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Anti-social personality disorder: Observations & Australian Law Reform

4/19/2021

ANTI-SOCIAL PERSONALITY DISORDER harms defendants and other parties in the CRIMINAL JUSTICE SYSTEM.
If there is a SERIOUS COGNITIVE ISSUE that is not accurately assessed, characterized or treated --- THAT MATTERS.
At the ROOT of much of this is a FEAR of recognizing BIOLOGICAL EXPLANATIONS for Criminal Behavior. BUT if you don't, the SYSTEM and the SOCIETY and EVERYONE in it are much less safe.
AND individuals in our SYSTEMS OF INCARCERATION often get worse -- that's according to Corrections Officials.

Australia's Civil Commitment for "Personality Disorder" in severe cases involving danger to others --- is an attempt to recognize REALITY.

One does see people in the criminal justice system with "PSYCHOSIS" --- a so-called Stage 4 of Mental Illness --- but before one gets there one is usually talking about DEVELOPMENTAL DISABILITY and often ADHD.

ADHD is the Developmental Disability that is often being associated with "ANTI-SOCIAL PERSONALITY DISORDER."

ADHD is one of a number of common neuro-developmental disorders that are associated with acute and chronic maternal inflammation during pregnancy.

The mechanism of maternal inflammation helps to explain the wide variety and idiosyncratic nature of these neuro-developmental disabilities or differences.

Further Inflammation and Immunity (Innate & Adaptive) go to a number of things, including SOCIAL BEHAVIOR.

ADHD is now commonly associated with something called "REJECTION SENSITIVE DYSPHORIA" (RSD).

Nationally recognized Colorado ADHD doctor William Dodson recognized the symptom as applying to ADHD and it had previously been identified with "ATYPICAL DEPRESSION."
- "Because RSD is always triggered by some event and because the mood shift matches the nature of the trigger, the internalized RSD can be considered a normal mood in every way except its intensity."

That sounds like a lot of what one sees in the criminal justice system.

Further, it sounds a lot like what the criminal law has been trying to get at since ancient times --- OUT OF PROPORTION EMOTIONAL INTENSITY that is FUELING BAD ACTS.

I would also submit that RSD is a lot of what one sees in Police Excessive Force Cases. An officer feels DISREPECTED --- and "goes off" on somebody --- and IT IS NOT PROPORTIONAL to the alleged insult or threat.

Personality Disorder, the Criminal Justice System & the Mental Health System

Victorian Law Reform Commission (Australia) --

On the US Dept. of Justice, Office of Justice Programs, Virtual Libraries website

Civil commitment is justified for a person with a personality disorder so severe as to render him or her functionally equivalent to a mentally ill person and also dangerous to others.

Victoria's Community Protection Act provides a mechanism for civil commitment in such cases, goes further than Mill did by requiring two criteria rather than one, and is consistent with the criteria of the Mental Health Act.

TAKE THE "O TRAIN" --- OLMSTEAD TRAIN ---TO CRIMINAL JUSTICE REFORM

4/19/2021

I've seen a number of criminal justice reform efforts that had less than spectacular results because what was needed was so UNDER-ESTIMATED.
90-Day Treatment Programs or even 1-year Treatment Programs --- some of the time that works and a fair amount of the time it doesn't.
So we have no choice but to PUNISH the person --- THAT WOULD BE THE WRONG ANSWER.

We know there are people with complex and multiple cognitive issues, namely High IQ Developmental Difference / Disability, Brain Injury, Substance Issues, and Mental Illnesses.

Now I would say those are the primary issues, but occasionally someone with even more EXOTIC ISSUES finds their way to the Criminal Justice System such as someone with HUNTINGTON'S CHOREA.

There's an enormous amount to consider in all this. That is why ON-GOING, DATA-DRIVEN OLMSTEAD PLANNING that is COMPREHENSIVE & EFFECTIVE is so important for CRIMINAL JUSTICE REFORM.

When we start to appreciate the Nature and Complexity of the Challenge ---- we realize this isn't going to get resolved in 2 weeks --- it's going to require years of systematic, data-driven PLANNING ---

That needs to be INCLUSIVE

Further, it has to be ACCOUNTABLE with legally required:

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

If Colorado and other States are serious about Criminal Justice Reform --- they will take the "O Train" to get there in a HURRY.

