Category:

Anti-Social Personality Disorder & the Most Incarcerated Country in the World

11/5/2017

There are really HUGE issues that we SHOULD be dealing with in mental health competency in the criminal justice system, and we're thinking specifically about the rampant "Anti-Social Personality Disorder" Diagnosis.

Now that's a complicated issue -- BUT there's no interest on the part of the Colorado Dept. of Human Services in tackling this even with a suggestion to try and enlist the CU National Behavioral Health Innovation Center (of course, our offer was awhile back)

Now, CDHS can't staff their forensics unit or find a new Superintendent for CMHIP.

We live in the most incarcerated country in the world with a well-meaning and over-reaching mental health profession given the knowledge base and that is hurting a whole lot of people in the Colorado Criminal Justice System right now whether one finds competency or not.

Oxford Univ. Press Blog: Personality Disorders

Personality Disorders Must Be Reformed

Sufficiency of Knowledge, the Criminal Justice System, People with Disabilities and the Human Rights Issue of Our Time

9/27/2017

So what are we trying to say with regard to the sufficiency of the body of knowledge in mental health as it relates to the criminal justice system?

We're NOT saying ----there is NO knowledge in the mental health profession. In fact, there is a lot of knowledge.
What we are saying is that whether knowledge is sufficient depends on the task @ hand. One may be a whiz @ engineering and not be able to get a rocket out of the Milky Way Galaxy.
Because of the historical nature of "mens rea" or mental element in the criminal law, mental health professionals have been pressed into service by desperate defense attorneys to provide "expert" testimony as to whether their client was "insane" and prosecutors have engaged their own "experts."
No other area of medicine [mental health] is so implicated in punishment and no other is so struggling in lack of sufficient scientific grounding.
The Criminal Justice System really can't just reform itself, or not easily. It will likely take a combination of Legislation and Court decisions to reform the fairly routine human rights violations that are committed against people with disabilities, especially invisible, largely cognitive disabilities, that occur on really a daily, hourly basis.
Of course, what we really need to do is get people with disabilities -- mental illness, brain injury, developmental disability, etc. --- out of the criminal justice system and provide the housing and services, including intensive services if necessary, that they will need to remain outside of the Criminal Justice System and other institutions.
This truly is the Human Rights and Civil Rights Issue of Our Time.
We Hope You Will Support Our Draft CO Olmstead Planning Bill

Mary Robinson was an Irish Independent politican who served as the 7th, and first female, President of Ireland from December 1990 to September 1997, and the United Nations High Commissioner for Human Rights from 1997 to 2002. -- Wikipedia

New Science Is Amazing AND It Has HUGE Moral Implications for Our Society: NOW

Our Criminal Justice System Can Be A Very Nasty Disability Service Provider with an Abusive Edge -Because the State Isn't Providing the Beds, Housing or Services @ the Scale Needed for People with Disabilities

9/23/2017

Mad Eye for the Sane Society

Mad Eye Moody from the "Harry Potter" series by J.K. Rowling

"If You Can't Keep A Simple Appointment, Probation May Not Be Right For You -- Same is True for My Fellow Judges."

---Denver District Court Judge
Sept. 22, 2017

So generally the Criminal Justice System doesn't really look @ Disability per se.
What it looks @ is:

Competency to Stand Trial

AND

Guilt by Reason of Insanity

Of course, Reality is a lot more complicated than that.

A lot of the people in the Criminal Justice System in Colorado and nationally have:

Learning Disabilities
Developmental Disabilities
Executive Functioning Deficits
Mental Illness
Substance Use Issues
Brain Injury

AND they are probably not going to meet our high bar:

incompetent to stand trial (ITP) or
not guilty by reason of insanity (NGRI)

We really picked on the Denver Judiciary in the Headline, but the Truth is that Denver Judges and Judges around the State have indicated a problem of lack of services.

The fact is Colorado may need:

2000 more psych beds than what it has. (This is loosely based on the Mental Illness Policy Organization's recommendation for 50 psych beds for every 100,000 people)
3000--7000 more slots in Assertive Community Treatment (ACT) (That's a pretty broad range and is based on people trapped in the criminal justice system, nursing homes, homeless, and in institutions without sufficient intensive services in the community)

BOTTOM LINE: ACT Needs to be available where reasonably medically necessary.

WE HAVE TO HAVE SAFETY
But the people in our criminal justice system have pretty complex, expensive needs & pretending they're just BAD, just makes it more difficult not less to do the hard planning ahead for this State--

AND IRONICALLY INCREASES THE NEED FOR HOUSING & SERVICES which is already
ENORMOUS.

