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PRIVATE PSYCHIATRY & INSURANCE ----AN UNSUSTAINABLE MATCH?

8/7/2020

My Personal Experience

I've been with a private psychiatrist since 2006 -- since my psychotic episode in which I was hospitalized
My private psychiatrist generally doesn't take insurance, although she does take limited insurance.
I (my family) have paid both out of pocket and an insurance deductible.
I was just informed by my psychiatrist that by the end of the year she probably won't be taking my current insurance anymore.
As many people know most of these insurance companies have various "packages"
Further, if you are getting your insurance through an employer -- especially maybe a hospital or other healthcare employer -- they maybe kicking in a big portion.
Since my husband retired with Stage 4 Cancer -- we don't have the same "package" --- so now our deductible for psychiatric services is pretty high.
So I told my psychiatrist we would run the numbers between the current out-of-pocket and out-of-network and see where we are.
My psychiatrist does not have a secretary.

[Couldn't there be some CENTRALIZED ADMINISTRATIVE SUPPORT provided to private psychiatrists

BTW -- there are a lot of people with ADHD who need EMPLOYMENT ADMINISTRATIVE SUPPORT -- what about some ENTREPRENEUR OR OTHERS providing CENTRALIZED SUPPORT for those folks.]

Why Psychiatrists Don't Take Insurance
Dinah Miller, M.D. (2014)

While many psychiatrists in private practice are able to manage their practices without secretarial support, a psychiatrist who practices in-network usually needs a secretary, an overhead expense his I-don’t-accept-assignment friends may or may not want or need.

And he now has to have an office big enough to accommodate secretarial space. I’ll also tell you that while the secretary is paid an hourly fee, his ability to get paid is only as good as her motivation to follow through on dealing with the insurance companies, refiling denied claims, clarifying primary versus secondary insurance and getting the amount of the co-pays correct.

PART II: WHEN WE SAY MENTAL HEALTH & FORENSIC HEALTH ARE HURTING A LOT OF PEOPLE --- WHAT DO WE MEAN?

8/7/2020

THE DELICATE ART OF DEALING WITH BIOLOGICALLY HIGHLY REACTIVE PEOPLE WITH DEVELOPMENTAL DIFFERENCES THAT NEED "WORKAROUNDS"/"ACCOMMODATIONS" A LOT MORE THAN THEY NEED "CHANGE"

Who is really against that MAGIC ELIXIR that will alleviate the problems of MENTAL HEALTH DISORDERS --- not really anybody.
BUT ya gotta be prepared to hear if UNCLE PHARMA's MAGIC ELIXIR isn't working as intended -- and it's very individual.
We are living in a VERY MESSED UP SOCIETY in which people may be consuming all kinds of SUBSTANCES to FEEL BETTER -- from alcohol to huffing gasoline to cocaine to methamphetamine and other opioids.
Further, people with "MENTAL HEALTH DISORDERS" aren't just emotionally highly reactive --- many of them have "HIGHLY REACTIVE CELLS," according to the University of Michigan.
So psychiatric medication that works globally on the brain and its circuits can be very problematic.

So if we get the MAGIC ELIXIR we want it -- but that is NOT really where we are at right now.

If Medication can be helpful -- that's great -- BUT many people are still left with those HIGHLY REACTIVE CELLS and the medication isn't completely addressing what people would like to see addressed.

Well, the ANSWER is OBVIOUS the person needs to:

Take Some Personal Responsibility, and
CHANGE

  That "CHANGE MANTRA" doesn't work very well with DEVELOPMENTAL DIFFERENCES and it's PROFOUNDLY ABUSIVE --- even though it almost always is WELL MEANING.

A lot of what is DRIVING some challenging behavior --- is STRESS + HIGHLY REACTIVE CELLS.

You don't have to have "highly reactive cells' to pick up on MICRO-AGGRESSIONS but you're picking up on a lot of stuff (not perfectly) and if you're trapped in an inhospitable environment -- you generally know it.

Further, there are a lot of DIVERSE people in this society contending with MICRO-AGGRESSIONS -- because DIVERSE/MINORITY people are who MICROAGGRESSIONS are generally directed towards.

