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"Boundaries," "Medication Non-Adherence" and "Joker" and the new movie "Fourteen"

5/17/2020

What made "Joker" such a Masterpiece was the complexity and nuance of what's going on in the society and for the individual when it comes to "mental illness."
"Fourteen" is a much more conventional story of friends -- one when a "mental illness" and:

"Medication Non-Adherence" and
"Boundaries" set by the friend without "serious mental illness."

I don't necessarily think "Fourteen" is wrong -- and in its own way it does have the sophistication and complexity of "Joker."

NOTE: When it comes to "Medication Non-Adherence":

Just because someone has a serious mental illness, doesn't mean the medication works, and
Further, even if the medication doesn't work, that doesn't mean the person doesn't have a "serious mental illness"
The science on this is moving on to:
- genetic testing where possible,
- the use of neuro-pharmacologists,
- recognition of the inherent problems of medications that impact the brain globally, and
- moving to biomarkers and the role of the gut and the immune system.
- Some of these psychiatric medications may have bad impacts on the gut which can ultimately negatively impact the brain.

The EXCRUCIATING NEED of Friends, Family Members, Mental Health Professionals, Legal Professionals, Others and State Administrators to set "BOUNDARIES" regarding the NEEDS of People with "Serious Mental Illness"

This is where I think "Fourteen" is much more straight-forward than "Joker" in portraying in one friendship -- what is really going on throughout multiple levels of the society.
It takes A LOT MORE than what we have been prepared to do to meet those needs -- and it destroys RELATIONSHIPS throughout the society when we don't-- and we ultimately leave it to the Homeless Shelter or the Criminal Justice System to deal with the MESS.
We gotta get really honest about why we need these "BOUNDARIES" and it is in no small measure because of our FAILED SYSTEMS.

"Fourteen"

Daily Beast Review

MEANWHILE: Ignorance, "The Wages of Sin" & Cognitive Disability

5/16/2020

The great "Sin" of current Cognitive Disability Treatment, Policy and Criminal Justice is only partially SCIENTIFIC IGNORANCE.

That will hopefully ULTIMATELY be solved with BETTER, MUCH BETTER funding for RESEARCH & TRANSLATIONAL MEDICINE.

On the other hand, MEANWHILE . . .

   Our IGNORANCE has SERIOUS POLICY & CRIMINAL JUSTICE IMPLICATIONS as well as basic MORAL & ETHICAL IMPLICATIONS --- NOW -- for the past several decades -- NOW.

    Not terribly surprisingly -- the hang up is RESOURCES.

   We are in the somewhat unenviable position of KNOWING ENOUGH to know people have COMPLEX COGNITIVE DISABILITIES -- and often not enough:

to "CURE" them,
provide a "VACCINE" -- knock-out TREATMENT
we do provide some ameliorative treatments that are all over the map in terms of effectiveness -- and its very individual

That means there is a MUCH GREATER NEED FOR "SUPPORT" -- and for Hundreds of Thousands of People in this Country --- that's more than a weekly support group.

That's supportive housing and it's placements.

In the words of famed US Senator Everett Dirksen:  "A billion here, a billion there, pretty soon, you're talking real money."

   That's really the problem: WE'RE TALKIN' REAL MONEY.

  There are Economic arguments to be made for doing this, logical arguments, medical arguments and moral and ethical arguments.

  Ironically, many more conservative folks might be more inclined to go along with this if it is paired with SUPPORTIVE EMPLOYMENT.

This is going to require innovative funding strategies such as:

Social Impact Bonds, and
Economic Stimulus such as we're proposing in our Double V Campaign

Of course, we could do something really CRAZY & INSANE and comply with the LAW -- ADA/Olmstead:

Measurable Goals
Reasonable Time Frames
Funding to Support the Plan

"MEANWHILE" on the Late Show with
Stephen Colbert

The Covid-19 Tsunami: A Medical & Economic Challenge & Quarrel

5/15/2020

Our Response Must Include Economic Stimulus &
arge Scale Restructuring of Debt --Bankruptcy Court on Steroids

When we think about the answer to the COVID-19 Pandemic -- the answer is often ALL OF THE ABOVE.

social distancing
masks
research
testing
contact tracing
cash payments to individuals and businesses
re-imagining the Works Progress Administration (WPA) for the 21st Century, including Supportive Employment. Integrating a 21st Century WPA with technical assistance provided to Small Business through the Small Business Administration.
Large scale restructuring of debt -- it seems very unlikely US Bankruptcy Courts are ready for the TSUNAMI of cases that are poised to hit.
Long range Economic Stimulus, including our Double V Campaign for Supportive Housing & Placements for People with Cognitive Disabilities to avoid homelessness and incarceration while providing the least restrictive environment.

