Blog Archives

INTEGRATING PHYSICAL & MENTAL HEALTH CARE ---- RATIONALLY

12/14/2020

   Whether we're talking genetics, epigenetics, lead exposure, maternal immune activation or trauma or emotional flooding ---- we're talking biology.

    Once you start talking BIOLOGY -- you realize how SERIOUS & DIFFICULT this really is --- and how much SUPPORT people are likely to need.

BUT if we don't INTEGRATE Physical & Mental Health Care ---- We don't have to deal with that and we can just keep incarcerating people with cognitive disabilities 'til the cows come home.

NOW when I say INTEGRATION what I am referring to is: A Common Understanding that Cognitive Disabilities / Mental Disorders generally are MULTI-DIMENSIONAL with one those DIMENSIONS being BIOLOGIC.

    We're NOT talking about excluding Social or Environmental Factors --- but if we don't believe those Social or Environmental Factors have real Biological Consequences then HARSH TREATMENT is often a Result.

We have a lot of FUZZY thinking about this in the SOCIETY and among PROFESSIONALS. If we want to debate biology and environment, let's debate it --- BUT these FUZZY IDEAS are causing a lot of harm.

On a related front, It's getting harder and harder to act SHOCKED over the FAILURE of CURRENT SYSTEMS.

BUT to change them requires a significant re-allocation of TIME, ENERGY & RESOURCES and a DATA-DRIVEN RE-IMAGINING of what we're doing.

In his book "Behave: The Biology of Humans at our Best and Worst," acclaimed neuroscientist Robert Sapolsky argues for the primacy of BIOLOGY across human behavior.

Sapolsky is a professor of biology, neurology and neurological sciences at Stanford -- Wikipedia

We have recognized from the get-go that the Free Will vs. Determinism Debate is NOT essential to Criminal Justice Reform --- BUT it hangs like a shadow over it.

In the past, we've taken the position that the Free Will vs. Determinism Debate is an ANCIENT CONSTRUCT -- We need to step out of it and engage in some DIVERGENT THINKING.

More recently, we've made arguments that BEHAVIOR IS what it IS in the present --- and "IMPROVEMENTS" have to come in the "FUTURE" --- which they can --- BUT if they don't the likelihood that we've MISSED SOMETHING is probably great.

Further, "INTENT" as the arbiter of morality is becoming more and more problematic, especially as behavior is more and more tied to the innate and adaptive immune systems and other systems of the body as well.

On the other hand, "INTENT" may be a good arbiter of SAFETY.

Finally, the FREE WILL vs. DETERMINISM DEBATE is an admittedly interesting and rock bottom DEADLY PARLOR GAME.

"BEHAVING WISELY" ----OFTEN INVOLVES A FAIR AMOUNT OF DIFFICULTY AND RE-ALLOCATION OF TIME, ENERGY & RESOURCES

12/12/2020

   A big part of Orchid began with the idea that MENTAL HEALTH housing, placements and services are NOT CHEAP.

Further, like a lot of things --- the better you get at --- the less difficult it becomes.

BUT in 2020 Mental Health / Cognitive Disability housing, placements and services are NOT CHEAP.

    Beyond that -- Cognitive Disability Housing, Placements and Services are a lot more complicated than a vaccine for COVID-19.

    WE NEED THAT OLMSTEAD PLANNING.

Abba Solomon Meir Eban was an Israeli diplomat and politician, and a scholar of the Arabic and Hebrew languages. During his career, he was Israeli Foreign Affairs Minister, Education Minister, Deputy Prime Minister, and ambassador to the United States and to the United Nations. Wikipedia

THE NEED TO GO BEYOND LAW & PSYCHIATRY TO --LAW & MEDICINE

12/11/2020

    We are in a Crisis in our Society and certainly a Crisis in Criminal Justice.
We had demonstrations in the streets this Summer and Fall due to anger and frustration over not only Law Enforcement brutality but a Criminal Justice System that just doesn't seem to work.
Democrats like Obama are counseling activists to TONE IT DOWN -- that DEFUND THE POLICE stuff turns people off.
Well there is a lot to MESSAGING but we are at MULTIPLE CRISIS POINTS being forced to RE-IMAGINE what we're doing.

