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THE NEED FOR INTERDISCIPLINARY COLLABORATION IN MENTAL HEALTH--- WHAT DOES THAT MEAN?

7/24/2020

One of the most obvious things it means is having the capacity to deal with:

Brain Injury
Mental Illness
Autism and ADHD
Substance Issues

with 1 TEAM.

Further, that TEAM is not just the usual suspects such as Neurology and Mental Health -- it needs to pull in from Experimental Immunology, Gastroenterology and Endocrinology.

    We need something along the lines of the Cancer Centers that pull in a lot of different specialties and give people access to the latest research and scientific trials.

    Having Mental Health as some orphan child on its own -- has been DISASTROUS for improvements in treatment that are desperately needed.

   Further, private practitioners often don't even take insurance -- they are just at SURVIVAL MODE much less trying to really substantively further the practice. Whatever administrative support they have is generally very limited -- and they're pretty much running in place and so are their patients.

  The American Psychiatric Association is all about expanding business opportunities for Psychiatrists -- but the reality is the profession has been stagnating for sometime  -- a lot of what the Mental Health Profession needs is to be brought into the rest of the World of Medicine and provided the SUPPORT it really deserves.

STATEWIDE DISCHARGE PLANNING COORDINATION AND MEDICAID RE-DESIGN

7/22/2020

Discharge Planning for Individuals with Cognitive Disability is COMPLEX..
We need Systems that can engage in CONTINUOUS IMPROVEMENT and ENHANCED DATA COLLECTION.
Whether we are talking about discharging from:

a hospital
a mental institute
nursing home
the Streets
a jail or
a prison

Many people with Serious Cognitive Disability are often looking at similar needs:

Supportive Housing
Intensive Services, or
Placements if necessary

We need to be collecting information regarding those individual needs from people discharging around the State -- and making yearly reports to the Legislature regarding needs and proposed ways to address those needs.

We think this could be covered under Medicaid, and such Coordinated Discharge Planning is a key element of effective Olmstead Planning.

Medicaid Coverage of Housing-Related Activities

At least back to 2015, CMS saw a prominent leadership role for Medicaid in Olmstead Planning -- including HOUSING.

This cuts across Disability Categories.

It's an EMERGENCY for People with Cognitive Disabilities -- BUT we're DE-SENSITIZED to Homelessness and Incarceration of People with Cognitive Disabilities -- it is HARD for us to do what is NECESSARY.

POLITICAL CORRECTNESS IS OFTEN A SIGN OF SERIOUS UNRESOLVED ISSUES

7/20/2020

Semantic Political Correctness is not necessarily a bad thing -- BUT it can get RIDICULOUS pretty quickly.

The reason it can get so out of control is that it is often an easy ask for the aggrieved party and it's not that hard to comply with.

On the other hand, it can be pretty far removed from the SUBSTANTIVE and COMPLICATED CONCERNS and NEEDS of the group in question.

All sides need to be dealing with those SUBSTANTIVE issues.

People are RE-ACTING and OVER-REACTING to words like "TRIBE" and a Cycle Shop -- because the "GENOCIDE" they are really concerned about hasn't been sufficiently addressed.

We've got to have the ability to deal with the real issues or we are not going to get out of our SEMANTIC and REAL-WORLD HELLS.

When it comes to DISABILITY, that means providing ADEQUATE SUPPORTIVE HOUSING, not just PEOPLE-FIRST LANGUAGE as important as that may be.

We think there actually is a reason for some political correctness -- and that is the more complicated and substantive issues are -- the more they are viewed as too difficult to deal with.

JOHN LEWIS--A MORAL GIANT SETS A HIGH BAR

7/20/2020

OUR TAKE regarding THE NEXT STEP To "FREEDOM":
MARRYING A MORE SOPHISTICATED "RESTORATIVE JUSTICE" WITH A PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE

Even Martin Luther King, Jr. and Mother Teresa had their flaws -- it's not clear what John Lewis' flaws were.
When confronted with great Societal Dysfunction and Injustice,, he had the RAW COURAGE to speak out against it.
He also engaged in CONTINUOUS ACTION to address PROFOUND PROBLEMS he was just born into -- as human beings tend to be.

