Category: Olmstead

Telephone Conferences on CMHIP Staffing Issues & Olmstead Planning Bill

9/11/2017

1. CMHIP Staffing Issues Telephone Conference

   We will be having a brief telephone conference on CMHIP Staffing Issues on Friday, September 15, 2017 from 2 -2:30 p.m.

2. Olmstead Planning Bill Telephone Conference

I have been contacted by folks about next steps specifically regarding the Olmstead Planning Bill. We will be have a brief telephone conference from 2:45-3:30p.m.

I'll get out a draft agenda Tues. along with the specifics on the calling information. If you would like to be on the e-mail list, e-mail val -- [email protected]

Anybody is welcome whether individuals, advocates, providers, or people with government.

Dialogue, Data, Inclusion, & Olmstead -- Something Old & Something New

9/8/2017

I remember being in a Comedy Club in College and the comic asking some of us what our majors were.
   I said I was a Letters Major -- it's a broad liberal arts major concentrating on Literature, History {Including History of Science], & Philosophy with Ancient and Modern Language.
"What are you going to do -- open up a philosophy shop?" he asked.
   Well, of course, not. I was much more practical than that -- I was going to go to Law School -- and Change the World.
   Well, unbeknowst to me and a lot people I had ADD and didn't get diagnosed until I was 50. I picked a helluva career for someone with ADD, but like a lot of things maybe it's a blessing in disguise.

So this is a very long introduction to my relationship to philosophy and DIALOGUE and mental health and our Olmstead Planning Bill.

   Classically, we think of Socrates asking impertinent questions about the meaning of common words such as "virtue" and revealing that our understanding of those "common" words isn't as good as we think it is.

   On the Orchid website, we try to ask difficult questions about the State of the Science regarding psychiatry and psychology.

   With "Open Dialogue," I did notice that the Finnish practitioners were linking this up to "democracy."

   Initially, I thought "Yeah, yeah -- that's really going to freak some people out in the US."

   BUT it was really only after seeing the UK Psychiatrist and Psychiatric Leader promoting "Open Dialogue" as a means of general political reform -- that I realized the full meaning & importance of this.

All around the world, people are viewing their circumstances and those of others through a "mental health" lens.

More and more, people want "Open Dialogue."

   "Change" is messy and stressful. My experience is that DATA, A PROCESS, & INCLUSION can calm things down.

One of the things I loved about going to a University was the many different colleges -- AND how they all saw the world and the universe through their own lens.

"Open Dialogue" by itself is not enough
Data by itself is not enough
A Process by itself is not enough
Inclusion by itself is not enough
Etc.

Those are some of the many reasons we are asking everyone to help make our Draft CO Olmstead Planning Bill the best it can possibly be and so that it may serve as a National Model.

^Change Around The World
We're NOT big fans of "chaos" & there is no getting around that change can be messy & stressful.

BUT It can certainly be worth it. Our efforts are about Olmstead Planning, disability rights, mental health rights -- it is also about Inclusion & Democracy..

Complexity: One of the Biggest Reasons We Need An Olmstead Planning Bill

9/7/2017

It is both very complex for States to comply with Olmstead and very complex for people with disabilities to enforce Olmstead.
From our perspective that has lead to widespread non-compliance. That doesn't mean that tremendous life-changing progress hasn't been made -- it has.
But if we want to realize the promise of Olmstead -- we must embrace the complexity of a:

Comprehensive
Effectively working Olmstead Plan

Well what does that mean? Federal Courts & the US Department of Justice have been fleshing that out.
We know it means:

Specific Measurable Goals (the Goals under Colorado's Community Living Plan are Too Vague & Lack Accountability)

We also know from the 2010 US Department of Justice Delaware Findings Letter, general Public Health principles, and common sense that we need to link these specific measurable goals with the overall need.

Bringing Housing & Services to Scale to Meet the Need [for people with disabilities who are institutionalized or are at great risk of institutionalization such as in homelessness]

We need to build the Olmstead Planning Process into Statute because we want to specify what it looks like and we know it is going to span administrations.

This is a LONG TERM PROCESS and IT IS GOING TO SPAN ADMINISTRATIONS

We want to:

Comply with Federal Law,
Build In Some Certainty & Predictability, &
Tailor Our Olmstead Planning Process to Colorado

Some Thoughts Down On The Animal Farm: Criminal Justice Must Be Included In Our Draft Olmstead Bill

8/26/2017

One of the things I really liked about J.K. Rowling's Harry Potter series was that Rowling so brilliantly contrasted the sometimes monumental challenges people were facing in their lives with the often oblivious demands of the society.