When in Law School 30 years ago --- "Law & Psychiatry" seemed cutting edge. It doesn't anymore.
There are a lot of reasons for that, but the SCIENCE OF BEHAVIOR has galloped past sole concerns of the BRAIN & the CENTRAL NERVOUS SYSTEM to multiple other systems of the body.
At this same time, we haven't funded the TRANSLATIONAL RESEARCH SYSTEMS needed to keep psychiatrists, or immunologists, or gastro-enterologists or endocrinologists up to speed on this FLOOD of INFORMATION coming out of the RESEARCH INSTITUTIONS.

  Further, all this is critically relevant to the Criminal Justice System and the parties within it.

   We've mentioned before BURDEN of PROOF issues that are HUGE and need to be considered ACADEMICALLY and in the COURTS.

  But right now what we need more than anything are:

Housing
Placements, and
Intensive Services, including Supported Employment

brought to SCALE to meet the NEED.

"This volume is the product of an NIH Human Microbiome Project grant. It represents three years of conversations focused on consensus formation by the twenty-seven members of the interdisciplinary Microbiome Working Group."

Personality Disorders, Developmental Disorders --- Conceptualization Matters --- It Matters A Lot In The Criminal Justice System

THE CHALLENGE OF EXECUTIVE FUNCTIONING DIFFERENCES

12/10/2020

AFFECTING MULTIPLE DOMAINS OF FUNCTIONALITY BUT OFTEN WITH AVERAGE OR ABOVE AVERAGE IQ

Incarceration of people with Cognitive Disabilities, often Executive Functioning Differences, is really born of desperation and frustration.

As far as "INTENT," most of these people did "INTEND THE CRIME." Further, that "INTENT was often fueled by significant EMOTIONAL DYSREGULATION.

Certainly the people themselves are often more frustrated than anybody.

There is "COACHING" and some Software Programs, but I'm not sure that is enough.

We need specialized Translational Research targeted to Criminal Justice Populations to hone in on Executive Functioning Differences / Deficits in a systematic manner.

Maybe that is coaching, it might also be innovative microbiome or immune treatments (Fruits & Vegetables probably will help -- but they probably won't be enough).

These "dysregulations" do not discriminate and can affect "people" whether they are in the citzenry, immigrant population or law enforcement.

Executive Functioning & Innovative Programs

Executive Functioning & Maternal Immune Activation

Executive Functioning &
The Microbiome

THIS IS NOT EASY, IT IS NOT CHEAP & IT'S MORE THAN COMMUNITY SERVICE

12/10/2020

I don't know if you've ever had the experience of meeting someone who reminds you of yourself and then thinking ---- OMG -- so that's how I come across!
One of the reasons I'm so passionate about Criminal Justice work is ---- I can often understand both where people are coming from and why society's prescription is not gonna work or be enough.

If we think the underlying problem is a "MORAL PROBLEM," --- then maybe "COMMUNITY SERVICE" or some type of "MORAL EDUCATION or THERAPY" --- will be SUFFICIENT.

BUT what if that isn't the problem?

What if the person is struggling with developmental and/or acquired differences in EXECUTIVE FUNCTIONING ?

Honing in on EDUCATION and WORK AROUNDS and ACCOMMODATIONS for those EXECUTIVE FUNCTIONING issues is often what is needed.

A lot of "MENTAL ILLNESSES" start out as DEVELOPMENTAL DIFFERENCES that were not picked up in K-12.

Further, psychiatric and inflammatory disorders are relatively common in our society so we may think we understand the LEVEL OF DISTRESS someone is experiencing --- when we really don't.

We're using this quote in an IRONIC way, and what we're trying to get at is we're NOT going to stop RECIDIVISM if we underestimate the challenges and we don't see them coming.

It's hard for ADVOCATES to say these things -- BUT we can't keep setting people up for failure, either.

