Blog Archives

BIO-MARKERS: THE TIMES THEY ARE A CHANGIN'

10/29/2019

First, Some Charity--sort of

The search for bio-markers in mental health has been long and frustrating, though more recently it has been yielding results.

That has led some clinicians and even researchers to question whether bio-markers even exist.

Although, the US National Institute of Mental Health and most researchers are heavily invested in finding and utilizing bio-markers.

The Psycho-Social/Interview Approach and the Bio-marker/Biological Approach are sometimes set off in opposition to one another.

However, the Approaches are not in opposition to one another or somehow exclusionary, but as different ASPECTS of the same thing: HUMAN HEALTH.

The problem is that we have focused so heavily on the Psycho-Social/Interview Approach out of NECESSITY that we don't have a SOLID FOUNDATION for our Mental Health Diagnoses.

That SOLID FOUNDATION is the BIO-MARKERS.

Further what we are utilizing now -- again out of NECESSITY -- are clusters of SYMPTOMS.

This is hugely problematic. It is like talking about the NATURE of a STOMACH ACHE when a lot of different things and combinations of things cause STOMACH ACHES.

This brings us to the University of Leiden. Just as Japan's RIKEN Center for Brain Science was announcing the discovery of a bio-marker for a sub-type of Schizophrenia, the University of Leiden boldly DENIED INFLAMMATION when it didn't see it in all cases of "DEPRESSION." Even further, the folks in Leiden threw into question all bio-markers.

Of course the point that other researchers have been trying to make is that our current categories are very BLURRED- and inexact.

So it is hardly all settled, right? So we don't have any choice but to put the BURDEN of IGNORANCE on INDIGENT DEFENDANTS WITH COGNITIVE DISABILITIES -- right?

Folks that is NOT the right answer. These kinds of problems really bring up issues of DUE PROCESS and FUNDAMENTAL FAIRNESS. It is not really clear our JUSTICE SYSTEM is capable of addressing such BIG ISSUES.

Further, if the US JUSTICE SYSTEM does finally address these FUNDAMENTAL ISSUES -- it may be long after STATE LEGISLATURES are well into that process-- and that process has already begun.

So using our LATERAL PROBLEM SOLVING -- we move from reforming the CRIMINAL JUSTICE SYSTEM to:

Measurable Goals for Housing, Placements and Services for People with Cognitive Disabilities
Reasonable Time Frames, and
Funding to Support the Plan

SANITY by any other name.

Brandi Carlile: "The Times They Are A Changin'

Japan's RIKEN Center for Brain Science

Neuroscience News: Japan's Riken Center For Brain Science Finds Hair Biomarker for Sub-Type of Schizophrenia

BIO-MARKERS -- THAT OUT-GROUP ISN'T AS DIFFERENT FROM US AS WE THOUGHT

The Mental Health Profession

We've just started to do genetic testing for some psychiatric medications.

Our Mental Health Profession needs NEW TOOLS if they are going to EFFECTIVELY address our MENTAL HEALTH CRISIS.

Further, Mental Health Specialists should be integrated with Neurology as both are being integrated with Immunology.

Domestic Policy

Bio-markers really corroborate what BIOLOGICAL SCIENCE already knows -- there are biological reasons why people and other animals do what they do.

They also give us potential avenues for treatment.

Of course, deciding who needs TREATMENT is a pretty big issue.

Danger to self and others or Gravely Disabled is a good if not perfect FILTER.

BUT we have to have the HOUSING, PLACEMENTS & SERVICES available to do that.

If we do that, many or our CRIMINAL JUSTICE CONUNDRUMS will go away.

On the other hand, it will FORCE a PROFOUND EXAMINATION of SAFETY.

Foreign Policy

Here, again Bio-markers could CORROBORATE Human Suffering and give us potential and more effective ways of addressing that.

TRANSLAT-IONAL MEDICINE: A CRYING NEED

10/24/2019

University of Arkansas for Medical Sciences, Translational Research Institute

VERY IMPORTANT PREFACE: This is NOT about debating the merits of private or socialized medicine. THAT REALLY MISSES THE POINT.

This is really about what WORKS. We need a PRIVATE SECTOR, we need a PUBLIC SECTOR and we need CIVIL SOCIETY ORGANIZATIONS.

