Heart Forward Conversations from the Heart

Send us a textIn this episode we sit down and talk with Caterina Vicentini in my hotel room in Trieste.  Caterina is a math and physics teacher at the secondary school level in a town – Monfalcone --  that is about 30 minutes from the city centre of Trieste.She is a service user and takes advantage of opportunities like this to share her story to help destigmatize mental illness and to offer hope that one can have a full life --  education, career and family –-  even while encountering the challenges of a mental illness.  Of course, she lives and works in a region that is known for exemplary care.Her first crisis in her 20's happened when she was a graduate student.  At that time, she had been awarded an Erasmus Fellowship which allowed her to study in Belgium.  Then she was offered an opportunity as a PhD student to be a teaching assistant.She recalls for us her first experience of being taken to the hospital, forcibly injected by someone she did not trust, and then placed in a padded room with four point restraints.  The shock of all that is beyond frightening and you will hear about her Houdini-like liberation that took all night long.In 1991 she and her husband returned to Trieste and she shares the stories over the subsequent decades of a few more incidents that would set her back, and how she emerged stronger each time.  Note:  when she talks about going to the “centro di salute mentale” or staying there in one of their beds, this is not a hospital.  This is the community mental health center, which is an unlocked place with crisis beds for those who might need to stay for a day, a week or longer.  

Send us a textIn this episode, we speak with Claudia Battison, a Psychiatric Rehabilitation Technician (PRT) in the mental health system in Trieste Italy.  I am joined in this interview by Dr. Joy Agner, Assistant  Professor at the USC Chan School of Occupational Therapy and Occupational Science at USC.   Heart Forward has become particularly interested in the potential role that occupational therapists --  if empowered to practice their profession to its full potential --  could play in mental health support settings in the U.S.  Unfortunately, the way that OT services are primarily funded (through short-term, medically oriented reimbursement systems) constrain their ability to come alongside people in their recovery journey over the long term. This topic was already approached in a Season Four podcast with Dr. Deborah Pitts from USC's Chan School. In this conversation, we learn about the ways in which the PRT engages with the system users.  Three stark differences emerge: Time.  There are no deadlines.  They are afforded the time necessary to get to know the user and tease out the life plans/goals (also referred to as a personal rehabilitation project) that are meaningful to the user.Friendship.  The relationship is described more like a friendship than what might be more typical in an American context.  This equates with the ethos of coming alongside people in horizontal relationships that eschew the power dynamics associated with “professional” more verticalized relationships.Team.  The PRT is part of a broader team – an équipe of other “operators” (their word for staff) – in the Community Mental Health Center.  The other team members can help to weigh in on how to support the system user; the PRT is not left to his or her own devices.And, or course, all of this is grounded in the belief that a mental health system must support a person in all three pillars of one's life:  casa, lavoro e socializazzione, or housing, work/purpose and community.  The PRT must pay attention to each of these pillars to provide support for recovery. As we have researched this further, it appears that this role if fairly unique to Italy and was created to augment the psycho-social support that is an underpinning to the Italian model.  As described in one of the articles linked below, “Psychiatric rehabilitation technicians are trained to perform multidisciplinary rehabilitation and education interventions for people and their carers.”   Here are two articles about the role of the Psychiatric Research Technician. Psychiatric Rehabilitation in Italy:  Cinderella No More – The Contributions of Psychiatric Rehabilitation Technicians.  Internation Journal of Mental Health.   2016 Who cares for it?  How to provide psychosocial interventions in the community.  International Journal of Social Psychiatry.  2012  

Send us a text Elena Cerkvenic recently published a book, Sono Schizofrenica e amo la mia follia, which translated  means:  I am schizophrenic and I love my madness.  This book ia part of a new series being published – La Collana 180:  Archivo Critico della Salute Mentale by Meltemi, a publisher in Milan.   Elena meets with us to share her story as a young woman, living in Trieste,  excited by her career studying and teaching languages and literature with a bright future ahead of her.  While on a study visit in Munich, at the age of 29, she experienced a psychiatric disruption that was sudden, scary and unexplainable.  Her life now is bright and full and she describes herself as happy and empowered.  She credits the mental health services in Trieste for supporting her recovery and coming alongside her as a “family,” especially during about 20 years of suffering when she was quite isolated and somewhat abandoned by her family and friends.  Elena was motivated to write this book as a source of hope for others who should not give up on their recovery and their future.  She provides a very first-person glimpse into the mental health services in Trieste and feels grateful for the kindness of the people she met along the way and their belief in her potential. Bio from the official website for the book:Elena Cerkvenič was born in Trieste into a Slovene minority family. A graduate in Languages, she has taught German in middle and high schools. She is currently involved in initiatives for the dissemination of Slovenian language and culture and is involved in associations of people who live or have lived the same experience as her. Her publications include the poetry collections Amore chissà se (2009) and Sapor di.vini (2012). Links:"Sono schizofrenica e amo la mia follia": presentato il libro di Elena Cerkvenič - RTV SLOShe speaks about the influence of philosopher Pier Aldo Rovatti.    If you want to reach out to Elena, please send an email to kerryhmorrison@gmail.com.

