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WE NEED COLORADO MENTAL HEALTH PROFESSIONALS TO RECOGNIZE "ALTITUDE" AS A FACTOR AND MORE BROADLY -- GET ON TOP OF THE SCIENCE

9/30/2020

WE CANNOT PUT UP WITH THIS LOW BAR MENTAL HEALTH PRACTICE ANYMORE

Altitude


Living High and Feeling Low: Altitude, Suicide, and Depression.

Kious BM, Kondo DG, Renshaw PF. Harv Rev Psychiatry. 2018 Mar/Apr;26(2):43-56. doi: 10.1097/HRP.0000000000000158.PMID: 29517615 Review.

After participating in this activity, learners should be better able to:• Assess epidemiologic evidence that increased altitude of residence is linked to increased risk of depression and suicide• Evaluate strategies to address hypoxia-related depression and s …


Altitude and risk of depression and anxiety: findings from the intern health study.

Kious BM, Bakian A, Zhao J, Mickey B, Guille C, Renshaw P, Sen S. Int Rev Psychiatry. 2019 Nov-Dec;31(7-8):637-645. doi: 10.1080/09540261.2019.1586324. Epub 2019 May 14.PMID: 31084447

Multiple studies suggest that the risks of depression and suicide increase with increasing altitude of residence, but no studies have assessed whether changing altitude changes these risks. ...The data suggest that moving from low to high altitude is a …

Association between altitude, prescription opioid misuse, and fatal overdoses.

Ombach HJ, Scholl LS, Bakian AV, Renshaw KT, Sung YH, Renshaw PF, Kanekar S.Addict Behav Rep. 2019 Feb 18;9:100167. doi: 10.1016/j.abrep.2019.100167. eCollection 2019 Jun.PMID: 31193784 Free PMC article.

Living at altitude has been linked to greater reward benefits of other drugs of abuse, and living at altitude may also exacerbate the respiratory depression linked to opioid use. ...This increased misuse of both stimulants and opioids may increase likelihood …

Exaggerated systemic oxidative-inflammatory-nitrosative stress in chronic mountain sickness is associated with cognitive decline and depression.

Bailey DM, Brugniaux JV, Filipponi T, Marley CJ, Stacey B, Soria R, Rimoldi SF, Cerny D, Rexhaj E, Pratali L, Salmòn CS, Murillo Jáuregui C, Villena M, Smirl JD, Ogoh S, Pietri S, Scherrer U, Sartori C. J Physiol. 2019 Jan;597(2):611-629. doi: 10.1113/JP276898. Epub 2018 Nov 24.PMID: 30397919 Free PMC article. Clinical Trial.

KEY POINTS: Chronic mountain sickness (CMS) is a maladaptation syndrome encountered at high altitude (HA) characterised by severe hypoxaemia that carries a higher risk of stroke and migraine and is associated with increased morbidity and mortality. ...Systemic OXINOS was m …

Suicide and High Altitude: An Integrative Review (2018)

"All the studies found that high altitude was independently associated with suicide."

[This is a particularly interesting study because it finds these ASSOCIATIONS between ALTITUDE & SUICIDE --- and then discounts them.]

I think what some Researchers, Professionals and Advocates have tended to miss:

Even though ALTITUDE may not be the greatest cause of DEPRESSION or source of underlying NEURO-DEVELOPMENTAL INFLAMMATION ---
ALTITUDE is EXACERBATING BIOLOGICAL VULNERABILITIES that are already there.
So we tend to MINIMIZE what would seem to be a SIGNIFICANT FACTOR as well as MISS an IMPORTANT TARGET for INTERVENTION in MOUNTAIN STATES.

I'm not saying the Western Rugged Lifestyle isn't a factor ---

BUT to miss ALTITUDE at this point seems like MALPRACTICE.

High Altitude, Sky High Suicide Rates and the Need to Take Altitude into Account in Integrated Mental & Physical Health Care

Viva La Resistance -- South Park

The "Resistance" we're referring to here is on the part of the Mental Health Profession --- and it is a "com si, com sa" (so so) attitude towards concerns of:

the US National Institute of Mental Health
Researchers around the World
An explosion of research involving the immune system and the microbiome

La, La, La . . .