Somebody needs to be SYSTEMATICALLY TRANSLATING RESEARCH into CLINICAL PRACTICE. Right now, that Research is more than any CLINICIAN or for that matter RESEARCHER could read and incorporate on their own.

Ironically, there is a certain ADHD quality to this -- it is fun and exciting to be on the cutting edge -- BUT if we can't take the time or somebody can't take the time to INTEGRATE this into the LARGER SYSTEM we're left with a MESS.

The UK has really done a lot to INTEGRATE their Research and National Health Service.

The Centers for Medicare & Medicaid Services (CMS) have done some joint projects with the National Institute of Mental Health (NIMH).

That needs to be ramped up in a BIG WAY.

Now Cancer Practitioners tend to be a lot better @ this than Mental Health Practitioners. Surprise, Surprise Cancer Practitioners are getting more practical support.

A lot of amazing research is going on right here in COLORADO -- it sure would be nice to TRANSLATE that to COLORADANS.

The NIHR Imperial BRC Institute for Translational Medicine and Therapeutics (ITMAT) is the cornerstone of our approach to translation of pre-clinical research projects into therapies, techniques and medical products. The aim of ITMAT is to accelerate fundamental discoveries into improvements in human health and economic benefits. ITMAT is a virtual centre built on a number of core technology platforms across Imperial College London and the Imperial College Healthcare NHS Trust. ITMAT includes genomics platforms, imaging technologies and health informatics, along with the NIHR Wellcome Trust Imperial Clinical Research Facility (ICRF), and one of the largest tissue collections in Europe. As well as an annual funding call to support specific translational projects, ITMAT supports translational medicine through the following:

Health Informatics
We integrate multimodal clinical and ‘omics data to describe phenotypic variations and increase our understanding of patient biology and diversity. Our systems approach facilitates new knowledge of the causes and development of chronic human diseases, resulting in improved treatments, preventive approaches, patient stratification and personalised therapy. As part of ITMAT, the Data Science Institute offers powerful new tools and expertise to help clinical analyse, interpret and visualize large datasets. Routinely-collected clinical electronic data is being used collaboratively across 5 BRCs to answer research questions in Acute Coronary Syndrome (ACS), renal transplantation, viral hepatitis, critical care and ovarian cancer.
ITMAT Data Science Group
With BRC funding, ITMAT provides a talent pool of expertise in bioinformatics. This is composed of six domain data scientists (bioinformatics, genomics, software engineering, biostatistics, and imaging). The group is headed by Professor Robert Glen from the Department of Surgery and Cancer and co-led by Dr Elsa Angelini. The focus of the Data Science Group is to enable scientific discovery through the curation and sharing of data, advanced applications of computational methods, development of novel algorithms and software, implementation of analytical pipelines, and maintenance of existing software tools. In addition to having expertise in state of the art data analytics, the group has expertise in the use of high-performance computing (HPC) at Imperial.
Biobanking
ITMAT provides the resources and infrastructure to support tissue biobanking across the Trust, including through;

The NIHR BioResource initiative – a partnership between the BRCs in London, Cambridge and Oxford, and the Cardiovascular Biomedical Research Unit (BRU) in Leicester, aiming to increase the number of patients involved in research and appeal to the commercial sector.
The NIHR Health Informatics Collaborative (NIHR HIC) – a collaboration between Imperial, UCLH, Oxford, Cambridge, and Guy’s, to share and re-use data collected in the course of routine patient care for collaborative, translational research.

Metabolic Phenotyping
With the capacity to analyse more than 50,000 biofluid and 5,000 tissue samples per year, the Imperial Clinical Phenotyping Centre applies Nuclear Magnetic Resonance (NMR) Spectroscopy and Mass Spectrometry Imaging (MSI) to discover new disease biomarkers for real-time diagnostics and monitoring, ultimately informing clinical decisions.
Genetics and Genomics
We apply genetics, genome biology, genome technologies, and genome informatics to better predict patient risk before a disease develops, and create novel preventative strategies and treatment methods for a range of hereditary diseases. The BRC-funded Genomics Facility delivers high throughput sequence data, as well as support.
Imaging
With capacity and expertise in imaging technologies, we develop and apply novel diagnostic biomarkers and approaches to improve clinical decision making, predictive and prognostic biomarkers, and approaches for defining patient heterogeneity and improving patient management. We undertake first-in-man and deep phenotyping studies and co-ordinate studies using advanced imaging through the Clinical Imaging Facility.
Clinical Trials
With support from NIHR, the NIHR Imperial Clinical Research Facility occupies 1500 sq.m of the ground floor of the Imperial Centre for Translational and Experimental Medicine building on our Hammersmith Hospital Campus.