Send us a textIn this episode, we learn about the inner workings of two critical elements of the community-based ecosystem in Trieste:  the community mental health center (CMHC) and the psychiatric unit in the city's general hospital (known as the Psychiatric Diagnostic and Treatment Services or SPDC).  Tommaso Bonavigo, is a psychiatrist at the CMHC Maddalena.  He received his education at the Università degli studi di Trieste, graduating first as a doctor (2010) and then as a psychiatrist (2016).Alessandra Oretti is the interim director of the mental health department for the city of Trieste and also serves as the head of the central hospital's psychiatric unit.  She has worked in the Trieste mental health system dating back to 1994 and received her degree from the Università degli studi di Trieste in 1998. The Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) is the Health Authority which services the Friuli Venezia Giulia region.  Oretti and Bonavigo  are part of the team of ASUGI experts in the following cooperation projects:RING project (INTEGRATED STRENGTHENING OF THE PALESTINIAN HEALTH SYSTEM) led by the Italian Agency for Development Cooperation (AICS) in the West Bank area (mainly in the psychiatric hospital of Bethlehem)DUSM project (Diritti umani e salute mentale dei detenuti ) in Albania, which means Human rights and mental health of the prisoners in Albania,  led by a consortium of Italian and Albanian NGOsCollaboration with East London Foundation Trust for developing a pilot CMHC which will remain open 24 hours In this interview, you will pick up on these themes:The importance of the therapeutic relationship which is based upon trust built up over time. How services are integrated in Trieste and the ways in which all the various people impacting a service user – the social worker, nurse, psychiatrist, police (if warranted) and others – create a team around a person.How accountability is assured through the designation of catchment areas – which denotes a territory for which the staff in a CMHC feel responsible for the people they serve. Resources: How a small Italian city became a model for mental health care. Financial Times, Sarah Neville, December 2024. Guidance from World Health Organization:  "Comprehensive mental health service networks. Promoting person-centered and rights-based approaches.”   See chapter at page 18.  

Send us a textDr. Giovanna  Del Guidice has spent her entire career in pursuit of promoting a more humane and relationship-based treatment ethos for people living with mental health conditions.  In this interview we hear the story about how she boldly travelled to Colorno Italy as a young psychiatrist in her 20's to meet Franco Basaglia in person.  The fact that she had read his books and wanted to follow his lead, because she was uncomfortable with the teachings of conventional psychiatry, clearly impressed him because you will hear the story about how she was offered a job and became part of the original equipe!  On her part, it was a bold move but clearly changed the trajectory of her life.  Giovanna, since 2010, has been involved in the Conferenza Basaglia (CONFERENZA PERMANENTE PER LA SALUTE MENTALE NEL MONDO FRANCO BASAGLIA ).   This is an organization that she co-founded with Dr. Franco Rotelli, the psychiatrist who followed Franco Basaglia to lead the mental health department in Trieste in the late 1970's.   She currently serves as president.From the website, her biography is presented:“Psychiatrist, one of Franco Basaglia's collaborators, has worked since 1971 in the deconstruction process of the Trieste psychiatric hospital and for the construction of community mental health services. She was director of the mental health department of the Caserta Health Authority (2002-2006) and of Cagliari (2006-2009). Mental health consultant of the Calabria health councilor. She is a champion for the abolition of mechanical restraint in mental health services,  which is seen as a remnant of the old asylum culture and is detrimental to the dignity and rights of those who suffer it, but also negatively impacts the operators who are required to implement it.  She is the author of a book … e tu slegalo subito (“and you untie it immediately”) which was published in 2020.  [Note:  this Vimeo trailer for the book underscores why this is such an inhumane practice.] In this episode, we are aided by the translation skills of Erika Rossi, a documentary filmmaker who recently directed a film that features Giovanna Del Guidice among many others.  The film, 50 years of CLU, captures the story of the formation of the first social cooperative in Trieste.  