It is going to take some RAW COURAGE and CONTINUOUS ACTION to get to real CRIMINAL JUSTICE and SOCIETAL REFORM.

"Governing" website has an article about "RESTORATIVE JUSTICE" and the need to move beyond PUNISHMENT.

It is a BIG, HUGE STEP for "Governing" to recognize the need to move beyond PUNISHMENT.

On the other hand, the model of Restorative Justice that has been around for 30 years or more --- ISN"T GOOD ENOUGH.

This really is a lot more COMPLICATED than people saying they are sorry and asking for forgiveness. If that is all you think you have to do, you're going to set a lot of people up for FAILURE.

We need that Restorative Justice sensibility with the John Lewis insight that it's the society that has a lot to answer for.

If anybody wants that higher spiritual sense to Criminal Justice Reform -- we do -- but we need it married to a PUBLIC HEALTH APPROACH to Criminal Justice.

A lot of this can be more COMPLICATED than we think -- like:

is there LEAD in the water?
are people dealing with the biological effects of TRAUMA or AGGRESSION
are you living in a FOOD DESERT
there are many, many, many causes of psychiatric symptoms or poor or dangerous judgment -- do we have the RAW COURAGE to acknowledge REALITY

"When you see something that is not right, not just, not fair -- You have a moral obligation to say something or do something,"
JOHN LEWIS

SPECIALNESS AS EFFECTIVENESS

7/18/2020

       I have a rather unfortunate habit of getting an idea, getting an insight --- and 10 seconds later saying -- "Why aren't people doing this, these blankety-blank idiots -- do I to have to do everything myself -- and the HUMAN SUFFERING this is causing -- is there a cross I could nail these people to."

    The EMBARRASSING REALITY for me has often been by the time I get this fleshed out (years later)-- many people are already there -- and some are ahead me.

The EXCRUCIATING REALITY is that none of this negates the real SUFFERING these REFORMS are meant to AMELIORATE.

  I've spent some time attacking EXCLUSIONARY NOTIONS of SPECIALNESS, because the US has over 350 Million People and the world has over 7 Billion people that need SPECIAL ROLES in SOCIETY -- need to be recognized as "SPECIAL" and treated as "SPECIAL ".

"THAT's IMPOSSIBLE!" Actually, it's NOT impossible and a lot of animals have found ways to do it for a very, very long time. (Although HIERARCHY is the often easy and destructive niche creator, we need to do better than that.)

   This is also a lot about DIVERSITY and INCLUSION --- and using DIVERGENT THINKING as a TOOL to achieve INCLUSION of a very DIVERSE POPULATION -- that isn't totally HUMAN (See University College London's Graham Rook and the Old Friends Hypothesis).

A lot of life as we know it is about RE-COMBINANT DNA -- a lot of CREATIVITY and INNOVATION is about taking known things and ideas combining them in new ways -- and there are often an INFINITE NUMBER of COMBINATIONS.

   Every person is a unique combination of BIO/ENVIRONMENT and they have INFORMATION that nobody else has -- about what's working and what's not working in this LIFE.

   INFORMATION is ENCODED in all kinds of things -- it is ENCODED in ROCKS, it's ENCODED in BACTERIA, it's ENCODED in EMOTION, it's ENCODED in MAMMALIAN BIO-MARKERS, in PRIMATE BIO-MARKERS, HUMAN BIO-MARKERS and IDIOSYNCRATIC BIO-MARKERS of the INDIVIDUAL -- hence the NEED for INDIVIDUAL and PRECISION MEDICINE.

   COGNITIVE DISABILITY often puts this need for INDIVIDUAL AND PRECISION MEDICINE in HIGH RELIEF where we're talking MULTIPLE SYSTEMS of the BODY --- that we're only beginning to appreciate in the 21st Century, most notably the IMMUNE SYSTEM and the MICROBIOME -- but the ENDOCRINE SYSTEM is right there along with that CENTRAL NERVOUS SYSTEM and BRAIN that we've known about for awhile even if we haven't completely understood..

    It is recognizing BOTH our PROFOUND COMMONALITY and INDIVIDUALITY that is the KEY to HEALTHY INDIVIDUALS and HEALTHY SOCIETIES.