The first thing is implement a STRENGTHS-BASED APPROACH -- and that is likely to REDUCE a lot of that STRESS -- because somebody's not asking people to be somebody -- they're not.

Dr. Gail Saltz advises spending 80% of the time on STRENGTHS DEVELOPMENT -- things people are already good at.

Now, wouldn't it be LOVERLY if you could stop there --- and if you can that's great.

BUT many people, including myself will need WORK AROUNDS or ACCOMMODATIONS.

This is REALLY HARD because mental health professionals and even very well-meaning, educated, caring people are not good at this.

This is very much Maya Angelou -- "When you know better, do better."

  Some of us do know better now -- and we are about the practical work of "changing" these systems, not necessarily people -----

   BUT WE ABSOLUTELY WANT TO INCLUDE A LOT MORE PEOPLE.

DE FACTO TAUTOLOGY AND PERSONALITY DISORDERS

8/6/2020

One of the HUGE challenges for PSYCHIATRY has been getting that DEFINITION of the MENTAL DISORDER.
People have OBSERVED and WITNESSED --- CHALLENGING and/or BIZARRE BEHAVIOR for a long time THOUSANDS of YEARS --- and it's been obvious something isn't right -- especially if the person is "PSYCHOTIC."
One of things that people have used as both a SHIELD and a SWORD is their MORAL JUDGMENTS. When that comes to the Criminal Law --- it's a lot about did the person "INTEND" to do it --- and most people did intend to do it --- some are so out of it that "they didn't appreciate the nature and consequences of their actions" ---- BUT that is defined pretty narrouwly BECAUSE if it's not defined narrowly ---- HOW ARE WE GOING TO PROTECT OURSELVES????
  Perhaps even more importantly --- are we BETRAYING the CLAN, the COMMUNITY, the VICTIM --- by joining the SIDE of the PERPETRATOR if we recognize a much more COMPLEX VIEW of HUMAN INTENT.
For a lot of Criminal Law -- MOTIVE has been that COMPLEXITY -- it's just that doesn't look very COMPLEX in 2020.

   The VINEER of MEDICALIZATION of BAD BEHAVIOR is the PERSONALITY DISORDER --- and if we're really FANCY --- CRIMINOGENIC FACTORS.

The National Institute of Mental Health is really saying that MENTAL HEALTH PRACTICE in the 21st Century is NOT really a MEDICAL DISCIPLINE or if it is --- it is a very poor one because other MEDICAL DISCIPLINES have moved BEYOND "SYMPTOM BASED CATEGORIES."

    [Further, in many cases a criminal act is an observable SYMPTOM of a Cognitive Disability.]

BUT for MENTAL HEALTH and CRIMINAL JUSTICE once you get away from SYMPTOM-BASED CATEGORIES -- to BIOLOGICALLY-BASED CATEGORIES, not only should you not be WEIGHING IN on PUNISHMENT (even indirectly), it is much more CLEAR you shouldn't be doing it at all.

[A HUGE irony in all this is some ANCIENT PEOPLE sort of thought that, too: "They Know Not What They Do."]

In the US today and in many countries, jails and prisons are FULL NOT WITH CLASSIC POLITICAL PRISONERS -- they are full of COGNITIVE DISABILITY PRISONERS who are there because there is nowhere else to put them.

  NOW DOING better is NOT just KNOWING BETTER --- CRIMINAL JUSTICE maybe hasn't known all this --- BUT THEY HAVE KNOWN A LOT. So we should PUNISH them, right?

The problem is CRIMINAL JUSTICE doesn't have the ABILITY to effectively address this situation.

International Journal of Psychological Research (2016)

Potential Biomarkers in personality disorders: current state and future research.

What's Stanford Neurobiology Professor Robert Sapolsky's POINT about the TRAJECTORY of BIOLOGICAL EXPLANATIONS and What are the RAMIFICATIONS for the Criminal Law?

[We do think the free will/determinism question is too simplistic and ultimately somebody's going to have to figure out a way to get out of it -- largely because observed exercise of animal and human INTENT is not running in the direction the debate assumes --- MEANING Maya Angelou --- when you know better, do better -- and there is a lot more to be teased out.]