 Beatrice Stanig is a young woman who is making her way in Trieste.  She is a member of the Women's Association, L'Una e L'Altra and a peer support worker in the mental health system.  She has also written a book, Sei Innocente and started the process to work on a second. In this conversation, we cover several topics that help to provide insight into the way in which community based mental health system comes alongside the users who depend upon it.  We touch upon:The special place in holds in her heart for the women's association, Luna e l'Altra which has provided her a place of community and purpose since she first stepped across the threshold when she was 22. Her role as a peer support worker and her desire to see this profession recognized by the Italian system in order to create a viable path toward economic independence for those who do this job.The recent creation of an association in Italy meant to organize peer support workers.  It is called the Associazione Italiana Persone Esperte in Supporto tra Pari (AIPESP).  Translated that would be the association for experts in peer support.    Here is another article that describes the formation of this association.Her thoughts (and personal experience therewith) about the “power gap” that exists between system users and the clinicians and staff professionals in the mental health system and why it is important to have another person in the room when users meet with the professional staff. 

Season Five is a special treat:  made in Italy!  This past year, with generous support from the Conrad N. Hilton Foundation, Heart Forward was afforded the opportunity to curate a study group to learn about a system in Trieste, Italy that the World Health Organization (WHO) has declared a global best practice for community-based mental health care.   As the  Équipe met regularly via Zoom to prepare for their October 2024 study visit, they fashioned a mission statement define their purpose:The Équipe is an intentionally curated and diverse learning community that is committed to advancing a more humane and holistic mental healthcare system. Rejecting the institutional status quo, which contributes to suffering, homelessness and incarceration in the US, we look abroad for bright spots that could inform sustainable change. So about these conversations.   During our week in Trieste,  I snuck away to do interviews in the city.  Who will you meet?Claudia Battiston.  Claudia is a Psychiatric Rehabilitation Technician – which is a role unique to Italy, but seems to complement what we know as occupational therapy.   Dr. Tomasso Bonavigo, interviewed alongside his colleague, Dr. Alessandra Oretti.   Bonavigo works in a community mental health center and Dr. Oretti is the director of the psychiatric unit in the central hospital and is as the interim director of the mental health department.  Elena Cerkvenic.  She is a service user in Trieste and just published a book this year called Sono Schizofrenica e amo la mia follia.  Dr. Mario Colucci.  A psychiatrist and philosopher, who has worked in the community system for most of his career and has written extensively about the Basaglian vision.  Dr. Giovanna Del Guidice.  Here's a female psychiatrist who managed to work alongside Franco Basaglia and now is dedicated to keeping the flame alive as she travels to other countries to provide training.Stefania Grimaldi.  One of the cornerstones of the model in Trieste is the network of social cooperatives.   We'll learn about one such social cooperative, La Collina, and how this system works.    Michele Sipala.  Michele, in a peer support role, is involved with a very innovative six-month residential program for young service users in the city's mental health system, Recovery House.  Beatrice Stanig.  She speaks about how the association – L'Una e L'Altra – has provided a place of purpose for her.  She is now a peer support specialist and has  written a book called, Sei Innocente.    Caterina Vicentini.  Caterina is a service user who provides a glimpse into how valuable the services in Trieste have been to her recovery and her ability to continue her career as a teacher.  The episodes will be ready for release mid-January 2025.  Subscribe so you will be alerted when the first episode is available. This is a non-sponsored podcast with no ads and entirely supported through donors.  To support this podcast, please consider a donation HERE.   And thank you to my technical producer, Aaron Stern of Verdugo Sound for editing and production support.  

Meet Georgette Darby in this interview.  She is one remarkable woman who has endured so much and has emerged strong and resilient.  Georgette has a Bachelor of Science in Public Administration with an emphasis in Criminal Justice from California State University at Dominguez Hills. She graduated in 1996.    She also has an AA degree in Science, Computer Information Technology from Los Angeles Trade Tech College.  She was awarded that degree in 1988.  These are accomplishments that she doggedly pursued and was the first person in her family to earn a college degree. Georgette worked as a junior legal secretary in the law firm Manatt Phelps and Phillips for nearly 10 years.  In the fall of 2008, as the world began to reel from the downward slide associated with the financial crisis that sparked the Great Recession, the law firm laid off all staff who did not have at least 10 years tenure.  Georgette was just a few months shy of that. According to this January 2009 article in the New York Times, the United States lost 2.6 million jobs in 2008, the worst year since 1945.  By early 2009, more than 11 million Americans were unemployed and the unemployment rate jumped to 7.2 percent.   This was the world that Georgette had to navigate all by herself.  As she says, her sorority is “Me Fi Me.”  She is a survivor.  Georgette is currently extremely involved in her community, serving on the Board of the Hollywood United Neighborhood Council and as an ambassador member of the new clubhouse in Hollywood which is being created as a part of the Hollywood 2.0 mental health pilot. Georgette is the personification of the word tenacious.  Her lived experience falling into homelessness and navigating our county mental health system is not to be overlooked.   She does not give up easily and is a wonderful mentor for anyone who thinks their life is hard.  Listen to this interview and see if you could've walked a mile in Georgette's shoes and ended up here! Links:Article in LAist re the new LA Clubhouse forming in HollywoodOur World in Data  re/ Covid death rate since 2020 