Getting thru a docket in a US Courtroom is often a model of judicial efficiency and horrific ineffectiveness when it comes to people.

"FREE WILL," PUNISHMENT, RISK ASSESSMENT & EUGENICS

7/17/2020

Societies tend to be PROBLEMATIC on their own terms.
On the other hand, we're often re-cycling Old or even Ancient Ideas with very little appreciation of:
- Where they came from, or
- How they relate to other FOUNDATIONAL IDEAS in the Society, and
- How those ABSTRACT IDEAS have REAL-WORLD CONSEQUENCES -- sometimes CATASTROPHIC CONSEQUENCES

So what is so baffling about the use of "suspect classifications" such as anti-social personality disorder or psychopathy as a justification for PUNISHMENT is that the HISTORICAL JUSTIFICATION for PUNISHMENT is NOT ------we don't have a good treatment.

St. Augustine and other Christian, Muslim and Jewish philosophers and theologians have had more SOPHISTICATED views than this over the centuries.

BUT they weren't dealing with LARGE SCALE BIOLOGICAL EXPLANATIONS for HUMAN BEHAVIOR.

PUNISHMENT is about PUNISHING the Exercise of FREE WILL, and more pragmatically ending the BLOOD FEUD or its modern equivalents.

If you're in the REALM of BIOLOGY -- you NEED to get the HELL OUT of the REALM of PUNISHMENT.

RISK ASSESSMENTS can be a very powerful demonstration that this is a lot more COMPLICATED than ISOLATED BAD ACTS coupled with ISOLATED BAD INTENT.

We shouldn't be using RISK ASSESSMENTS for purposes of PUNISHMENT -- further, those RISK ASSESSMENTS are in need of a lot of CONTINUOUS IMPROVEMENT -- they're NOT perfect.

Rabbi Hillel

At Hillel, fostering a culture of disabilities inclusion

WHAT"S THE POINT? A lot of religions such as Judaism have come A LONG WAY in their approach to mental illness and cognitive disability in general.

If ancient religions can change -- so can the US Criminal Justice System.

Channel 7 Detroit: Muslim American Voices: Psychologist Dr. Halim Naeem, activist in Muslim mental health movement

WHAT'S THE POINT? Religious Diversity, Perceptions of an unjust system both racially and for some religious minorities such as Muslims.

Also, raises the issue of CONTINUED GRIEVANCE (the modern day Blood Feud) because issues have not been sufficiently addressed.

The Use of "Anti-Social Personality Disorder" and "Psychopathy" as a justification for PUNISHMENT is a form of EUGENICS.

What the labels lack in Scientific Understanding, they make up for in IMPLIED INFERIORITY and MORAL DISGUST.

The result is a NIGHTMARE for people who receive these UNSCIENTIFIC LABELS in the Criminal Justice System where the most inhumane punishments may be rationalized as even humane custodial care is denied..
US Criminal Justice is a PROFOUNDLY FAILED SYSTEM. One of the reasons for that is the people running it don't feel empowered to ASK the Hard Questions.

Further, much of REALITY and the SOCIETY"s role in Criminal Behavior is deemed OFF LIMITS and IRRELEVANT.

SAFETY and HUMANE TREATMENT are GOOD GUIDEPOSTS.

It's time we get out of the PUNISHMENT BUSINESS before we hurt anyone else.

IT'S TIME FOR A PUBLIC HEALTH APPPROACH TO CRIMINAL JUSTICE.

St. Augustine, Florida

ST. AUGUSTINE, CATHOLICS, AND MENTAL ILLNESS (2013)

The first comes from St. Augustine. In his City of God, in which he covers and theologizes upon the whole of history as he knows it, he considers, briefly, the gift that is the human intellect.

What a wondrous thing it is that we have been given the ability to know our world, our selves, and even, with the help of grace, our God!

In the midst of this beautiful, celebratory passage, however, he interrupts himself to say this:

Crazy people say and do many incongruous things, things for the most part alien to their intentions and their characters, certainly contrary to their good intentions and characters; and when we think about their words and actions, or see them with our eyes, we can scarcely — or possibly we cannot at all — restrain our tears, if we consider their situation as it deserves to be considered.

