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THE CONSERVATIVE WING OF THE MENTAL HEALTH MOVEMENT NEEDS THE P&A SYSTEM & OLMSTEAD

2/2/2021

Our real thesis is that any wing of the Mental Health Movement that is concerned about bringing Housing & Intensive Services to SCALE --

Could Greatly Benefit from the P&A System & Olmstead.

DOJ & the P&As

The US Department of Justice does see an OFFICIAL ROLE for the federally mandated Protection & Advocacy Offices for People with Disabilities within the context of Olmstead.

That role is primarily the P&As statutory role as INVESTIGATOR of abuse, neglect and rights violations.

This role is specifically referenced in DOJ's 2011 guidance on Olmstead towards the bottom of the page.

That guidance also speaks about the rights of private enforcement.

Our concern is that without BETTER ADMINISTRATIVE ENFORCEMENT --- P&A and/or private enforcement efforts are left with MULTIPLE RESOURCE INTENSIVE ACTIONS.

We're really wanting NDRN and other disability groups to work with the FEDS on PRACTICAL Olmstead Technical Assistance and Administrative Enforcement.

In the meantime, we're interested in more P&A Partnerships to specifically address Olmstead Compliance.

Disability Law Colorado (Colorado's P&A) and the Colorado Lawyer's Committee have had a lot of success with partnerships to address Civil Rights, specifically the Jail Wait Case.

Curtis Decker, Executive Director of the National Disability Rights Network which provides support to all the Protection & Advocacy Offices around the Country

D.J. Jaffe who was the former Executive Director of the Mental Illness Policy Organization --- focused fiercely on the needs of people with the most serious mental illness, including those who were incarcerated or homeless.

In his zeal, he did try to destroy the P&A System -- there was that.

But Jaffe's advocacy did change the discussion.

More assessment and/or studies of inmates and people who are homeless is leading to wider spread recognition of the huge numbers of people with brain injury, mental illness, substance issues and developmental disabilities in these situations.

WAITLISTS & OLMSTEAD, PARITY & MEDICAID NETWORK ADEQUACY

2/2/2021

The US Supreme Court in its 1999 Olmstead decision specifically talked about "waitlists moving at a reasonable pace."

Additionally, US Department of Justice Guidance says more is expected the further out States are from 1999 and the original decision.

At least by 2011 if not before, it started to become clear what needed to be on the MENU for people with Mental Illness --- Supportive Housing and Assertive Community Treatment.
- Now if the person doesn't need that okay.
- If we have something better -- okay.
- There have to be objective criteria for Supportive Housing & ACT
- If people start to have problems, there needs to be a community placement -- so they don't end up in jail or prison.

Further, one take on a waitlist is a list of specific people with disabilities who are leaving the institution (mental institute, jail, prison, etc.) or are at great risk of institutionalization (such as homelessness).

Another take on waitlist is a list of housing, community placements, and intensive services and assignments of the people based on need for that particular housing, community placement, and/or intensive services.

Olmstead Waitlist for:
- Housing, and
- Assertive Community Treatment
- Would be fine if "moving at a reasonable pace."

Medicaid Network Adequacy

Again Medicaid Network Adequacy is not going to get to Housing in 2021
It's less vague than it was -- it's still vague.
Modern Heathcare (2019)
- "Health plans clashed with provider and consumer groups in their reactions to the CMS' proposal to give states more flexibility in regulating the adequacy of provider networks in Medicaid managed-care plans."

DISABILITY CIVIL RIGHTS LAWS & STATE DESIRE FOR FLEXIBILITY

People with Disabilities continue to suffer because states are not in compliance with various disability rights laws.
- Olmstead is Clear in 2021 -- to us
- Parity is Complicated in 2021 -- to us
- Medicaid Network Adequacy is too vague -- to us
We would like to see the FEDS through DOJ, CMS and HUD provide clear regulations, guidance and templates to States for Olmstead Compliance
- Templates States may request to modify if they can still comply with the law.
- Modifications can be posted on a Federal website.

