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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

BRINGING STATES TO OLMSTEAD COMPLIANCE --- CO CaSE In POINT

9/17/2020

Colorado is an interesting case in point with regard to treatment of Cognitive Disability and People who are Homeless and/or in the Criminal Justice System.

Prior to Covid, Colorado was one of the top economies in the Country. Colorado politicians love to tout that as they failed to comply with Olmstead.
Because of our economy, Colorado is a lot less sympathetic than some poor states.
Coloradans are of two minds when it comes to gun control --- BUT both sides have significant problems:
- Gun control is NOT a SUBSTITUTE for the MAJOR INVESTMENTS in Housing, Intensive Services and Placements that this State Needs and that are Legally Required for people with cognitive disabilities.
- Things can be pretty out of control in this country when it comes to Guns & Behavior. Further, Mental Health Professionals don't have a perfect handle on it --- and we haven't made the necessary investments in Translational Research & Medicine to deal with this.
Colorado has been sued A LOT when it comes to its Mental Health Programs ---- for good reasons. Further, Colorado and a lot of States are primed for Olmstead Lawsuits --- IF ADVOCATES CAN GET THE RESOURCES --- That's a big if.
- Further, suing during Covid maybe isn't the best strategy.
- Of course, nobody is against doing this the EASY WAY -- let's just all work together.
Colorado SEEMS to have a fair amount of RESISTANCE to Olmstead Compliance even under Polis --- WE NEED FEDERAL LEADERSHIP
There are a lot of states out there and people with cognitive disabilities and their families need FEDERAL LEADERSHIP to overcome obstacles to State Olmstead Compliance.

It would be ridiculous not to acknowledge the unprecedented challenges of Olmstead Compliance during a time of Covid.

The problem is we're more than 20 years out from Olmstead --- and conditions are NEVER PERFECT.

Olmstead and the ADA (Americans with Disabilities Act) are very much about what is "REASONABLE."

What has been "UNREASONABLE" about State attempts at Olmstead Compliance --- they have failed to have:

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

We NEED to have those components to State Olmstead On-going Planning.

What is "REASONABLE" in terms of

Measurable Goals
Time Frames, or
Funding

Can change based on a lot of factors.

BUT JUST NOT taking the trouble to make those reasonable:

Measurable Goals
Time Frames
& Funding to the Support Plan (even if that is extended because of Covid -- and there should be on-going and modifiable planning)

Is Clear NON-COMPLIANCE.

FUNDING HUMANE TREATMENT

9/16/2020

There is plenty of SUFFERING in the Criminal Justice System on all sides.

There are a lot of aspects to addressing that suffering. A very important aspect is bringing housing, intensive services and placements to SCALE to meet the NEED.

One of the things that psychiatrists are sometimes fond of saying -- and I actually agree with ---
- "When you've seen one case of Schizophrenia or Bipolar Disorder -- you've seen one case of Schizophrenia or Bipolar Disorder."
There are Immune Connections to a whole lot of things --- we've certainly understood that with infection and cancer, but it is really in the last few years we're connecting the Immune System to Social Behavior, Intelligence, Developmental Disabilities, Psychiatric Disorders, Brain Injuries and Substance Issues.
That's a lot to ADD to the KNOWLEDGE BASE.
But it is NOT just ADDING ALL OF THAT to the KNOWLEDGE BASE of CLINICIANS --- it's ADDING that KNOWLEDGE to INSTITUTIONS of the SOCIETY, POLICYMAKERS, Other Professionals and Individuals & Families.
There is a DISTINCTION between:
- Understanding an issue or problem is more complex than we thought ---
- AND having a COMPLETE UNDERSTANDING or an UNDERSTANDING SUFFICIENT for an ADEQUATE REMEDY in all cases.
The "IDEAS" around:
- Danger to Self or Others,
- Gravely Disabled

 Are largely good.

BUT we just don't fund the Housing, Intensive Services, and Placements that people need.

Further, a lot of people, including a lot of clinicians --- are really in over their heads when dealing with some people in the Criminal Justice System.