Bridging the academic and practice/policy gap in public health: perspectives from Scotland and Canada

This report highlighted a lack of coordination among federal and other agencies in developing capacity to use evidence appropriately and a number of research priorities that were disconnected from the needs of public health practice.

PHAC [Public Health Agency of Canada] was partly created to help overcome this ‘gap’ by upgrading the research and research-utilization capacity of the public health policy and practice community.

Riding the elephant

10/23/2019

I'm so angry with the Mental Health Profession, the Criminal Justice System and our Society -- I could scream.
Of course, that's how some prosecutors, judges and juries feel regarding some criminal defendants who come before them.

    This really goes to our theme of --- SUPPORT and our Insistence on SAFETY.

    It is NOT Safe to use an out-of-date diagnostic manual that the US National Institute of Mental Health determined lacked validity and UK and Canadian researchers have found "disingenuous" and bearing little relationship to brain scans.

   The concern is NOT that this won't be remedied @ some point -- it very likely will be.

BUT, it is not looking like it is going to be in time for people living now.

AND IT DOESN'T HAVE TO BE THAT WAY.

Researchers are already FAR AHEAD of CLINICIANS. Do they have all the answers -- NO. Do they have more than the CLINICIANS -- YES.

    We need to build our systems and processes to Translate evidenced-based Research into Clinical Practice. MEDICAID funding for that could transform Healthcare and bring down costs.

   Those costs are NOT just in Healthcare -- they are in the broader economy, counties, municipalities, the Community and the lives of individuals.

  We've been doing a lot of COST SHIFTING for a long, long time.

Science Up

The DSM 5 and its Divergent Critics

The Need for Adequate Processes & Enlightened Self-interest to ensure Cognitive disability housing & Placements

10/21/2019

Housing is traditionally NOT covered by Medicaid. Placements are not covered in sufficient quantity-- and that is probably a violation of Parity. This failure leads to Homelessness and Incarceration of people with Cognitive Disabilities.

HUD and most States, including Colorado, do SOMETHING with respect to providing HOUSING for people with Cognitive Disabilities.

By the Homeless Point In Time Count and EXISTING DATA of People with Cognitive Disabilities in Jails & Prisons -- IT IS WAY NOT ENOUGH.

MEDICAID

Colorado needs to seek a Medicaid Supportive Housing waiver along the lines of New York in which the State pays for the Housing
Colorado needs to fund Comprehensive Discharge Planning from Incarceration maximizing Assisted Living and Nursing Home Placements where Supportive Housing is not available and Individuals meet the criteria for Long Term Care.
A wide-range of Stakeholders need to push for Medicaid coverage of Supportive Housing and Elimination of the Institute of Mental Disease Rule for Individuals meeting the criteria for Long Term Care.

DATA

The FIRST THING: Those Cognitive Disabilities aren't limited to Mental Illness or Psychosis, they include Brain Injury, Developmental Disability, and Substance Problems and often combinations of such issues. We need on-going mechanisms to COLLECT THAT DATA.

PLACEMENT CHALLENGES

Further, most of the people "intended" the crimes they committed under a Traditional Analysis -- but they wouldn't have intended the crimes BUT for the Cognitive Disability -- and males are more @ risk than females.
Developing Placements for Males who may be big and strong and dangerous is a BIG CHALLENGE, especially when many of the people working in Mental Health and Health Care generally are women.
I think that is one of the many practical reasons this hasn't happened -- and the Disability Community has been in BIG TIME DENIAL that these are their folks. Further, humanity has been in BIG TIME DENIAL that these are their folks just as the Victims and the rest of the Community are their folks.
For people who need very high security, say couldn't safely stay @ CMHIP or Ft. Logan -- it may make sense to transform existing correctional facilities such as San Carlos but more therapeutic. That is NOT most prisoners, and most prisoners could step-down to Supportive Housing.

