Blog Archives

STATE FAILURE TO COMPLY WITH DISABILITY CIVIL RIGHTS LAWS-- THANK YOU STATE OF COLORADO

12/30/2019

Well, we have been negligent in our Thank You Notes to the State of Colorado:

Every time you see a Homeless Lawsuit, or
A person with Mental Illness gouging his eyes out in a Colorado County Jail, or
Law Enforcement & Prosecutors begging for more Judges, Jails and Prisons

We can thank the State of Colorado for that -- and their horrifically incomplete compliance with:

Olmstead
Mental Health Parity & Addiction Equity, and
Medicaid Network Adequacy.

A lot of places around the country are REDUCING the level of HOMELESSNESS.

For a lot of complicated reasons, that hasn't happened in COLORADO.

Homelessness is a big problem in a lot of places, it is often an even bigger problem in multiple areas around Colorado.

So theoretically we should have a PLAN with

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

to provide HOUSING for people with disabilities, INCLUDING COGNITIVE DISABILITIES, for those:

who are institutionalized and can safely be served in the community,
are at great risk of institutionalization,
are homeless, or
at great risk of becoming homeless

"Thank You Notes" -- Jimmy Fallon

"Tegridy Farms" -- South Park

It is often hard to talk about homelessness without also talking about Substance Use & Co-Occurring Brain Injury, Mental Illness, and/or Developmental Disabilities.

These are such COMPLICATED ISSUES and we treat them so SIMPLISTICALLY on bath sides of the argument.

We are in desperate need of moving towards an INDIVIDUALIZED MEDICINE APPROACH & TREATMENT and doing the necessary research on Substances such as Marijuana.

The Bottom Line: It looks like Marijuana can help some people, and hurt others.

The challenge for us as a Society is that people are often taking Substances (Legal & Illegal) because they don't feel good -- and they want to feel better.

Further, we are often not offering a lot of great ALTERNATIVES.

Of course, we always have the possibility of making things worse and with Substance Use -- we often do.

COMING TO TERMS WITH ADHD IN THE CRIMINAL JUSTICE SYSTEM

12/30/2019

If we had confidence in our mental health/developmental disability diagnostic process the push-back on ADHD might not be as great.

Further, some of these classifications have been refined, and they likely will be greatly refined even more. THIS is one of the reasons why BIO-MARKERS are so important.

ADHD is a BIG FACTOR in the Criminal Justice System often with co-occurring concerns.
Further, people with ADHD often are:

Smart, and
Hyper-Sensitive

    [retired global ADHD expert William
  Dodson, had the critical insight that for
many people with ADHD -- "Rejection
Sensitive Dysphoria" is a much bigger issue
than Inattention. Dodson was based in   Greenwood Village, CO],

Note also that Bipolar comes with "highly reactive cells" and is genetically related to ADHD
Impulsive

So when we look for BAD INTENT to explain that Impulsive Action -- we may very well find it.

So we've got our justification for PUNISHMENT -- but what we really need is to address ADHD as a Public Health Crisis.

What is ramping up the Genetic Risk for ADHD in the 20th and 21st Centuries?

smoking, and
high fat, sugary diets
With impacts that may not go away in the next generation, regardless of smoking or diet.

In addition to ADHD itself, ADHD paired with an impoverished background, neglect, and/or abuse can greatly increase criminal justice involvement, according to one Canadian study.

Of course, the goal is NOT just to keep people with ADHD out of jail or prison or the streets, it is to help them THRIVE -- and some people with ADHD are doing just that.

Kings College London

The Identification and Management of ADHD Offenders Within the Criminal Justice System:

A Consensus Statement From the UK Adult ADHD Network and Criminal Justice Agencies (2018)

ADHD -- A Public Health Crisis

ADHD: Crime & Prison Issues

ADHD: The Public Policy Implications for Public Health & Criminal Justice are Mind Boggling

ADHD, RECIPROCITY, REJECTION SENSITIVE DYSPHORIA, & DIFFERENCES IN INTENSITY

THE "BLURRED LINES" BETWEEN SOME DEVELOPMENTAL DISABILITIES & MENTAL ILLNESSES [& "SOME IDEAS" ABOUT GIFTEDNESS]

Understand-ing the connection between Prisons that make people worse AND Comprehen-sive continuums of care

12/26/2019

Colorado Inmate Theatre Production @ DU's Newman Center for the Performing Arts.