WHAT'S THE POINT? We're very interested in marrying Saint Augustine's sentiment above with:

New Understandings on the Biological -Bases of Behavior, especially although not limited to the Immune System.
A much more sophisticated and complex view of human cognitive disability
A PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE. That is how we loosen our sometimes self-defeating moral judgments, and tighten our grip on SAFETY and HUMANE TREATMENT

COMING TO TERMS WITH NOT JUST BIOLOGICALLY BASED MENTAL ILLNESSES --BUT BIOLOGICALLY BASED HUMAN BEHAVIOR

7/16/2020

Moral judgments are a lot of what people use to protect themselves. Recognizing BIOLOGY doesn't get us out of that, but it does inform it.
In Stanford Neuroscientist and Biology Professor Robert Sapolsky's book "Behave: The Biology of our Best and Worst Selves" -- the point Sapolsky is making goes beyond saying there is a biological basis for BAD BEHAVIOR -- he is making an EXPERT's ARGUMENT that there are extremely COMPLICATED BIOLOGICAL BASES for HUMAN BEHAVIOR.

PARSING A LITTLE MORE

Sapolsky spends a lot of time in a lengthy book fleshing this out.
Further, the most current research is that SOCIAL BEHAVIOR is greatly impacted by the IMMUNE SYSTEM -- Who Knew?*.
When you get an ARCHAIC "Anti-Social Personality Disorder Diagnosis" running rampant as CODE for Go Ahead and PUNISH -- that leads to HORRIFIC MORAL PROBLEMS within the Criminal Justice System.

INTEGRATION & SUPPORT

Probably the most URGENT NEED is to FULLY INTEGRATE mental health with physical health -- and integrate Mental Health Centers into larger HOSPITAL and Primary Care settings
That INTEGRATION needs to extend to FORENSIC INTEGRATED PHYSICAL/MENTAL HEALTH SERVICES.
RIGOROUS VOLUNTARY DIFFERENTIAL DIAGNOSIS of those within the CRIMINAL JUSTICE SYSTEM
SYSTEMS that provide for the HIGHEST LEVELS of Community Safety and Humane Treatment
A PUBLIC HEALTH APPROACH to Criminal Justice.

*University of Virginia researchers are the ones that discovered the important role of the Immune System in the Social Behavior of Mice.

Less than 10 years ago, National Institute of Health funded researchers discovered Immune Pipelines into the brain where none were previously known to exist.

Summarizing Where We Are At with Orchid & Looking to the Next Year

7/13/2020

There is an ENORMOUS amount of material and information we are trying to SYNTHESIZE to make our "POINTS."

Those "POINTS" typically revolve around solving and/or improving address of COGNITIVE DISABILITY to prevent homelessness and incarceration.

Those "POINTS" involve:

Medicaid
Public Housing
Employment
the State of the Science
Religious, Ethical and Moral beliefs and ideas
the Law, and
REASON

    In 2020 people and organizations have done a lot of the hard work of CONCEPTUALIZING where we need to go -- with BLACK LIVES MATTER doing the HEAVY LIFTING and driving that home this summer with massive protests.

   It is a lot about RE-ALLOCATING RESOURCES.

It's also a lot about understanding what's an "EMERGENCY."

We've started this year with 20 to 30-page small reports. We intend to continue to do that and pair with 1-page FACT TABLES with references.

The SCIENCE is both one of the most important points we make and one of the most difficult for us to make persuasively because we are not perceived as a SCIENTIFIC AUTHORITY.

  We do try to rely on SCIENTIFIC AUTHORITIES to bolster our CREDIBILITY for our TAKE, INTERPRETATION or CONJECTURE with regard to various pieces or clusters of evidence.

"CONJECTURE" regarding INCOMPLETE EVIDENCE is very important and in some ways goes to the HEART of our ATTACKS on FORENSIC Mental Health in the Criminal Justice System.

    Our ARGUMENT is NOT that we have THE ANSWER.

   BUT it is that FORENSIC MENTAL HEALTH doesn't have THE ANSWER either, and given the number of VARIABLES to COGNITIVE DISABILITY and our KNOWLEDGE GAPS -- we can't fold this into a PUNITIVE CRIMINAL JUSTICE SYSTEM.