Duke Ellington
Take the A Train

Let's take the "O Train" (Olmstead Train) to Criminal Justice Reform

Jazz Academy at Lincoln Center (2020)

Music scholar Greg Thomas discusses the lasting legacy of Duke Ellington's 1943 masterwork "Black, Brown, and Beige."

One of the many interesting observations of Thomas is that Ellington composed with certain musicians in mind --- understanding their strengths and weaknesses.

That complicated challenge is what we are called on to do as a Society.

COMMON COGNITIVE ERRORS OF "NEURO-TYPICALS"

4/13/2021

Fundamentally, the cognitive errors of "NEURO-TYPICALS" are the cognitive errors of most groups neuro-typical or not.
There are an infinite number of ways to consider the "Strengths" and "Weaknesses" of Human Beings.
And in many if not most cases --- what is a "Strength" and what is a "Weakness" --- depends on the ENVIRONMENT.
I've talked a lot about BIOLOGY & ENVIRONMENT --- it is their INTEGRATION that is important --- they are not separate in the common experience of LIFE.

As any parent, teacher or judge probably knows --- wouldn't it be great if we could just LECTURE people or PUNISH them ---- and all those BEHAVIOR ISSUES would just go away. Unfortunately, that is the rarely the case.

Behavior issues associated with a brain injury, a developmental difference, substance issues, or mental illness are very unlikely to resolve with a LECTURE. Further, many people with those BEHAVIOR ISSUES in the Criminal Justice System have more than one or all of those underlying biological issues.

It sounds out of place or out of turn to say in our Society ---- BUT PEOPLE WANT TO BE LOVED.

One of the ways we can show that LOVE is by BUILDING on people's STRENGTHS, and WORKING AROUND their weaknesses --- creating a Society and Environments that work for all of us.

Paraphrasing singer-songwriter Tierra Whack -- "Let's Build Something."

Tierra Whack
Link

Stanford's Tina Seelig: Divergent Thinking

Big Think: Johann Hari: Why Depression is a Socioeconomic Disease.

We're beating up on a lot of NEURO-DIVERSE PEOPLE and by and large we're not even aware of it.

The video to above is a POWERFUL statement by Aurora Public Schools on Twice Exceptional Students BUT the application is BROADER.

One of the TAKEWAYS from this short video is the statement by the mother who says: "THERE IS NO SHOULD."

There are numerous important insights from the teachers as well.

See 3:08: "The most important piece to remember is to identify their strengths and program for that first.

"That's how a student will feel valued, engaged in the classroom and that they have a piece of the community they fit into.

"Then we can plan for their area of disability."

HEMINGWAY: OUR JUMPING OFF POINT TO THE MESSY BIOLOGY OF COGNITIVE DISABILITY

4/11/2021

One of the things the Novelist, Dramatist, Artist or Comedian knows --- all those separate and distinct aspects of HUMAN LIFE are really thoroughly INTEGRATED.
We tend to have a lot of seemingly ridiculous debates about BIOLOGY vs. ENVIRONMENT --- they're NOT OPPOSITES.

When we think of:

the epigenetics of mental illness which often involves the IMMUNE SYSTEM, or
TRAUMA which impacts the IMMUNE SYSTEM & the BRAIN, or
Concussions that lead to BRAIN INJURY and often Mental Illness

And we look at the HUMAN BEING --- Cognitive Disability is DYNAMIC, COMPLICATED and IDIOSYNCRATIC --- and it often involves NEURO-INFLAMMATION.

How does that fit with the DSM 5? Not well.

Living Beings and all Animals live in an ENVIRONMENT.

All Living Beings and all Animals have a BIOLOGY.

It's the THOROUGH INTEGRATION of BIOLOGY and ENVIRONMENT that make up LIFE.

We've gone from no understanding of BIOLOGY as an aspect to BEHAVIOR to some circumscribed UNDERSTANDING --- but the categories and systems we've developed don't withstand MODERN SCIENTIFIC SCRUTINY or even just BASIC PRINCIPLES OF LOGIC.

Our Society kinda believes that BIOLOGY can account for BEHAVIOR --- and kinda doesn't.