Budget Shortfalls, Cognitive Disability & Economic Stimulus

5/12/2020

It is going to take a lot for us to get out of our COVID-19 Recession or Depression.

Construction of SCATTERED SITE SUPPORTIVE HOUSING & PLACEMENTS would be a HUGE Step in the Right Direction.

Corporation for Supportive Housing, Fairfax County

This Supportive Housing Development is in New York. Most states including Colorado have "Something" but it is far from what is necessary to address the needs of people with Cognitive Disabilities.

Modern Day Double V Campaign: A Victory Over Covid-19 and Bringing Supportive Housing & Placements to Scale

Utah was once lauded for solving homelessness — the reality was far more complicated
May 10, 2020

Paying for these projects often involves cobbling together state and local assistance with federal tax credits and private donations and requires a high level of cooperation, said Janice Kimball, executive director of Housing Connect, formerly the Housing Authority of Salt Lake County.

"It really does take a village," she said.

Still, the state has boosted permanent supportive housing capacity by about 600 since 2015.

For instance, Kimball’s agency has focused on expanding rental assistance programs and adding scattered supportive housing units in various apartment complexes.

But the high demand in Salt Lake City’s residential market makes building deeply affordable housing even more difficult as construction and property costs soar, explained Preston Cochrane, former executive director of Shelter the Homeless.

"The market-rate housing has the ability to capture the higher-market rents to get bigger loans," he said.

"But affordable housing projects don't have that luxury."
There are a couple of housing projects in the pipeline --

The Road Home and Shelter the Homeless just broke ground on a 65-unit complex called the Magnolia, and the Salt Lake City Housing Authority is working on a 100-unit facility called Pamela's Place Apartments. Both communities are designated for individuals experiencing chronic homelessness.

But the need for permanent supportive housing in all forms will continue to grow as the state does, mainly because many residents remain there for the duration of their lives. And that's OK, Kimball said.

"Most of the people there have a disability, maybe a mental health issue, maybe a substance abuse issue," Kimball said.

"So being able to stay there, take care of the unit, pay the rent, we consider to be a success."

Housing first is much broader than permanent supportive homes, said Michelle Flynn, executive director for The Road Home.

Flynn argues the state and its providers have never been more focused on the concept, which is baked into the state’s brand-new emergency shelter system and a range of homeless services.

For people experiencing episodic homelessness, that could mean rental assistance or rapid rehousing.

Still, officials and advocates agree that affordable housing — from permanent supportive communities to apartments that are financially within reach for working-class families — is the biggest piece of addressing homelessness across the board in the state.

And they hope Utah’s next governor makes it a top priority to address this fundamental need for shelter.

“In terms of preventing homelessness, it’s pretty straightforward,” Cochrane said. “It’s housing.”

Data-Driven Solutions vs That Less Expensive Solution That Doesn't Work

5/10/2020

The World is moving to a Public Health Approach to Criminal Justice.

Nobody has unlimited resources.

As alluring as it is -- PREVENTION alone won't get us there -- RIGHT NOW -- because our understandings are NOT ACCURATE ENOUGH -- and our TREATMENTS are NOT ACCURATE ENOUGH.

In many ways this is not unlike Alzheimer's or Parkinson's -- except hundreds of thousands of adults with Cognitive Disability from the teenage years (sometimes before) through middle age present more of a Public Safety issue.

Now none of this is "FAIR."