"That's irrelevant." "No excuse."

Well, I don't think the point of recognizing Reality is so much an "excuse" as addressing and ameliorating that "Reality."

So what am I talking about:

Class
Poverty
Homelessness
Race, Racism, Discrimination
Ethinicity, Discrimination
Discrimination against People with Mental Illness, Traumatic Brain Injury, and other invisible disabilities.

  With respect to disabilities, the State has a legal obligation under the Americans with Disabilities Act and the 1999 US Supreme Court Olmstead decision to provide Housing and Services to meet the need or have a comprehensive, effectively working plan with measurable goals to bring housing and services to scale.

   The institutions where most people with mental health disabilities are in Colorado and around the country are jails and prisons. THIS IS AN OUTRAGE.

   There has been a lot of change -- BUT NOT NEAR ENOUGH.

   That is why we want to specifically list Criminal Justice and jails and prisons in our draft Olmstead bill.

We don't think J.K. Rowling is talking about "inferiors" and people not one's equal in any absolute sense but rather in the context of often damaging self-serving human hierarchies and social classes. In the US we sometimes like to think we're beyond all that -- but you really just have to visit the Criminal Justice System to realize that is not the case. Difference whether race, ethnicity, real or perceived disability, sexual orientation, and many others we use to categorize and rank each other and the results are often not pretty.

George Orwell's "Animal Farm"

US Supreme Court: "Equal Justice Under Law"

Reality, Diversity & the Need to Change Systems to Fit

8/23/2017

The Dominant Group(s) tends to think -- they're the best, they're #1 -- what could be more obvious.
   (Or maybe that's just because I come from Oklahoma and an OU family -- Sooners #1)
Anyway, not everyone shares their opinion, and often that usually includes people who for one reason or another are not in the dominant group(s).
Often we value the strengths we ourselves possess the most, and minimize the weaknesses that we possess.
   That is probably not a totally bad thing, especially if it keeps us from becoming depressed or despondent.
But we often tend to minimize the strengths of others especially if we can't relate to them easily, and exacerbate their weaknesses sometimes through bad social environments (social determinants of health) and systems they couldn't possibly fit into.
   Well, how are we going to find out what works for other people not in the middle of the distribution map and the scale of their needs -- well we could talk to professionals and attorneys -- and policymakers and officials probably should --- BUT ultimately we've got to talk to the people themselves and collect the necessary data.
   The challenge of democracy and life is recognizing reality and diversity -- we all want to be # 1 and ultimately we are the one -- the person, individual that needs a society and system we can ALL fit into.
   I don't mean # 1 in terms of a "participation certificate" -- I mean #1 in terms of being able to fully maximize our "strengths" and compensate for our "weaknesses" -- and of course so much of that is a matter of perspective.
   That demands inclusion and is part of what Olmstead Planning is all about.

I want to thank Scott Durairaj PGC, MBA with the NHS (National Health Service) England for posting this on Linkedin.

Where There Is A Will There's A Way -- Our Draft Olmstead Planning Bill

8/23/2017

I don't know if our draft Olmstead Planning Bill will be successful or not this year.
I do know that Specific Measurable Goals are now legally required for viable Olmstead Plans per various cases, specifically the Minnesota Court-Ordered Olmstead Plan. Colorado doesn't have that.
We're going to be getting a draft bill to the Governor's Office probably within a week.
We'd like to work with the Governor's Office to address their concerns and objections in a substantive way so that we could move forward together on this if possible.

Crying Need for "Open Dialogue" in Colorado

8/19/2017

First, a lot of people in the mental health communities in the US and Colorado were really drawn to "Open Dialogue" -- because it dramatically reduced medication use.
In the pilot in Massachusetts of Open Dialogue, it did reduce medication use --- it did not eliminate it.
When we think about somebody perhaps needing significant assistance we think:

Crisis Unit
Hospital

Of course, most people don't want that even though the assistance they may need and even want (with a lot of caveats) is pretty intensive.
   "Open Dialogue" is significant not only because it reduces medication use, but because of extremely intensive support services in the first year after psychosis.
   We tend to have the hospital -- which many people don't like -- and the community -- that doesn't have the services people want and need [others include Peer Run Services, Assertive Community Treatment -- if its done right, etc.]-- at the level of intensity that is needed.
   And so we just let things get so bad that we certify somebody, maybe we grumble about the certification statutes -- BUT THE REAL PROBLEM IS THE LACK OF ADEQUATE COMMUNITY SERVICES PEOPLE WANT -- and have been asking for, in the case of OPEN DIALOGUE -- for over a decade (THANK YOU AMY SMITH!)
One of the things that one of the psychologists from the Open Dialogue project in Finland talks about is "psychosis" as a form of "meaning making."
   I'd never really heard that before and that is an interesting take. I think one of things that the US and Colorado could really do to build on the Open Dialogue approach is to put it in the context of an Integrated Care Model that Colorado is already trying to lead on.
I think sometimes (NOT ALWAYS) people are trying to make sense of their physical health breaking down which is (sometimes unbeknowst to them their mental health as well) and that is having mental health consequences in multiple respects which can include psychosis.
"Open Dialogue" had been in our Draft Measurable Goals we sent to the State. This may not be something we want to specify in a draft Olmstead Bill -- and we need to get moving on it.
   We may be looking at fleshing out the "Services" Topic to require Specific Measurable Goals in the State's Analysis and Consideration of Peer Generated Service Category Requests -- such as Open Dialogue & Peer Run Services.
   We are not satisfied with respect to how the State has handled such requests.

‘OPEN DIALOGUE’
IN THE TREATMENT OF
MENTAL ILLNESS

The focus in this approach to the treatment of mental illness and maintaining mental health is on keeping patients in the community as long as possible.

To achieve this local community centres are scattered around the region. Teams visit patients at home. All staff participating in the treatment are highly qualified and have additional three-year training in family therapy.

There is enough staff to meet the demand for team meetings with the patients and their social network as frequently as needed to help patients to live at home in their normal surroundings. Hospital admissions are used only as on outreach from the community services when the crisis cannot be handled in the community.

In all meetings there are preferably at least two staff members familiar with the patient present. Any staff member can be given the ongoing responsibility for the new patient and of organising the team for the first crisis meeting with the patient and the social network as well as the follow up.

The continuity is seen as important. Because the treatment team always consists of several people it is not too difficult to have at least one familiar staff member in every meeting.

The first meeting, usually in crisis, has to take place as soon as possible within 24 hours of the initial contact. In most cases it takes place at the patient’s home. Depending on the needs, there may be several treatment meetings with the patient and social network people in a day.

The five year research to the patients in this program shows outcomes that have not been achieved by any other program in the western world, eg:

Number of relapse cases         17 %
Studying or working               76 %
Unemployed                           10 %
Disability allowance               14 %

It is claimed that the program is not more expensive than traditional mental health programs in Finland. Taking everything in consideration it may even result in savings.
This may be due to lesser need for hospital beds, less medication, fewer people on disability pension and more people returning to work force. The program is fully functional in Western Lapland where it was developed over the last two and half decades.

Open Dialogue approach has now been built into the state psychiatric system. Many western countries including other Scandinavian countries, Germany and the USA are also showing interest in the program.

In view of my personal experience and the glowing research findings of the program over 2- and 5-year periods of follow-up as well as the fact that the schizophrenia is disappearing from the Western Lapland I am convinced that this is the approach that should be adopt[ed] in NSW mental health system.

. . .
Satu Beverley 2.9.2011

www.arafmi.org/wp-content/uploads/2016/.../Introduction-to-OPEN-DIALOGUE.doc

[Mental Health Carers for New South Wales -- Australia]

Univ. of Mass. Dept. Of Psychiatry Open Dialogue

CO Good @ Data BUT Can't Do An Olmstead Plan With Specific Measurable Goals -- That Sounds Like Some Hickenlooper Sheet Cake

8/18/2017

I remember several years ago trying to get information from the Colorado Dept. of Public Health & Environment regarding the minimum data set for Colorado Nursing Homes which would show among other things how many people wanted to be someplace else.

   CDPHE refused to release the information without a court order. Many disability groups are interested in that information.

   Today a lot of it is available on the internet on the CMS website.

   I remember when the State set the July 31 meeting on Community Living issues with stakeholders -- Bring your data and metrics -- they said.

   Of course most of the data and metrics are in the possession of the State or they are in the best position to get them.

The Colorado State Government gets how important data is and in fact has been recognized in Governing Magazine for its use of data in Human Services.