MEANWHILE: Our Mental Health Crisis is NOT abating and many people are finding themselves in the Criminal Justice System for behavior that is controlled by the Immune System.

From now until Oct. 10 and likely beyond, we'll be shoring up our arguments both with respect to:

Altitude, and
The Immune System

Altitude is really just one of numerous factors that can impact the immune system and ultimately the brain and behavior. These impacts can lead to psychiatric disorders.

One of the most common things may be Altitude-Induced Sleep Apnea
See Research Links Higher Altitude with Increased Sleep Apnea

American Journal of Psychiatry (2018): Screening for Sleep Apnea

Sleep Apnea Linked With Higher Levels Of Inflammation (2017)

"The severity of sleep apnea was found to be associated with high levels of inflammation.

"Inflammation is an immune response, where the white blood cells produce chemicals to fight the foreign substances."

Altitude is just one factor among many, many factors.

Colorado and other Mountain States are really outliers with sky-high suicide rates.

That's a problem.

How high altitudes could raise risk of depression, suicide (2018)

University of Utah research shows high altitude linked to depression and suicidal thoughts (2018)

Utah Women's Health Review

Utah has the highest rates of depression and suicide in the US, despite high rates of antidepressant prescriptions. People living at altitude are exposed to chronic hypobaric hypoxia, which may disrupt brain serotonin and bioenergetic function, to worsen depression and reduce selective serotonin reuptake inhibitor (SSRI) function.

The Impact of Living at Altitude on Depression and Anti-depressant Function in Utah Women: The Need for Novel Antidepressants (2019)

This blog last Updated July 24, 2022

The Tyranny of Positivity

9/29/2020

We're contrasting John Green's cartoonish Crash Course on Voltaire's "Candide" with Benjamin Clementine's "I Won't Complain."

  One of the things we're constantly told is: Positivity makes us feel better and if we can just convince ourselves that everyone who might criticize us or the SYSTEM we're pushing is TOXIC ----maybe we do feel better.

    The thing about criticism --- it is often brought by people who don't feel heard. So there maybe some "REFERRED PAIN" --- but there is generally a kernel of truth in the criticism --- and that's what HURTS --- and that's why we want the critical person to be more POSITIVE.

We advocate for Positive Strength-Based Treatment Approaches --- 80% of the time developing Strengths and 20% of the time identifying Work-Arounds for Weaknesses.

A Strength-Based Approach is not about denying weaknesses.

When we think about Human Societies we often think: those people in History were IDIOTS, we're so much smarter now, and if things aren't perfect we have self-correcting mechanisms that will REMEDY INJUSTICE.

  That really hasn't been the reality for many people. Further, the problem with all 3 branches of government --- they are TOO EXPENSIVE for most people.

AND that really brings into HIGH RELIEF --- ECONOMICS -- which is a SACRED GOLDEN COW in this society. Nobody's saying this isn't COMPLICATED.

    But Modern forms of POSITIVITY often serve the same functions as OLDER FORMS of POSITIVITY or OPTIMISM--- maintaining the STATUS QUO by trying to de-legitimize criticism.

  Further, just listening to criticism has it limits -- ultimately, we have to substantively address criticism and bring people into the problem-solving process.

That is about recognizing that we don't live in "the best of all possible worlds" --- and there is a lot of INCLUSIVE Problem-Solving that needs to be done.

IN THE CRIMINAL JUSTICE SYSTEM: MANIC, DESPERATE SHORT-TERM REHAB OR RECOGNITION OF LONG TERM NEEDS

9/27/2020

   The Criminal Justice System for 30 or 40 years at least has been trying to incorporate various "TREATMENTS" into SENTENCING.

It probably hasn't been a HUGE FAILURE in ALL CASES, but clearly has not solved all the problems.

Further, there is often a predictable TRAJECTORY some of these cases take ---- "We've given you every opportunity to turn your life around -- you've squandered those opportunities --- you leave us no choice but to send you to prison for a long time."