U D Side's cover of REO Speedwagon's "Keep On Loving You"

Our off the wall paraphrase:

--- "Even Though States Know All About Those Laws, Still They Don't Comply"

"And though I know all about those men
Still I don't remember"

Parity

Mental Health America -- policy brief
To me "parity" is a very complicated political compromise.
Theoretically, if one can prove a violation -- the State or Insurance Plan just needs to correct it -- and one doesn't have to worry about "waitlists."
BUT it doesn't seem to cover housing in 2021 and there is a lot of unnecessary complexity that often empowers avoidance rather than compliance.
Having said that a California Court found that a state parity law did cover -- Assertive Community Treatment

CMS did issue new guidance on Parity in 2020

Factsheet
- Mental Health Parity
- Regulations
- November 8, 2013
  CMS-4140-F: Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
- Guidance
- June 1, 2016
  Warning Signs- Plan or Policy Non-Quantitative Treatment Limitations (NQTLs) that Require Additional Analysis to Determine Mental Health Parity Compliance (PDF)
- April 23, 2018
  Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA)
- April 23, 2018
  Form to Request Documentation from an Employer-Sponsored Health Plan or and Issuer Concerning Treatment Limitations
- October 23, 2020
  Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA)

The need to make immunopsychiatry a public health priority

2/1/2021

THE UK AND AUSTRALIA "SEEM" AHEAD OF THE US IN RECOGNIZING THE ROLE OF THE IMMUNE SYSTEM IN MENTAL HEALTH

THE WORLD NEEDS US TO TAKE THE LEAD --- WHY AREN'T WE?

I don't know that the US has to lead everything, but we are still considered the richest country in the world and we have a huge mental health problem.

It is very frustrating to be living in the richest country in the world and at least the UNDERSTANDINGS of mental illness "seem" more advanced in the UK and Australia -- and those advanced understandings seem to be more widespread.

There are leaders in the US and at US Universities pioneering IMMUNOPSYCHIATRY.

The idea that mental disorders are related not only to the brain but also the immune system is sometimes referred to as IMMUNOPSYCHIATRY, sometimes NEUROIMMUNOLOGY, sometimes PSYCHONEUROIMMUNOLOGY, and there may be other classifications getting to or including this idea.

Our common understandings in the US have not been affected that much, except on the DIET BOOK CRAZE.

That is concerning to me because these new understandings are MORE COMPLICATED THAN SUGAR MAKES YOU FAT or for that matter MENTALLY ILL.

A lot of this "seems" to involve MATERNAL IMMUNE ACTIVATION and DEVELOPMENTAL DIFFERENCE / DISABILITY (in some / many cases).

WHAT'S THE POINT?

As a society, we're outraged by months delay in COVID treatment -- and yet people with mental illness are looking at even more years and decades if we can't get on this. (& It may be years anyway, even if we make IMMUNOPSYCHIATRY a PUBLIC HEALTH PRIORITY)
Not to mention paying BILLIONS for all the HOUSING, PLACEMENTS & SERVICES --- Federal & State Governments should be bringing to SCALE -- and aren't.
Making IMMUNOPSYCHIATRY a PUBLIC HEALTH PRIORITY --- could have ripple effects throughout the society, including CRIMINAL JUSTICE, HOMELESSNESS, EDUCATION and EMPLOYMENT.

HUGELY SIGNIFICANT DISCOVERY of Jonathan Kipnis while at the University of Virginia -- so a lot of important stuff does happen in the US

University of Virginia School of Medicine -- the Immune System & Social Interactions.

University of Virginia Youtube Note -- also represented to the right

The lymphatic system plays an integral role in the immune functions of the body. It is the first line of defense against disease. This network of vessels and nodes transports and filters lymph fluid containing antibodies and lymphocytes (good) and bacteria (bad).