Now if we come at this from the 20th/21st Century Perspective of the American Criminal Justice System:

We're open to reform, in fact we want rehabilitation
The hugely SALIENT and RELEVANT FACTS for what is "going on" for the DEFENDANT -- will generally be deemed IRRELEVANT

Criminal Justice alone and Public Health/Mental Health alone have been HUGE FAILURES in the US.

Ramping Up the Role of Public Health in Criminal Justice with an INCREASED Epidemiological Perspective has the potential to improve things and improve things a lot.

The reality is -- if one person is struggling with Behavioral Challenges -- there are likely many more in states across the nation and countries across the world.

There are a myriad of biological and environmental factors interacting in very complex individuals ways -- but when we have large studies we can see surprising or not so surprising patterns.

As a Society-- WE SHOULD DO NO HARM & PROVIDE FOR SAFETY

There is a HUGE Challenge of what do when someone is a danger to others or is perceived to be a danger to others.

A lot of judges would probably throw up their hands in exasperation at the notion that they should be doing more-- when the STATE isn't providing sufficient resources.

The Jail/Prison Incarceration System is ironically in most states a form of HARM REDUCTION.

Except even many of those presiding over it, know it doesn't work.

IT'S AS SIMPLE AS A "CASEWORKER" -- HMMM . . .

Yeah BUT:

Many people with Cognitive Disability in the Criminal Justice System are by definition High Needs.
Even Medicaid "Intensive Case Management" will often be insufficient.
Assertive Community Treatment provides TEAMS with low caseloads of 8 to 10 people. ACT is an evidence-based treatment and may work well for many people with intensive mental health needs..
For some people ACT is not going to be enough and they may need something like an Assisted Living.
Colorado is looking at various other placement models-- and that is needed.
When we UNDER-ESTIMATE what it is going to take to provide for people with significant cognitive disabilities in:
- Supportive Housing or
- Placements

It often doesn't work.

And if it doesn't work (meaning it doesn't provide SAFETY) -- Where are we back to?

Homelessness
Jails, and
Prisons

A Public Health Approach to Criminal Justice

Our "Hierarchical Meritocracy," Utilitarianism & Behavioral Health

5/6/2020

The 2020 US Presidential Race is shaping up to be a COLOSSAL DISASTER with charges of sexual harassment on all sides.
On the other hand, is this an important step on our never-ending road to REFORM -- grappling with reality?
Part of that REFORM ROAD needs to include:

Flattening the Curve of American Political Hierarchy, and
Bringing More People Into Policy-Making and Decision-Making

If there was anyone who epitomized the idea of American Meritocracy it was in many ways former Oklahoma Governor, Senator and University of Oklahoma President David Boren. Oh, and he was a Rhodes Scholar.

Boren had very sophisticated views on American Politics and it would be pretty hard to say -- he was just some IDIOT who got elected.

He spent most of his career with "allegations" swirling around that he was gay, more concerning were charges of same sex sexual harassment for some years, more recent charges ultimately forced him from his position as President of the University of Oklahoma.

Boren was a big time POWER BROKER in Oklahoma and Oklahoma's Political Class was pretty prepared to PLAY ALONG, TO GET ALONG.

Not unlike our 2 Major Political Parties: the Republicans and the Democrats.

I don't think the point is Tom Wolfe's satire of the "Bonfire Fire of the Vanities" and the GREAT WHITE DEFENDANT.

I think we have to go a lot deeper than that.

It is NOT just recognizing the PROFOUND IMPERFECTIONS of our Leaders and Celebrities:

it's recognizing it in humanity, and
having the courage to both acknowledge it and not acquiesce to it, but
ameliorate it for everyone concerned.

Mental Illness & Intelligence: A Common Aspect -- Not Only the Brain But the Immune System As Well

5/5/2020

At the same time we've been experiencing a "Mental Health Crisis" -- we've been having a RE-EXAMINATION of what "INTELLIGENCE" is.
THAT'S A GOOD THING.
On the other hand, what we're contending with is much more COMPLICATED than the "EMOTIONALLY INTELLIGENT PEOPLE" and the "TOXIC PEOPLE."
Further, I would submit there are some causal links between our "Mental Health Crisis" and our perceived need to "RE-EXAMINE" the nature of "INTELLIGENCE."