THOUSANDS OF COLORADANS and MILLIONS in the US and for that matter around the world are being sacrificed on the ALTAR OF BIOLOGICAL AGNOSTISM.

Understanding that BIOLOGY is always part of the EQUATION of BEHAVIOR-- just as ENVIRONMENT -- is crucial.

A BIOLOGICAL UNDERSTANDING provides a CROSS-REFERENCE to understand what is going on with the Behavior and to ameliorate it if necessary.

BIOLOGY gets to the INDIVIDUAL response to the ENVIRONMENT.

ENVIRONMENT is important because it can and does impact our BIOLOGY.

Further, many people in the same or similar ENVIRONMENTS will have different experiences of that ENVIRONMENT --- because of their BIOLOGIES.

This is a SCARY PLACE to go for many people with DISABILITIES --- Science has often not been our friend -- and the HORRORS OF EUGENICS always had a SCIENTIFIC GLOSS.

So you can't do what needs to be done on BIOLOGY & BEHAVIOR without a strong ETHICAL FOUNDATION that appreciates not only rugged individualism but also community responsibility --- and an EXPANDED PRO LIFE VIEW OF THE WORLD.

Hemingway is an excellent example of Cognitive Disability, and especially the Cognitive Disability one finds in the Criminal Justice System.

He had a family history of mental illness, some family conflict, a series of concussions, a complicated and often deeply destructive society and world, mental illness of his own, and alcohol problems.

God of the Gaps, Criminal Liability of the Gaps

"Pro Life" as a Progressive Issue

Criminal Justice Policy --- Shooting in the Dark

A DSM 5 that is NOT BASED on the underlying BIOLOGY of mental illness, but a collection of symptoms. Most researchers are finding those categories BLURRED.

Criminal Categories of "INSANITY" and "INCOMPETENT TO PROCEED" that don't reflect the COMPLICATED NATURE OF COGNITIVE DISABILITY / NEURO-INFLAMMATION which is both IDIOSYNCRATIC and LARGELY UNIVERSAL in the CRIMINAL JUSTICE SYSTEM.

What Stanford Neurobiologist Robert Sapolsky says: It is NOT just BAD ACTS that BIOLOGY is behind, it's good acts and meh acts, too.
- That's hard to swallow when one is responding so BIOLOGICALLY to acts of other people.
- It is a blurred mess.
- BUT at the end of the day, BIOLOGY is FOUNDATIONAL to BEHAVIOR

We're going to have RECIDIVISM PROBLEMS if we're not dealing with UNDERLYING BRAIN INJURY, DEVELOPMENTAL DISABILITY, SUBSTANCE ISSUES and MENTAL ILLNESS.

"DEALING WITH THAT" does include Housing, Placements and Healthcare.

It also includes "INDIVIDUALIZED SUPPORTIVE EMPLOYMENT" which is NOT only what many Conservatives need to go along with all this -- it's also what most Individuals want.

DEVELOPMENTAL DISABILITY, MENTAL ILLNESS & INTELLIGENCE

4/10/2021

Conjecture

Val's Take

Questions are important.
Societies tend to have FUZZY IDEAS that are connected to OTHER FUZZY IDEAS and it turns out that matters and it matters to the lives of individuals, to families and to societies.
Three FUZZY IDEAS in our society are "DEVELOPMENTAL DISABILITY," "MENTAL ILLNESS" and "INTELLIGENCE."
Historically, we have thought of them as DISTINCT, although "genius" and "madness" have been associated since ancient times.
What "Developmental Disability," "Mental Illness" and "Intelligence" have in common is "NEURO-INFLAMMATION."
Whether you have Down Syndrome, ADHD, Autism and/or are "Gifted" -- you have a higher level of NEURO-INFLAMMATION than "NEURO-TYPICALS."

That Neuro-Inflammation often comes with Executive Functioning Differences.

Further, the most recent research says INNATE & ADAPTIVE IMMUNITY (that are driving that NEURO-INFLAMMATION) are connected to SOCIAL BEHAVIOR -- Who would've THUNK IT?

I would submit "MENTAL ILLNESS" is much higher among people with intellectual disabilities, ADHD, Autism, Gifted, Sensory or Information Processing Disorders, Etc. --- because they already have a high level of NEURO-INFLAMMATION.