In this episode, we visit with two representatives from Fountain House in New York.  Our primary intent was to provide a platform to share the results of a recent research report issued by Fountain House:  Beyond Treatment: How Clubhouses for People Living with Serious Mental Illness Transform Lives and Save Money.  This first of its kind analysis not only offers a fuller accounting of the fiscal and societal costs of untreated mental illness — looking beyond health care spending to include lost wages and productivity, disability benefits, repeated emergency room visits, and criminal justice impacts — but demonstrates how clubhouses are uniquely positioned to drive down spending across the board.  The report finds that if clubhouses were appropriately resourced and expanded to serve even just five percent of the 15.4 million adults in the U.S. who live with serious mental illness, the net societal benefit would exceed $8.5 billion and offer a dramatic improvement in quality of life for countless individuals, their families, and their communities. The report notes that the U.S. has historically spent most of its mental health care dollars on clinical treatment, such as medication and therapy, with a fraction allocated to fund the community-based social supports people also need to manage their mental illness. These are policy decisions that can and should be changed. Fountain House is knitting together a national network of clubhouses to help amplify voices throughout the country to underscore the importance of the clubhouse model as a compelling mental health intervention that should be more robustly funded. The bios for our two guests are linked on the Fountain House website. Rev. Dr. Phillip Fleming wears many hats, including member, certified peer specialist and member of the Fountain House board of directors. Dr. Joshua Seidman is the Chief Research and Knowledge Officer.   Other resources and reports mentioned in this interview: Community as Therapy: The Theory of Social Practice. Psychiatric Rehabilitation Journal.  12/23.   Mental Health During the Covid-19 Pandemic. National Institute of Health. Impact of COVID-19 pandemic on mental health in the general population: A systematic review  PubMed Central.  2020. Project to Evaluate the Impact of Fountain House Programs on Medicaid Utilization and Expenditures. NYU. 2017. UCLA loneliness scaleQuality of life measureBrief inventory of thriving  Clubhouse International:  Mental Illness Recovery - Clubhouse International (clubhouse-intl.org)

In Part II of this interview with Adrian Berumen, an inmate at Calipatria State Prison,  we track his journey from serving as an inmate Mental Health Assistant (MHA) at LA County Twin Towers to being sentenced to serve a 25-year to life sentence. Adrian's story resonates with Heart Forward because his peer service, under the supervision of the LA Sheriff's Department (LASD) and the LA County Correctional Health Services in LA County jail, exemplified the radical hospitality that undergirds the mission of our organization.  We note that Adrian spent 9 years at LA County jail awaiting his trial and in 2017 volunteered to move from Men's Central Jail into Twin Towers to assist with the most seriously mentally ill inmates living in 141 E and F pod.  Over time, in collaboration with his partner Craigen Armstrong, who had been transferred from San Quentin's Death Row to await a new trial, they began to flesh out their role as Mental Health Assistants.  In 2020, they collaborated on a book about their experience.Owing to the leadership of Supervisor Hilda Solis on the LA  Board of Supervisors, there is a commitment to expand the number of MHA's  and to provide greater support to their work.  Supervisor Solis had unanimous support for a motion she introduced in June 2023 to expand the number of MHA's three-fold.  More recently, in a November 2023 motion, which was seconded by Janice Hahn,  she asked for a report back in 90 days on a number of potential supports that would acknowledge the work of the inmate MHA's.Adrian's story raises important questions:·       What does rehabilitation look like with our California prison system?·       Why can't we consider a different model to come alongside prisoners with mental illness?  The pilot that has been successful in LA County could be replicated by CDCR.  This might be similar to the work done by the Gold Coats in San Luis Obispo County.·       Could LA County and CDCR negotiate an agreement that inmate MHA's doing this work in LA  could see their "credits" transferred to the state prison system?+++Podcast interview S1 Ep 5  conducted  in 2020.12/23  article in LA Times:  Seeking Redemption:  A death row Inmate's journey into LA County's largest psych ward.Prison Levels in CA State SystemWebsite which documents the work of the  Mental Health AssistantsTo contact Adrian Berumen, BU 1415PO Box 1415Calipatria State PrisonCalipatria, CA 92233-5007To support this podcast - you can donate HERE. 