  Do we have ideas about where the science needs to go and what we need to investigate -- yeah -- and so do a lot of other people.

At this point, the SOCIETY is really at doing the HARD, PRACTICAL WORK of"

RE-ALLOCATING RESOURCES
Acknowledging we don't always have the best treatments and providing for SAFETY and TREATING PEOPLE HUMANELY as best we can,
Fund Research and Translational Research to Clinical Practice, and
Figure out how we can SMARTLY FUND ALL THIS.

Mark Twain

We have over 1,000 pages on the Orchid website:

If we'd had more time, we would have made it shorter.

In Praise of SB 20-181 -- Measures to Improve Outcomes for Incompetent to Proceed (ITP)

7/12/2020

AND
* CMHIP VOLUNTARY Patient Collaboration with CU Boulder on Microbiome Issues
*Olmstead Compliance as Lateral Problem Solving for Archaic ITP Laws

SB20-181

Really deals with the HARD REALITY of Current Long Term Disability as evidenced by:
- More than one finding of Incompetent to Proceed;
- MODERATE TO SEVERE INTELLECTUAL OR DEVELOPMENTAL DISABILITY, ACQUIRED OR
  TRAUMATIC BRAIN INJURY, OR DEMENTIA, WHICH EITHER ALONE OR TOGETHER WITH A CO-OCCURRING MENTAL ILLNESS AFFECTS THE DEFENDANT'S ABILITY TO GAIN OR MAINTAIN COMPETENCY, THE EVALUATOR
  SHALL PROVIDE AN OPINION AS TO WHETHER THERE IS A SUBSTANTIAL PROBABILITY THAT THE DEFENDANT WITH RESTORATION SERVICES WILL ATTAIN COMPETENCY WITHIN THE REASONABLY FORESEEABLE FUTURE.

Voluntary Collaboration with Microbiome Researchers @ CU Boulder or Elsewhere

There are literally Trillions of VARIABLES when it comes to Cognitive Disability -- so it's no wonder this has taken awhile to tease out.
The current research model of the Brain-Immune-Gut Triangle with the MICROBIOME in the middle gives us an idea of just how COMPLEX many of these issues are.
Some of the people at CMHIP or Ft. Logan are pretty IDIOSYNCRATIC and have fallen through the MENTAL SYSTEM as it is currently constructed NUMEROUS TIMES.
The ANNA KARENINA PRINCIPLE put forth by Oregon State University is that the HUMAN MIcrobiome is largely HEALTHY in the same way, but it can go off track in a MULTITUDE of WAYS impacting Mental Health.
Some of the most important RESEARCH -- some of which is going on right here in Colorado -- involves that MICROBIOME and that it can be much more complicated to STABILIZE than one would expect.

SB20-181 -- Is A BIG STEP UP for Colorado Incompetent to Proceed Law

The Imagine Microbiome Program in Canada

The Microbiome is in Our Guts, and it appears to be in Our BrainsButton Text

Our SCARY ITP System: Implicit Bias + Pathologizing Conflict = Structural Discrimination at CMHIP

Click Here

Getting Out of the Nightmare of Archaic Laws & an Out-of-Date DSM 5 is in part About Olmstead Compliance

In some ways this is similar to the debates about the Civil Commitment Statutes -- is the REAL issue the Civil Commitment Statute or the State's failure to provide:
- Housing
- Intensive Services,
- Placements to SCALE, and
- INCLUSION
IT"S THE STATE's FAILURE to provide Housing, Intensive Services and Placements to SCALE and Radical Inclusion that is the REAL issue.
A lot of Law Enforcement, Prosecutors and Judges would like to see RESOURCES for the Long Term so people don't just keep coming back.
A lot of Individuals and Families desperately NEED those RESOURCES.
Figuring out how to fund it has always been the issue.
To paraphrase Senate candidate John Hickenlooper, let's stop arguing over COGNITIVE DISABILITY HEALTHCARE and figure out how to fund it and drive down costs.
For many reasons, including to comply with FEDERAL LAW -- Title II of the ADA and Olmstead.