The ENVIRONMENT that many people with High IQ Developmental Disability or Difference are walking into can be akin to a BUZZ SAW.

Basically, you have many NEURO-DIVERSE people who are UNUSUALLY SENSITIVE to the JUDGMENTS of OTHERS and who are NOT "FITTING IN" for a whole host of reasons, not least of which their EXECUTIVE FUNCTIONING is significantly different than "NEURO-TYPICALS."

High IQ Developmental Disability sounds like an OXYMORON and our Society treats it like an OXYMORON.

BUT for many people with HIGH IQ Developmental Disability or Difference that lack of understanding is leading to HIGH IQ Developmental Disability & Mental Illness.

We're not facile as a society at making ACCOMMODATIONS or WORKAROUNDS for Executive Functioning Differences.

THAT IS THE BUZZ SAW MANY NEURO-DIVERSE PEOPLE ARE WALKING INTO ---- AGAIN & AGAIN & AGAIN.

The stress of our NO EXCUSE Society is quite real.

That is also why some people charged with crimes --- choose incarceration over probation. Probation is much harder from an executive functioning standpoint.

There are even commentators on YOUTUBE recommending people with ADHD charged with crimes --- take time so the person doesn't set themselves up for failure on PROBATION.

THAT SHOULD NOT BE THE RIGHT ANSWER.

I'm not for putting anybody at risk, but we must UP OUR GAME when it comes to understanding and accommodating COGNITIVE DISABILITY.

Neuroinflammation as a risk factor for attention deficit hyperactivity disorder (2019)

Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017)

Inflammation and Neuro-Immune Dysregulations in Autism Spectrum Disorders (2018)

Recognizing and Treating Comorbid Psychiatric Disorders in People With Autism (2019)

“High intelligence: A risk factor for psychological and physiological overexcitabilities” (2017)

(The authors take a psycho-neuro-immunological approach)

Evolution of Neuro-Inflammation Across the Lifespan in Individuals with Down Syndrome (2020)

Psychiatric Morbidity in Adults with Down's Syndrome

In Groups & Out Groups: Dragon Ladies, Folk Dancers & Human Beings

4/9/2021

As is my want, I confess other people's sins and not my own.
Further, people who live in glass houses --- shouldn't throw stones --- and if anybody lives in a metaphorical glass house -- it's me.
Nonetheless . . .

When people think of Oklahoma, they think of a conservative state --- which it is --- BUT I would say even 30 years ago the Oklahoma County D.A.'s office like most D.A. Offices worked hard to be TOUGH BUT FAIR.

But these were SMART, TALENTED, COMPETITIVE PEOPLE placed into an ADVERSARY SYSTEM --- with very clear in-groups and out-groups.

I never really saw any "CORRUPTION" at the Oklahoma County D.A.'s Office --- what I did see was "UNCONSCIOUS BIAS" and it took awhile but I ultimately recognized that in myself.

But let's be clear, I've seen UNCONSCIOUS BIAS at the Denver D.A.'s Office.

I refer back to this time frequently, considering it was only 2 or 3 years of my life ---- BUT there was SO MUCH INFORMATION crammed into that experience and it has been important for me to unravel it.

THE FOLK DANCERS

After the DA's Office, I got involved with an ECLECTIC & INCLUSIVE Group of Folk Dancers in Oklahoma City.

One of the regular dancers was FUN & SMART and was also from SERBIA.

This was during the war and my fellow folk dancer worked to get his mother out of Serbia to live with him.

His mother was an East European Intellectual and Professor of Architecture.

My friend began bringing his mother to folk dancing.

Well, the only person who was really near his mother's age was Ora.

Ora was a German Jew who escaped Nazi Germany, worked as a nurse in the RAF (British Royal Air Force), and married a Southern Baptist Soldier from Oklahoma. Her father and sister did not escape Nazi Germany and were murdered.

Well one night we're all at a restaurant, and I'm talking to my friend and his mother about the war in the Balkans, and I'm very interested to understand the HISTORY of all this.

OMG --- the Centuries Roll By as do the hands on the clock.

