planning Bill is a Big Piece of the Puzzle -- and helps Colorado comply with Federal Law-- It's Not necessarily the whole puzzle.

AND even for those other pieces -- we need inclusion.

We do need to work with people if our Olmstead Planning Bill is going to be successful. If you do have concerns, please let us know -- we want to work with people.

John Knowles was an American Novelist best known for "A Separate Peace" -- Wikipedia.

One of Orchid's Symbols: The Vietnam War

9/24/2017

Orchid Themes & Symbols

Ken Burns & Lynn Novick's Documentary "The Vietnam War" does on a much grander scale what we try to do with mental health and criminal justice, etc. -- look at multiple perspectives -- with one big significant difference -- some historical distance.
We've really had a perfect storm of:

psych meds that weren't as great as we hoped for some people;
a disability community that was in horrible denial that a small but nonetheless significant percentage of their members could be caught up in the criminal justice system. Further, most did not want to be further "stigmatized" as criminals.
a criminal justice system and public that just didn't "buy" the "medicalization of evil"
a DSM 5 that lacks scientific validity according to Dr. Thomas Insel, former head of the US National Institute of Mental Health, and one of the driving reasons for the Institute's creation of the Research Domain Criteria Program.
Mental Health is now much more linked to gut and immune health than previously appreciated.
AND the reality is if the State does start to take some responsibility for the true Scale of the Need for BEDs, HOUSiNG, & INTENSIVE SERVICES -- that's expen$ive.

Our Criminal Justice System Can Be A Very Nasty Disability Service Provider with an Abusive Edge -Because the State Isn't Providing the Beds, Housing or Services @ the Scale Needed for People with Disabilities

9/23/2017

Mad Eye for the Sane Society

Mad Eye Moody from the "Harry Potter" series by J.K. Rowling

"If You Can't Keep A Simple Appointment, Probation May Not Be Right For You -- Same is True for My Fellow Judges."

---Denver District Court Judge
Sept. 22, 2017

So generally the Criminal Justice System doesn't really look @ Disability per se.
What it looks @ is:

Competency to Stand Trial

AND

Guilt by Reason of Insanity

Of course, Reality is a lot more complicated than that.

A lot of the people in the Criminal Justice System in Colorado and nationally have:

Learning Disabilities
Developmental Disabilities
Executive Functioning Deficits
Mental Illness
Substance Use Issues
Brain Injury

AND they are probably not going to meet our high bar:

incompetent to stand trial (ITP) or
not guilty by reason of insanity (NGRI)

We really picked on the Denver Judiciary in the Headline, but the Truth is that Denver Judges and Judges around the State have indicated a problem of lack of services.

The fact is Colorado may need:

2000 more psych beds than what it has. (This is loosely based on the Mental Illness Policy Organization's recommendation for 50 psych beds for every 100,000 people)
3000--7000 more slots in Assertive Community Treatment (ACT) (That's a pretty broad range and is based on people trapped in the criminal justice system, nursing homes, homeless, and in institutions without sufficient intensive services in the community)

BOTTOM LINE: ACT Needs to be available where reasonably medically necessary.

WE HAVE TO HAVE SAFETY
But the people in our criminal justice system have pretty complex, expensive needs & pretending they're just BAD, just makes it more difficult not less to do the hard planning ahead for this State--

AND IRONICALLY INCREASES THE NEED FOR HOUSING & SERVICES which is already
ENORMOUS.

Uncle Billy with George, after George realizes Uncle Billy lost the money in "It's A Wonderful Life"

More -- A LOT MORE -- Money in Housing & Intensive Mental Health Treatment is Needed in Colorado for People with Mental Illness -- It Could Be Along The Lines of A Billion Dollars

9/20/2017

A lot of people in the general disability community were pretty envious of the Mental Health Community -- an investment of $40 Million in mental health this year in the Legislative Session.

But that was before the Sh**
Hit the Fan on CMHIP (CO Mental Health Institute @ Pueblo) and the "immediate jeopardy" designation, persistent staffing problems, ad nauseam.

BUT -- WHAT IS IT GOING TO TAKE TO HOUSE and TREAT THOUSANDS OF PEOPLE WITH MENTAL ILLNESS IN CO JAILS & PRISONS --

WHEN WE CURRENTLY DON'T HAVE THE HOUSING & ASSERTIVE COMMUNITY TREATMENT (ACT) IS OFTEN NOT AVAILABILE.