CO Dept. of Corrections Executive Director Dean Williams: "We've made prisons very stark, very idle, devoid of purpose, devoid of life, devoid of hope, and the people who live there get worse.

"There is nothing good for us as a state for the people behind the walls to get worse."

OBH's
Population in Need (PIN) Study

OBH is working with Health Management Associates on a behavioral health needs assessment and strategic planning process.

The goal is to identify behavioral health needs and gaps in services across Colorado.

We invite community members including individuals with experience receiving services, family members, care givers, advocates who support individuals with behavioral health needs, and the general public to take a brief survey.

Behavioral health providers are welcome to respond. However, in addition to this community survey, there will be a second survey in the coming months specifically for behavioral health providers. Please share this survey with your networks. The survey will be open until early March 2020.

In the Community, there is a lot of frustration with these needs assessments that often either don't go anywhere or the needs that are being documented are already well known.

Colorado has several thousand people with behavioral health needs that are homeless or justice involved.

That is a really, really tough problem.

It seems like we should already have a comprehensive, effectively working plan to address this or be working on one.

CHRISTIANITY ISN'T ABOUT FORGIVING PERFECT PEOPLE -- & THERE IS A CALL FOR JUSTICE

12/25/2019

By and large, humans have struggled with their natures -- sometimes as the Greeks viewing themselves as a combination of animals and the gods.

In the words of Joseph Campbell, you really don't want that Old Time Religion that was marked by Human Sacrifice and all manner of horrors.

Of course those "horrors" were in response to greater but partial awareness and a lot of horror in nature.

Many of the religions of the last 5 Thousand Years or so seem to be important STEPS UP.

When Human Beings saw bad things happening -- they had an Advanced but still Rudimentary sense of CAUSALITY. If some storm comes, that is because one of many or one god -- WILLED IT.

Well, that is a BIG SOURCE of our Criminal Law -- if there is a human bad act -- it's because some person INTENDED IT.

This does historically have religious elements and it has elements of science (empiricism) and reason, too.

So if we stop at the question of INTENT: we don't get to the BIOLOGY OF THE INTENT --- and that turns out to be a HUGE PROBLEM --- religiously, scientifically and logically.

Further, we end up with a Society marked by Mass Incarceration of people:

Brain Injury
Mental Illness
Substance Use Impairment
Developmental Disabilities
Trauma
Etc.

Moreover, we have really struggled with seeing Human Beings as ONE RACE, and if something is negatively impacting one group of people --- we probably need to pay attention to it, if nothing else out of our own self-interest.

So we're not adequately addressing the root causes of these issues as Public Health Challenges.

Which brings us back to the Christmas Story. Jesus isn't here to save PERFECT PEOPLE, he is here to save very flawed people, who often experience great injustice and may act unjustly to others.

THAT'S OUR WORLD.

Evolutionary Biologist Richard Dawkins doesn't want to live in a Darwinian World.

WHY WE ARE FOR BRINGING RELIGION IN FROM THE COLD

12/24/2019

First off, I'm not making these arguments with regard to religion because I think:

Religion is perfect, or
The Definition of Religion is consistent throughout Time.

The point I want to make in 2019 is that:

Science/Empiricism and Reason are not perfect, and
The Definitions of Science/Empiricism and Reason are not consistent throughout Time.

In a lot of ways Religion has suffered from the same brittle pretensions to certainty that are currently plaguing Psychiatry.

However, some of religion has been able to incorporate changing and evolving science. Further, some religion in our society really gets the PROBLEM of:

Demonstrable Cognitive Disability, and
Not Always Great Treatments
And at least in some cases, the Trauma, Inter-Generational Trauma & Depression are the result of a Highly Delusional "Meritocracy"
Further, brain injury and some forms of developmental disability are turning out to be much bigger factors in Justice-Involved people than previously realized.

The Legal System is trying to do some things but without more Support and Leadership from the Legislative Branch -- it remains pretty limited. That Leadership could come from many quarters, including religious communities.

So the point is that Religion, Science/Empiricism and Reason are NOT perfect, and we need all 3 to serve as checks on one another.

That doesn't mean that we won't still go off the rails -- but maybe we won't go as far as incarcerating large segments of the population.

