Blog Archives

OLMSTEAD & THE HIGH END OF THE CONTINUUM OF CARE ---BEYOND CRISIS SERVICES

1/19/2021

WE'RE Focusing OUR 2021 COLORADO COGNITIVE DISABILITY Report on Olmstead

   We anticipate providing issue briefs on a Strength-Based Approach and Accommodations or Workarounds for Executive Functioning Issues later this year.
   It would appear that Colorado needs a lot more in Housing and Residential Services and Enhanced Services.
We need a system that is "RATIONAL" and "DATA-DRIVEN" and maintains "WAITLISTS MOVING AT A REASONABLE PACE."

   Some type of Crisis Services often are a part of many US Department of Justice Olmstead Settlement Agreements.

BUT they are HARDLY EVER the sole element of COMPLIANCE --- it's often also:

Housing
Assertive Community Treatment
Supportive Housing

States like Colorado often correctly say --- "Hey, we're doing that!" YEAH BUT ---- you need several thousand more slots.

Orchid's 2021 Colorado Cognitive Disability Report

BREAKING OLMSTEAD COMPLIANCE INTO SMALL STEPS

1/19/2021

When I came to Colorado over 20 years ago, I came with over 100 boxes of files and other papers.
Just yesterday, I went through the last of those boxes.
One of the things that made that such a time-consuming process was that I REALLY HAD TO THINK about these pieces of paper --- what could I recycle, what did I need to shred, what did I need to keep.
Over the last several years I've gotten rid of over a million pieces of paper.
I've had to learn the hard way not only with paper but also with Olmstead and also with children and with adults and myself ---- that I need to break things down into smaller steps.

But BREAKING THINGS DOWN INTO SMALLER STEPS is much more of a COMMITMENT than I'll do something when I can.

Olmstead Compliance -- Avoidance is a common thing.

When Polis came in --- there was this Behavioral Health Task Force --- and it wasn't as INCLUSIVE as some of us would have liked ---- but there was still a need to see what they were going to do.

The One-Stop Shop is a great idea for Behavioral Health --- but it seems unlikely to be able to sufficiently address the PROFOUND SHORTAGES in HOUSING and the UPPER END of the CONTINUUM of BEHAVIORAL HEALTH CARE.

AND NOW there's COVID.

We need to start:

Waitlists for:
- Supportive Housing
- Community Placements, and
- Intensive Services such as Assertive Community Treatment
Comprehensive Data Collection Plan for housing, placement and service needs of people with mental illness, brain injury, substance issues, ADHD & Autism
- people who are institutionalized including jails and prisons
- people who are at great risk of institutionalization, including those who are homeless

ACT & SUPPORTIVE HOUSING ---- HOW ARE WE GOING TO FUND IT TO SCALE

1/19/2021

Olmstead has always been a BIG ECONOMIC issue, even as advocates have tried to point out the ECONOMIC BENEFITS.

But back in 1999 when Olmstead was decided by the US Supreme Court, Assertive Community Treatment and Supportive Housing were not the CLEAR ALTERNATIVES for people with SERIOUS MENTAL ILLNESS that they are today.

Now, that doesn't mean that:

every person with SERIOUS MENTAL ILLNESS needs ACT or Supportive Housing, and
it doesn't mean that we can't come up with better treatments

Three Big Complicating Factors:

States have COST-SHIFTED TREATMENT of a good percentage of men and some women with SERIOUS COGNITIVE DISABILITIES to the Criminal Justice System.
CMS has refused to recognize HOUSING as HEALTHCARE even for people needing LONG TERM CARE.
Is HOUSING under Olmstead an UNFUNDED MANDATE?

Maybe no Federal or State policymakers or officials living today CREATED the NIGHTMARE of inadequate:

Housing
Placements, and
Services

for people with Cognitive Disabilities --- but we would sure like to see them come together to solve it.

A DSM THAT'S OUT-OF-DATE, EXECUTIVE FUNCTIONING CHALLENGES & CRIMINAL JUSTICE

1/13/2021

WHY THAT "MENTAL ILLNESS" / VIOLENCE DEBATE MISSES SO MUCH

Where's Our "Scientific" Definition of "Mental Illness"

The first thing one needs for a good "Mental Illness" / Violence debate is a Scientifically valid definition of "Mental Illness."
- We don't have that.