Uncle Billy with George, after George realizes Uncle Billy lost the money in "It's A Wonderful Life"

Integrating Physical Health, Mental Health & the Law: Trying To Shore Up Our Incompetent Mental Health & Legal Systems

9/10/2017

The Telegraph (UK)

“You can’t separate the mind from the body,” said Prof Sir Robert Lechler, President of the Academy of Medical Sciences.

“The immune system does produce behaviour. You’re not just a little bit miserable if you’ve got a long term condition, there is a real mechanistic connection between the mind, the nervous system and the immune system.

“Our model of healthcare is outdated.

"We have a separation. Mental healthcare is delivered by mental health professionals, psychiatrists, mental health nurses and so on, often in separate premises from where physical health care is delivered and that is simply wrong and we need to find ways to ever more closely integrate and train amphibious healthcare professionals who can straddle this divide.”

"Research has also shown that people who have suffered severe emotional trauma in their past have inflammatory markers in their body, suggesting their immune system is constantly firing, as if always on guard against abuse."
. . .

One promising treatment for depression on the horizon is the use of electrical stimulation to change the signals between the brain and the immune system.

Prof Kevin Tracey, President and CEO, of the US Feinstein Institute for Medical Research, discovered that the brain controls production of a deadly inflammatory chemical called TNF, which if released in high doses can be fatal, causing people to, literally, die of shock.

He has recently developed a electrical device which reproduces the connection and switches off the chemical. Three quarters of patients with rheumatoid arthritis recovered following trials.

“This is the tip of the iceberg of a new field called bio-electric medicine,” he said.

“This is a new way of thinking about medicine. We’re using electrons to replace drugs. This will not replace all drugs. But there will be many drugs that are either too expensive, too toxic which may be replaced by these devices.”
http://www.telegraph.co.uk/science/
2017/09/08/depression-physical-
illness-could-treated-anti-inflammatory/

Val's Take

It is not just our model of Healthcare that is outdated -- our model of Justice is outdated and not just a little bit -- It Shocks the Conscience.
We have Legal Systems in place that purport to make determinations in which the scientific knowledge to make such determinations does not exist -- and saying they're just Legal Concepts is a Legal Fiction I'm not willing to go along with.
Amazingly, these determinations are made everyday.
How did this happen? Well, I think actually for initially benevolent purposes and at the behest of defendants and their counsel to address the situation of someone who at the time of the crime was "insane. "
Well, this hardly ever happens -- except it happens a lot -- things turned out to be a lot more complicated than we thought.
Right now (subject to change):

One of the leading theories regarding mental health is the Immune-Gut-Brain Triad
Former National Institute of Mental Health Director Thomas Insel says we don't even have a parts list for the Brain and this is a time of "discovery" -- we have to be "humble."
Further, Insel maintained that the DSM 5 lacked scientific validity and that's one of the reasons for the Research Domain Criteria Program (RDoC).

The Law treats the criminal law and "punishment" differently than other determinations with higher burdens of proof.

When we punish someone we're theoretically punishing both the bad act and the bad intent.

Reality is presenting us a very messy picture not only with the Immune System and the Microbiome but with Social Determinants of Health.

It is long past time for us to let go of punishment, and focus on:

safety
evidence-based treatment, and
addressing the "root causes" of problems.

The Criminal Justice System As A General Diversion Mechanism for an Under-Resourced Mental Health System

7/7/2017

"Typically prosecutors undertake one of two roles with mental health issues.

"There is the traditional role as the “skeptical advocate”—one who contests forensic issues of competency, sanity, guilty but mentally ill, and factors in sentence mitigation.

"But some prosecutors are now accepting the new role as a “diversionary gatekeeper,” using mental health treatment programs as alternatives to criminal charges or traditional sentencing.

"Neither of these roles is sufficient to implement the prosecutor’s duty to promote a just society.

" Prosecutors must go beyond these roles and address a larger injustice that makes both our mental health and criminal justice systems a scandal.

"They must reverse their point of view and recognize that the criminal justice system is a general diversion mechanism for the mental health system."

-Gerald E. Nora, American Bar Association
"Prosecutor As Nurse Ratched"

We posted this article some time ago, and I was glad to notice a renewed interest in it on the Orchid website.

What does it mean when Colorado Medicaid won't fund Assertive Community Treatment for all where reasonably medically necessary?