ACT is NOT AVAILABLE to ALL WHERE REASONABLY MEDICALLY NECESSARY UNDER CO MEDICAID -- THAT'S DISCRIMINATION.

BTW -- ADULT & YOUTH ACT are available in Minnesota where reasonably medically necessary.

https://www.usgovernmentspending.com/colorado_state_spending_pie_chart

Colorado's gross domestic product is $334.7 billion.

As a lot of States, we have chosen to ignore the SCALE of the housing needs of people with disabilities regardless of Olmstead for years.

The cost shifting of people with intensive mental health needs to the Criminal Justice System and to the Homeless Shelter and the Streets is being called out and recognized in a way it hasn't been in the past.

The Chickens are coming home to roost -- AND WE WANT:

Inclusion
A Comprehensvely, Effectively Working Olmstead Plan with Measurable Goals that Bring Housing & Services to Scale to Meet the Need, and
Facilities for People with Disabilities that are ADEQUATELY FUNDED & STAFFED and NOT RIFE with ABUSE or BREEDING GROUNDS FOR SUICIDE.

Many people charged with crimes are already on SSI & Homeless -- What does That say about our Service Delivery & Criminal Justice Systems?

9/18/2017

The Large Scale Need for Intensive Discharge Planning in Colorado's Jails & Prisons -- NOW

To the right is Hawaii's Mental Health Discharge Planning Process for Prisons and Jails.
   We think Colorado is trying to do some of this, probably a lot of this.
The McKinney-Vento Homeless Act Funds require that a condition for receipt of funds is prevention of Homelessness from State Institutions, including jails and prisons.
  Further, many of the people who are in jails and prisons are already on SSI when not incarcerated.

   Court personnel, CMHIP (Colorado Mental Health Institute @ Pueblo), jail and prison staff --

many people in the criminal justice system are on SSI based on disability when not incarcerated!

Do you know how hard it is to get on SSI?

   That may not be determinative, but it sure is a big, big HINT regarding how these cases need to be handled and the ultimate need for intensive discharge planning, and any competent professional needs to be looking into that.
      AND we know of at least one case in which CMHIP totally missed it -- of course, they didn't even evaluate the person before labelling this Black person with an anti-social personality disorder because the person refused the evaluation -- CMHIP thought they knew more than they did.
   The person is actually on SSI not for anti-social personality disorder but for schizophrenia and paranoia which isn't to say the person doesn't have a criminal record.

   If we do get to the point of discharge planning and placement -- if things haven't gone horribly wrong -- AND THAT"S A BIG IF, we have to make some reasonable accommodations here --

IT IS NOT REASONABLE TO GIVE SOMEONE WITH COGNITIVE DISABILITIES A PACKET & NO HOUSING UPON RELEASE FROM JAIL.

Now our understanding is the legislature approved some money ---$2.7 million (we think) for supportive housing for people with mental illness being released from jails and prisons -- and that probably hasn't gotten in the pipeline --

At least in another instance where things for another one of our guys (he's on SSI, too) -- things are presumably going a little better, he's going to be released in 2 weeks -- UNFORTUNATELY, HE'S LOOKING @ HOMELESSNESS ONCE AGAIN

BUT even when the $2.7 million comes through for supportive housing ---

HOW FAR IS IT GONNA GO?

2010 Hawaii Dept. of Corrections Discharge Planning Policy for Inmates with Mental Illness

Why D.J. Jaffe is Such A Hero -- States Must Have Community Mental Health Systems that Can Serve People Coming Out of Prisons, Jails, Nursing Homes, Homeless Shelters/Streets & Hospitals

9/17/2017

An Emerging Consensus Mental Health Policy for Citizens with Intensive Mental Health Needs After Decades of Gross Neglect