Francis Collins headed the Human Genome Project at the National Institute of Health. We don't think Science and Religion have to be "at war." However, in 2019 we do think they are checks on one another.

New York Times -- Nov. 27, 2019

Susannah Calahan's:
"The Great Pretender"

"Pretensions to certainty can be seductive, eking out a temporary tactical advantage, but their victories are often brittle.

"Once the veneer of impermeability gets cracked, it “breeds an anti-science backlash born of distrust,” Cahalan writes.

"Instead of arrogance, her book counsels humility. As one Oxford psychiatrist haltingly puts it: “I think we should be honest about — acknowledge how limited our understanding is.”

Religion Has Evolved A Lot Over the Past 100,000 years &--
It Has Learned Some Things in the Process

It was 100,000 years ago that humans first began burying their dead, this is often considered a religious act.

A lot has changed.

Just as many are wanting to throw Religion on the Ash Heap history -- even as there are Billions of diverse followers -- and we live in a "Secular Society" -- we would argue "Religion" is an indispensable component to knowing and must be used in conjunction with Science and Reason.

In 2019, it has often been people of diverse faiths that have understood our Mass Incarceration Nightmare is WRONG.

VIEWING THE WORLD THROUGH THE LENS OF THE "GOOD PEOPLE" AND THE "BAD PEOPLE"-- IS PREVENTING US FROM SEEING BIOLOGICAL REALITY

12/23/2019

We Think Biological Forces are driving LAW ENFORCEMENT EXCESSIVE FORCE & AGGRESSION as well as other aggression in our society

The seemingly never-ending media accounts of Law Enforcement Excessive Force we would contend are really the Tip of the ICEBERG.

Well, maybe we need more TRAINING or Punishment for these officers.

Well, maybe.

When we think about human intent -- the inquiry often stops at did the person intend the act.

Most people did INTEND the act. Well, we need to punish them -- give them some serious consequences -- to fix this and serve as a warning to others.

    We can certainly take people out of the game -- but we often find the people we took out of the game have cognitive disabilities often as a result of Brain Injury, Mental Illness, Impairment from Substance Use, or Developmental Disabilities.

Further, many of the cognitive disabilities listed above are co-occuring in homeless and incarcerated populations.

Putting people with such complicated cognitive issues back in the game can be pretty complicated.

BUT what about those Law Enforcement officers and Excessive Force that is pretty endemic across this country and certainly Denver?

  The latest science is saying that we have "Aggression Neurons" and the number of those neurons increases with more Aggression.

We think that is a big problem for law enforcement and for some of the people law enforcement are policing -- and in both cases -- it goes both ways -- although often NOT in nice, neat, moral reciprocal ways.

Aggression: Humanity's Ultimate Double-Edged Sword

Karolinska Institutet, Sweden

Neuroscience News

High activity in a relatively poorly studied group of brain cells can be linked to aggressive behaviour in mice, a new study from Karolinska Institutet in Sweden shows.

Using optogenetic techniques, the researchers were able to control aggression in mice by stimulating or inhibiting these cells.

The results, which are published in the scientific journal Nature Neuroscience, contribute to a new understanding of the biological mechanisms behind aggressive behaviour.

https://neurosciencenews.com/aggression-neurons-9139/

SO MY POINT IS:

Our frightening problems with Law Enforcement Excessive Force may have a lot to do with the Biology of Aggression.

Law Enforcement often get a pass on this horrific behavior because there is an understanding we've put them in these situations.

Of course, the multiplying effects of Aggression don't just impact Law Enforcement -- they impact all of us, especially males.

BUILDING ON SB19-222

12/22/2019

One of the things that has happened over the course of the last 50 years is that basic disability civil rights concepts have been re-stated in numerous laws to address specific contexts -- :

Fair Housing
Section 504 of the Rehabilitation Act
Individuals with Disabilities Education Act (IDEA)
Americans with Disabilities Act (ADA)
Mental Health Parity and Addiction Equity Act
Strengthened Medicaid Network Adequacy Requirements

In a sense, Colorado's Landmark SB19-222 is a part of this tradition, trying to accomplish what is often already legally required but there is insufficient structure to accomplish the task.

Part of the Structure that Colorado needs and is legally required is contained in the 2011 US Department of Justice Guidance on Olmstead, requiring:

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

Further, Olmstead Planning doesn't work as a one-off ad hoc activity, it must be an on-going activity --circumstances are constantly changing. This is both a blessing and a challenge to state government-- and it will require resources to implement.