Now this has a lot of implications for PUNISHMENT because it's KNOWING BETTER + HAVING THE ABILITY TO EFFECTIVELY CONTROL ONE"S BEHAVIOR. BUT if you have the ABILITY to effectively control your behavior, generally there is nothing to PUNISH.

DR. ROBERT SAPOLSKY ---- A PROFESSOR OF BIOLOGY, NEUROLOGY AND NEUROLOGICAL SCIENCES, AND NEUROSURGERY @ STANFORD UNIVERSITY: "You are never really going to understand what is going on if you get it into your head that you're going to be able to explain everything with this is--

the part of the brain
the childhood experience
the hormone
the gene
or the evolutionary mechanism

---That explains everything.

"It doesn't work that way. Instead any behavior is the result of biology that occurred a second ago, hours ago, days ago -- a million years ago."
. . . .

"O000h it's complicated. Well, that's very useful.

"How 'bout, 'OOOh it's complicated and you better be really careful and really cautious before you think you understand the causes of a behavior, especially if it's a behavior you judge harshly.' "
. ------Prof. Robert Sapolsky Stanford

WHAT'S THE POINT of the US National Institute of Mental Health's criticism of the DSM 5?

NIMH 2013
"This approach (RDoC) began with several assumptions:

A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
Each level of analysis needs to be understood across a dimension of function,
Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.

"It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data.

"In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”

"The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories.

"Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category.

"We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.

"That is why NIMH will be re-orienting its research away from DSM categories. "

https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

WHEN WE SAY MENTAL HEALTH AND FORENSIC ARE "HURTING A LOT OF PEOPLE" --- WHAT DO WE MEAN?

8/5/2020

A BUDDHIST KOAN:

Is having a highly REACTIVE IMMUNE SYSTEM and CELLS -- a good thing or bad thing?

AWARENESS

We're largely NOT AWARE of our internal bodily systems -- EVEN IF we are more AWARE than other animals
It is relatively recently that HUMAN DRIVES have been located in the BRAIN --- a lot of CULTURES located it in the HEART
A lot of Researchers are saying we've got to understand this as an ENTIRE FUNCTIONING ORGANISM --- and all the SYSTEMS of the BODY are INTEGRATED.
It's really in the 21st Century that we've recognized the HUGE IMPORTANCE of the HUMAN MICROBIOME -- which is this SYSTEM we didn't know about that is CRITICAL to our physical and cognitive functioning.
Further, it is really in the 21st Century that the IMMUNE SYSTEM has exploded on the scene as HUGELY IMPORTANT not only to Cancer and Autoimmune Diseases but to Mental Health as well.

What's The Harm?
There are probably a lot of CATEGORIES of HARM. We're going to focus on 1 CATEGORY of HARM.

You can't get to "BEYOND A REASONABLE DOUBT" with these new understandings, new science, and many more questions on the Mental Element of the Crime BECAUSE:
- Our old conceptualizations of HUMAN INTENT (the mental element of the crime) are NOT RATIONAL and that VIOLATES DUE PROCESS.
  - Why aren't our CONCEPTUALIZATIONS "RATIONAL" -- we don't have a SUFFICIENT UNDERSTANDING --- the NEW KNOWLEDGE hasn't answered all the questions -- BUT it has thrown into question in HIGH RELIEF our underlying ASSUMPTIONS.

Some/Maybe a lot of this is DEVELOPMENTAL. BOTH CLINICIANS and PATIENTS haven't really thought of it that way BECAUSE:
- Most patients are average or above intelligence, and
- Most patients don't have obvious physical disabilities (although some do)

These Developmental Genetic and Epigenetic DIFFERENCES involve among other things the IMMUNE SYSTEM. The IMMUNE SYSTEM has been taking a lot of HEAT/INFLAMMATION since the INDUSTRIAL REVOLUTION and URBANIZATION and FACTORY FARMING. See Graham Rook's THE OLD FRIENDS HYPOTHESIS.

HISTORIANS have been talking about the CHANGES wrought by the moves away from AGRICULTURAL SOCIETIES for some time -- but now we are several GENERATIONS out and some of those CHANGES appear to be BIOLOGICAL.