   Hmmmm. . . . AND we can't have a:

Comprehensive
Effectively Working Olmstead Plan
With Specific Measureable Goals
With Reasonable Plans to Bring Housing & Services to Scale for People with Disabilities who are Institutionalized or At Great Risk of Institutionalization.

I think we're being fed some Tina Fey Sheet Cake -- Hickenlooper Edition.

From Minnesota's Court-Ordered Olmstead Plan
Cross-agency coordination of data strategies

Within each of the Topic Areas in this Olmstead Plan, there is at least one Strategy that requires better and different collection and/or analysis of data in order to change certain key processes, to establish baselines against which progress can be measured or to measure outcomes.

Because these strategies involving data are so pervasive within the Plan, it will be essential that the subcabinet and the Olmstead Implementation Office develop a means of promoting cross-agency collaboration around these strategies.

The Olmstead Implementation Office will develop a workplan within 60 days of the publication of this new Plan that will contain key activities necessary to ensure that this cross-agency collaboration will take place.

he Office will consult with the Commissioner of MN.IT, which is the consolidated information technology office for the State of Minnesota, in the development of this workplan.

This workplan will be approved by the subcabinet, and overseen and reviewed in the same manner described for the workplans described above.

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_FILE&RevisionSelectionMethod=LatestReleased&Rendition=Primary&allowInterrupt=1&noSaveAs=1&dDocName=dhs16_196300 (See Page 98)

We Want CO To Use Its Data Expertise In the Context of An Olmstead Plan

8/17/2017

The State needs to use its data expertise in the context of an Olmstead Plan that is:

Comprehensive
Effectively Working
With Specific Measurable Goals
Making Reasonable Plans to Bring Housing And Services to Scale to Meet the Needs of People with Disabilities who are Institutionalized or at Great Risk of Institutionalization.

Reggie Bicha, the director of human services in Colorado (David Kidd)

States Add a Human (Services) Touch to 'Stat'

http://www.governing.com/topics/health-human-services/gov-colorado-human-services-stat-data-reggie-bicha.html

Olmstead Planning & Community Engagement

8/15/2017

"Community Engagement" is a really important topic under Olmstead Planning, . AND we may need to further define this -- and work with the State.
"State Busyness" is both a legitimate concern and a cop out for inconvenient topics. When the State can't manage to answer a question on whether it has an objection to a waitlist for assertive community treatment for 2 1/2 years -- it's a cop out.
This is a huge problem for people with disabilities and their advocates because there are serious problems that need to be addressed, and really in the context of Dialogue and if the State refuses to Dialogue on important serious issues like:

Olmstead Planning
Assertive Community Treatment
Parity
Long-standing staffing problems @ the Colorado Mental Health Institute @ Pueblo (CMHIP)

That is a huge frickin' problem.

   No one would say the Hickenlooper Administration has not done a lot of good things -- they have -- but they are a mixed bag -- and advocates and peers would like more consistent access, inclusion and redress of our concerns and that's why we are pursuing the Olmstead Planning Statute.

In that process, we are going to be trying to work with the State in addressing their concerns.

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Val's Blog

Telephone Conferences on CMHIP Staffing Issues & Olmstead Planning Bill

Dialogue, Data, Inclusion, & Olmstead -- Something Old & Something New

Complexity: One of the Biggest Reasons We Need An Olmstead Planning Bill

Some Thoughts Down On The Animal Farm: Criminal Justice Must Be Included In Our Draft Olmstead Bill

Reality, Diversity & the Need to Change Systems to Fit

Where There Is A Will There's A Way -- Our Draft Olmstead Planning Bill

Crying Need for "Open Dialogue" in Colorado

CO Good @ Data BUT Can't Do An Olmstead Plan With Specific Measurable Goals -- That Sounds Like Some Hickenlooper Sheet Cake

We Want CO To Use Its Data Expertise In the Context of An Olmstead Plan

States Add a Human (Services) Touch to 'Stat'

http://www.governing.com/topics/health-human-services/gov-colorado-human-services-stat-data-reggie-bicha.html

Olmstead Planning & Community Engagement

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States Add a Human (Services) Touch to 'Stat'​ http://www.governing.com/topics/health-human-services/gov-colorado-human-services-stat-data-reggie-bicha.html

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States Add a Human (Services) Touch to 'Stat'

http://www.governing.com/topics/health-human-services/gov-colorado-human-services-stat-data-reggie-bicha.html