   Those people with intensive community mental health needs have to go some place and thousands of them are going to Colorado jails and prisons.

   We're not saying all those people need Assertive Community Treatment -- BUT when we de-prioritize the people with the most intensive mental health needs, we can't be surprised by the consequences.

   D.J. Jaffee in his timely book, "Insane Consequences" blames both the Mental Health Industry and Government for the unwillingness to prioritize those will the most challenging mental health needs.

That has certainly lead to what Gerald Nora refers to above in his American Bar Association article: the Criminal Justice System as a general diversion mechanism for an inadequately resourced Mental Health System.

   Jaffee argues it is just a question of priorities and leadership not money. Well, we are definitely going to have to have the leadership, but we're not gonna be able to just write off people with less serious mental health issues either -- or they will be serious.

   Besides, as Microsoft's Bill Gates points out treatment without prevention is unsustainable.

If we pull thousands of people out of the Criminal Justice System who have:

Mental Illness
Traumatic Brain Injury
Developmental Disabilities
Etc.

And provide the intensive community services and housing they may need to live successfully in the community there should ultimately be savings from the criminal justice system to do that or in the worst scenario provide a therapeutic environment.

Not the JESUS GOD HELP US SCENARIO --- we've got now.

Everyone Has to Play Their Role In the Criminal Justice System or the Morality Play or the Highest Stakes Legal Gambling You'll Find in this Country

1/1/2015

So what am I bitchin' about now? Well, the criminal justice system -- doesn't everyone do that? My concern is that we can still obtain safety (maybe better) & squeeze some more of the "gambling" nature out of the criminal justice system.
Truth is -- we've squeezed a lot out already AND not near enough.
Which inelegantly brings me to jail diversion programs, the Olmstead lawsuit that we will be filing against the State includes demands for a massive increase in jail diversion programs since the largest institutions most people with mental illness are in--- are jails and prisons.
I love colorful characters and goodness knows you're going to find them at a courthouse.
AND that rolling the dice with other people's lives --- that wears on everybody.
How 'bout some massive new jail diversion programs to ring in the New Year, Guvn'r?

"You know, I was just knee-high to a grasshopper when I first met Racehorse Haynes. Certainly, I was not the Trial God I am today.
"Stories, I'm telling you that man had stories like you would not believe.
"And now I'm traveling all over the country defending these poor (or in my case these guys are probably filthy rich) sons of bitches.
"This is what God put me on this Earth to do."
----extremely fictional account of a Southwest Criminal Defense Attorney
(who I have the deepest respect for, I love you man).

Colorful & Flamboyant Texas Criminal Defense Attorney Richard "Racehorse" Haynes. Time Magazine once listed Haynes as 1 of 6 of the best criminal defense attorneys in the country.

Everyman fighting with Death -- A Medieval morality play.

US Supreme Court Justice Antonin Scalia

Justice Scalia has on occassion (based on my flawed memory) referred to criminal trials as modern society's morality plays.

P.S. True Confessions: This Blog is NOT Exactly what it appears to be. The concern I had at the time was actually with the Gambling Nature of Jury Selection and the Criminal Justice System and "Denver High Dollar Criminal Defense Attorneys" AND I also wanted help from certain High Dollar Denver Criminal Defense Attorneys.

So the Blog Post is focused on a "fictionalized" Southwest High Dollar Criminal Defense Attorney -- who is actually a really good guy if he were real. [With Friends Like Me -- Who Needs Enemies].

It is easy to make fun of this kind of stuff -- and the problem is with the System. Attorneys are just responding to the System & Trying To Make a Living and Help People in a Profound Way.

I do strongly think and believe this waste of resources on "Jury Selection" is NOT leading us closer to Justice.

to go back to toP^

We Can't Handle the Truth about Intent, Mental Disorders, the State of the Science, or our Failed Service Delivery System

11/10/2014

Ari Liggett (Chopped Up Mom, long history of mental illness),
James Holmes (Aurora Theater Shooting, history of mental illness)
Karl Pierson (Arapahoe High School Shooting, history of emotional problems)
Ad Nauseum