The Lymphatic System - Lymphangiomatosis & Gorham's ...

"Our neuroimmunology team examines the link between dysregulations of the immune system and its impact on neurological disorders such as multiple sclerosis and dementia, as well as psychiatric diseases including schizophrenia."

Inpsych -- Inflammation and Psychology Research Group

Investigating the Role of the Immune System in Psychiatric Disorders

The Inflamed Mind on Discovery

A rogue immune system is implicated in mental health disorders from depression to psychosis. James Gallagher meets the pioneers of "immunopsychiatry".

Novel Antibody Treatment for OCD Demonstrates Efficacy in Mice

Scientists report that they have discovered patients suffering from obsessive compulsive disorder (OCD) have increased levels of a protein called Immuno-moodulin (Imood) in their lymphocytes.

They say that this protein presents a drug target and animal models of the condition have been treated with an antibody.

The study was conducted by researchers at Queen Mary University of London and the University of Roehampton, both UK.

Antibodies are proteins produced by the immune system from the body's stores of immunoglobulin protein. A healthy immune system produces antibodies in an effort to protect us. The immune system cells produce antibodies when they react with foreign protein antigens, such as infectious organisms, toxins and pollen.

Immune Antibodies - My-MS.org

Researchers determine that the immune system affects – and even controls – social behavior.
• Blocking a single type of immune molecule made mouse brains go hyperactive and caused abnormal behavior; restoring it fixed both.
• Discovery could have enormous implications for neurological conditions such as autism and schizophrenia.
• “It’s crazy, but maybe we are just multicellular battlefields for two ancient forces: pathogens and the immune system. Part of our personality may actually be dictated by the immune system.”

In a startling discovery that raises fundamental questions about human behavior, researchers at the University of Virginia School of Medicine have determined that the immune system directly affects – and even controls – creatures’ social behavior, such as their desire to interact with others.

So could immune system problems contribute to an inability to have normal social interactions?

The answer appears to be yes, and that finding could have great implications for neurological diseases such as autism-spectrum disorders and schizophrenia.

“The brain and the adaptive immune system were thought to be isolated from each other, and any immune activity in the brain was perceived as sign of a pathology.

And now, not only are we showing that they are closely interacting, but some of our behavior traits might have evolved because of our immune response to pathogens,” explained

Jonathan Kipnis, PhD, chairman of UVA’s Department of Neuroscience. “It’s crazy, but maybe we are just multicellular battlefields for two ancient forces: pathogens and the immune system.

Part of our personality may actually be dictated by the immune system.”

THE HIGH COST OF SUPPORTIVE HOUSING ---$1.5 MILLION FOR 25 NEW APTS

1/31/2021

   Supportive Housing in General is different than Supportive Housing for Competency Restoration, BUT Supportive Housing is EXPENSIVE and that is probably the #1 Reason we don't have enough of it.

Further, the monetary cost / benefit analysis is COMPLICATED.

If people go to the ER and are on Medicaid --- that costs the State money. BUT a lot of people don't go to the ER -- they go to JAIL.

That JAIL is NOT funded by the STATE -- it's primarily funded by the MUNICIPALITY or the COUNTY.

That is why COUNTIES are the ones behind the STEPPING UP INITIATIVE to reduce incarceration of people with mental illness in "jails."

Now go to PRISON --- that is a state expense.

BUT OFTEN, many people unless it is a very serious offense do NOT go to PRISON --- they go back on the Streets and there is NOT ENOUGH SUPPORT.

So people keep coming back, get more and more convictions on their record and they often do go to PRISON.

  The likelihood that someone can get TAGGED with ANTI-SOCIAL PERSONALITY DISORDER at this point is pretty high.