   Hmmm . . .

One of things that is coming out strongly in the 21st Century is that behavioral issues, social behavior and substance issues often involve INNATE IMMUNITY, meaning immune system anomalies we were BORN with.

So --- nobody knew that --- and maybe a lot of that knowledge hasn't TRICKLED DOWN to most CLINICIANS but it is certainly there in the research.

Well --- it is starting to become more and more clear why some of these SHORT TERM TREATMENT Programs aren't working to address incredibly complex INNATE IMMUNITY issues.

Further, it also may be one explanation as to why a lot of mental health treatment for ANYBODY tends to stay on the SURFACE of the EMOTIONAL DISTRESS --- and the MEDICATIONS that are sometimes trying to get to UNDERLYING BIOLOGY are sometimes a MIXED BAG.

BACK TO THE CRIMINAL JUSTICE SYSTEM: Even without this new research identifying prominent roles for the Immune System and the Microbiome in Human Behavior -- the TREATMENTS were not adequate in many cases and the understandings Clinicians had were not sufficient.

  SO WHAT TO DO? A fair number of people in the Criminal Justice System may need Long Term Care until we get better treatments.

Long Term Care can be in the Community in most cases -- and it should be whatever level of care people need.

Nature Immunology (2017):

Scientists at Riken Center for Integrative Medical Sciences in Japan found that T cells -- immune cells that help to protect the body from infections and cancer -- change the body's metabolism when they are activated, and that this activation actually leads to changes in behavior.

360 PROBLEM-SOLVING IN JUSTICE

9/26/2020

There are definitely attorneys and judges who know how bad the current Criminal Justice System is and are working as hard as they can to fundamentally change systems.

We need protests in the Streets for Criminal Justice Transformation as much as Law Enforcement Transformation and there is also the need for SOCIAL and ECONOMIC Transformation that is CONNECTED to many of these problems.

There are a lot of ways to address the PREFERENTIAL TREATMENT LAW ENFORCEMENT receive from prosecutors and often jurors.

We really need to analyze the situations in which these problems are arising:

Jails
No Knock Warrants
Traffic Stops
Etc.

and see how we might change the DYNAMICS of these situations to prevent the CRIMINAL BEHAVIOR of LAW ENFORCEMENT.

By the time one gets to the Criminal Justice System, many other Systems in the Society have often failed.

Further, the person charged with the crime has been clearly identified as THE PROBLEM --- and you're in the ADVERSARY SYSTEM --- the only thing more US versus THEM is --- WAR.

This system hasn't worked as well as anyone would have wanted -- and we need to HACK IT.

A big part of what we need to HACK is the ADVERSARY SYSTEM itself.

Problem-solving courts are starting to do that. There is a lot of work to be done.

A Public Health Approach to Criminal Justice would be a BIG STEP in the right direction.

ANTI-SOCIAL PERSONALITY DISORDER ---IS LIKELY TO GO DOWN AS ONE OF THE GREAT TERRORS OF 20TH & 21ST CENTURY PSYCHIATRY

9/25/2020

Our "Pro-Social" Mental Health Profession engages in a fair amount of frightening IGNORANCE in the Criminal Justice System, amounting to EVIL.

BUT it is NOT just the Mental Health Profession that engages in this ritual IGNORANCE--- it's really the SOCIETY as a whole.

There are a lot of people who would BEMOAN Trump for failing to follow the science in COVID-19 and putting POLITICS above the SAFETY of the Nation.

That kind of behavior is NOT limited to one whacked out President--= and it's not limited to conservatives or liberals.

What's the Problem with Anti-Social Personality Disorder? There are anti-social people or even anti-social behavior -- why shouldn't we have Anti-Social Personality Disorder Diagnosis?

We have made some DISTINCTIONS in the LAW that are not holding up to REALITY, namely there are narrowly drawn categories of "INSANITY" and "INCOMPETENT TO PROCEED" and everything else is fair game for our PUNITIVE WRATH.
On top of this, Forensic Psychiatrists and Psychologists utilize categories in the DSM 5 that most researchers around the world consider invalid, and the US National Institute of Mental Health does not support.