Medicaid resources could be sought to fund this on-going planning as well as the complicated Medicaid Re-Design the State needs to address:

Supported Housing
Comprehensive Continuums of Care
Housing, Services & Placements for Homeless and Justice-Involved people with cognitive disabilities

CO SB19-222 Individuals At Risk of Institutionalization

HOW MANY OF US WILL RAISE OUR HAND AND ASK FOR HELP?

12/21/2019

One of the things I do to fund Orchid is substitute teaching.

I'm a very direct person and in the course of my life -- I've certainly come up against the limits of that.

One of the things I've found is that asking students if they need help is often a non-starter. "No, got it. Don't need any help."

While that maybe true, often it is not.

Well, that's also true for adults and for myself.

"No, don't need any help -- got it, thanks."

To make life even more interesting, we can generally see where others need help much more than we see it in ourselves and some of this may be hardwired.

So as a mental health/cognitive disability advocate, when I see thousands of people with cognitive disabilities who are homeless and incarcerated -- I want to help the State provide the services, housing and placements needed to deal with this.

When the State says --- "SEE, SEE --- we did this fantastic Anti-Stigma Video" -- we do need to celebrate that.

We also have to re-focus on actually complying with the law and significantly reduce the number of people with cognitive disabilities who are homeless and justice-involved in our State.

THE BIG BLOCKS OF MEDICAID REFORM IN COLORADO & THE US

12/20/2019

Data Collection -- # of people within the State who need LONG TERM CARE as a result of a NEED FOR SUPERVISION.

Combined MI/SU Waiver -- including people with Substance Use Issues who need long term care as a result of a NEED FOR SUPERVISION

Supported Employment -- All Adult Medicaid Long Term Care Waivers should have a SUPPORTED EMPLOYMENT component for those who would like to take advantage of it.

Housing & Assisted Living -- All Adult Medicaid Long Term Care Waivers should have a Housing Component -- most do with respect to Assisted Living. This becomes very problematic when ALRs are NOT making reasonable accommodations for Cognitive Disabilities as required by Law.

Maintain a Waitlist of People in the Waiver Programs who desire Supportive Housing.

CO Medicaid Workgroup on Reasonable Accommodations for Medicaid Providers, especially placement providers such as Assisted Living & Nursing Homes.

There should be no involuntary HOMELESSNESS of People who need Long Term Care as a Result of a Need for Supervision. Anything else is DISCRIMINATION -- which is what we have now.

Determine Need for Secure Bed Space -- as long as we're pretending there are no people with cognitive disabilities in jails & prisons -- this isn't a problem. Once we have the courage to face reality -- it is an issue. This isn't just MI -- it's brain injury, substance use and developmental disabilities.

ORCHID PLANS: ALWAYS OPEN TO REVISION

12/14/2019

FAMILY PRIORITIES

My husband was diagnosed with Stage 4 Metastic Lung Cancer this fall -- this for a man who has never smoked a day in his life.
He has a genetic mutation and is taking a PILL -- it seems to be working
This is a very THANKFUL HOLIDAY SEASON for us

INDIVIDUAL ADVOCACY

We're not going to be able to provide that anymore. [Of Course, what we were providing was pretty limited anyway]
We realize that is pretty cold comfort to individuals & families.
We will be prioritizing the INCREASE of such ADVOCACY RESOURCES in the Community & welcome suggestions or proposals we could SUPPORT and/or take to others.

Colorado Cognitive Disabilities Report 2020

This will be going out under the Orchid banner by the end of the year.
Some have indicated they are willing to review.
What we are looking for are:
- Objections
- Inaccuracies, and/or
- Omissions
We may or may not change the base report based on Feedback -- but we most likely will note the Feedback within the Report. That could be for a lot reasons:
- We don't agree with the Feedback,
- We don't have time to make wholescale substantive changes
- Etc.
- If something is just WRONG -- we will work to correct that.
There likely will be a follow-up report for 2021 -- and some suggestions may be more fully included in that report.

1st Quarter 2020

Much more concentration on upstream Systemic Issues in the US
Finishing & Sending our Letter to the Criminal Law Section of the American Bar Association regarding problems with the DSM 5 and RELEVANCE to the American Criminal Justice System.

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