   When I criticize the diagnosis of Anti-Social Personality Disorder, I am nonetheless saying:

the person may have committed anti-social acts,
the person is probably not psychotic,
BUT probably is extremely reactive and can be or is emotionally dysregulated
- Does it matter whether the reactivity or emotional dysregulation is the result of just being BAD or TRAUMA and/or INNATE IMMUNITY ?
  - How we think about these things DOES MATTER
Supportive Housing may or may not be sufficient,
Some people may need a secure placement
Any secure placement should be humane and NOT a jail or prison.

Supportive Housing for Individuals Ordered to Competency Restoration

OBH and the Colorado Coalition for the Homeless will spend $1.5 million to provide 25 additional supportive housing apartments for unhoused individuals who have been ordered to outpatient competency restoration services, bringing the program total to 53 Denver-based units. Read the press release to learn more.

--- from OBH UPDATES Jan. 2021
Colorado Office of Behavioral Health

I am Olmstead

Getting an Honest Accounting of Supportive Housing & Accessible Housing Needs & Supply

Developing Some Measurable Goals & Reasonable Time Frames

Now is a good time when the State Budget Expectations are Low ---

To get the numbers
Post them on a State website
Update them at least yearly
Provide the Current Cost Estimates for
- Individual Units
- Any cost savings that could be realized by purchasing more units
- Etc.
- What is the Current Cost Estimate to bring Supportive Housing & Accessible Housing to SCALE to meet the needs of people with disabilities?

WE NEED AI -- OR MORE SOPHISTICATED AUTOMATION ---TO GET MENTAL HEALTH PROFESSIONALS UP TO SPEED

1/30/2021

In some ways this TECHNOLOGICAL ADVICE is pretty funny because I'm NOT a Techie.

I got a little more on top of the research the early 21st Century way -- I searched PUBMED and put 2 & 2 together --- maybe.

But you know what? It takes time and energy and resources to do that -- especially if you are trying to INTEGRATE all that.

If you're not being paid to do that, it is hard to justify --- in our society.

SO WHY AM I DOING IT?

I'm FEELING it MORE
I'm More UPSET by the INJUSTICE
I"m MORE ANXIOUS by the fact that we're NOT getting to the ROOT CAUSES of these PROBLEMS
AND these 'feelings" are biological

Now somebody else is going to be more "passionate" about something else and it's all biologically individual and being shaped by our individual experiences and environments as well.

I AM ANXIOUS ABOUT THE APPARENT FACT THAT I KNOW MORE ABOUT THE RESEARCH THAN MUCH OF THE MENTAL HEALTH PROFESSION

My point is NOT --- HEY, I want to do this research for you ---
THE POINT IS: Mental Health Clinicians Need More Support in the form of a Better System to Stay on Top of This Research

RIFFING OFF AI and "TRADITIONAL INTELLIGENCE" and "EMOTIONAL INTELLIGENCE"

I have been pretty UNINTERESTED in AI and the many debates and scenarios that various people and entities have been discussing.
What I really began to recognize as a young adult was that OTHER PEOPLE'S "TRADITIONAL INTELLIGENCE" was a lot MORE COMPLICATED than the SOCIETY had led me to believe.
When we've thought about TRADITIONAL INTELLIGENCE -- it's been all about the BRAIN.
The idea that part of your "TRADITIONAL INTELLIGENCE" might relate to how many PARASITES you do or don't have and what they are -- is NOT SOMETHING we were thinking.
So that's the MICROBIOME --- and really relates to "MENTAL HEALTH" as well as IMMUNE DISEASE.
We have more genetic material from our MICROBIOME than we do "HUMAN" genetic material.
So we need pretty sophisticated ways to understand all these INTER-RELATIONSHIPS, which could also be thought of as EQUATIONS.
Our Biology is So Complicated --- can we fully understand it without AI or at the very least Super Computers?
Further, there do "seem" to be some built-in CATCH-22s for some people and "TRADITIONAL INTELLIGENCE" -- and part of that does seem to involve the IMMUNE SYSTEM.