It's very easy to check that "Anti-Social Personality Disorder" BOX --- when your own PSYCHIATRIC MANUAL is OUT OF DATE.

We need policymakers to ensure that people in the Criminal Justice System are treated humanely as we come to grips with Human Behavior that is even more complicated than we thought --- and we already thought it was complicated.

Roddy Ricch -- The Box
"Please Excuse Me for Being Anti-Social"

THE CRYING NEED FOR STATE OF THE ART MEDICINE, HUMILITY & OPEN DIALOGUE

9/14/2020

BEYOND PRO-PSYCHIATRY & ANTI-PSYCHIATRY

  People are so STRESSED by the COMPETITIVE NATURE of the SOCIETY as well as ECONOMIC & POLITICAL PRESSURES --- they can't really do a GOOD JOB.

They have also had to erect a lot of BOUNDARIES to SURVIVE emotionally and economically.

   That's true in LAW --- It's true in Mental Health. It's true in most of American Society.

With most JOBS -- the GOAL should really be to WORK OURSELVES OUT OF A JOB -- GET TO THE ROOT CAUSE OF THE PROBLEM --- and move on to the NEXT.

  We're not in danger of running out of problems.

I recently came across an Initiative of the American Psychiatric Association --- I was excited --- I thought it was going to be about getting on top of the latest science.

This new APA Initiative was about marketing and expanding one's business. I just wanted to cry . . .

In fairness, the APA does have Educational Initiatives -- BUT they seem so far behind and propriety in their RESISTANCE to acknowledging that the DSM 5 is not only OUT OF DATE --- IT'S DANGEROUS.

PROVING that the Mental Health Profession isn't really on top of it -- isn't really that hard, BUT THAT'S JUST THE TIP OF THE ICEBERG --- talk about COLD COMFORT.

There's A LOT OF HEAVY LIFTING HERE:

Modern Societies and increasingly developing societies have an increased incidence of autoimmune disease and depression, and likely other psychiatric disorders as well.
These psychiatric disorders involve multiple complex systems of the body, including not only the Brain, but also the Immune System, the Endocrine System and the Microbiome.
The FACTORS that can impact these systems of the body are LEGION.
How these FACTORS play out is HIGHLY INDIVIDUAL and demands PRECISION MEDICINE of the HIGHEST ORDER.

Even if the APA and Psychiatric Establishment got up to speed -- TODAY -- there's so much work to done and so much DAMAGE to be undone, especially in the Criminal Justice System.

A lot of "getting up to speed" is recognizing how COMPLICATED this really is --- and How some of our toss off "personality disorders" have done so much damage.

We can't change the past, BUT we can work in the PRESENT to REMEDY as much as we can.

We NEED NOW:

A Public Health Approach to Criminal Justice -- Olmstead Planning could help get us there; and
Major Investments in Translational Research & Medicine, involving:
- National Research Institutions
- University Research & Teaching Hospitals, and
- Clinicians

New York University, Clinical and Translational Science Institute

Finnish Mental Health Approach: "Open Dialogue"

Integrating BIOLOGY and the FULL SPECTRUM of ENVIRONMENT

Those Soft Concerns like Environment, and Soft Treatments do have Biomarkers.

Understanding the COMPLEX DYNAMICS we're faced with:

BIOLOGIES WE WERE NOT EXPECTING:
- a Human Being and other animals that are NOT individuals the way we thought, but ECO-SYSTEMS and can't function well without a healthy and diverse MICROBIOME;
- an immune system that controls "social behavior" -- who would've THUNK IT.
COMPLEX ENVIRONMENTS: we're tethered to our Social Environments in very COMPLEX ways, including BIOLOGICAL WAYS with BIOMARKERS
NOT HAVING ALL THE INFORMATION WE NEED: To really understand what is working and not working for people, we must have OPEN DIALOGUE
THE MAJORITY. The Majority often thinks what it is doing is working because it is working for the "MAJORITY" --- if it's not working for the INDIVIDUAL PERSON [microbiome and all] --- it's not working.