A lot of those challenges come in the form of EXECUTIVE FUNCTIONING DIFFERENCES in:

activation & initiation
planning & organizing
emotional regulation
etc.

"Emotional Flooding" certainly common with ADHD but other disorders as well --- I think it is at the ROOT of a lot of CRIMINAL JUSTICE problems.

Further, I would argue --- it is NOT JUST A FLOOD of EMOTION --- there is information in there, too.

That's the UP SIDE to all that --- and it is often found in ARTISTIC, CREATIVE or ACTIVIST INSPIRATION that may need SUPPORT in unpacking, planning and organizing.

"PRO-LIFE" AS A PROGRESSIVE ISSUE

12/9/2020

"Meritocracy" and our "Specialness" Culture (only a very few are "Special" and worthy of love, respect, consideration, whatever) have created a living nightmare in many cases.

For all those economic progressives like myself --- the way to REAL TRANSFORMATION is through the ABORTION DEBATE.

I'm NOT talking about using the CRIMINAL LAW to address ABORTION --- but I am talking about using DATA and VOLUNTARY SUPPORTS to address the issue.

This Culture, like many before it, values MONEY & RESOURCES before HUMAN LIFE.

That is perhaps the EASY, SCAPEGOAT formulation of the issue --- it is NOT EASY to address issues that are often on-going in nature and require enormous amounts of SUPPORT -- at least in 2020.

Further, we've created a CULTURE in which it seems EASIER to hate on Racial Minorities or Immigrants than it is to say we fear for our own ECONOMIC SECURITY.

A "Pro-Life" Culture based on SUPPORT rather than PUNISHMENT seems to be what a lot of Americans really need.

What's the Point?

Gladwell is a little utopian in his belief that SOMEDAY we will get to that Meritocracy --- even if we're not there now.

THE GOOD SAMARITAN, MARIA BAMFORD AND MENTAL ILLNESS

12/8/2020

The Maria Bamford video to the right raises the moral dilemma for many people, including many people with mental illness ----
"There's a homeless person in my path who has severe mental illness and/or substance problems and/or brain injury -----
WHAT'S MY MORAL OBLIGATION?"
I would submit the "Good Samaritan Story" is the EASY CASE.
Most of us could pretty easily call 911 for help for someone who was physically injured in some way --- even if the person was a STRANGER or even a member of one of our OUT-GROUPS.
When we are talking about:

Mental Illness
High IQ Developmental Disability like ADHD & AUTISM,
Substance Use, and/or
Brain Injury, and/or
Homelessness, and/or
Incarceration

    We are often talking about "IMPAIRMENTS IN MULTIPLE DOMAINS OF FUNCTIONALITY." That is how the National Institute of Mental Health describes Mental Illness and it seems to be roughly accurate for many COGNITIVE DISABILITIES.
    Well, I have called 911 for a chronically homeless Black man in his 50s with schizophrenia and substance use problems and he was taken to Denver Health --- and released in a few hours because some of his problems involved substance use.
  Subsequently, in an intoxicated state he broke into a garage and was arrested.
He'd been arrested before, many times, and there were pleas of guilty (he would argue just to get out of jail but nonetheless the convictions were there and some of them were serious.)
His public defender requested a competency exam and our chronically homeless guy with schizophrenia and substance problems and record was sent to PUEBLO -- the Colorado Mental Health Institute @ Pueblo (CMHIP).
That turned into a FIASCO and a HALF. Our guy wouldn't talk to the examining professionals in Pueblo --- he was TOO PARANOID.
Unfortunately, the examining professionals were NOT TOO COMPETENT. They issued a report diagnosing our guy with ANTI-SOCIAL PERSONALITY DISORDER without having examined him.
How do I know that our guy had "Schizophrenia" --- prior medical records had been obtained and a social security attorney had obtained SSI for our guy on the basis of "Schizophrenia."