Meanwhile --- we're in the midst of a biological revolution that is undermining many traditional notions contained both in the LAW and the DSM 5.

We have not only the CRIMINALIZATION of COMPLEX, BIOLOGICAL Substance Issues --- but that is figuratively turned into a NUCLEAR WEAPON when we tack it on to our out-dated notions of Anti-Social Personality Disorder.

There are so many QUESTIONS the Mental Health Profession should be asking, and they're not.

Poor Performance and Behavior is often EVIDENCE of INADEQUATE SUPPORT.

The Big Chill (1983) --- It's A Cold World Out There

We chose this scene for a lot of reasons --- it doesn't shy away from what one can find in the Criminal Justice System and it doesn't shy away from how cynical and damaged many people have become in this society --- up and down our meritocratic ladder.

Further, the attorney played by Mary Kay Place is quite shocked that her clients in the Criminal Justice System weren't "INNOCENT."

A lot of the arguments we make on ORCHID are NOT dependent on the person being "INNOCENT."

If you move to a Public Health Approach to Criminal Justice a lot of those DOCKETS will thin out and maybe the Justice System will have the TIME AND ENERGY to ADEQUATELY INVESTIGATE & LITIGATE DISPUTED FACTUAL MATTERS --- which aren't most cases.

Further, the ADERSARY PROCESS really asks ADVOCATES and PROSECUTORS to LIE TO THEMSELVES about very COMPLEX SITUATIONS.

So when acclaimed Judge Leifman in Florida says we're moving to a COLLABORATIVE SYSTEM, a COLLABORATIVE PROCESS --- that's NOT about lying to yourself regarding:

the Seriousness of the ISSUES or
very real SAFETY concerns or
persistent Economic and Social issues
COMPLEX Biological Issues

--- It's about recognizing REALITY.

OLMSTEAD COMPLIANCE: A FAILURE OF FEDERAL TECHNICAL ASSISTANCE & OVERSIGHT

9/23/2020

Is Olmstead Compliance EASY, despite Covid, it is probably EASIER than it's ever been because --- it is CLEARER than it was back in 1999 what Olmstead MEANS.

NONETHELESS, States have had a hard time with compliance and even progressive Colorado with a good economy in recent years has had a HARD TIME.

Colorado could still come out of this a LEADER if the Behavioral Health Task Force can SHORE UP their "ACCOUNTABILITY" --- with Olmstead Compliance. Olmstead is a legally required form of "ACCOUNTABILITY" when it comes to STATE PLANNING & PROVISION of Disability Services, Housing & Community Placements.

Further, we would argue there is a HARM REDUCTION COMPONENT to OLMSTEAD --- all "INSTITUTIONS" are not created equal. A nursing home can be a terrible place to be --- a JAIL or PRISON is typically WORSE.

If there is inadequate HOUSING or SMALL COMMUNITY PLACEMENTS and the person otherwise qualifies for Medicaid long term care --- we need to make stand- in provisions while we build that housing:

Rigorous FAIR HOUSING COMPLIANCE for nursing homes and assisted living residences.
HOTEL VOUCHERS
etc.

The FEDS have such a HUGE ROLE in not requiring each State to RE-INVENT the WHEEL while allowing for STATE INNOVATION ---- SO LONG AS States can still comply with the law --- which includes OLMSTEAD -- it also includes Parity and Medicaid Network Adequacy.

The reality is STATES have FAILED to comply with Olmstead and people with Behavioral Issues associated with Cognitive Disability are paying a big price as are families and community members.

A Federal Technical Assistance Center on Olmstead, Parity and Medicaid Network Adequacy Compliance, focusing on:

Data Systems
Innovative Practices, and
Plan Templates

could reduce the NEED for ENFORCEMENT considerably.

Additionally, a TRANSITION from a Criminal Justice System for Cognitive Disability Behavioral Problems --- to an INTEGRATED Justice/ Public Health System that can address these issues --- is going to require a lot of TECHNICAL SUPPORT.