My friend's mother who was the Educated Elite of Serbian Society and had never been anything but absolutely lovely to me ----- maintained that all the reports of ATROCITIES by the SERBS were PROPAGANDA --- NONE OF IT WAS TRUE.

Ora and my friend's mother were great friends, and privately Ora would comment that the mother wasn't really connected to reality when it came to the war.

My friend had a much more complete and nuanced view of things.

My own grandmother who was so close to me was not the epitome of RACIAL EQUITY and JUSTICE.

WHAT'S THE POINT:

We want to think that UNCONSCIOUS BIAS, Dangerous In-Groups and Out-Groups are just the province of BAD PEOPLE or PEOPLE WE'RE IN CONFLICT WITH --- but it is very HUMAN.

In Modern Society, we tend to write COMMUNITY BUILDING OFF --- we don't have time for that.

We can't afford not to do SIGNIFICANT, INCLUSIVE COMMUNITY BUILDING.

This is not the official pin of the Oklahoma County DA DRAGON LADIES --- a small group -- by invitation only --- of TOUGH AS NAILS FEMALE PROSECUTORS.

But a pin much like it was worn by the DRAGON LADIES to signal to themselves and everyone else --- who was in their group and who wasn't.

This was some 30 years ago.

PBS --- The Brain with David Eagleman

This is one of the fundamental insights of HUMAN HISTORY --- it goes to the BIOLOGY of in-groups, out-groups and empathy and how those "decisions" are being made in a split second.

PBS: The Brain with David Eagleman
The Massacre At Srebrenica

Matt D'Avella
The Loneliness Epidemic (2019)

IT COULDN'T MATTER MORE THAT WE DON'T HAVE THE RIGHT MAP

4/8/2021

EVEN IF WE DON'T HAVE A COMPLETELY NEW MAP -- WE CAN'T KEEP USING THE OLD ONE WITHOUT MODIFICATION

Bonnie Raitt covers The Talking Heads --- "Burning Down the House"

When Covid vaccines are contaminated -- we're all over it.
It was 2013 when the US National Institute of Mental Health said we didn't have a scientifically valid Psychiatric Diagnostic Manual because it just described symptoms and didn't get to the underlying biology.
'We don't live in a perfect world, and we're never going to live in a perfect world.
The world we live in now has INVALID DIAGNOSTIC CATEGORIES crammed in with ANACHRONISTIC LEGAL CATEGORIES.
What a F'ing mess.

We wouldn't just say --- use the tainted Covid vaccines until the new ones arrive --- and yet a version of that is what we are doing in Mental Health & Criminal Justice.

With all the conceptual problems and unsustainable "categories" --- the biggest problem for this society is PRACTICAL.

Olmstead could help states address those practical problems -- if they would just comply.

Cohen Veteran's Bioscience

NEUROINFLAMMATION & COGNITION ACROSS PSYCHIATRIC CONDITIONS (2019)

Executive Dysfunction (2015)

Dysexecutive symptoms therefore occur in most neurodegenerative diseases and in many other neurologic, psychiatric, and systemic illnesses.

Management approaches are patient specific and should focus on treatment of the underlying cause in parallel with maximizing patient function and safety via occupational therapy and rehabilitation.

Summary: Executive dysfunction is extremely common in patients with neurologic disorders.

Diagnosis and treatment hinge on familiarity with the clinical components and neuroanatomic correlates of these complex, high-order cognitive processes.

General intelligence is associated with subclinical inflammation in Nepalese children: A population-based plasma proteomics study (2016)

Hyper Brain, Hyper Body: The Trouble with High IQ (2017)

Mass Shooting -- A rare event that underscores common shortages for High Need Cognitive Disability

3/30/2021

Another mass shooting and another gunman that may have mental health problems.

When mental health professionals talk about these problems -- they often talk about Civil Commitment Statutes. (See our analysis of Colorado's 72-Hour Hold Procedure vs. the Petition for Court-Ordered Examination)

When judges talk about these problems --- they often talk about the need for "RESOURCES, RESOURCES, RESOURCES."

With respect to Colorado's Civil Commitment Statutes, from a TECHNICAL STANDPOINT --- they're probably fine --- BUT
They do appear too complicated for many people to apply AND that's a BIG PROBLEM in these situations

HAVING SAID THAT, We are kidding ourselves and our fellow citizens if we think we just need to amend the civil commitment statutes.