HOUSING & PLACEMENT PLANNING FOR HOMELESS & DISCHARGING INMATES

That's another thing -- the idea that we are DISCHARGING People with Cognitive Disabilities from Jail and Prison to Homelessness is INSANE.
If we care anything about SAFETY, we will provide for Comprehensive Discharge Planning from Jail & Prison.

HOMELESS PEOPLE and PEOPLE with COGNITIVE DISABILITIES BEING RELEASED FROM INCARCERATION have to be incorporated into Housing, Placement, & Service Design & Data Collection

The 4 BIG CAVEATS are:
- SAFETY of the PERSON & the COMMUNITY has to be maintained.
- The Housing, Placements and Services must be Evidenced-Based for State Funding for the protection of TAXPAYERS and the PERSON.
- Federal and State governments may fund research to investigate promising practices and treatments. There is a lot of opportunity for COLLABORATION with University Research Institutions.
- If the person has a cognitive disability without sufficient known treatment, the STATE MUST provide SAFE, THERAPEUTIC CARE and CUSTODIAL CARE if necessary.

There is a whole lot of ENLIGHTENED SELF-INTEREST in our PRESCRIPTIONS for EVERYONE.

SB19-222

Perhaps what really needs to be done is build on
SB19-222 which passed the CO Legislature in 2019.

MANY PEOPLE CHARGED WITH CRIMES ARE ALREADY ON SSI & HOMELESS -- WHAT DOES THAT SAY ABOUT OUR SERVICE DELIVERY & CRIMINAL JUSTICE SYSTEMS?

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

THE US' DISASTROUS AD HOC APPROACH TO HOUSING, SUPPORTS & PLACEMENTS FOR PEOPLE WITH COGNITIVE DISABILITIES

10/21/2019

  Cognitive Disabilities are so hard because we are extremely visually oriented -- so one has to be pulling in from different senses and reason to often pick up on the "disability." That doesn't mean those senses and reason are perfect or that there might not be some visual cues.

Some of those visual cues/ evidence are becoming more apparent with greater technology.

    Some of the VISUAL CUES/ EVIDENCE we have always had -- we tend to write off as the person is being a LAZY PERSON, a BAD PERSON, a MONSTER, or maybe TOO SENSITIVE or GULLIBLE. Folks, the PROOF IS IN THE PUDDING.

    In any case, not having visual cues and misreading the visual cues we have is a BIG REASON why I think we are suffering under the current BIG SHORTAGE of Cognitive Disability Housing, Supports and Placements.

ANOTHER BIG PROBLEM is that our SUCCESS in other areas is creating more people with COGNITIVE DISABILITIES, whether it is:

More people surviving from Brain Injury
The Old Friends Hypothesis -- destroying the Diversity of the Human Microbiome and our Immune System and ultimately impacting our Brains. The US is a country in which the majority of the population have low-grade INFLAMMATION.
Huge Substance Problems that we've been treating as Criminal Justice Problems, and are really HEALTH PROBLEMS. Those Substances impact the Immune System and the Brain, too.
The Trauma of Incarceration. That also impacts the Immune System and the Brain.
etc.

So often the question is not WHY but HOW.

States need to establish standing on-going processes to specifically bring HOUSING, SUPPORTS AND PLACEMENTS to scale for people with COGNITIVE DISABILITIES, and more broadly comply with Olmstead and the needs for HOUSING, SUPPORTS, and PLACEMENTS FOR PEOPLE WITH DISABILITIES.

The Alternative is the ad hoc approach we've been engaged in where Individuals, Families, Communities and the Criminal Justice System -- are left with the MESS.

By Zuzana Uhlíková

The Need for Housing & Placements for Thousands

SOCIAL IMPACT BONDS FOR HOUSING IN AUSTRALIA & NEW ZEALAND

10/19/2019

Housing is SO IMPORTANT and yet alone it is NOT ENOUGH.

The Consensus Service right now for people with significant disabilities is Supportive Housing.