Further, as Neuro-biologist Robert Sapolsky points out -- any BEHAVIOR is the result of BIOLOGY that occurred:
- a second ago
- a month ago
- a year ago
- a 100 years ago
- a million years ago.
Some ANCIENT SOCIETIES appreciated that a lot better than we do.

WHY DOES THE MENTAL HEALTH PATIENT LAMENT, "BUT I'M SMART" --- REVEAL MORE THAN HE OR SHE REALIZES----

University of Michigan:
Cells of people with Bipolar Disorder are developmentally different than the cells of people without Bipolar Disorder.

Those CELLS are MORE REACTIVE.

Blurred Lines

We're NOT Who we THINK we are:

Not just because we may be very "intelligent" and our "intelligence" isn't the result of what we think it is and it has had some unintended mental health consequences, but also --
Because much of our physical and cognitive functioning is coming from BACTERIA we weren't even AWARE of 10 years ago, and
Because Historical BIOLOGY/ENVIRONMENTS we're only PARTIALLY AWARE of NOW are affecting current Physical and Mental Health, and
AND MAJOR SYSTEMS of THE BODY play a HUGE ROLE in Cognition and Mental Health and we're just beginning to understand that, AND
ALL OF THIS IS INTERACTING AND INTEGRATED INTO --- THE PRESENT MOMENT

For a SPECIES that is DESPERATELY SEARCHING for "CONNECTION" --- it's more than there and it's beyond comprehension in 2020.

The Immune System, Social Behavior, Intelligence and Mental Illness

"We are inhabited by as many as 10,000 bacterial species, these cells outnumber those which we consider our own by 10 to 1, and weigh all told about 3 pounds.--- the same as our brain.

"Together, they are referred to as the microbiome and they play such a crucial role in our lives that scientists have begun to reconsider what it means to be human."

------------------------------Michael Specter is an American journalist who has been a staff writer, focusing on science and technology, and global public health at The New Yorker since September 1998. He has also written for The Washington Post and The New York Times. ---Wikipedia

THE 99%'ERS AND GREED

8/3/2020

Many years ago I went with an attorney friend to the LUXURY HOME of husband and wife doctors who were promoting sale of NUTRACEUTICALS, and I wasn't quite clear if it was a PYRAMID SCHEME or not.
I was not inclined to sell nutraceuticals BUT it was pretty hard to ignore the LARGESSE that was in front of you --- which included a GIGANTIC HOME, a BEAUTIFUL, LARGE TAPESTRY in the dining room, all kinds of amazing works of art, and just generally GORGEOUS.
Well, a day after this I went over to my parents to tell them about this experience and this OVER THE TOP HOUSE.
I got a REACTION from my Dad that I had NOT expected and seemed so out of proportion to what I was actually saying and so uncharacteristic of my father.
    HE WAS FURIOUS. He said I was probably going to go to JAIL, no good was going to come of this -- "HOW COULD YOU BE SO STUPID?"
  WHOA, WHOA --- I haven't agreed to do anything.
Then out comes this story about my grandfather (who I never knew personally but I knew of).
Evidently, my grandfather got involved in some kind of PYRAMID SCHEME in the 1950s.
What's so interesting about my father's RANT is that I never really found out if my grandfather made any money or not (although it couldn't have been much) --- BUT what was repeated over and over and over was that my grandfather was "FEVERISH WITH GREED."
I ended up blowing off this NUTRACEUTICAL SCHEME -- it certainly had a lot of RED FLAGS.
  For me the American Economy is very much like the NUTRACEUTICAL Scheme --- is it a "TRUE PYRAMID SCHEME" -- I'm not sure, but I am sure it's not working for a lot of people.
Further, most of the people it's not working for are POWERING it.
We're NOT looking for a DEBATE on the pros and cons of CAPITALISM vs. SOCIALISM.
We're looking for PRAGMATIC CHANGE that works for people.