 In this 2 -part interview with Adrian Berumen, an inmate at Calipatria State Prison,  we track his journey from serving as an inmate Mental Health Assistant (MHA) at LA County Twin Towers to being sentenced to serve a 25-year to life sentence. Adrian's story resonates with Heart Forward because his peer service, under the supervision of the LA Sheriff's Department (LASD) and the LA County Correctional Health Services in LA County jail, exemplified the radical hospitality that undergirds the mission of our organization.  We note that Adrian spent nine years at LA County jail awaiting his trial and in 2017 volunteered to move from Men's Central Jail into Twin Towers to assist with the most seriously mentally ill inmates living in 141 E and F pod.  Over the course of this time, in collaboration with his partner Craigen Armstrong, who had been transferred from San Quentin's Death Row to await a new trial, they began to flesh out their role as Mental Health Assistants.  In 2020, they collaborated on a book about their experience.Owing to the leadership of Supervisor Hilda Solis on the LA  Board of Supervisors, there is a commitment to expand the number of MHA's  and to provide greater support to their work.  Supervisor Solis had unanimous support for a motion she introduced in June 2023 to expand the number of MHA's three-fold.  More recently, in a November 2023 motion, which was seconded by Janice Hahn,  she asked for a report back in 90 days on a number of potential supports that would acknowledge the work of the inmate MHA's.Adrian's story raises important questions:·       What does rehabilitation look like with our California prison system?·       Why can't we consider a different model to come alongside prisoners with mental illness?  The pilot that has been successful in LA County could be replicated by CDCR.  This might be similar to the work done by the Gold Coats in San Luis Obispo County.·       Could LA County and CDCR negotiate an agreement that inmate MHA's doing this work in LA  could see their "credits" transferred to the state prison system?Resources:Podcast interview S1 Ep 5  conducted  in 2020.12/23  article in LA Times:  Seeking Redemption:  A death row Inmate's journey into LA County's largest psych ward.Prison Levels in CA State SystemWebsite which documents the work of the  Mental Health AssistantsTo contact Adrian Berumen, BU 1415PO Box 1415Calipatria State PrisonCalipatria, CA 92233-5007

Dr. Deborah Pitts is a Professor of Clinical Occupational Therapy at the USC Chan Division of Occupational Science and Occupational Therapy.  Her practice expertise includes community-based mental health and psychiatric rehabilitation, particularly in the permanent supportive housing (PSH) context, and the ‘lived experience' of recovery for persons labeled with psychiatric disorders, in particular occupational engagement and psychosis.   Her doctoral dissertation focused on practice reasoning of front-line service providers (i.e., Personal Service Coordinators) in a community-based mental health wrap-around program known as a Full-Service Partnership (FSP) serving persons labeled with psychiatric disabilities.   She took the lead for the Chan Division's participation in the USC Homeless Initiative through her partnerships with local organizations providing services to persons experiencing homelessness to create student learning opportunities. In this interview, we will explore the basic framework to understand the untapped potential to fully integrate occupational therapy into residential contexts to come alongside and support people living with a serious mental illness.  We will tease out the distinction between psychosocial rehabilitation and clinical interventions.  We'll define the terms “occupational science” and “occupational therapy" and "functional cognition."    She will underscore the importance of developing a relationship between the therapist and the client – and this takes time, something the American payment system does not reward for when reimbursing for services. And, most important, we will explore how occupational therapy could be additive to the service support teams in our homeless housing ecosystem – if we could find a way to pay for this. 