THE CRYING NEED FOR RAMPED UP SYSTEMATIC TRANSLATIONAL RESEARCH & MEDICINE IN US MENTAL HEALTH

9/13/2020

Some popular websites are starting to address the Immune System Connection to Mental Health a little more seriously.
This is probably 5 years or more after the UK. Of course, some of the STARS of this research are in the UK ---- but STILL --- this has been SLOW to catch on in the US.

That's regrettable --- but in the US --- Mental Health is both the Step-Child of Medicine and the 900 pound gorilla in the Criminal Justice System.

The fact that US MENTAL HEALTH PROFESSIONALS might not, probably can't distinguish between:

Complex behavioral issues involving not only the Brain, but also the Immune System, the Endocrine System and the Microbiome and
An Archaic Personality Disorder Classification of "Anti-Social Personality Disorder"

RUINS Lives Every Day in this Country. Further, those are often the Lives of Poor People and People of Color.

Right now --- Mental Health private and public practitioners are very ISOLATED and are not thoroughly INTEGRATED with the REST OF MEDICINE.

That's a HUGE PROBLEM for psychiatric and behavioral disorders that appear to have a LARGE IMMUNOLOGICAL COMPONENT.

We need to be FUNDING:

Greater Multi-Disciplinary Translational Research & Medicine at the Nation's University Research & Teaching Hospitals
Integrate Clinicians into that process as the UK is trying to do
Fund an integrated PUBLIC HEALTH APPROACH to Criminal Justice. (Our level of KNOWN IGNORANCE is FAR TOO HIGH to engage in the HISTORIC PUNITIVE MEASURES of the Criminal Justice System.)
Ironically, our widespread MENTAL HEALTH CRISIS and OPIOID CRISIS and other Crises --- may provide a MAJORITY that not only sees but feels the need to adopt a PUBLIC HEATH APPROACH to Criminal Justice WITHOUT SACRIFICING SAFETY.

CONCEPTUALIZATION MATTERS: WHAT IS "MENTAL ILLNESS"

9/7/2020

Human "moral" sense is a MIXED BAG and in 2020 - there is really just EDUCATING IT, NOT trying to ELIMINATE IT which would probably be a very BAD THING.
That is why "KNOWLEDGE" / "SCIENTER" is such a BIG THING in THE LAW and it is also how we EXPAND and CHANGE our MORAL SENSE.
What did you know and when did you know it?
Let's APPLY this concept of "KNOWLEDGE" and "SCIENTER" to EVOLVING CONCEPTS of "Mental Illness"
- If we think someone is possessed by a demon then burning them at the stake or treatment by Hyena -- might drive out that demon. Right?
- Punishing those "BAD ACTS" and "BAD INTENT" could send the person a message --- unfortunately even in 2020 corrections systems struggle with RECIDIVISM.
- It now is much clearer that people may be struggling with Executive Functioning Issues, especially Problems in Emotional Regulation.
- The Brain is a BIG PLAYER in Cognitive Disability/ "Mental Illness" --- BUT in 2020 --- it is clear the Immune System, the Endocrine System and the Microbiome are CRITICAL PLAYERS as well.
- BUT WE DON"T KNOW AS MUCH ABOUT THOSE OTHER SYSTEMS OF THE BODY in relation to "MENTAL ILLNESS."
- We've got a Criminal Justice System that TRADES in "PROOF BEYOND A REASONABLE DOUBT."
- That Mental Element of the Crime is often focused on various levels of Punishment.
- Some countries such as Sweden have moved away from a Punitive Model of Criminal Justice -- and many countries are moving to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE.
- That Public Health Approach is perhaps the much more PRAGMATIC APPROACH rather than engaging in some type of OVERHAUL of the CRIMINAL LAW.
- Further, we really need that PUBLIC HEALTH APPROACH -- when we don't have all the answers and the knowledge base in constantly changing and expanding.

AFTER ALL IS SAID & DONE -- TRILLIONS of POTENTIAL VARIABLES if NOT MORE

The Brain
The Immune System
The Endocrine System
The Microbiome
Other?

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