HUMANE TREATMENT FRONT & CENTER IN A 2ND ENLIGHTENMENT

8/2/2020

I think this really is a 2nd Enlightenment and a 2nd Founding of the US, building on many of the principles of the original founding.
(Author Eric Foner argues that the Civil War was the 2nd Founding -- so maybe this is a 3rd Founding)
CRIMINAL JUSTICE is front and center in this 2nd Founding and is BUILDING on the 1st Founding;.

4th Amendment Right Against Unreasonable Searches and Seizures
5th Amendment Right to Due Process
5th Amendment Prohibition Against Double Jeopardy (being tried TWICE for the same crime)
5th Amendment Right Against Self-Incrimination (protection against so-called TRIPLE JEOPARDY -- multiple punishments for a single incident -- the Underlying Crime, Perjury, and Contempt)
6th Amendment Right to Counsel
8th Amendment Protection Against Cruel & Unusual Punishment

Better PROTECTIONS against UNREASONABLE USE of FORCE by LAW ENFORCEMENT is a BIG part of this 2nd Founding and Enlightenment.

What made people consider MADISON & HAMILTON & JEFFERSON and the rest -- GENIUSES was that they were looking deeply at the problems of MONARCHY,

Now, those 1st Founders took a lot from ENGLAND and this 2nd Founding is BUILDING upon what we've got, too.

BLACK LIVES MATTER isn't just asking some hard questions about LAW ENFORCEMENT but the CRIMINAL JUSTICE SYSTEM as well as other systems in the Society.

A lot of the the HEAVY DOCKETS of CRIMINAL JUSTICE are a FAILURE to DIVERT early on -- even serious cases which might warrant a secure placement.

We need the CRIMINAL COURTS, PROSECUTORS and DEFENSE ATTORNEYS fully capable of handling DISPUTED FACTUAL MATTERS ---- not tied up in 1000s of cases in which the real issue is HUMANE TREATMENT.

AIDS, COVID-19, BLACK LIVES MATTER AND MENTAL HEALTH----------SCIENCE, ANTI-INTELLECTUALISM, PSEUDO-INTELLECTUALISM AND HEALTH

7/31/2020

    Politicians tend to respond to people protesting in the Streets.

That has been a BIG PART of the CIVIL RIGHTS MOVEMENT and BLACK LIVES MATTER and other movements such as the DISABILITY MOVEMENT --- and ACT UP for AIDS RESEARCH.

  Now AIDS Activists could afford to believe in SCIENCE and it's served them very well ----- they didn't have a history of SCIENCE gone wrong such as MENTAL HEALTH and LOBOTOMIES and the more recent great, to so-so to terrible medications.

    [That, of course, is not really true --- sexual orientation has it's own scary history of scientific and psychiatric HARMFUL "treatments." But maybe because AIDS was NOT psychiatric --- AIDS activists felt comfortable demanding SCIENTIFIC RESEARCH.]

    What AIDS Activists had was a SOCIETY --- that didn't feel their pain and was engaged in GROSS NEGLECT and INDIFFERENCE.

THE SAME IS TRUE FOR MENTAL HEALTH AND COGNITIVE DISABILITY -- even as that SOCIETY is PAYING BEAUCOUP BUCKS for UNDERWHELMING TREATMENTS.

   What tends to pervade MENTAL HEALTH CLINICAL PRACTICE is a lot of PSEUDO-INTELLECTUALISM ---- "A person who claims proficiency in scholarly or artistic activities while lacking in-depth knowledge or critical understanding."

What's the CRITICAL UNDERSTANDING Mental Health Professionals LACK:

At the end of the day, they don't know WHY the DSM 5 and its categories MATTER -- because in some ways it may seem pretty FAR REMOVED from what they are ACTUALLY DOING anyway.
What they are ACTUALLY doing is very well-intentioned -- so it must be right, right?
Mental Health Professionals do tend to be SMART -- but they don't tend to be good at questioning UNDERLYING ASSUMPTIONS and/or AUTHORITY. (We're NOT advocating a mindless questioning of assumptions or authority --- BUT the PROFESSION as a WHOLE has to EMPOWER CRITICAL THINKING ABILITIES to question UNDERLYING ASSUMPTIONS and AUTHORITY -- or one ends up in the MESS we're in NOW).
A BIG PART of EMPOWERING that is FUNDING the TIME and ENERGY for Research and Translational Research/Medicine to Clinical Practice.