 This is Part Two of a conversation with Leila Towry and Aimery Thomas of The Future Organization (TFO) about their recent year-long research study into Los Angeles County ARFs and RCFEs.  These are commonly referred to as “board and care” homes, but the researchers make a case that the community and regulators should intentionally move away from that labelling as we attempt to forge new policy in this space. The study was supported by an Initiative, involving the participation of Brilliant Corners, the LA County Department of Mental Health, the LA County Department of Health Services, and Genesis LA, funded by the California Community Foundation and Cedars Sinai.In this interview, we discuss TFO's findings relative to the connections between this segment of the housing market in LA County and our crisis of homelessness.  We will explore how licensed facilities are not seen as part of the continuum of housing options in the “homeless services” sector, and, in fact, the federal department of Housing and Urban Development does not recognize licensed facilities as housing according to federal regulations which require individual leases.  As the study authors will assert, not recognizing the market of ARFs and RCFEs and the vulnerable populations they serve represents a blind spot in public policy discourse on ending structural homelessness.We will also focus on just ten of the more than 50 recommendations offered in this report, across the domains of key players affecting outcomes for this Market – municipalities, Los Angeles County, the State's Community Care Licensing Division that licenses and regulates facilities, and the facilities operators themselves.  Los Angeles County owners and operators have been collectively advocating for change and improvement through a newly-formed organization, the Licensed Adult Residential Care Association, or LARCA. Resources associated with this episode:Here are some links to help you navigate this issue:Summary of study findings from Brilliant Corners website re/ this study.Full report, Serving our Vulnerable Populations:  Los Angeles County Adult Residential Facilities and Residential Care Facilities for the Elderly, August 2023.August 26, 2023 article in LA Times summarizing key finding of TFO report. July 12, 2022 article in LA Times about continuing closure of board & care homesBlog at Accoglienza.us

This is Part One of a two-part podcast interview.A long-awaited research study and report prepared by The Future Organization (TFO) helps to shine a light on an important, but fragile segment of our housing continuum for people with mental health conditions, many formerly homeless.  Colloquially referred to as “board & care homes,” they are officially referred to as Adult Residential Facilities (ARFs) and Residential Care Facilities for the Elderly (RCFEs).Sponsored by Brilliant Corners and funded by the California Community Foundation and Cedars Sinai, the study was part of an initiative involving the participation of the LA County Department of Mental Health, the LA County Department of Health Services, and Genesis LA, with intention to draw attention to the issues affecting licensed residential facilities that care for people with serious mental illness in our communities.  In this interview with the study's authors, Aimery Thomas and Leila Towry of The Future Organization, we will learn about the scope of their research, the intent of the study, and explore some of the findings and insights from their year of research:The “Market” in Los Angeles County, which consists of over 750 licensed facilities serving people with mental illness and elderly residents;  “Market Users,” or the range of agencies, service providers, government partners and others who are connected with, or place clients into, licensed facilities; The Market's residents: their demographics, perceptions, and unmet needs; and,The owners and operators and their challenges, needs and perceptions.This promises to be an eye-opening interview for anyone involved in the homeless housing sector as the importance of this housing resource in serving people with experience of homelessness is not often acknowledged or understood.  In fact, as the study reports, owners and operators of these facilities feel invisible and disconnected from the policy and agency connections who could provide vital aid to sustain them in the important work they do in caring for the most vulnerable in our communities across Los Angeles County.Part Two of this conversation will largely focus upon the recommendations of the study report.Here are some links to help you navigate this issue:Summary of study findings from Brilliant Corners website re/ this study.Full report, Serving our Vulnerable Populations:  Los Angeles County Adult Residential Facilities and Residential Care Facilities for the Elderly, August 2023.August 26, 2023 article in LA Times about the release of the TFO report. July 12, 2022 article in LA Times about continuing closure of board & care homesBlog at Accoglienza.us

Is involuntary psychiatric treatment a solution to the intertwined crises of untreated mental illness, homelessness, and addiction? In recent years, elected officials and advocates have sought to expand the use of conservatorships, a legal tool used to require someone deemed “gravely disabled" (e.g.,  unable to meet their needs for food, clothing, or shelter as a result of mental illness) to take medication and/or be placed in a facility (often locked) under the care of a guardian for a defined period (usually one year at a time).    This is Part Two to a conversation with Professor Alex Barnard.  Two years ago, Heart Forward interviewed Barnard who was in the initial stages of his research into California's laws under the umbrella of the Lanterman-Petris-Short Act adopted over 40 years ago.  It would be advisable to listen to that interview first.  Since that time, he has managed to publish a book which is an excellent resource, and that is the focus of this interview.  Conservatorship is an incisive and compelling portrait of the functioning—and failings—of California's conservatorship system. Drawing on hundreds of interviews with professionals, policy makers, families, and conservatees, Professor Barnard takes readers to the streets where police encounter homeless people in crisis, the locked wards where people receiving treatment are confined, and the courtrooms where judges decide on conservatorship petitions. He will make a case that  California's state government has abdicated authority over this system, leaving the question of who receives compassionate care and who faces coercion dependent on the policies and priorities of California's 58 counties, the financial incentives of for-profit facilities, and the constraints of under-resourced clinicians.  He gives a voice to the desperate struggles of families to obtain treatment for their loved ones and the challenges people with mental illness themselves face getting the services they want and need. He challenges us to walk a mile in their shoes and the shoes of their family members who are often left adrift. Additional resources: Website for Professor Alex BarnardArticle about passage of SB 43 (Eggman D-Stockton) to expand definition of grave disability passed by CA State Legislature on 9/14/23.  