CO BEHAVIORAL HEALTH TASK FORCE: MEASURABLE GOALS & REASONABLE TIME FRAMES ---WHERE ARE THEY?

9/22/2020

One of the things that INFURIATED Federal Judge Donovan Frank in the Minnesota Jensen case ---- Minnesota kept bringing plans to the Court that didn't satisfy the Law and didn't satisfy the explicit directives of Judge Frank.

Colorado is under a Court Order -- it's not an Olmstead case BUT a lot of Stakeholders are specifically requesting:

Measurable Goals and
Reasonable Time Frames, and
Funding to Support the Plan

[Now, everybody knows Covid is going to impact these things -- BUT we need to do these things --- NOW]

Saying the word "ACCOUNTABLE" is NOT the same thing as being ACCOUNTABLE. States around the Country have a Big Problem with this --- Colorado has a HUGE PROBLEM.

Further, both States around the Country and Colorado tend to believe that if Olmstead is INCONVENIENT --- they don't have to comply with it. Well, from a practical standpoint they have often been right --- because individuals and advocates often don't have the resources to litigate this.

BUT these States are NOT right as a matter of LAW. Those CHALLENGING CIRCUMSTANCES can be taken into account in determining what's "reasonable" in setting the goals and time frames --- BUT you still need MEASURABLE GOALS and REASONABLE TIME FRAMES.

This national and state discussion is not legally or politically at vague notions of ACCOUNTABILITY.

We need the Behavioral Health Task Force to SHORE THIS UP. The final report is supposed to be issued this coming Wednesday --- Sept. 23, 2020.

One recommendation could be for a State Olmstead Planning bill or an Accountability bill.

Olmstead really has fleshed a lot of this out --- but politicians keep ignoring it. If you want to call it something else, call it something else BUT we NEED:

Measurable Goals
Reasonable Time Frames, and
Funding to Support the Plan

Jensen Case

KOAA Story on Task Force Recommendations

REFLECTIONS ON RBG, MEN AND WOMEN AND THE FAMILY

9/21/2020

The New York Times remembrance of Ruth Bader Ginsburg brought back the huge challenge for Ruth Bader Ginsburg's mother and for women of the early 20th Century --- their own mothers didn't really value them.

Today, the issue is much more about the SOCIETY and MEN.

I didn't experience maternal discrimination, my mother didn't experience that --- she was born in 1938 --- but my maternal grandmother did --- she was born in 1911.

It was a painful part of her family life and upbringing.

Certainly we're aware of the preference for male children in China over female children and the stories of widespread abortion.

I don't think Ruth Bader Ginsburg was for that, but I think she did know that the CRIMINAL LAW wasn't the right vehicle to address the issue of voluntary abortion.

As it is currently constructed, the CRIMINAL LAW isn't the right vehicle for a lot of things.

DIET & EXERCISE: "FAT-ASS LAZY AMERICANS" AND INTELLECTUALLY LAZY PRACTITIONERS

9/20/2020

Two disfavored groups are people with mental health problems and people with weight issues. The BIAS against these groups EMPOWERS a lot of INTELLECTUAL LAZINESS.

With many medical problems today --- we don't have great treatments, BUT we don't STILL BLAME THE PERSON or HOLD THEM ACCOUNTABLE like we STILL do in mental health and weight issues.

We say "STILL" BLAME THE PERSON --- because historically we blamed people for every medical problem they had.

    It may have a lot to do with the FEAR of these ISSUES that keeps us in a SEMI-PUNITIVE MODE towards individuals who have mental health issues or weight issues.

   The argument is NOT that DIET and EXERCISE can't help --- BUT when we have a COUNTRY and COUNTRIES full of people who want to be THIN and BILLIONS aren't ----- maybe --- let's say obviously --- this is MORE COMPLICATED THAN WE"RE TREATING IT.

    Further, a lot of "INVISIBLE" (ADHD and Autism) and VISIBLE (Cerebral Palsy) DEVELOPMENTAL Disabilities involve DYSREGULATION of the MICROBIOME.