AN ASIDE

There is a lot of "CONJECTURE" on Orchid --- there's a lot of playing with IDEAS, mainly because I see the VALUE of that, and
I see it as CRITICAL to PROBLEM-SOLVING
We have inadvertently and sometimes purposefully shut a lot of that down in this SOCIETY --- in the name of EFFICIENCY
BUT we're often NOT EFFECTIVE
If there is anything that is NOT being handled EFFECTIVELY on MULTIPLE LEVELS -- it's "MENTAL HEALTH" and Cognitive Disability

RESEARCH --- THE SYNDROME VS. THE DISTINCT ILLNESS

1/30/2021

ADHD, AUTISM AND MENTAL ILLNESS --- AND THE IMMUNE SYSTEM

The DSM has looked at clusters of symptoms and said this is a particular type of "mental illness" --- one could also say a particular type of "mental syndrome"
What research seems to be saying is that many developmental disorders and "mental illnesses" share clusters of symptoms.
Further -- the IMMUNE SYSTEM keeps coming up.

We want Olmstead Planning for Cognitive Disability and we want every bit that is necessary and legally required.

BUT we are never going to be able to afford the unsupported low bar of our current mental health profession.

AND they can't afford it, either.

Click Medpage logo for Jan. 19, 2021 article referenced below.

"Study IDs Puzzling Risk Factor for ADHD— Strong statistical association but biological connection remains a mystery" (hmmm . . .)

Moms with auto-immune disorder more likely to have children with ADHD

(I'm not sure this is very puzzling if you've been paying attention to the research)

DRAFT: Innate & Adaptive Immunity in Cognitive Disorders

National Institute of Mental Health: 5 Disorders Share Common Genes (2013)

"Now that doesn't match with the idea that these are distinct."

In summary, calcium seems to play a central role in the activation of cells of the immune system. When the cells are stimulated, [Ca2+]i generally increases as a result of entry from the external medium, as well as mobilization of calcium from intracellular membrane-bound compartments.

Calcium homeostasis and the activation of calcium channels ...www.ncbi.nlm.nih.gov › pmc › articles › PMC1807782

Calcium channels are membrane-spanning proteins that regulate the intracellular concentration of calcium ions (Ca2+). After entering the cell, Ca2+ activates specific calcium receptor proteins, e.g., calmodulin, troponin-C, or calcium-activated calcium, potassium, and chloride channels.

Calcium Channel - an overview | ScienceDirect Topics www.sciencedirect.com › topics › medicine-and-dentistry

Archive | Disorders Share Risk Gene Pathways for Immune, Epigenetic Regulation

Click Image to go to 2015 article

FORM & SUBSTANCE---- MINNESOTA'S HOUSING OLMSTEAD GOALS

1/28/2021

Two incorrect assumptions that make Olmstead Planning so scary to policymakers are:

Olmstead Planning is a one-time event-- often a 5 to 10 year Soviet-style plan that has to be PERFECT.
- In fact, while a legally sufficient Olmstead Plan may go out 5 or 10 years -- it's constantly being REVIEWED.
That Olmstead Plan is NON-MODIFIABLE --- it is like an IRREVOCABLE TRUST -- so let's make this as vague as possible.
- Olmstead Plans are MODIFIABLE and generally changed circumstances or new information are common bases for MODIFICATIONS.

Minnesota's on-going Olmstead Planning came out of the Jensen case in which Federal Judge Donovan Frank insisted on Measurable Goals even as Minnesota state officials kept trying to feed him plans without "measurable goals."

Minnesota has been providing an UPDATED OLMSTEAD PLAN with MEASURABLE NUMERIC GOALS now since 2015 and they did make modifications based on COVID.

We feel strongly that people with disabilities would be a lot better off if the FEDS make a FIRMER COMMITMENT to DISABILITY HOUSING.

BUT maybe the FEDS won't do that.

"Measurable goals" are still legally required in State Olmstead Planning.