If one wins the debate, one may feel comfortable to start moderating -- and that seems to us to be the case with conservative D.J. Jaffe and the Mental Illness Policy Organization.
  Jaffe had to take on pretty much the entire mental health advocacy world including Bazelon and the National Protection and Advocacy System for People with Disabilities to make what now seems the obvious case that the sites of greatest institutionalization for people with mental illness in the US are jails and prisons.
  But even if you weren't in DENIAL, it seemed like Jaffe's policy prescriptions left something to be desired: GO BACK TO INSTITUTIONALIZATION and/or FORCED TREATMENT.
   Now, of course, Colorado has Assisted Outpatient Treatment [Outpatient Certification] -- what that really means without resources is pretty questionable and even Jaffe would acknowledge that.
  Of course, certification, inpatient or outpatient -- is really treatment failure -- and in this environment you have to look @ the paucity of resources as a potential factor -- and the paucity of resources for treatment of people with INTENSIVE MENTAL HEALTH NEEDS such that they would otherwise be in the:

Prison
Jail
Nursing Home,
Hospital. or
Homeless Shelter/Street

still shocks the conscience even with all the good things that have been done.
    In 2017, Jaffe is arguing for 50 psych beds for every 100,000 people.  That doesn't strike us as grossly unreasonable -- especially, in Colorado's case which has a very large and growing transient and homeless population which includes some people with serious mental health needs. It may especially be needed to stabilize people before more permanent placements.
      Colorado has a population of roughly 5.5 million people -- that would be about 2,750 psych beds. The mental health institutes have less than 600.
   Additionally, our understanding is that CMHIP is pretty much forensic at this point and they still don't have enough beds.
   As our understanding grows of some of these mental health issues in the criminal justice context we should anticipate more not less need for both inpatient and intensive community care.
   Of course, community care is less expensive than hospital care generally BUT INTENSIVE COMMUNITY MENTAL HEALTH SERVICES ARE NOT INEXPENSIVE --

THAT IS WHY Evidenced-Based Gold Standard in Community Mental Health Treatment --ASSERTIVE COMMUNITY TREATMENT --- IS NOT AVAILABLE TO ALL WHERE REASONABLE MEDICALLY NECESSARY

     That is BIG Time Discrimination CO Department of Health Care Policy & Financing / Hickenlooper Administration.

   And this brings us to where Jaffe really surprised us -- the call to FUND Community Mental Health Care for those with the most intensive mental health needs.

   We don't think you can just write off people with less intensive mental health needs ---- and maybe this is the beginning of a Beautiful Friendship.

D.J. Jaffe, CMHIP, Our Olmstead Planning Bill & TABOR: It Is Long Past Time To Have A Come To Jesus or More To The Point -- A Come To Reality

9/16/2017

Colorado Hasn't Allocated the Resources for the Inpatient Care or Community Care Colorado Citizens with the Most Intensive Mental Needs --- Need. That Has and Is Leading to in the words of Conservative Mental Health Advocate D.J. Jaffe "Insane Consequences." And that is true even in economically prosperous Colorado.

D.J. Jaffe is hardly a darling of the Left, in fact he is generally embraced by the Right, and we don't necessarily agree with all the prescriptions -- BUT he has pretty accurately described the problem in the US that people with the most intensive mental health needs have been written off as too expensive and cost shifted to the criminal justice system and the homeless shelter.

How can we have:

an evidenced based community mental health treatment such as Assertive Community Treatment that is the gold standard in intensive community mental health treatment
a major component of many MI US Dept. of Justice Olmstead Settlement Agreements, and
Yet not systematically required to be provided where reasonably medically necessary and desired --- politics? this is insane & life-destroying.

AND We Do Need More Beds & Sufficient Salaries for Staff.

We're asking the Hickenlooper Administration, Colorado Attorney General Coffman's Office, and the Colorado Legislature to look at the State's obligations under Federal Law as falling outside of TABOR restrictions based on the Supremacy Clause to the US Constitution.

Specifically, for our purposes that would mean:

State obligations to meet Federal Safety and Staffing requirements of facilities, etc.
Obligations under the federal Americans with Disabilities Act and the 1999 Olmstead decision and subsequent caselaw and federal guidance, etc.