Seeing Things In a New Light

7/10/2020

There is something about hearing an idea expressed in another language or context that gives it new meaning, richness and dimension.

By and large, I haven't been one of those people who is offended by "All Lives Matter" -- even as I'm supportive of BLACK LIVES MATTER.

It was only after seeing Lone Bannana's picture to the right that I realized how HOLLOW that "All Lives Matter" seems to many people, especially when espoused by white people.

When we think about SLAVERY/Jim Crow REPARATIONS or addressing TREATY OBLIGATIONS with Indigenous People ---- that's very complicated, and it does go to the diminished health of those populations.

Mental Health/Activism and Law are different sides of the same coin. Sometimes you do just have to get through a terrible situation and cope as best you can.

On the other hand, we're almost always called upon to change those situations for others.

The idea of a SOCIAL CONTRACT has been around for a LONG TIME. Some SPIRITUAL IDEAS regarding obligations to the community have been around EVEN LONGER.

Hammering out the DETAILS of that -- is a BIG PART of the work of SOCIETY.

When we IGNORE TREATIES or LAWS it has a BIG IMPACT on the lives of Individuals, their Families and Communities.

Some of these OBLIGATIONS are NOT EASY -- like the ADA and Olmstead and their relationship to the needs of People with Cognitive Disabilities.

But if you don't honor those obligations-- you wind up with the modern day horror of MASS INCARCERATION.

Trail of Tears: 21st Century Edition
by
Lone Bannana

Val's Note: If you would have asked me a week ago if Oklahoma had any "reservations" -- I would have said no. Indian Land -- yes, reservations -- no.

That was before the US Supreme Court's ruling July 9, 2020 that almost half of Oklahoma is Creek and other Indian Reservations for purposes of Criminal Court Jurisdiction.

The diagram above shows a relatively close proportion of Native Americans in Oklahoma and as Defendants in Federal Court.

But that is because most Native American defendants in Oklahoma are prosecuted in STATE COURT.

That is not going to be true anymore for almost half the State.

Native Americans refer to -- the RESERVATION TO PRISON PIPELINE.

With --

A Lot of Inclusion
Honoring Existing Obligations, and
Bringing in a Public Health Approach

MAYBE WE COULD GET OUT OF THIS NIGHTMARE.

Cronkite News (2019)

Native Americans have the highest suicide rates in the nation and young Native Americans face an even greater risk.

Here in the Southwest, efforts are under way to overcome the stigma of talking about mental health issues, and to help native youth build resiliency and connect with their culture.

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Val's Blog

THE NEED FOR INTERDISCIPLINARY COLLABORATION IN MENTAL HEALTH--- WHAT DOES THAT MEAN?

STATEWIDE DISCHARGE PLANNING COORDINATION AND MEDICAID RE-DESIGN

POLITICAL CORRECTNESS IS OFTEN A SIGN OF SERIOUS UNRESOLVED ISSUES

JOHN LEWIS--A MORAL GIANT SETS A HIGH BAR

OUR TAKE regarding THE NEXT STEP To "FREEDOM":
MARRYING A MORE SOPHISTICATED "RESTORATIVE JUSTICE" WITH A PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE

SPECIALNESS AS EFFECTIVENESS

"FREE WILL," PUNISHMENT, RISK ASSESSMENT & EUGENICS

ST. AUGUSTINE, CATHOLICS, AND MENTAL ILLNESS (2013)

COMING TO TERMS WITH NOT JUST BIOLOGICALLY BASED MENTAL ILLNESSES --BUT BIOLOGICALLY BASED HUMAN BEHAVIOR

Summarizing Where We Are At with Orchid & Looking to the Next Year

In Praise of SB 20-181 -- Measures to Improve Outcomes for Incompetent to Proceed (ITP)

Seeing Things In a New Light

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OUR TAKE regarding THE NEXT STEP To "FREEDOM": MARRYING A MORE SOPHISTICATED "RESTORATIVE JUSTICE" WITH A PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE​

ST. AUGUSTINE, CATHOLICS, AND MENTAL ILLNESS (2013)

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OUR TAKE regarding THE NEXT STEP To "FREEDOM":
MARRYING A MORE SOPHISTICATED "RESTORATIVE JUSTICE" WITH A PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE