Blog Archives

The Mental Health Crisis, Level of Care, SCALE & Funding

2/25/2020

The Feds and the States have for sometime used as their defense for the Mental Health Crisis -- well, we're doing some good things.
And they are doing some good things.
But what if we were talking about:

the coronavirus, or
a wildfire, or
dementia

Doing "some good things" wouldn't cut it.

Even as we are trying to move to a more sophisticated Continuum of Care for Mental Health (most current Medicaid Mental Health Continuums of Care violate Parity at the same time they have accurately identified that people with the greatest needs are the most expensive and apparently the least entitled to appropriate care).

   So states such as Colorado and most States have spent a lot of money on Mental Health and still not done a very good job or complied with the Law.

   Savvy policymakers at the Federal and State Level recognize that Mental Health is a MONEY PIT -- & it is.

  But there are ETHICAL & UNETHICAL ways to deal with this problem -- and we have been choosing some UNETHICAL ways largely because we are OVERWHELMED with the SCALE of the problem.

Comprehensive Continuums of Care, Comprehensive Data Collection & Reasonable Plans are a much better way to deal with our Mental Health Crisis than the ad hoc mess we currently have.

Photo Credit: apa.org

Funding Comprehensive Olmstead Planning with State Supplemental Funding

2/24/2020

There are several Supplemental Funding bills in the Colorado Legislature, some of these should be used to fund on-going comprehensive Olmstead Planning.
The Minnesota Legislature has an Olmstead Subcabinet.
More and more, whether it is business or government -- DATA is the key to improvement.
That Data largely needs to come from the STATE.
How many people who are in jails, prisons homeless:

have substance use issues,
brain injury
mental illness, and/or
developmental disabilities

and
what level of care do they need?

We have scraps of this information but we need a coherent whole to make effective service, housing and placement allocations and decisions.

State Governments like Colorado must plan for and fund Comprehensive Olmstead Planning.

State Supplemental Funding could be a great opportunity for Colorado State Government to comply with Federal Law and provide the State with the Comprehensive Disability Planning it needs.

Our Kafkaesque Fixation on Forced Care Statutes Often Misses the LARGER Problem of RESOURCES

2/20/2020

California governor Seeks Lower bar for forced mental health care

"California should lower the legal bar for providing forced treatment to the mentally ill and building more homeless shelters, Gov. Gavin Newsom said Wednesday in his second State of the State address.

"He took the unusual step of devoting most of the annual speech to just two related issues: affordable housing shortfalls and homelessness. They have quickly eclipsed the state's other problems since the Democratic governor took office a year ago.

"He called it “a disgrace, that the richest state in the richest nation ... is falling so far behind to properly house, heal and humanely treat so many of its own people."

CO Medicaid's Too Dangerous/ Too Difficult to Treat Problem

Gravely Disabled

Orchids' Comparison of CO"s Emergency Process for 72-Hour Holds & Petition Process to the Court for Mental Health Evaluation

California Governor Gavin Newsom

In fairness to California Governor Newsom -- he does seem to understand the need for more resources.

Before we expand Forced Care statutes, we need to implement the statutes we have.

The failure of Civil Commitment in Colorado is largely:

A Failure of Resources, and
A Misunderstood Civil Commitment System that needs Resources within the Mental Health Community to Properly Function
Law Enforcement and Mental Health Professionals and some family members would like to have an expanded 72-hour hold procedure as opposed to a court-petitioned process that many are unaware of, and won't use even if they are aware of it.
Even the major players are NOT adequately applying Colorado's Court Petitioned Process.

The reality is there are THOUSANDS of uncertified "gravely disabled" individuals in Colorado jails and prisons who are interested in treatment -- if we would just provide the services, housing, and placements needed.

The Cautionary tale of Nebraska, which could be Colorado or most states

2/19/2020

So advocates have increasingly sought state law enforcement for Federal Disability Rights.

This is the result of a lack of consistent and widespread Federal enforcement.

  Advocates in Colorado have certainly sought State law backing of Mental Health Parity. Theoretically, that is redundant and unnecessary -- but in the real world in Colorado -- it is necessary.

  Procedures for Comprehensive Olmstead Planning are front and center among the needs of Disability Rights. There is some Federal Guidance and cases discussing "MEASURABLE GOALS" -- but states never seem to think this applies to them.

The small Disability Section within the US Department of Justice brings illustrative cases with the idea that the vast majority of states will follow suit.

  Well, the vast majority of states, including Colorado, DO NOT follow DOJ Olmstead Cases and argue the cases are specific to that individual state -- that's what Colorado does.

There needs to be REAL, CREDIBLE Legal and Legislative Strategies to address State failure to make reasonable plans to bring Housing and Services to SCALE for people with disabilities.

Testimony on LB 800 Before the Health and Human Services Committee Nebraska Legislature

Dianne DeLair, JD Senior Attorney Disability Rights Nebraska

LB800 - Provide and change strategic plan requirements for services for qualified persons with disabilities

--Apr 18, 2018 Indefinitely postponed

DRIVERS OF HIGH-COST MEDICAL COMPLEXITY IN A MEDICAID POPULATION

2/17/2020

Medicaid costs are exploding and we are still NOT complying with various disability laws.

There is a lot of education that needs to be done about the current benefits and cost benefits of providing significant supports, especially in the area of cognitive disability
Mental Health is on the cusp of TRANSFORMATIVE CHANGES after years of stagnation---WE NEED MORE RESEARCH to ethically address these spiraling costs

All Sides of the Political Spectrum need to understand that the true meaning of PRO LIFE -- is supporting life -- even when it isn't easy--not criminalizing people.