Current Research vs. the "DSM" & the APA

I am somewhat sympathetic to the American Psychiatric Association (APA) --- Hey, we don't have anything other than the DSM --- researchers / others if you have something you want us to consider --- contact us.
I am sympathetic in that the APA doesn't know what else to do ---- on the other hand, that "ADMISSION" really means that the Research is not something they are competent to stay on top of by themselves.
A lot of researchers have already written off the DSM --- and they are not being compensated to keep the APA updated on the latest research ---- which is FLOODING OUT OF THE RESEARCH INSTITUTIONS.
- Further, a lot of that Research is NOT coming out in a form that easily translates to the DSM --- where's the IMMUNE SYSTEM SECTION of the DSM?
- Further, the Categories the DSM does have are being viewed in a much more "BLURRED" way by the Researchers

"Mental Illness" is NOT the only Cognitive Disability Represented in the Criminal Justice System

Brain Injury, Substance Issues, ADHD, Autism --- are also in the Criminal Justice System.
Further, the REAL COMMON DENOMINATOR appears to be Significant Executive Functioning Challenges.
To make things even more complicated, many people in Criminal Justice have more than 1 cognitive disability.

What We Need:

A Public Health Approach to Criminal Justice
Olmstead

"THEY DRANK THE KOOL AID"--DIDN'T WE ALL

1/12/2021

Our son is fond of saying the Capitol Rioters: "Drank the Kool Aid." Referring to the Jim Jones Massacre in Guyana in 1978.

One of the most sophisticated voices crying in the wilderness on the American Economy is Colorado Senator Michael Bennett.

One of his points is that our economic challenges didn't just start within the last few years.

Further, I would submit that we have some "IDEAS," "REVEALED WISDOM" that are really starting to bite us in the butt, namely:

the Two Party System --- mainly because it creates powerful IN-GROUPS and OUT-GROUPS. The INCENTIVES need to be on SOLVING PROBLEMS, not defeating the other person. People are already thinking about this --- Adjunct Citizen Assemblies is one idea and there are others.

Back in March 2020, there was an article in PsyPost: The desire to matter and feel significant among Donald Trump supporters is associated with support for hostile and vindictive actions against the president’s political rivals, according to new research published in the journal Political Psychology.
- I don't want to shock anyone but the desire for SIGNIFICANCE is pretty common

SPECIALNESS / SIGNIFICANCE Only a few can be truly SPECIAL or SIGNIFICANT --- This is a DANGEROUS IDEA and we've used to it in various ways, including to SHORE UP OUR UBER COMPETITIVE CULTURE.
- If only a few can be SIGNIFICANT or SPECIAL, people may fight fairly or unfairly against their OUT-GROUP for that SIGNIFICANCE.

George Zarkadakis
TEDxThessaloniki

Reclaiming Democracy Through Citizen Assemblies

THE BIDEN ADMIN.--Olmstead, State ASSISTANCE & ADMIN. ENFORCEMENT

1/8/2021

We would like to see the US Department of Justice 2011 Olmstead Guidance incorporated into the US Code of Federal Regulations.

Technically, many if not most of the principles articulated are already in subsequent caselaw ---- BUT State Administrators are NOT REVIEWING subsequent caselaw ---- but someone within their ranks probably is familiar with the federal regulations.

Additionally, I think we provide as little or as much structure as States need to comply. After 20 years, it certainly seems like States need more "STRUCTURE" --- and states may inconveniently report that they need more money, too.

It would be a HUGE STEP UP to turn Housing into a Federal/State ENTITLEMENT under HUD linked to need for Medicaid Long Term Care.

Colorado has certainly tried to MANIPULATE the definition of HCBS-MI qualification for budgetary reasons. That is DANGEROUS and we need more oversight over qualification changes, especially for people with cognitive disabilities.