What we do each day and how we define ourselves to others is critical to our identify and sense of self worth.  In this interview, we will explore the importance of identity as a foundational component of mental health recovery.  For those who are involved in designing social enterprise businesses, or creating more pathways to employment for people living with a mental illness in their community, this interview will provide ideas and inspiration.Paul Barry has had a distinguished career in this space, beginning as a teacher in a maximum security prison for Teach for America, and ending as the head of employment programs at the Village in Long Beach, a highly regarded mental health community under the direction of Mental Health America.  He holds a Masters in Education (Urban Specialty) from the University of Hartford and post-graduate certification in Managed Care from the CA School of Professional Psychology. Over his career, he developed the first community-based business of its kind that employed adults with developmental disabilities in Pasadena, CA in the early 80's (the “Hot Dog Building Company”).  He created, developed and managed a non-profit agency-owned competitive business, Corporate Cookie, in the Mid-Wilshire business district in Los Angeles in the late 80's.He moved on to become the Director of Employment and Community Integration at The Village in Long Beach. In this role, he started three agency-owned businesses (Deli 456, Village Maintenance Business & The Village Cookie Shoppe) and oversaw five job developers to identify community employment opportunities. As his career at The Village progressed, he moved from that role to Associate Director and ultimately Executive Director.The Village employment program was also awarded 1988 Program of the Year from the California State Dept of Rehabilitation.  In 1999 he received  Eli Lilly's National 1st place award for Social Worker of the Year.   And, in 2014, he accepted the award on behalf of the Village for the most innovative mental health program in the country, awarded by the National Council on Behavioral Health in Washington DC.  Articles and reports referenced in this interview.Corporate Cookie Wilshire Blvd 1990Corporate Cookie on Santa Monica Blvd 1995DMH E-News 9/29/16Accoglienza blog on The Importance of Work to Our Identity 2019Revisiting the Developed Versus Developing Country Distinction in Course and Outcome in Schizophrenia:  Results from ISoS, the WHO Collaborative Followup Project.  By Kim Hopper and Joseph Wonderling (2000)Podcast interview (2022) referenced in conversation between Dr. Mark Ragins and Dr. Dave Pilon discussing the 1990's Village Pilot

This interview with an amazing couple – Rhoda and Gochin – who have operated a small family-style board and care home in the San Fernando Valley (Los Angeles) for the last 22 years, will leave you feeling anxious at the end.  And that is the objective:  to stimulate not just a sense of urgency, but emergency, to protect precious beds that provide homes for people living with mental illness in our city, in the county, in the state of California.  In this interview, we  move past the sterile staff reports that document the steady loss of facilities and beds.  These are important statistics (see below for links) but what often is lost is the human impact of this emergency.  Through Rhoda and Gochin's story, you will gain a glimpse into: The people who are living in the home, entrusted to their care, who feel safe and secure.  What happens to them if this facility closes? The families of adult children with mental illness who worry about where their loved one will end up once they pass away and can no longer pay attention to the situation.  The owner/operators of these facilities, who too often work for free, dip into their personal finances to make ends meet, and as Gochin says, “suffer in silence.”  I am grateful to Rhoda and Gochin who were willing to trust me with this interview.  I am also grateful to Barbara Wilson (interview guest in Season Two of this podcast) who is a tireless advocate for saving the board and care system and arranged for the meetings to prepare for this interview.  In this interview, I reference recent reports documenting the state of the board and care crisis: County of Los Angeles, report issued June 5, 2023. City of Los Angeles, report issued May 12, 2023. I reference the petition sponsored by the Los Angeles Residential Care Association (LARCA).  Please consider adding your name and sign up for more updates.I'm also including a link to a recent blog I posted on this topic entitled:  Can We Commit to a Net Zero Loss of Board and Care Beds? Also, just this week, an excellent article appeared in the L.A. Times and references several board and care operators, including Rhoda.   Other articles from the archives:Here's Why California Housing For Mentally Ill Adults Is Disappearing - capradio.orgMental Health 'Catastrophe': Few Options for Residents as Care Homes Close | KQEDHomes for people with severe mental illness are rapidly closing. Will help come fast enough? - Los Angeles Times (latimes.com) SF rescues homes for elderly, homeless and mentally ill on the verge of closing (sfchronicle.com)