THE MESS WE'RE IN NOW &
GETTING OUT OF IT

A lot of people with "MENTAL ILLNESS" tend to be "gifted" (meaning -- asynchonous development and have some "advanced ability" in one or more diverse areas)
They are often contending with both SIGNIFICANT Sensory and/or INFORMATION OVERLOAD as well as SIGNIFICANT EMOTIONAL DIS-REGULATION.
We don't think these ADVANCED ABILITIES are MAGIC -- even if the effect can be very IMPRESSIVE and/or MAGICAL.
Some people are taking in A LOT "MORE" than the "NORM" -- it can be and generally is a MIXED BAG (one of our themes).
Especially, for people who are TWICE EXCEPTIONAL (which is probably most "gifted" people) --- who have ADVANCED ABILITIES and DISABILITIES --- it can be very DIFFICULT to have one's ideas appreciated especially if they come wrapped in a lot of EMOTIONAL DIS-REGULATION.
The ARTS are one of the few places that really ACCEPT and TOLERATE that.
The REALITY is there are RIGHT NOW some Mental Health Patients who are very good at QUESTIONING UNDERLYING ASSUMPTIONS and AUTHORITY and are as Emotionally Disregulated as all get out -- they don't look or act like Mr. Spock -- even if their intellectual abilities are very high.
Mental Health Patients and Professionals have a lot to teach each other.

What's The Point or The Proof Is In the Pudding

There are some FUNDAMENTAL LOGICAL and even ALGEBRIAC PRINCIPLES that Mental Health Clinical & Forensic -- don't seem to get. Namely,
- if you can't cure it -- your understanding is at least on some level incorrect.
- Some mental health is looking a whole lot like developmental disability with high IQ or other advanced ability;
- Further, this seems to be intimately connected with the BRAIN-IMMUNE-GUT TRIAD or TRIANGLE.
- and that Re-conceptiualization SHOULD BE changing TREATMENT MODALITIES
Further, a lot of the PEOPLE IN THE LEGAL SYSTEM probably do get those "logical" principles even if they are not aware of some of the latest research --- BUT what's the "STRATEGIC" best course of action? If you undermine Clinical and Forensic -- what are we left with?
We gotta have a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE
Further, we want to make clear that NO ONE has to BUY INTO our INTERPRETATION of our EXPERIENCE, OBSERVATION, or the RESEARCH to REALIZE we need a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE.
The LOGICAL PROBLEMS ARE THERE REGARDLESS.

What's The Point? (We're Using this clip to symbolize a lot of things):

Mental Health Clinical seems STUCK IN TRAFFIC and GOING NOWHERE FAST
"La La Land" aka "Hollywood -- home to a lot of very talented (and intelligent) emotionally dis-regulated people.
"Giftedness" comes in a lot of shapes, sizes and colors.
If you want to MOVE -- sometimes you have to get out of your CAR or INTELLECTUAL BOX

What's The Point?

"I like a good demon sperm joke as well as the next guy, but this is serious."
When it comes to Clinical and Forensic Mental Health it is NOT so much that professionals are OUTRAGEOUSLY BIZARRE -- it is that they are well-meaning, they don't know their limits -- and they are oblivious to the harm they are causing.
Now maybe one could say that about us -- that we don't know our limits -- BUT the fact of the matter is CLINICAL & FORENSIC are IGNORING/UNAWARE of the concerns of the US National Institute of Mental Health --- and we should be very concerned about that.

Mental disorders are among the most complex problems in medicine, with challenges at every level from neurons to neighborhoods.

Yet, we know so little about mechanisms at each level. Too often, we have been guided more by religion than science.

That is, so much of mental health care is based on faith and intuition, not science and evidence.

On the plus side, we put a premium on listening and compassion. We help people to change through understanding.

But not enough of our care has been standardized to a high level of quality, as expected in the rest of medicine.

