Val's Take/Conjecture

• I would say to Denver, Aurora and the State --- the people who are chronically homeless in Colorado generally are contending with various combinations of:
  • Neuro-Developmental Disorders
  • Psychiatric Disorders
  • Brain Injury, and
  • Substance Issues
• Those are serious health issues, some requiring long term care.
• Mike Johnston's "We're gonna help people get back on their feet" ---
  • Seems absolutely clueless as to the serious and complicated health issues people are actually contending with.
• Aurora's "Tough Love" Approach and a "HARD COURT" --- that is maybe not that "hard" ---
  • Still seems an inappropriately punitive way to deal with health issues --- even if it is trying to be a step up from not so "benign neglect."
    

9 News Next:  Aurora City Council Approves "Tough Love" Approach to Homelessness

Bottom Line:

Chronic Homelessness is a State Olmstead Issue.

There are a lot of ways one could think of an Olmstead Plan --- one way is as a Work Breakdown Structure  in Project Management --- maybe not quite as detailed, but it needs to have Measurable Goals, Reasonable Time Frames and Funding to support the plan..

The State of Colorado is very familiar with Project Management in a wide range of areas.

Especially in the area of Supported Housing, we need the State to bring that expertise to the table and get us a Supported Housing Plan for People with Disabilities who are Institutionalized or at risk of institutionalization and medical professionals support community living.

ABA Section on Civil Rights & Social Justice
The Future of Olmstead:  2020 & Beyond

Criminal Justice discussion begins at 32:20

ABA Transcript

U.S. v. Georgia – 10-CV-249 – (N.D. Ga. 2010)

•    Georgia will serve in community settings by July 1, 2015, 9000 individuals with serious and persistent mental illness who currently are served in:

• the State Hospitals,
• frequently readmitted to the State Hospitals,
• frequently seen in Emergency Rooms,
• chronically homeless, and/or
• being released from jails or prisons

from DOJ's Fact Sheet

Olmstead at 20:  Using the Vision of Olmstead to Decriminalize Mental Illness

By Kevin Martone, Francine Arienti, Sherry Lerch

Georgetown Journal on Poverty Law and Policy

The Paradox of Inclusion:
Applying Olmstead’s Integration Mandate in Prisons (2020)

By Jamelia N. Morgan

In 1999, the US Supreme Court issued a compromise ruling in Olmstead --- and States, people with disabilities and their advocates have been struggling with it ever since.

States ostensibly love Olmstead and people with disabilities, and States really struggle to comply with Olmstead.

Two Key Concepts:

• If States have a Comprehensive, Effectively Working Plan to de-institutionalize people with disabilities where possible and support those at risk of institutionalization --- THEN states have a defense to a claim brought under Title II of the Americans with Disabilities Act (ADA)
• That Defense is the Fundamental Alteration Defense --- State's are not required to make a fundamental alteration to the State's Plan for People with Disabilities if:
  • The State's Plan is comprehensive, effective and moving at a "reasonable pace."

ASIDE

• The more science-based that Mental Health becomes --- the easier this will be for:
  • the Public to understand and support

Integrating Mental Health with the rest of Medicine is crucial.

Olmstead Condensed including
The Fundamental Alteration Defense

Most States' Plans for People with Disabilities have been relatively siloed and disjointed --- there has been a lot of effort to address that --- but it hasn't completely been solved.

So one of the points the US Department of Justice has made is that this State Plan for People with Disabilities is NOT LIMITED TO MEDICAID.

The big challenge is that Medicaid does not cover Housing --- that is a HUGE PROBLEM.

With regard to housing and supportive housing, most states do what they want and call it "reasonable."

That fiction becomes harder and harder to maintain if you've got a lot of people with cognitive disabilities incarcerated in jails and prisons or homeless --

• and no comprehensive, effectively working State Plan for People with Disabilities moving at a reasonable pace.

Further, a lot of people with cognitive disabilities can live in supportive housing, not necessarily all.

Val's Take

• I heard Kyle Clark on Next say that Denver ran into REALITY when it came to homelessness and housing.
• I think Denver and this Country need to "RUN INTO REALITY" --- a lot more than we have.

 

• Many if not most chronically homeless people are going to meet the criteria for "disability."  Now has that been worsened by CHRONIC STRESS --- probably.

 

• I've tried to make this point numerous times --- but it is actually the STATE that has a legal responsibility to provide:
  • MEASURABLE GOALS
  • REASONABLE TIME FRAMES, and
  • FUNDING TO SUPPORT THE PLAN

to prevent unnecessary institutionalization of people with disabilities and the unnecessary risk of  institutionalization inherent in homelessness.

So COLORADO should have an adequate Continuum of Care --- NOW --- but we don't --- we need to make that plan and get those MEASURABLE GOALS.

Now we have existing evidenced-based models that can help and provide safe places, and we have EMERGING MODELS that "may" dramatically improve the lives of some people on the neuro-developmental/psychiatric spectrum.

Conceptualizing this as an ENERGY ISSUE with MITOCHONDRIA DYSREGULATION seems to be an important step up in our understanding of some of these issues.