THE PARADOXICAL NEED FOR COMMUNITY

    Often one of the last places we see a problem is in ourselves.

But we may pick up on it pretty quickly in our immediate or extended family members or associates, our myths, legends, stories, and history and in Modern Times the media presentations of the lives of our celebrities and political figures.

Ultimately, we have to recognize issues within ourselves -- BUT it is usually AFTER we've recognized "issues" in others.

INTELLIGENCE WASN'T WHAT I THOUGHT IT WAS GOING TO BE

      Originally, I just thought "INTELLIGENCE" came with my BRAIN and if I worked hard which I was inclined to do -- it would all work out.

University of Basel, Switzerland (2017): Scientists have demonstrated that both the structure of the brain and several memory functions are linked to immune system genes.

Emotional Dysregulation & the Immune System

Within my family, I was pretty much always considered "high strung" and intense -- but my family also thought I was smart and so did the School System.

We're not sure what "INTELLIGENCE" is as a Society -- it is pretty clear it is more COMPLICATED than we thought.

It is not that surprising that "EMOTIONAL INTELLIGENCE" would become a "THING" when so many people with TRADITIONAL INTELLIGENCE appear to have significant issues of "EMOTIONAL DYSREGULATION."

It is NOT THAT UNCOMMON for some very intelligent people to have some SIGNIFICANT EMOTIONAL DYSREGULATION -- & I would submit that's NOT AN ACCIDENT.

Further, I'm NOT the first person to make this connection -- and it does seem to have a lot to do with the Immune System.

MIT News (April 28, 2020): How could Covid-19 and the body’s immune response affect the brain?

The Desperate Need to 'FLATTEN THE CURVE" in American Political Structures -- If not DIRECT DEMOCRACY, INCREASED REPRESENTATIVE DEMOCRACY

I think the idea of "MERITOCRACY" was that the person with the most merit and often the most "political intelligence" should be at the TOP of the AMERICAN POLITICAL HIERARCHY -- President of the United States.

Who those people are is very complicated -- we used to glorify those failings or pretend they didn't exist-- we don't do that anymore -- but we have become resigned to those failings.

"Power Corrupts, and Absolute Power Corrupts Absolutely," according to Sir John Dalberg-Acton and many others.

Not only that, human beings are contending with a lot of things, none of us are perfect whether we have power or not.

One of the ways we "COMPENSATE FOR WEAKNESSES" is we provide INCLUSION and FLATTEN THE CURVE of HIERARCHICAL POWER in as PRACTICAL a way as possible.

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

A new study in the journal Intelligence reports that highly intelligent people have a significantly increased risk of suffering from a variety of psychological and physiological disorders.

. . .

“We know that for many of the examined conditions there must be a combination of genetics and environment for them to manifest,” says Karpinski.

“The results of this study support our hyper brain/hyper body theory, and may help direct future studies regarding high intelligence as a potential genetic piece of a psychoneuroimmunological puzzle.”

NIMH (2015): Disorders Share Risk Gene Pathways for Immune, Epigenetic Regulation

Genome-wide findings add to evidence blurring traditional psychiatric categories

Housing Stimulus -- We're Going to Need More

5/5/2020

Part of what we need to fund is Long Term Planning for Supportive Housing to bring it to SCALE in line with Olmstead for people with disabilities.

With "Medicaid Services" -- we often don't have Medicaid Network Adequacy -- but there is at least the understanding that we should have it.

Housing has become such a NIGHTMARE for people with disabilities --- with:

the Feds funding a large proportion of disability housing
the States funding some
the Feds placing the ultimate responsibility for Disability Housing on the STATES, and
the States not getting it done.

We do need additional major Federal appropriations for Supportive Housing --- we also need COMPREHENSIVE FEDERAL/STATE PLANS to bring HOUSING TO SCALE for people with disabilities.

These plans have to be MODIFIABLE and should be regularly modified at least on an ANNUAL BASIS.

COVID-19 is a great excuse to do what should have been done 20 years ago.