We have to have safety. We have to. AND nothing I say below is intended to undermine that fundamental fact.
Socrates allegedly made quite a few enemies by asking what appeared to be simple definitional questions such as "What is virtue?"
Well, "What is mental illness?" ; "What is insanity?"
In our society those turn out to be very complicated questions involving two primary disciplines: mental health and law.
Both mental health and law are constrained by the limitations of the other.
The law doesn't turn on a dime -- if a statutory definition is behind current knowledge then it has to be changed either in the legislature or challenged in the Court System.
In my humble opinion, the laws regarding "Competency to Stand Trial" and "Not Guilty By Reason of Insanity" are about as arbitrary and capricious as it gets.
Speaking of being humble (which I'm not), Dr. Tom Insel none other than the Director of the National Institute of Mental Health speaks about the need for "Atonement" in the area of mental health and the need to be "humble."
Our current criminal laws involving competency and insanity are based on mental health AND dare one say they are not very humble.
If one is paying attention to the science, with the identification of bio-markers in mental health one could easily come to the conclusion that at some point in the future this "insanity" regarding the criminal law and our failed service delivery system will be largely fixed.
Now, the question really is how long do we have to wait for the madness to stop?

To Go Back To Top^

DAMN IT -- WE NEED PEOPLE OUT OF THE CRIMINAL JUSTICE SYSTEM -- WITH ALL APPROPRIATE SERVICES & SAFETY PROTOCOLS --- NOW ---- & AS FAR AS I KNOW THAT MEANS MEDICAID

11/1/2014

We can't wait any longer, people are dying AND saying we're now not going to subject people with mental illness to "administrative segregation" is NOT near enough.
The misguided idea that we can subject people with "mental illness," brain injury, neurological disease or developmental disability to further emotional trauma to obtain some penological goal is in itself delusional and not based on any evidence that I am aware of.
We need to be able to ramp up the CO Medicaid Community Mental Health Services Waiver that has struggled and struggled to be relevant to the actual needs of people with "mental illness."
( For more "insight" see our Instructive Comparison of the HCBS-EBD Waiver & the HCBS-CMHS Waiver)
At the top of the list --- Assertive Community Treatment (ACT) and ULTRA Intensive Case Management -- on a daily basis if necessary. And if we are really smart "housing as healthcare."
WE CAN DO THIS & WE NEED TO DO IT NOW!

Let's Start Costing It Out NOW for this Upcoming Legislative Session.
Some of the Intended Benefits:

Terminating the practice of putting people with bad behaviors in torture chambers (aka modern prisons & jails) to "teach them a lesson."
Terminating the practice of scapegoating people from jailors to judges in impossible positions with inadequate alternatives and training.
Achieving greater community safety than what we currently have.

Research reveals that get-tough tactics may worsen rates of juvenile delinquency
http://www.scientificamerican.com/article/how-to-turn-around-troubled-teens/

to go back to top^

I'm Gonna Cry Me A River BUT First We've Gotta Continue To Build Better Systems

10/20/2014

I'll never forget watching the closing argument in one particular Oklahoma County death penalty case.
The Defendant was a young man who committed a murder and the defense's argument was that a mitigating factor was that the man had been sexually abused as a child beginning at age two.
The sexual abuse was uncontroverted, and my boss at the time Oklahoma County DA Bob Macy argued that such sexual abuse was no excuse. The man received the death penalty.
From my perspective, I did not feel comfortable morally judging that man (or anyone for that matter) although I felt perfectly comfortable saying he was very dangerous and the community needed to be protected.
Which brings me to my experience today in a Colorado courthouse many years later, in a different state (in more ways than one), presumably and in actuality more progressive, and observing the disposition of much less dramatic and primarily non-violent offenses.
It was all there-- the impatience, the system's unrealistic expectations regarding the abilities of people with mental illness, developmental disabilities, substance abuse issues, brain injuries, trauma, etc. to comply with "Court Orders" and "Terms of
Probation."
And these weren't trials, so the familiar long dockets, attorneys with more than they could possibly handle given the complexity of the people and problems they were presented.
A lot has been and is being done for community corrections and attempts at Mental Health Court -- from my perspective these efforts still seem punitive and disconnected from the realities (both known and unknown) of the people with whom the system is dealing. Perhaps the punitive component is to make it politically palatable.
In any case, before I cry my river I'm going to work with any person and organization I can to build something new. Luckily, many people have been and are still hard at work.
Maybe if we stop putting unrealistic demands on the criminal justice system, it will stop putting unrealistic demands on the people before it.

Oklahoma County Courthouse

Socrates

“The secret of change is to focus all of your energy, not on fighting the old, but on building the new.”