If we don't deal with the MITOCHONDRIAL DYSREGULATION --- it's going to be hard for people to "get back on their feet."

Val's Take

• The Psychotropic Medications of the 1950s and 1960s along with NEXT GENERATION Medications---
  • have been a MIXED BAG
  • and instituted a BACKLASH in Mental Health AGAINST the Medical Model

 

• The DSM 5 is an embarrassing list of categories with subjective symptom clusters that often don't track brain scans or the research.

Having said all that, research of the last 10 years is making REAL BREAKTHROUGHS:

• Discovery of lymphatic vessels in the brain.
• Linking Maternal Immune Activation with Neuro-Developmental and Psychiatric Disorders as well as "Hyper-Connected" Brains
• Recognizing the Metabolic aspects of Neuro-Developmental and Psychiatric Continuum and the role of Mitochondria and ATP.
  

New insights into the role of mitochondria in autoimmune diseases (2019)

Mitochondrial DNA (mtDNA) normally stays within mitochondria, energy-producing structures inside cells. However, it can be released from the mitochondria into the cell in response to stress. When this happens, the mtDNA can trigger an overactive immune response, as occurs in autoimmune diseases.

"In most cells, mitochondria (green) form complex tubular networks that help them distribute energy throughout the cell. Disruption of these mitochondrial networks is a hallmark of many human diseases."

Photo credit: UC San Diego Health Sciences

Video reports UC San Diego research
Biomarkers for Suicidal Thoughts in the Mitochondria

Developmental Stage-Dependent Changes in Mitochondrial Function in the Brain of Offspring

Following Prenatal Maternal Immune Activation (2023)

• As mentioned above, prenatal activation of the maternal immune system has been connected with both increased risk of ASD [Autism Spectrum Disorder] and with mitochondrial dysfunction.
• It has been demonstrated that the mitochondria have a noteworthy relationship with the immune system, as they can impact the immune response and vice versa.
  

Val's Take/Conjecture

"University Teaching Hospitals"  are an important connection between RESEARCHERS and CLINICIANS.

One of the scariest things to observe in Mental Health is the LARGE DIVIDE that has grown up between the RESEARCHERS and the CLINICIANS.

Generative AI in Healthcare

• Is this an Olmstead Issue?

So Olmstead is about preventing the unnecessary institutionalization of people with disabilities.

Further, it is currently understood to include the risk of institutionalization of people with disabilities that is inherent in HOMELESSNESS.

I do think we are reaching our limits to process information.  There is a need to expand those limits to achieve more effective individualized medicine.

AND

The largest institutions for people with mental illness are JAILS & PRISONS.

The grand OLMSTEAD Soviet-Style Plan hasn't really worked over the past 20 years since Olmstead was decided.States by and large are OVERWHELMED with the MAGNITUDE of the ISSUES ---

• States try to stay as VAGUE as possible so they are NOT ACCOUNTABLE
• & Generally do "some good things."
  

 The Disability Community often doesn't feel like it can look Olmstead --- this gift horse --- too closely in the mouth --- and the US Department of Justice files "some cases" (including in Colorado) ---

• BUT WIDESPREAD NON-COMPLIANCE IS THE NORM.

We need STATE NUMERIC YEARLY GOALS for SUPPORTIVE HOUSING

• I think the State needs an "Objective Measure" for that --- Medicaid Long Term Care might be such a measure.
• Further, partnering with municipalities probably makes a lot of sense.
• Further, there are various funding streams this could come out of.
  

One of the things that is happening with the recognition of:

• the prevalence of Neuro-Diversity in Homelessness and Criminal Justice, and
• the IDIOSYNCRATIC nature of Neuro-Diversity in which brains differ from the NORM but in IDIOSYNCRATIC WAYS
• we're called on to invest in highly person-centered INDIVIDUAL supports
  • that requires us to really understand the person and his or her strengths and challenges
    • that is a form of love and an investment of time, energy and resources --- that amounts to love
    • that we may not really be feeling as a society.
      

The only problem is --- lesser strategies often fail.

Abba Eban was a South African-born Israeli diplomat and politician, and a scholar of the Arabic and Hebrew languages. --- Wikipedia

State officials in Colorado and around the Country may finally come to Olmstead Compliance after much passive resistance.

It could be in their own best interest to collect the data to make the case for more Federal assistance, especially around Supportive Housing and integrating neuro-diverse folks into the work force.

Which son is the true Prodigal Son in Luke 15:11-32?

Two-Minute Museum
Rembrandt's The Return of the Prodigal Son

Aurora Mayor Mike Coffman who is now calling for a "Work First" solution to Homelessness is more sophisticated than he lets on.

He knows that "Housing First" is NOT SUFFICIENT and he has said as much --- recognizing that mental health and substance treatment were big parts of the equation --- but municipal officials don't have the resources for that.

Further, I don't see how we effectively address Homelessness or Criminal Justice unless we do a better job of INTEGRATING Neuro-Diverse folks into the work-force.

Employment of people with disabilities or perceived to have disabilities is an Olmstead Issue.