For a large % of people with disabilities that will be an excellent fit.

For some people with Cognitive Disabilities there need to be options for "PLACEMENTS" both unsecure and secure.

Not always but more often than we think, people with Cognitive Disabilities may be requesting more SUPPORTED PLACEMENTS beyond SUPPORTIVE HOUSING.

In the Stanford Social Innovation Review, Filmmaker Nadine Pequeneza argues that Social Impact Bonds are doing more harm than good.

We think it important to recognize what social impact bonds are and are not.

They can be a practical and publicly acceptable way of funding urgent social needs.

They don't eliminate the need for good Program Design and Data-Driven Continuous Improvement or many other things.

THE ETHICS OF KNOWLEDGE & LACK THEREOF

10/18/2019

So our Criminal Law and the Mental Health Profession are really based on a number of ASSUMPTIONS.

    One of the ASSUMPTIONS underlying the CRIMINAL LAW is that the RULE is that people are "COMPETENT" for their INTENTIONAL BAD ACTS.

The Criiminal Law grants an exception for Mental Incompetency or Insanity.

Further, the Criminal Law ASSUMES that by PUNISHING ISOLATED, INDIVIDUAL BAD ACTS --- its going to get the SOCIETY to SAFETY.

   Well, one can certainly take people out of the game BUT problems of RECIDIVISM have long plagued the CRIMINAL JUSTICE SYSTEM and we can't kill our way or incarcerate our way out of this.

  The REALITY is that the VAST MAJORITY of people within the CRIMINAL JUSTICE SYSTEM have some form or various forms of COGNITIVE DISABILITY. This is NOT the EXCEPTION -- It's the RULE.

Further, those COGNITIVE DISABILITIES definitely include "Mental Illness" but they also include brain injuries, developmental disabilities, trauma and substance use issues.

  Well if we've got a SYSTEM based on getting to SAFETY via PUNISHMENT --- this becomes a HUGE problem and one of the reasons the SOCIETY has such a HARD TIME acknowledging REALITY.

BUT what if we take the MIDDLEMAN of PUNISHMENT out and just go DIRECTLY to SAFETY?

  That is a very different SYSTEM that SAFETY HAWKS and Civil LIBERTARIANS must wrestle through the DETAILS.

In a lot ways this involves UTILIZING LEGAL AVENUES we already have but are HORRIBLY UNDER-RESOURCED.

    LIMITED GUARDIANSHIP makes a lot more sense for a lot of people than the MERRY-GO-ROUND of the CRIMINAL JUSTICE SYSTEM.

Image Credit: Calvary Murrieta Christian Academy

AN AGE OF FALSE DICHOTOMIES

10/16/2019

[Wilma Mankiller, first Female Chief of the Cherokee Nation]

So 2 big False Dichotomies running through Human Rights Enforcement and the US Presidential Election:

Its Endless War or Abandoning our allies such as the Kurds and people around the world to horrible Human Rights Disasters
Its Capitalism or its Socialism

  Those just aren't the only ALTERNATIVES.

Further, when it comes to Capitalism and Socialism -- the pure forms of those economic systems failed during the 20th Century. Whatever we're needing is a mixture of the 2 and other practical policies to keep a global economy from running off the rails.

CONTEXT MATTERS

When I was younger I was very interested in PHILOSOPHY -- I still am, but HISTORY turns out to be a lot more important than I realized as a younger person.

    Further, Americans are often woefully IGNORANT of HISTORY and GEOGRAPHY while we're DEBATING the ETHICAL POINTS of War and Peace.

    Further, many people around the world including some of our Western European Allies are woefully IGNORANT of the HISTORY and HUGE COSTS of the HUGE ROLE the US has taken on in the World both in people and money.

Additionally, economic & climate change crises in Latin American countries are fueling a Migrant Crisis in the US.

  A THIRD ALTERNATIVE -- (which we sorta engage in) is collaborative and integrated efforts for EMERGENT HUMANITARIAN RELIEF and LONG TERM SUSTAINABILITY.

Further, Climate Change is going to mean that vast numbers of people need to relocate even without the complicated factor of armed conflict.