National Review
By D.J. Jaffe
Price's War On Mental Illness
http://www.nationalreview.com/article/451039/mental-health-spending-serious-illnesses-should-get-bulk-spending

Democracy, Representative Government, & Inclusion -- We've Got To Change -- Our Governments Don't Work for a LOT of PEOPLE

9/13/2017

     We trace our democratic roots to ancient Greece, and yet even there democracy had a bad rap among some -- Mob Rule basically.
It is certainly not easy, and generally in modern times we agree with Churchill -- it is the worst form of government -- except for everything else.
Of course, we don't have "direct democracy" and direct democracy's manifestations in the US -- think especially California, but Colorado too, the referendum process -- has its critics.
   AND yet the US-form of democracy is in a lot of trouble folks. To the untrained eye, it looks a whole lot like an oligarchy.
   Even with all the good things the Hickenlooper Administration has going for it -- AND there are a LOT -- there have been A LOT of problems with LACK OF INCLUSION & NULLIFYING COMMUNITY DECISIONS in the case of the choice of the Crisis Center Providers, never really having the diverse input that is necessary for the mess that is CMHIP (Colorado Mental Health Institute @ Pueblo), etc.
     In fairness, some of this may be (likely be):

unconscious bias (they are not even aware of any bias)
lack of capacity and a protective reaction (it takes time and energy to include people)
etc.

It is critically important that our government officials have the "capacities" -- in time, money, and processes to substantively engage with people who are perceived as significantly different from themselves or marginalized.

Those reasons as well as many others are why we are supporting a CO Olmstead Planning Bill. We believe its potential as a model could go beyond the disability community.

We Need Real Inclusion On CMHIP & Olmstead

9/11/2017

I don't have a problem with "empathizing" with state officials who are charged with the difficult duty of addressing the CMS initial "immediate jeopardy" determination and the larger long-standing staffing problems at the Colorado Mental Health Institute @ Pueblo.

   In fact, such empathy and understanding is no doubt essential.

   Having said that, it does not appear that Colorado State Government has the processes in place to successfully address the scope of this problem.

   The State does not appear to be empowered to do what it needs to do, or does not "think" it is empowered to do what it needs to do to address this crisis -- and large scale staffing problems at a large institute of vulnerable individuals is a crisis.

   No doubt in the midst of crisis it is hard to figure out how to include people -- but that lack of inclusion is part of the reason for the current crisis @ CMHIP.

   We don't know whether to laugh or cry or both when the Hickenhooper Administration sets up what come off as pretty bogus "listening sessions" around state -- and they can't talk about Olmstead or CMHIP with the diverse Mental Health Community that wants to talk them about those issues..

   BTW Olmstead Compliance is required by federal law and NOT subject to a poll taken by the State.

<<Previous

Val's Blog

Sufficiency of Knowledge, the Criminal Justice System, People with Disabilities and the Human Rights Issue of Our Time

Continuum of Care Mental Health Planning: The Olmstead Planning Bill and the Need for Inclusion in Mental Health Bed Expansion Planning

One of Orchid's Symbols: The Vietnam War

Our Criminal Justice System Can Be A Very Nasty Disability Service Provider with an Abusive Edge -Because the State Isn't Providing the Beds, Housing or Services @ the Scale Needed for People with Disabilities

Mad Eye for the Sane Society

"If You Can't Keep A Simple Appointment, Probation May Not Be Right For You -- Same is True for My Fellow Judges."

---Denver District Court Judge
Sept. 22, 2017

More -- A LOT MORE -- Money in Housing & Intensive Mental Health Treatment is Needed in Colorado for People with Mental Illness -- It Could Be Along The Lines of A Billion Dollars

Many people charged with crimes are already on SSI & Homeless -- What does That say about our Service Delivery & Criminal Justice Systems?

Why D.J. Jaffe is Such A Hero -- States Must Have Community Mental Health Systems that Can Serve People Coming Out of Prisons, Jails, Nursing Homes, Homeless Shelters/Streets & Hospitals

D.J. Jaffe, CMHIP, Our Olmstead Planning Bill & TABOR: It Is Long Past Time To Have A Come To Jesus or More To The Point -- A Come To Reality

Democracy, Representative Government, & Inclusion -- We've Got To Change -- Our Governments Don't Work for a LOT of PEOPLE

We Need Real Inclusion On CMHIP & Olmstead

Author

Archives

Categories

Val's Blog

​ ​Mad Eye for the Sane Society

​"If You Can't Keep A Simple Appointment, Probation May Not Be Right For You -- Same is True for My Fellow Judges." ---Denver District Court Judge Sept. 22, 2017

Author

Archives

Categories

Mad Eye for the Sane Society

"If You Can't Keep A Simple Appointment, Probation May Not Be Right For You -- Same is True for My Fellow Judges."

---Denver District Court Judge
Sept. 22, 2017