President-Elect Joe Biden. Photo Credit Los Angeles Times

"WINNING" . . . TRYING TO GET BEYOND MIGHT MAKES RIGHT. . . AGAIN

1/8/2021

One of the things that is so interesting is the current conceptualization of SOCIAL BEHAVIOR as a DELICATE BALANCE of the INNATE & ADAPTIVE IMMUNE SYSTEMS.
You hear a lot of athletes say they can't stand the FEELING OF LOSING.
I don't think anybody likes the feeling of "losing" but many us --- however imperfectly --- try to put other VALUES over "WINNING."
BUT life in a Society with HUGE INCOME and POWER IMBALANCES ---- it doesn't look very fair, and it's not very fair.
So just recognizing "THE WAY OF THE WORLD" can seem "SMART."
That "WAY OF THE WORLD" is "MIGHT MAKES RIGHT," and if you "WIN" --- it must be alright.
Last night a lot of our Republican and Democratic Congressional Leaders sought to HEAL DIVISIONS that have been DECADES in the making.
The Political Parties have been stuck with a bad system that is creating powerful IN-GROUPS and OUT-GROUPS.
Further, the problem is NOT just in the US.
Some countries are experimenting with Citizen Assemblies assigned to especially difficult problems as an adjunct to traditional elected representative government.
We want to be focused on defeating our PROBLEMS, not each other.

Donald Trump Talks Charlie Sheen on the David Letterman Show (2011)

ABC News: Mitt Romney delivers remarks on Capitol Breach (Jan. 6, 2021)

Neuro Transmissions: The fascinating psychology behind why we are so divided right now (Nov. 2020)

GETTING BEYOND MEDIA REPORTS OF THE "MENTAL HEALTH CRISIS"

1/7/2021

Our Understanding is that the Colorado Behavioral Health Task Force is making a major recommendation for a ONE-STOP SHOP for Housing, Services, etc. for people with "mental Illness."

That is a MAJOR STEP UP in EFFICIENCY --- but when we have the kind of SHORTAGES of HOUSING, PLACEMENTS and INTENSIVE SERVICES that Colorado has (& most States have) it's unlikely to SOLVE THE PROBLEM.

We Need:

Comprehensive Data Collection
Waitlists Moving at a "REASONABLE PACE"
A Comprehensive & Effectively Working Plan to bring Housing, Placements and Services to Scale

If that sounds like Olmstead that is because it is --- the original Supreme Court case was decided in 1999. We will be attaching the US Department of Justice's 2011 Guidance to our report.

But it's not just Olmstead, its also Parity and Medicaid Network Adequacy. But if there is any doubt -- OLMSTEAD GETS TO HOUSING.

At the Federal Level

We Need a Covid Economic Stimulus Package that assists the States to bring DISABILITY HOUSING & SUPPORTED EMPLOYMENT to SCALE by 2030.
A Major Initiative that SYNTHESIZES VAST AMOUNTS of RESEARCH across Medical Disciplines on Cognitive Disability and provides Clinical Applications where possible

[We'll also be including by reference the Recommendations from our 2020 Colorado Cognitive Disability Report]

SERVICES, Including SUPPORTED EMPLOYMENT: Strength Based Approaches & Work Arounds & Accommodations for Executive Functioning Issues

We are advocating for HIGHLY SYSTEMATIZED Approaches that can be modified and tailored as necessary.

We're not really wanting to DICTATE, BUT without ACCESS to some kind of format --- often that Strength Based Approach and/or ACCOMMODATION just never really happens.

While most of us may readily recognize the need for a ramp for someone with a wheelchair --- most of us DON'T KNOW what REASONABLE and RECOGNIZED ACCOMMODATIONS may be available for someone with EXECUTIVE FUNCTIONING ISSUES,

We'd like to see a Public Education Campaign perhaps spearheaded by the Division of Vocational Rehabilitation.

plain-speaking on covid & Olmstead ---- "You Selfish Bastards"

1/7/2021

We have 3 Major Proposals in our 2021 Cognitive Disability Report.
The Core "LEGAL" Request / Demand involves STATE COMPLIANCE WITH OLMSTEAD.
One of the documents we're including is the 2010 US Dept. of Justice (DOJ)/Georgia Settlement summary.
This is important to us because it directly addresses among other populations, people with mental illness who are chronically homeless and/or being released from incarceration.
This was an historic Settlement Agreement for DOJ and they wanted it to be a TEMPLATE for States across the nation. That hasn't quite happened yet.