For the US, humanitarian and long term sustainability efforts do involve Latin America. They also involve the Kurds.

COMMON GROUND

   LONG TERM
Two big areas of common ground (and they are not the only ones) among people around the world are:

Social Determinants of Health
Sustainable Development

These largely represent LONG TERM STRATEGIES. There are other Long Term Strategies.

EMERGENT

Folks we are still dealing with the Genocide of Indigenous People in the Americas and Slavery of Africans
We're still dealing with the fallout from Colonialism in 2019.
The "MENTAL HEALTH IMPACTS" of our bad decisions are NOT just going to impact one generation -- they will impact many.
So addressing the Emergent Humanitarian Needs of People around the World -- can be a very effective LONG TERM STRATEGY but it is not enough if we are not also working on:
- The Social Determinants of Health
- Sustainable Development

Quote by Georgetown University Professor of Linguistics -- Deborah Tannen

False Dichotomy: A situation in which two alternative points of view are presented as the only options, when others are available.

National Institute for the Application of Clinical Behavioral Medicine

RIGOROUS DATA COLLECTION, ADMINISTRA-TIVE ENFORCEMENT, PLANS OF CORRECTION THAT AREN'T AFRAID OF "ROOT CAUSES"

10/15/2019

One of the BIG things in nursing home reform advocacy is STAFFING. Well, it is a BIG thing throughout human services and for that matter Big Box Stores.
When it comes to health and human services and education, those staffing problems can have serious consequences.
Of course, we don't have enough disability housing or placements either.

This all requires great amounts of DATA to thoroughly analyze how to fill the HUGE HOLES in our System in the US, Colorado, and probably for anyone else around the World concerned about these issues.

THE MAIN THING: It is what it is.

    Some policymakers have maybe not known exactly how concerning the DATA would be --- BUT they have a pretty good idea and that has led to resistance to even get the necessary DATA which really needs to come from independent organizations with which the State and/or Feds contract.

With Comprehensive Data, one can construct a Comprehensive Effectively working plan with Measurable Goals, Reasonable Time Frames and Funding to Support the Plan.

The First Step of Effective Administrative Enforcement may be Comprehensive Data Collection. Some of that is already going on in Medicaid and HUD.

  BUT we need Comprehensive Data Collection regarding people in Jails, Prisons and Homeless regarding disability needs, especially with respect to cognitive disability.

   I have a premonition that those disability needs include:

Housing
Placements
Intensive Services, and
Supported Employment

Special UN Rapporteur on the Rights of People with Disabilities says that Sustainable Development Goals depend on Disaggregated Data by Disability.

Disaggregate: to separate into its component parts

"CATEGORIES" AND HUMAN BEHAVIORAL BIOLOGY

10/9/2019

This is a very interesting video of acclaimed Neuro-endocrinologist, Stanford Professor and Author -- Robert Sapolsky on Behavioral Biology.
He really starts by questioning the use of "CATEGORIES" in our "REASONING" regarding Behavioral Biology.
   I'm not sure we get away from the need for "CATEGORIES" --- but it does seem pretty clear we are as Sapolsky argues MISSING THE "BIG PICTURE."
  That picture is that human behavior is caused by a lot of different things and those things are BIOLOGICALLY DRIVEN.
  So our poor use of "CATEGORIES" is NOT just a problem in discussions of pop science -- IT'S A PROBLEM FOR OUR SOCIETY.
It has led and it is CURRENTLY leading to some pretty amazing UNETHICAL CONDUCT by our Society -- especially given our current knowledge.
   Now a BIG part of that knowledge does come from SCIENCE -- but currently SCIENCE can't provide us all the answers.
    I think the need to use our REASON is part of what Sapolsky means by looking @ "THE BIG PICTURE."
    So we need SCIENCE AND REASON.
We would maintain, probably unlike Sapolsky, that we need -- FAITH to help us fill in the blanks the SCIENCE AND REASON don't answer.
SCIENCE, REASON & FAITH are NOT perfect and we must constantly revise them to accommodate new knowledge.
   Finally, we must use our SCIENCE, REASON AND FAITH to REFORM our CRIMINAL JUSTICE SYSTEM -- whose "CATEGORIES" couldn't be more "out of date."

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