Housing-related provisions in “Phase 3” coronavirus stimulus

A Modern Day Double V Housing Campaign Inspired by the Double V Campaign of African Americans During World War II

State Governments: "Even though we know about those laws, still we don't comply with them" ---paraphrasing REO Speedwagon

5/3/2020

There are a lot of things that people with cognitive disabilities need and HOUSING is right up there.

We really need HUD to condition any money to States on COMPLIANCE WITH OLMSTEAD.

Specifically, that means:

Measurable Goals
Reasonable Time Frames
& Funding to Support the Plan

To bring Housing to SCALE for people who disabilities who are:

institutionalized
being released from incarceration
homeless
or otherwise at great risk of institutionalization.

REO Speedwagon 2010 -- about 30 years after "Keep on Loving You" (1980):
"And though I know all about those men
Still I don't remember"

This is pretty off the wall reference -- but whenever I think of Olmstead Compliance in this country -- this is what I think of.

Housing: A Conundrum for the States, A Nightmare for People with Mental Illness

2016: MLK Marade in Denver -- "Why is Michael Marshall Dead?"

Internationally & In the US: People Are Raising HOUSING as the OBVIOUS Economic Stimulus After COVID-19

5/3/2020

One of the things that is so FRUSTRATING about some of our debates regarding "Capitalism" and "Socialism" is they are not the OPPOSITES that we think -- and to be truly effective -- they need to be INTEGRATED.
That's very complicated and it doesn't necessarily look the same for every moment or place in history. What we are really looking for is WHAT WORKS and that is dependent on a lot of VARIABLES.
A Big VARIABLE -- A BIG ROCK -- is HOUSING.
There are the:

Construction Workers
Architects
Bankers
Tenants
Landlords
Etc.

In addition, people with mental and/or physical disabilities are in NEED of LEGALLY REQUIRED -- SCATTERED SITE SUPPORTIVE HOUSING & SUPPORTIVE EMPLOYMENT where possible.
So when we are thinking about MIXED USE HOUSING/BUSINESS ECONOMIC STIMULUS:

It Must Include SCATTERED SITE SUPPORTIVE HOUSING, &
Incentives for SUPPORTIVE EMPLOYMENT

One of the things people don't want to lose after the COVID Crisis ends is the SENSE OF COMMUNITY.

HOUSING & BUSINESS Mixed Stimulus with SCATTERED SITE SUPPORTIVE HOUSING AND Incentives for SUPPORTIVE EMPLOYMENT could help us BUILD OUT the COMMUNITY most of us want.

Kate Henderson, Chief Executive, National Housing Federation (UK)

Investing in Housing will Help Our Economy Bounce Back

US: Supportive Housing as Economic Stimulus

Internationally: Supportive Housing As Economic Stimulus

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Val's Blog

"Boundaries," "Medication Non-Adherence" and "Joker" and the new movie "Fourteen"

MEANWHILE: Ignorance, "The Wages of Sin" & Cognitive Disability

The Covid-19 Tsunami: A Medical & Economic Challenge & Quarrel

Our Response Must Include Economic Stimulus &
arge Scale Restructuring of Debt --Bankruptcy Court on Steroids

Budget Shortfalls, Cognitive Disability & Economic Stimulus

Utah was once lauded for solving homelessness — the reality was far more complicated
May 10, 2020

Data-Driven Solutions vs That Less Expensive Solution That Doesn't Work

Our "Hierarchical Meritocracy," Utilitarianism & Behavioral Health

Mental Illness & Intelligence: A Common Aspect -- Not Only the Brain But the Immune System As Well

Housing Stimulus -- We're Going to Need More

State Governments: "Even though we know about those laws, still we don't comply with them" ---paraphrasing REO Speedwagon

Internationally & In the US: People Are Raising HOUSING as the OBVIOUS Economic Stimulus After COVID-19

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Val's Blog

Our Response Must Include Economic Stimulus &arge Scale Restructuring of Debt --Bankruptcy Court on Steroids

​Utah was once lauded for solving homelessness — the reality was far more complicatedMay 10, 2020

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Archives

Categories

Our Response Must Include Economic Stimulus &
arge Scale Restructuring of Debt --Bankruptcy Court on Steroids

Utah was once lauded for solving homelessness — the reality was far more complicated
May 10, 2020