If States are updating plans on a yearly basis, there are a lot of benefits -- two of which are:

Continuous Improvement, and
Responsiveness

It's unclear whether Colorado and most other States will get LEGALLY REGUIRED MEASURABLE OLMSTEAD GOALS in the next 5 years.

Minnesota's 2020 Revision to its Olmstead Plan

Housing and Services (DHS, MHFA)

GOAL ONE: By June 30, 2020, the number of people with disabilities who live in the most integrated
housing of their choice where they have a signed lease and receive financial support to pay for the cost
of their housing will increase by 5,569 (from 5,995 to 11,564 or about a 92% increase).

Annual Goals to increase the number living in the most integrated housing:

• By June 30, 2019 the number will increase by 5,569 over baseline

• By June 30, 2020 the number will increase by 5,569 over baseline

Minnesota Olmstead Plan Section on the Minnesota DHS Website

CAN THE FEDS GET US TO "MEASURABLE GOALS"

1/27/2021

    One of the reasons there is so much pressure on government to do something about cognitive disability -- there is so much pressure on families --- and a lot of that pressure is FINANCIAL PRESSURE.

We've made the point before that Cognitive Disability has already EXHAUSTED the Healthcare System.

    While the researchers and the National Institute of Mental Health may be self-interested, it is hard to get away from their argument that we're in desperate need of better understandings and better treatments.

    We are in a Behavioral Health Crisis in large part because we can't or won't afford the current remedies to SCALE --- Supportive Housing being right at the top of the list.

The call from Black Lives Matter to DEFUND THE POLICE may not be considered the right "messaging" --- BUT it is hard to see how we are going to get out of this without RE-ALLOCATING RESOURCES.

   Another way to think about this is DON'T COST SHIFT TO THE POLICE.

Colorado's Behavioral Health Task Force Blueprint for Reform

Colorado needs Federal Guidance (& mainly RESOURCES) and so do most States.

States "maybe" more receptive to that "GUIDANCE" with new proposed federal policy initiatives on Social Determinants of Health (including Housing) and already proposals for infrastructure housing that includes Disability & Elder Housing.

We need to get States to Measurable Goals --- and to me that's a role for Olmstead Planning & the FEDERAL GOVERNMENT with technical assistance and administrative enforcement by executive agencies with the US Department of Justice as the backup --- and private enforcement a last resort..

I think the reason the FEDS haven't been more UNIFORM in their ENFORCEMENT over the past over 20 years since Olmstead-- they didn't want to have that LARGE SCALE CONVERSATION ABOUT RESOURCES --- maybe they are ready to have that RESOURCE CONVERSATION.

If the FEDS are ready to have that conversation with real results, a lot of that passive resistance from the STATES to OLMSTEAD -- may go away.

That would be an excellent thing for people with disabilities in this country.

"PLANNING" FOR SCALE: THE TENSIONS IN OLMSTEAD

1/25/2021

There are many tensions in Olmstead, 3 Big Tensions are:

The US Supreme Court decided Olmstead in 1999 and most states still aren't in compliance.
- According to the US Department of Justice the further out States are from 1999 -- the more that is expected.

With respect to mental health and other cognitive disabilities, some of the high end of the continuum got cost shifted to the Streets and Law Enforcement -- so some of this isn't currently on the State's books--it's on the books of the Counties and Municipalities.

In 2021, there are lot more people with "cognitive disabilities" who are "institutionalized" or "at great risk of institutionalization" than were recognized in 1999.
- In cognitive disability, the primary institutions are jails and prisons. In 1999, most disability advocates were focused on large disability institutions such as mental institutes, and later nursing homes. Those are still important, but they are not as large as jails and prisons as the cognitive disability providers of last resort.
  - Further, "mental illness" is just one of a number of significant cognitive disabilities that can put one at risk of incarceration..
  - A lot of people in jails and prisons have brain injury, substance issues, ADHD or Autism and may also have traditional "mental illness."