------------Dr. Tom Insel, Director of the National Institute of Mental Health from his October 2014 Blog Atonement

THE HARSH REALITY OF UNSUPPORTED PEOPLE & PROFESSIONS

7/28/2020

The FURY we feel towards the MENTAL HEALTH PROFESSION (or for that matter the LEGAL SYSTEM) is often MIRRORED in the FURY the Criminal Justice System feels towards Defendants with Cognitive Disabilities ---- You SHOULD:

Know Better
Do Better
Be Better

The unfortunate reality is that those LECTURES and DIATRIBES generally do very little to CHANGE anything --- and the CHANGE and/or MAJOR SUPPORT that is NEEDED is often STRUCTURAL and the trick is how to make that DO-ABLE.

   I don't think we have a "COMPETENT" MENTAL HEALTH PROFESSION --- and I don't think the Criminal Justice System or our "MENTAL HEALTH CRISIS" can really be REFORMED or SUFFICIENTLY ADDRESSED without SUBSTANTIVELY addressing that.

Further, COMPETENCE is by and large NOT about knowing everything --- because if it were --- no one could ever be COMPETENT.

BUT when one is in such an area of COMPLEXITY --- you gotta REALLY PULL IT BACK, and REFUSE to ALLOW YOURSELF to be used for purposes of PUNISHMENT --- that includes STATE DOCS, that includes people who like to get on TV --- that includes all the people in the PROFESSION.

   The REAL DO-ABLE substantive address of these problems is SUPPORT, but it is NOT cheap:

Research and Translational Research to Clinical Practice -- not just of "mental illness" but cognitive disability across the board, since so many people experience more than one issue
Integrated, Multi-Disciplinary Teams including Mental Health & Neurology but also experimental Immunology, Endocrinology and Gastro-Enterology
Housing, Intensive Services and Placements in the meantime.

Hair Analysis, Psychological Analyisis, the Criminal Law and the Ethical & Moral Duty to Pull Back

Psychiatry & Criminal Justice: Simplicity on the Near Side of Complexity

30TH ANNIVERSARY OF THE ADA & THE NEED FOR FEDERAL LEADERSHIP

7/27/2020

WE NEED FEDERAL LEADERSHIP TO BRING ABOUT A COMPREHENSIVE CONTINUUM OF CARE FOR A BROAD RANGE OF COGNITIVE DISABILITIES

We talk a lot about Research and Translational Research/Medicine which we do think is the ULTIMATE SCIENTIFIC "ANSWER." but for many people with PHYSICAL or COGNITIVE DISABILITIES -- that ULTIMATE SCIENTIFIC "ANSWER" is NOT going to come in THIS LIFETIME.

THAT was at least some of the fury directed against well-meaning Jerry Lewis and the Jerry Lewis Telethon --- and not wanting to be pitied or exploited.

It is also dealing with the REALITY of what's SCIENTIFICALLY possible and what's not---- that is at the heart of the US Supreme Court's 1999 Olmstead decision, holding unnecessary institutionalization of people with DISABILITIES a violation of TITLE II of the AMERICANS WITH DISABILITIES ACT.

THEORETICALLY -- this is NOT anywhere near the UGLY REALITY --- States need to have a Comprehensive, Effectively working "Plan" for people with DISABILITIES who are "INSTITUTIONALIZED" or "AT GREAT RISK of INSTITUTIONALIZATION" that has:

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

Two of the things that means is:

Homelessness is covered by Olmstead, AND
INCARCERATION as a form INSTITUTIONALIZATION is covered as well, even if the HOUSING & SERVICES & PLACEMENTS required currently don't require an early release.

THE MADDENING THING about all of this is that even many prosecutors in CONSERVATIVE STATES have been employing TREATMENT ALTERNATIVES for DECADES --- those ALTERNATIVES are just often NOT TAILORED to the LONG TERM NEEDS of some people.

NOW --- not everybody needs that -- but often thousands of people within a STATE will need it --- and it is NOT CHEAP.

THIS IS VERY COMPLICATED -- it is NOT all "Mental Illness" -- a big part of it is BRAIN INJURY and HIGH IQ Developmental Disability (ADHD and AUTISM) with SIGNIFICANT EMOTIONAL DIS-REGULATION.