This is money and a lot of it for --- beds, placements and supportive housing.

BBC News: 10 People Killed in Grocery Store Shooting in Colorado

At 3:04:

"People Are Falling Through the Cracks All THE TIME. . .

"So to think that won't then boil up at some point and end up in a tragedy --- That is JUST NAIVE, THAT'S JUST NAIVE."

--- Chicago's Cook County Sheriff Tom Dart
60 Minutes (2013)

Whenever something like the King Soopers Shooting happens, we're generally in for a barrage of MENTAL ILLNESS DENIERS IN THE NAME OF STIGMA PREVENTION
First, Mental Illness is a HUGE CATEGORY representing a 1/5 to a 1/4 of the US POPULATION --- generally, we're talking about a tiny subset.
What is really important is NOT THE LABEL although it is the superficial tag we use in the Criminal Justice System --- and it does have legal ramifications.
SUBSTANTIVELY, the issue needs to be the UNDERLYING BIOLOGY.

Getting honest about our justice System & Cognitive Disability

3/29/2021

Individualized Precision Medicine and Individualized Precision Support

We need Voluntary Assessments & Data Collection
We need Individualized Plans --- some people (not most people) probably will need a PLACEMENT as opposed to living on their own or Supportive Housing
We need to be spotting TRENDS and developing appropriate public health responses.

This is a lot about getting HONEST about what it is really going to take to address Cognitive Disability for Justice-Involved People ---- which is most of the people in Criminal Justice.

There are significant:
- Health Needs
- Emotional Support Needs
- Supportive Employment Needs, and
- Housing, Placement, and/or Intensive Services Needs.

That's significant RE-STRUCTURING and it's a significant RE-STRUCTURING when we could see destructive behavior BUT we couldn't always see or accurately conceptualize and identify the underlying biology.

That is less and less the case every year and the new conceptualizations are certainly also identifying potential novel methods of treatment, especially with respect to the Immune System & the Microbiome.

Also, if we get savvier about recognizing some of the STRENGTHS people do have and accommodating weakness (often Executive Functioning Differences) this would be a lot better for everyone.

I was on a Zoom Meeting last week with Defy Ventures Colorado
They help people "defy the odds" in coming out of incarceration.
What they have found is many of the people they work with have already started businesses (legal or illegal) at one point in their lives --- and they are very interested in ENTREPRENEURSHIP.

To me with admittedly considerable conjecture, this goes to the HIGH PERCENTAGE of People with ADHD who are NOT FITTING IN to this society --- BUT want to and probably would with targeted support.

The Effectiveness of Mental Health Courts in Reducing Recidivism and Police Contact: A Systematic Review (2019)

Abstract

Mental health courts were created to help criminal defendants who have a mental illness that significantly contributes to their criminal offense.

The purpose of this systematic literature review is to assess the current evidence to address the question, "How effective are mental health courts in reducing recidivism and police contact?"

Systematic literature searches of eight electronic databases were performed. A total of 2590 unique citations were identified. Of these, 20 studies were included in the final analysis.

The results of this systematic review suggest there is some evidence to show that mental health courts help to reduce recidivism rates, but the effect on police contact is less clear.

Results also suggest case managers or access to vocational and housing services may be important components of effective mental health courts.

The Effects of Traumatic Brain Injury and Post-Traumatic Stress Disorder on Prison Adjustment and Recidivism among Military Veterans: Evidence from Minnesota
(Feb. 2021)

Studies also show that TBI and PTSD account for variation in prison-based and re-entry outcomes.

Despite this body of research, comparatively fewer studies have explicitly focused on how these factors affect prison adjustment for inmates with prior military experience.

We used administrative data provided by the Minnesota Department of Corrections (MnDOC) and employed a series of survival analyses to examine how prior diagnoses of TBI and PTSD (among other risk factors) influence metrics of institutional adjustment and recidivism among a sample of military veterans.

Our results indicate that the effects of TBI, PTSD, and other indicators of criminogenic risk are relevant when examining the experiences of justice-involved military veterans-especially with respect recidivism-based outcomes.