Medical Care March 2020 Abstract

Medical Care
March 2020

RESULTS:Compared with healthy individuals in our population, medically complex individuals had significantly higher rates of adversity.

The greatest risk of medical complexity and cost was associated with substance use [odds ratio (OR), 4.1], homelessness (OR, 3.0), childhood maltreatment (OR, 2.8), and incarceration (OR 2.4).

Those with the highest prior year acute care utilization and cost had the highest rates of these same factors: substance use (62.5%), homelessness (61.7%), childhood maltreatment (55.5%), and incarceration (52.1%).

CONCLUSION: Clinical and policy strategies that mitigate high-impact social drivers of poor outcomes are likely critical for improving both health and costs for complex, high-needs patients.

INCARCERATION & COGNITIVE DISABILITY: THE TIDE HAS TURNED

2/11/2020

When Olmstead was decided by the US Supreme Court in 1999, there was a general "feeling" that most people with mental illness were institutionalized in Mental Institutes.
A lot of advocates and even federal agencies, began talking about nursing homes as institutions with the greatest number.
The past 10 or 15 years have included a difficult internal Mental Health Advocacy struggle regarding Mental Illness within Criminal Justice and it has gotten very wrapped up with Stigma.
Perhaps not so ironically, law enforcement and conservative mental health advocates have more effectively pushed the issue than anyone else.
There are even some limited US Department of Justice Settlement agreements that order State provision of services and housing upon release from incarceration for thousands of people with mental illness or developmental disabilities.
In a lot of ways, the tide has already turned on Mental Illness and Criminal Justice.
On the other hand, it does need a lot of nuance and mental illness, may not even be the most common diagnosis in Criminal Justice -- it could be Brain Injury.

MOST STATES Failing to bring Olmstead Remedies to scale

2/9/2020

The problem in most states is that they have FAILED to bring various Olmstead remedies to SCALE. They are familiar with:

supported housing, Home and Community Based Services (“HCBS”) waivers, crisis services, Assertive Community Treatment (“ACT”) teams, case management, respite, personal care services, peer support services, and supported employment.

The major problem is that Colorado and other States have refused to comply with Olmstead and make reasonable plans to bring these services to scale.

This is a problem affecting thousands of people in every state. When states refuse to comply with Olmstead -- that puts the burden on the understaffed disability section of the US Dept. of Justice, non-profits and people with disabilities.

Is it impossible --no -- do we have widespread non-compliance because of it -- YES.

IT IS SO OBVIOUS -- BUT IT'S NOT --THE HIGH END OF THE MENTAL HEALTH CONTINUUM OF CARE

2/4/2020

It's the TOP and MOST EXPENSIVE TIERS of our Mental Health Continuum of Care that we are treating as OPTIONAL to fund.

We have over a 1/2 Century of treating these considerations as UBER POLITICAL as opposed to Standard Health Care Decisions.

There are a lot of reasons for this:

The Treatments are sometimes not very effective
Family Members may have already abandoned the person.
Freedom of the Person can be at stake.

We're not talking about the over 60 million people that have a touch of depression -- we are talking about people who are:

A Danger to Themselves
A Danger to Others, and/or
Gravely Disabled

AND we and other States routinely FAIL to allocate the resources for:

Bed Space
Housing Units
Intensive Treatment

In a large way we must improve treatments -- and a big part of that is breaking up our Balkanized Mental Health Centers and INTEGRATING them with neurology and immunology.

In the meantime and until we do have better treatments, policy makers must fund adequate:

Bed Space
Housing Units, and
Intensive Treatments

Dante's "Inferno"

HOUSING AS A STATE DISABILITY OBLIGATION UNDER FEDERAL LAW

2/3/2020

CMS, Colorado and a lot of other states are starting to talk about "Housing Related Services"--

Unfortunately, that doesn't meet Colorado's legal obligation TO PROVIDE HOUSING for people with disabilities who are:

Institutionalized
Homeless, or
Great Risk of Institutionalization or Homelessness

So right now CMS can say they don't cover housing (they probably shouldn't be able to do that but they can right now)

STATES can't do that -- and the US Department of Justice is very specific that the State's Obligations don't end with the Medicaid Plan.

MINNESOTA

Goal One: By June 30, 2019, 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

The Need for State Governments to get Serious About Solving Our Mental Health Crisis

State Legislatures around the country -- pass "good" legislation without making a dent in the Mental Health Crisis.

Colorado seems prepared to do that this year as it has so often. (& there could be a whole lot of stuff we don't know about -- we hope so)

Specifically, how many THOUSANDS of BEDS and HOUSING UNITS are we going to get this year for behavioral/cognitive disability.

Is Colorado going to finally make Assertive Community Treatment available to all where reasonably medically necessary?

REACTION TO RMPBS Report

2/2/2020

Reaction to Breakdown Report: Rocky Mountain PBS & 9 News

Progress is being made: the media and others seem to understand the problem is not the Civil Commitment Statutes, but rather RESOURCES.

The State is unclear about its legal duties outside of the Jail Wait Lawsuit.

"STAFFING" -- this is not some magical issue -- it is an economic and legal issue. BOTTOM LINE: the State is NOT paying enough.

It could be very helpful and practical if the State Legislature took a Medicaid concept such as "Network Adequacy" and gave Colorado State Government 5 years to achieve Inpatient & Intensive Mental Health Network Adequacy (including Housing) with funding to support the plan.

<<Previous

Val's Blog