MYTH BUSTING #1: If we just get the person on SSI --- everything will work out. SSI can help, BUT it is NOT HOUSING or a PLACEMENT and it is NOT INTENSIVE SERVICES.
The more serious the IMPAIRMENTS the more this is a problem.
It can be quite shocking to realize the number of people who are incarcerated who are already on SSI when not institutionalized.

MYTH BUSTING #2:  A showing of SMI (Serious Mental Illness) is the same as proving INCOMPETENCY under most Criminal Law ----- WRONG.

Further, Substance Issues are even more disfavored under the Criminal Law.

"Competency" is one of many places where the Criminal Law goes off the rails and it is very tied to the MENTAL ELEMENT of the CRIME or MENS REA.

  A lot of these "COMPETENCY STATUTES" were a Big Step Up at the time --- now they cannot RATIONALLY deal with the FIRE HOSE of information that is coming out of the research institutions regarding BEHAVIOR.

WHAT'S THE POINT?

Even though our guy had complex mental health issues and trauma issues ---- it wasn't clear that he was "INCOMPETENT" under Colorado's Competency Statutes.

He was sentenced to 24 years TO DO ---- because he had received "a lot of chances."

Warning: Language

Maria Bamford
"Strange Lessons from the Bible"

"The Good Samaritan" by Stephen S. Sawyer on Lord's Art

Photo Credit: "Brother's Keeper" film (2015)

Why as a "SOCIETY" do we drone on about "PERSONAL RESPONSIBILITY"

We often don't have the answer, and/or
The most LOGICAL, RATIONAL ANSWER is going to be DIFFICULT and EXPENSIVE and "maybe" LONG TERM.

If we find ourselves preaching "PERSONAL RESPONSIBILITY" to people with IMPAIRMENTS IN MULTIPLE DOMAINS OF FUNCTIONALITY --- it's time to look in the mirror.

Legal questions of competency are often DIVORCED from the BIOLOGICAL and ENVIRONMENTAL / SOCIAL and AGE issues of the person.

Our current system tends to punish older people with cognitive disabilities who have been in and out of our "FAILED SYSTEMS" ---- MORE because "THEY HAD A LOT OF CHANCES."

Further, we would argue COMPETENCY is not the right question anyway.

It's an OUTDATED ATTEMPT to deal with COMPLICATED REALITIES but it is TOO SIMPLISTIC given our current knowledge.

We need to FUND that PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE.

This is what it means to be the GOOD SAMARITAN in the 21st Century and it's NOT EASY.

KEEPING EVERYONE'S HEAD ABOVE WATER -----INCLUDING PEOPLE WITH EXECUTIVE FUNCTIONING DEFICITS / DIFFERENCES

12/3/2020

One of the many problems with our discussions of FREE WILL and "PERSONAL RESPONSIBILITY" is they run to THE PAST.
They run to the past NOT because that makes most sense from a CHRONOLOGICAL or LOGICAL perspective ---- BUT because our SYSTEMS of "ACCOUNTABILITY" & "PUBLIC SAFETY" ---- PRESUME IT.
So if we don't PRESUME FREE WILL and "PERSONAL RESPONSIBILITY" ---- it is NOT CLEAR what system we're going to use.
AND MOST PEOPLE DID "INTEND" THE CRIME.
BUT if we start noticing that a lot of the people who intend crimes tend to have EXECUTIVE FUNCTIONING ISSUES, especially PROBLEMS with EMOTIONAL REGULATION.
What are we going to do with that?
One of the BIG CHALLENGES for this SOCIETY and Many People In It --- is including people with executive functioning challenges in the Society, allowing them to:

work at their HIGHEST SKILL LEVEL, while also
WORKING AROUND & ACCOMMODATING those differences

This SOCIETY is a TORTORE CHAMBER for people with INVISIBLE Executive Functioning Differences:

that often DON'T KNOW they have those DIFFERENCES;
are often average or above intelligence in other respects, and
are having to work MUCH, MUCH HARDER than some to keep their heads above water.