Persons With Severe Mental Illnesses and Sex Offenses: Recidivism After Prison Release (2019)

Abstract

Individuals who have committed sex offenses (ISOs) with severe mental illnesses are a complex population to serve and more research is needed to guide practice and policy, especially around community supervision, enrollment in Medicaid, housing, employment, criminal justice contacts, and reincarceration after prison reentry.

To further the literature in this area, we used logistic regression to model recidivism and admissions to violator or prison facilities among 127 ISOs with severe mental illnesses and 2,935 people with severe mental illnesses who were incarcerated in prison for other crimes.

Compared to prison releasees with severe mental illnesses who committed crimes other than sex offenses, prison releasees with severe mental illnesses who committed sex offenses were admitted to violator facilities at higher rates, when controlling for substance use, Medicaid enrollment, homelessness, and unemployment. Implications for practice, policy and research are discussed.

WE NEED FEDERAL LEADERSHIP--------THIS IS A LOT MORE THAN GUNS --------- IT'S THE HIGH COST OF HIGH-NEED COGNITIVE DISABILITY

3/27/2021

When it comes to MOBILITY, we don't have a big problem recognizing various levels of "impairment"
- One person might have gait issues,
- Another walk with a cane,
- Somebody else might have a scooter
- Another person might have a power wheelchair, and
- Someone else might not be able to get out of bed.
High Need Mobility Impairment can be EXPENSIVE -
- If you can't get out of bed even with significant help --- you may be in a nursing home.
- Many disability activists fought very hard to get ATTENDANTS.

If I hear one more physical disability activist say, "PISS ON PITY" and "I'm NOT a SAINT" --- I think I'm going to SCREAM -----

Because of course that is NOT SOCIETY's REACTION to many serious cognitive disabilities, especially among people under 60.

I'm not angry with physical disability activists --- I am angry at the society that has such hard time appropriately addressing cognitive disability, especially for people who are homeless or justice-involved.

Various levels of Cognitive Disability Need:

Public Health Information
Monthly Therapy
Weekly Therapy
Medication if tolerated and helpful (that is not a given)
Case Management
Intensive Case Management
Occupational Therapy for Cognitive Accommodations & Workarounds, especially regarding Executive Functioning Differences
Assertive Community Treatment
Supportive Housing
Assisted Living
Placement specifically for cognitive disability (non-secure)
Nursing Home open unit
Placement specifically for cognitive disability (secure)
Nursing Home locked ward
Mental Institute
Jails & Prisons
- Now, a lot of people in jails and prisons could do lower levels of INTENSIVE CARE if we had it.

U.S. President Joe Biden

I'm going to pick on Colorado Executive & Legislative Leaders

(BTW --- I can dish it out BUT I can't take it)

There are all kinds of tragedies affecting people in our communities that are implicating our fuzzy understanding of our LEGAL DUTIES AROUND COGNITIVE DISABILITY
- Shootings
- Killings of inmates with cognitive disabiity
  - Marvin Booker
  - Michael Marshall
  - Christopher Lopez
  - Suicides while Incarcerated
  - Ryan Partridge gouged out his own eyes while in the Boulder County Jail
We have been conceptualizing these issues as:
- Criminal Justice Issues
- Law Enforcement Training Issues
- Jail Staff / Prison Training Issues
- Civil Commitment Issues
Colorado State Government certainly the LEGISLATIVE is adopting progressive issues, but they don't want to pay for them in some cases --- they want somebody else to pay them -- like the Counties and Sheriffs Offices.
- Most recently this involves a great idea to limit RESTRICTIVE HOUSING (Solitary) in jails -- but they wanted the Sheriffs to pay for the DISCHARGE PLANNING.

Are Colorado Sheriffs Leading the Way on Residential Services?

The Polis Administration got a 2 year pass from us to see what the Behavioral Health Task Force was going to come up with.

There are good things
There is a CONTINUING PASSIVE REFUSAL to be Accountable and commit to Measurable Goals associated with Olmstead Compliance.
When I say "commit to Measurable Goals" --- I mean the IDEA of "MEASURABLE GOALS" -- not any particular "MEASURABLE GOAL"

COLORADO and all States NEED FEDERAL LEADERSHIP and it would be particularly helpful if that came with some $.

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