COVID provides States a legitimate reason why they can't fund everything that would have been expected pre-COVID.

At the same time, it provides an opportunity to do that PLANNING and to press the Federal Government for COVID Stimulus and Economic Relief in various forms, including:

Supportive Housing, and
Accessible Housing

Orchid is primarily a GADFLY.

We see a lot of HYPOCRISY that is preventing Olmstead Compliance.

Further, we see Olmstead Compliance as Legally Required and such an obvious SOLUTION to Disability Housing Issues and a significant part of Criminal Justice Reform.

COMING TO TERMS WITH "THE TOTALITY OF THE CIRCUMSTANCES" IN BEHAVIORAL HEALTH

1/23/2021

"Totality of the Circumstances" feels very EQUITABLE as opposed to a BRIGHT LINE legal test.

Two driving factors in our current Criminal Justice Crisis are:

Bright Line Competency Standards, and
A Bgillion Factors regarding Cognitive Disability, some of which (many of which) mental health professionals are not even competent to assess.

What are some big areas in which mental health professionals may need to be supplemented with other heath care professionals to deal with:

Brain Injury,
Developmental Differences (At least the University of Michigan considers Bipolar Disorder a Developmental Disorder)
Maybe an occupational therapist to address executive functioning issues
Etc.

This is also about getting HONEST about the EQUATION. What do I mean by the EQUATION?

Basically, I mean what Robert Sapolsky means in the video to the right when he says: we've found all these Biological Explanations for Behavior over the last 500 years, you really have to ignore the whole TRAJECTORY OF SCIENCE to think this is going to stop.

What are some of the things that drive Human Intent that we didn't understand a 100 years ago:

Developmental Difference
Brain Injury
Substance Issues
Environmental Toxins
Societal Trauma
Childhood Trauma
Etc.

Now to me, we can satisfy the PERSONAL RESPONSIBILITY WARRIORS --- if we will just focus on SAFETY and HUMANE TREATMENT.

We post this video a lot. It is Stanford Neuro-Biologist and acclaimed Author Robert Sapolsky on "Free Will."

To us, the important thing is that Absolute Free Will is NOT in the past or in the present --- it is something we are trying to get, we make fitful progress, and the more we learn the more we realize we don't know.

BUT it is hard to get away from Sapolsky's basic point that we must understand the underlying BIOLOGY.

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Val's Blog

THE CONSERVATIVE WING OF THE MENTAL HEALTH MOVEMENT NEEDS THE P&A SYSTEM & OLMSTEAD

WAITLISTS & OLMSTEAD, PARITY & MEDICAID NETWORK ADEQUACY

The need to make immunopsychiatry a public health priority

THE HIGH COST OF SUPPORTIVE HOUSING ---$1.5 MILLION FOR 25 NEW APTS

WE NEED AI -- OR MORE SOPHISTICATED AUTOMATION ---TO GET MENTAL HEALTH PROFESSIONALS UP TO SPEED

RESEARCH --- THE SYNDROME VS. THE DISTINCT ILLNESS

ADHD, AUTISM AND MENTAL ILLNESS --- AND THE IMMUNE SYSTEM

DRAFT: Innate & Adaptive Immunity in Cognitive Disorders

FORM & SUBSTANCE---- MINNESOTA'S HOUSING OLMSTEAD GOALS

CAN THE FEDS GET US TO "MEASURABLE GOALS"

"PLANNING" FOR SCALE: THE TENSIONS IN OLMSTEAD

COMING TO TERMS WITH "THE TOTALITY OF THE CIRCUMSTANCES" IN BEHAVIORAL HEALTH

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ADHD, AUTISM AND MENTAL ILLNESS --- AND THE IMMUNE SYSTEM

​DRAFT: Innate & Adaptive Immunity in Cognitive Disorders

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DRAFT: Innate & Adaptive Immunity in Cognitive Disorders