Employment Index

Coming To Terms with the Criminal Justice System as the Provider of Last Resort for People with Disabilities

STEPPING UP OUR GAME ON INTEGRATION OF PHYSICAL & MENTAL HEALTH CARE ----WHAT DOES THAT MEAN?

12/2/2020

REMEDIAL EDUCATION & TRANSLATIONAL RESEARCH & MEDICINE AT THE TOP LEVELS

Lay people being frightened by the INCOMPETENCE of PROFESSIONALS or anybody or any of us for that matter is nothing new.

1st BIG RED FLAG

2013: US National Institute of Mental Health calls out DSM 5 as lacking scientific validity largely because the diagnostic manual is not tied to biological measures.
American Psychiatric Association pushes back.
Clinicians largely don't understand the issue if they know about it at all.

2nd BIG RED FLAG

In the Interim, research linking mental illness as well as other cognitive disorders to the IMMUNE SYSTEM and the MICROBIOME has been piling up.
Maternal Immune Activation during pregnancy is associated with with a number of mental health conditions.
There are a long list of things that can damage the immune system impair cognition from:
- Trauma
- Altitude Induced Sleep Apnea
- Environmental Toxic Substances
- Substance Use
- Etc.
Clinicians are overwhelming NOT up to speed on this. What's really surprising is some Academics & Researchers aren't either.
We are talking about an ENORMOUS VOLUME of Material that OUTPACED Clinicians' ability to keep up with it a long time ago.
But it is NOT uncommon now to see that an ACADEMIC or even a RESEARCHER who pretty clearly isn't aware of some of this research.
At this point, we have to come to terms with a FAILED TRANSLATIONAL RESEARCH & MEDICINE SYSTEM for Psychiatry.

3rd BIG RED FLAG

It has gotten harder and harder to ignore that Clinical Psychiatry hasn't progressed very much in the last 25 years.
What's Clinical Mental Health's problem according to some Clinicians and Mad In America: the Biomedical Model.
So ENVIRONMENT, EXPERIENCE is a BIG, HUGE ASPECT of Mental Health and we would argue one of the reasons it is SO HUGE is because of IMMUNE SYSTEM ABNORMALITIES.
The above is our TAKE, our CONJECTURE but the IMPORTANT thing is that ENVIRONMENT is NOT DIVORCED from BIOLOGY.
If we can't recognize the IMPORTANCE of ENVIRONMENT we've MISSED the BOAT --- but if we don't UNDERSTAND its INTERACTION with the BIOLOGY --- we're outside of MEDICINE.

The Economics of Bringing Mental Health Practice In Line with the March 2019 Editorial in Frontiers of Psychiatry & Current Research

CO's Special Session & the Stimulus Check --- Addressing Coronavirus economics & Ultimately Mental Health

12/1/2020

There is little question Colorado is a head of the curve in dealing with the ECONOMIC aspects of CORONAVIRUS.

Those ECONOMIC ASPECTS & EMOTIONAL ASPECTS are INTRICABLY LINKED to:

Mask Wearing, and
Social Distancing

If we can't HEAR & UNDERSTAND how ECONOMICALLY & EMOTIONALLY DIFFICULT this has been for people --- those people are going to TUNE OUT those important but often ineffective health care messages.

        Those health messages are failing NOT because we haven't tried to SHAME people enough.

    In authoritarian countries like China you can just mandate mask wearing and stay at home orders relatively easily and imprison anyone who doesn't comply.

In the US ---- it's very hard and you must deal with underlying ECONOMIC and MENTAL HEALTH complicating problems of the PANDEMIC.

    This PANDEMIC has been a lot harder than we were prepared for. This Special Session acknowledges that and seeks to provide some real practical relief.

9 News (Nov. 29, 2020) -- Colorado Special Session

The Colorado General Assembly plans to take up legislation to help families and small businesses in the session that starts Monday.

Polis' $375 Stimulus Check

Polis' official action is important on many levels --much needed support to individuals, an example to other States AND importantly a PUSH to the FEDS to GET MORE FEDERAL STIMULUS out the door.

Forward>>

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