There's no question that a lot of the STATE ANXIETY over OLMSTEAD is FINANCIAL. Even though nothing is required that isn't "REASONABLE" --- in the past, nobody was quite sure how that was going to be INTERPRETED.
Subsequent Caselaw and DOJ Guidance, have answered a lot of questions.
Most individuals, families and advocates want to work with the State and know that they ultimately must work with the State---- but we need States that are committed to complying with Disability Civil Rights Laws.
Colorado for all its PR hasn't been committed to Olmstead, and neither have most states.
We're interested in bringing Housing, Placements and Intensive Services to scale by 2030. That's over 30 years after the Olmstead decision, but given where we are at --- it is going to require an enormous amount of work.

Could you just comply with the damn law?

"A STRENGTH-BASED APPROACH" --- THERE'S MORE HISTORY HERE THAN YOU THINK

1/5/2021

Val's Take

When we think about how divisive things have gotten in our Country -- liberals such as myself might point to some groundless protest of a Trump supporter.

But any thought that this is limited to one side or the other really misses the point.

Just as the Legal System is trying to move to a "COLLABORATIVE PROCESS" ---- there are a WHOLE LOT OF PEOPLE (in fact an entire Country) that we got high and sometimes delusional on the ADVERSARY SYSTEM.

Now I'm not saying one shouldn't avail yourself of the courts when necessary IF YOU CAN AFFORD IT. A lot of what I do on Orchid is lay a FOUNDATION for a SUBSEQUENT LAWSUIT --- IF THE TIMING, PARTNERS & RESOURCES are right.

Further, people in other States utilize these resources, too.

Of course, the EASY WAY would just be STATE COMPLIANCE with Olmstead, etc.

I bring this up because one of the topic areas of the 2021 Report is a STRENGTH-BASED APPROACH --- who is against that, right? Well, the previous Hickenlooper Administration couldn't bring themselves to agree to it -- because I suggested it --- or that is sure what it seemed.

Even if we are beyond a knee-jerk objection to a "Strengths Based Approach" and maybe even trying to incorporate it --- we think a FLEXIBLE SYSTEMIZED APPROACH is important to ensure a Strength-Based Approach ACTUALLY is incorporated into various treatment schemes, etc.

Now one of the many, many problems with the ADVERSARY SYSTEM --- it's often NOT the DEN of LOGIC it pretends.

In fact, the ADVERSARY SYSTEM triggers a BIOLOGICALLY POWERFUL US vs. THEM response --- that has gotten this Country into a WHOLE HEAP of HURT.

If there are SUBSTANTIVE OBJECTIONS --- let's hash that out. BUT let's try to get beyond OBJECTING for the satisfaction of OBJECTING.

PBS --- The Brain with David Eagleman
We don't "feel the pain" of our "out-groups"

Person-Centered Care

Strength-Based Approach

US

Medicare & Medicaid Regulations

42 CFR 483.21

Comprehensive Person-Centered Care Planning

Some talk at the federal level.

In 2011, the Colorado Behavioral Healthcare Council endorsed a Strength-Based Approach

Cares Act

Cares Act

<<Previous

Forward>>

Val's Blog

OLMSTEAD & THE HIGH END OF THE CONTINUUM OF CARE ---BEYOND CRISIS SERVICES

WE'RE Focusing OUR 2021 COLORADO COGNITIVE DISABILITY Report on Olmstead

BREAKING OLMSTEAD COMPLIANCE INTO SMALL STEPS

ACT & SUPPORTIVE HOUSING ---- HOW ARE WE GOING TO FUND IT TO SCALE

A DSM THAT'S OUT-OF-DATE, EXECUTIVE FUNCTIONING CHALLENGES & CRIMINAL JUSTICE

WHY THAT "MENTAL ILLNESS" / VIOLENCE DEBATE MISSES SO MUCH

"THEY DRANK THE KOOL AID"--DIDN'T WE ALL

THE BIDEN ADMIN.--Olmstead, State ASSISTANCE & ADMIN. ENFORCEMENT

"WINNING" . . . TRYING TO GET BEYOND MIGHT MAKES RIGHT. . . AGAIN

GETTING BEYOND MEDIA REPORTS OF THE "MENTAL HEALTH CRISIS"

plain-speaking on covid & Olmstead ---- "You Selfish Bastards"

"A STRENGTH-BASED APPROACH" --- THERE'S MORE HISTORY HERE THAN YOU THINK

Author

Archives

Categories