Further, it absolutely includes SUBSTANCE ISSUES -- alone or as is often the case --- a DIY attempt at BRAIN INJURY, DEVELOPMENTAL DISABILITY or "MENTAL ILLNESS" or TRAUMA--- management.

WE'VE GOT TO HAVE MORE FEDERAL LEADERSHIP ON THIS.

That means a lot of THINGS. One of the Things it means is NOT FORCING STATES to RE-INVENT the WHEEL -- but providing a TEMPLATE they can TAILOR and EXPERIMENT with so long as they stay within the LAW.

When we talk about the ADA, Olmstead Planning and Cognitive Disability -- that is one of the most complicated endeavors in this society --- we're going to be waiting a long, long time for it to happen SPONTANEOUSLY.

Voice of America (July 26, 2020)

The Americans with Disabilities Act (ADA) is "A CIVIL RIGHTS LAW"

THE TIMES THEY ARE A CHANGIN' . . ."ANTI-SOCIAL PERSONALITY DISORDER" TESTING KEY ASSUMPTIONS

7/25/2020

David Brooks

Last night I heard political commentator David Brooks quoting somebody else regarding the EXTRAORDINARY TIMES we're living in as a combination of the:

1918 Spanish Flu
the Great Depression, and
1968 Civil Unrest

We would add to that:

a Second Age of Enlightenment, including Political Enlightenment
a Technological Revolution that is driving many things, including
a Biological Revolution that is in the process of transforming:
- The Legal System,
- Mental Health and maybe MORE IMPORTANTLY other Medical Disciplines when it comes to cognitive disability
- and the Society as a WHOLE

One of the BIG KAHUNAs in all this is "ANTI-SOCIAL PERSONALITY DISORDER" -- because it really brings in some of the KEY ASSUMPTIONS of the SOCIETY that don't seem to be true.

And what does seem to be "TRUE," that there are a lot of COMPLEX, BIOLOGICALLY-BASED and MEDIATED COGNITIVE DISABILITIES (not limited to mental illness or psychosis) as well as the Biological Impacts of Trauma or Aggression or Substances --- that we don't always have great treatments for --- and may require long term expensive HOUSING, Intensive Services, and/or Placements ----- is not anything anybody wants to hear.

So there is a very fine line to walk here -- WE HAVE TO HAVE HOPE, but plenty of Individuals and Families around the COUNTRY will tell you ----- what STATES are doing is frighteningly insufficient and that includes Colorado.

And a lot of judges would tell you that too.

ABSTRACT

It has been argued that a biomarker-informed classification system for antisocial individuals has the potential to overcome many obstacles in current conceptualizations of forensic and psychiatric constructs and promises better targeted treatments. However, some have expressed ethical worries about the social impact of the use of biological information for classification.

Many have discussed the ethical and legal issues related to possibilities of using biomarkers for predicting antisocial behavior.

We argue that prediction should not raise the most pressing ethical worries. Instead, issues connected with “biologization”, such as stigmatization and negative effects on self-image, need more consideration.

However, we conclude that also in this respect there are no principled ethical objections against the use of biomarkers to guide classification and treatment of adult antisocial individuals.

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THE TIMES THEY ARE A CHANGIN' . . ."ANTI-SOCIAL PERSONALITY DISORDER" TESTING KEY ASSUMPTIONS

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Val's Blog

​THE DELICATE ART OF DEALING WITH BIOLOGICALLY HIGHLY REACTIVE PEOPLE WITH DEVELOPMENTAL DIFFERENCES THAT NEED "WORKAROUNDS"/"ACCOMMODATIONS" A LOT MORE THAN THEY NEED "CHANGE"

WE NEED FEDERAL LEADERSHIP TO BRING ABOUT A COMPREHENSIVE CONTINUUM OF CARE FOR A BROAD RANGE OF COGNITIVE DISABILITIES

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THE DELICATE ART OF DEALING WITH BIOLOGICALLY HIGHLY REACTIVE PEOPLE WITH DEVELOPMENTAL DIFFERENCES THAT NEED "WORKAROUNDS"/"ACCOMMODATIONS" A LOT MORE THAN THEY NEED "CHANGE"