The MICROBIOME according to some researchers is the BIGGEST PREDICTOR of whether one is thin or heavy or somewhere in between.

Further, some psychiatric medications do cause weight gain and other UNINTENDED CONSEQUENCES. Some researchers are investigating the effect of some MEDICATIONS on the MICROBIOME.

Finally, we're now in the realm of experimental FECAL TRANSPLANTS for some illnesses.

Microbial Minutes (American Society for Microbiology) --- 2019

Linking the Gut Microbiome, Obesity and the Immune System

What's the Point?

When it comes to both mental health and weight issues --- Practitioners are NOT on top of the research
THAT MATTERS

COMPETITIVENESS & AGGRESSION ----NON-SEQUITUR SEX--- BUT IS IT?

9/18/2020

We're riffing off PBS' "Hacking the Mind" series. There is a lot that has been done on this in recent years, especially with the advent of Social Media but also the persistent problems of Racism and Unconscious Bias.

One of the things that was so interesting about the GAY RIGHTS / GAY MARRIAGE DEBATE was HOW STRONGLY people felt about it on both sides --- and when it FINALLY FLIPPED --- it did so very quickly and on MORAL GROUNDS.

One of the things that the GAY RIGHTS / GAY MARRIAGE DEBATE had going against it and for it --- was SEX. As a good friend of mine in college who was gay noted: people are really curious about this.

So SEX is really important to people --- and RACE at one time was really SEXY when we were talking about "INTER-RACIAL MARRIAGE" ----BUT we're sort of over that -- or at least most people are.

What could be more BORING than ECONOMICS ---okay, maybe there are a lot of obvious connections to SEX here -- I'm wanting to make some connections among -- the ULTRA COMPETITIVE SOCiETY, AGGRESSION & SEXUAL VIOLENCE and other less dramatic harmful behaviors..

One of the things we didn't really bargain for when we bought into Adam Smith and Alexis de Tocqueville's "Invisible Hand of Self Interest" and the alleged self-regulating nature of markets ----- AGGRESSION and SEXUALITY are linked in the human mind and in the minds of a lot of animals, and apparently insects.

Further, "aggression cells" multiply --- on a kinda prn basis --- but it's not clear they go back down easily.

Aggression: Humanity's Ultimate Double-Edged Sword

Live Science (2016): Primates, including Humans, are the Most Dangerous Animals

We're interested in HIGHLIGHTING the DYNAMIC between the HYPER-COMPETITIVE ENVIRONMENT and BIOLOGICAL AGGRESSION -- right down to AGGRESSION CELLS., including Sexual Aggression.

Stephen Hawking made the point that humanity's aggression may have made us TOP PREDATOR, but it is really threatening to DESTROY US. In fact, Hawking identified AGGRESSION as the greatest problem facing HUMANITY.

When we think about the AMAZING SCIENTIFIC REVOLUTION that is going on right now --- we've focused on it's implications for MENTAL HEALTH and the CRIMINAL JUSTICE SYSTEM.

These BRAIN HACKS are also calling into question our ECONOMIC SYSTEM (don't make this a binary debate between Captalism and Socialism) --- and our MENTAL HEALTH and the CRIMINAL JUSTICE SYSTEM.

The Brain Forum (in Switzerland) --- 2016

Cal Tech's David Anderson on The Neural Circuitry of Sex & Violence

This talk focuses on how aggression circuits are organised in the brain, and their relationship to circuits that control mating behaviour.

Studies have revealed that mice and flies contain "modules" (relatively small groups of neurons) that control both aggression and mating, suggesting that this is an evolutionarily ancient circuit "motif."

The role of these modules, and their relationship to decision-making and internal brain states, is discussed.

The long-term objective of these studies is to provide insights into the brain mechanisms that link emotion and decision-making, and their evolutionary origins.

"Greater competitive video game play and competitive gambling predicted higher levels of aggression over time, after controlling for previous levels of aggression, supporting the socialization hypothesis."

Journal of Youth and Adolescence (2013): Demolishing the competition: the longitudinal link between competitive video games, competitive gambling, and aggression

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