TO Go Back To Top^

The Structure of Legal Revolutions

8/20/2014

The findings in this initial exploration of the impact of genetic attributions for criminal behavior suggest limited direct effect on decisions regarding verdicts and sentencing. . . .Although confirmatory studies are needed, our data to date are consistent with the conclusion that both the hopes and concerns that have been expressed of the potential impact of behavioral genetic data in the criminal courts are overstated.

----- Paul S. Appelbaum, M.D. and Nicholas Scurich, Ph.D
"Impact of Behavioral Genetic Evidence on the Adjudication of Criminal Behavior,"
Journal of the Academy of Psychiatry and Law (2014)

This may not be a totally fair critique -- and if it's not I apologize -- AND from my perspective these kinds of studies so miss the point. We know that there are all kinds of complicated factors that effect behavior -- genetics, past history of abuse, etc. AND we know that we don't know it all. So who do we put the burden on in a competency proceeding or mitigating defense proceeding, an indigent defendant.
WTF.
I'm sorry -- that is beyond "arbitrary and capricious," -- that "shocks the conscience."
So why do we do it? I think it is because that we're afraid we won't be able to protect the community if we acknowledge reality -- there are very complicated reasons, including genetics, past history of abuse, bad environment, something we haven't discovered yet, etc. for much of human behavior, including bad behavior.
As for some ultra-conclusive evidence one way or the other to settle the old free will v. determinism debate -- in the words of a currently popular Disney song ---- "Let It Go."
We need a humane system that respects human rights right now and that does a better job of protecting the community right now -- acknowledging the reality of what we know, and that we don't know everything.
We can do that -- I feel a Structure of Legal Revolutions coming in the air tonight.
At least it's pretty to think so.

Press Release from the Karolinska Institutet in Sweden:

"The conference will focus on the development of the brain from conception, in utero to the early post natal stages.

"If something goes wrong during this time, it may have major consequences, and many known psychiatric illnesses can be traced back to this period.

"Schizophrenia, autism, ADHD, bipolar disorder and anxiety syndrome are just a few examples. "

Socrates

"The more you know, the more you realize you don't know"

Dr. Elias Zerhouni, Director of the National Institutes of Health

“The explosion of data about the brain is overwhelming conventional ways of making sense of it," said Elias A. Zerhouni, M.D., Director of the National Institutes of Health. "Like the Human Genome Project, the Human Brain Project is building shared databases in standardized digital form, integrating information from the level of the gene to the level of behavior. These resources will ultimately help us better understand the connection between brain function and human health.”

Thomas Kuhn, The Structure of Scientific Revolutions

to go back to top^

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Val's Blog

Anti-Social Personality Disorder & the Most Incarcerated Country in the World

Sufficiency of Knowledge, the Criminal Justice System, People with Disabilities and the Human Rights Issue of Our Time

Our Criminal Justice System Can Be A Very Nasty Disability Service Provider with an Abusive Edge -Because the State Isn't Providing the Beds, Housing or Services @ the Scale Needed for People with Disabilities

Mad Eye for the Sane Society

"If You Can't Keep A Simple Appointment, Probation May Not Be Right For You -- Same is True for My Fellow Judges."

---Denver District Court Judge
Sept. 22, 2017

Integrating Physical Health, Mental Health & the Law: Trying To Shore Up Our Incompetent Mental Health & Legal Systems

The Criminal Justice System As A General Diversion Mechanism for an Under-Resourced Mental Health System

Everyone Has to Play Their Role In the Criminal Justice System or the Morality Play or the Highest Stakes Legal Gambling You'll Find in this Country

We Can't Handle the Truth about Intent, Mental Disorders, the State of the Science, or our Failed Service Delivery System

DAMN IT -- WE NEED PEOPLE OUT OF THE CRIMINAL JUSTICE SYSTEM -- WITH ALL APPROPRIATE SERVICES & SAFETY PROTOCOLS --- NOW ---- & AS FAR AS I KNOW THAT MEANS MEDICAID

I'm Gonna Cry Me A River BUT First We've Gotta Continue To Build Better Systems

The Structure of Legal Revolutions

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Val's Blog

​ ​Mad Eye for the Sane Society

​"If You Can't Keep A Simple Appointment, Probation May Not Be Right For You -- Same is True for My Fellow Judges." ---Denver District Court Judge Sept. 22, 2017

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Archives

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Mad Eye for the Sane Society

"If You Can't Keep A Simple Appointment, Probation May Not Be Right For You -- Same is True for My Fellow Judges."

---Denver District Court Judge
Sept. 22, 2017