Wow - it's been 10 months since we uploaded the final episode of Season Three! This podcast is a labor of love -- and is not something that is casually produced on the fly.  So, the time is right to jump back in and resume these interviews!  We are excited to provide a platform for some compelling guests and stories in the coming months.The theme remains the same:  The American mental health system is broken and voices for change and examples of innovation and stories of hope are featured.  We continue to be inspired by the global best practice in Trieste, Italy.Topics on the docket this season:  the  human cost of losing our inventory of precious board and care beds in the state; a glimpse into occupational therapy and how it dovetails with radical hospitality;  how a cookie business from the 1980's was ahead of its time as a social enterprise;  why the clubhouse can be a place of recovery and transformation;  how radical hospitality has taken root on one floor in L.A. County Jail and more.  Your support of this podccast is welcome; there are no ads or sponsors and we rely on the support of donors and our listeners.  You can donate here.  This podcast is produced by Heart Forward LA with technical support provided by Verdugo Sound in Glassell Park.  

Mark Gale's credentials for this interview are unparalleled.  He serves as the Criminal Justice Chair of NAMI (National Alliance on Mental Illness) Greater Los Angeles County.  Mark also represents NAMI on the Los Angeles County District Attorney's Criminal Justice Mental Health Advisory Board, serves as a member of the Permanent Steering Committee of the Office of Diversion and Reentry (ODR), the Alternatives to Incarceration Initiative (ATI), and the Men's Central Jail Closure Workgroup in the pursuit of L.A. County's  Care First, Jail Last strategy.  Additionally, he leads the NAMI Crisis Intervention Team (CIT) partnership with law enforcement in Los Angeles County.   In addition to his extensive volunteer and leadership work with NAMI, Mark was one of the four co-hosts/editors of the LPS Reform Rask Force II.  This was a four year-long effort to identify important recommendations to reforming our LPS mental health statutes and protocols that were detailed in the report entitled “Separate and Not Equal.” He is also father of a son with a serious mental illness. Reports, articles and resources referenced in this interview:Front page article in L.A. Times on day of interview'You can't get out': Mentally ill languish in California jails without trial or treatment (msn.com)October 2021 JFA Institute Report on COVID-19 and Reduced Jail Population Cost Savings Estimate, Men's Central Jail Closure Fiscal Analysis, and Closure Population ProjectionsExcellent book, Crazy by Pete Earley. Article about the new LA County USC Restorative Villages and the individual IMD buildings.Council of State Governments Stepping Up InitiativePodcast references in this interview:Interview with Jackie Lacey re/ the Blueprint for Change in L.A. County.Interview with Alex Briscoe re/ the complicated public mental health funding paradigm Support this podcast through Heart Forward LA.  This project is 100 percent supported through your donations.  With gratitude!

Soumitra Pathare trained as a psychiatrist at Seth G S Medical College & KEM Hospital Mumbai and St Thomas' Hospital, London. He has a doctoral degree from VU University, Amsterdam and is a Member of The Royal College of Psychiatrists, United Kingdom.     Dr. Pathare is based in Pune, India and is the director of the Centre for Mental Health Law and Policy at the Indian Law Society.  His main area of work concentrates on mental health policy, legislation and human rights. Soumitra has worked as a consultant to many countries reforming their mental health policies and laws. As will be described in this interview, Dr. Pathare has been affiliated with the World Health Organization's commitment to equip and train mental health practitioners throughout the world about the importance of human rights.In this interview, Dr. Pathare will help to make the distinction between “civil or constitutional rights” and “human rights.”  In essence, human rights are those afforded all people. They are universal and inviolable and not dependent upon the country in which you live.    He will walk us through the establishment of the United Nations Declaration of Human Rights in 1948 and how, over the decades, there have been “elaborations” of that initial effort to focus on particular human needs (e.g., rights of children, rights of women, elimination of racism and discrimination, etc.).  It was only recently (2006), that the UN promoted the Convention on the Rights of Persons with Disabilities (CRPD) which is a landmark human rights treaty among countries around the world to protect the fundamental rights of all persons with disabilities.The World Health Organization (WHO) has created global initiative, called Quality Rights to transform the way mental health care is delivered and to change attitudes toward people with psychosocial, intellectual, and cognitive disabilities.  Their goal is to have all the countries in the world implement QR by 2030, but  the US hasn't even ratified the CPRD. Dr. Pathare will talk about how Quality Rights represents a movement away from a bio-medical approach to mental illness to a recovery approach which values the ability of people to make choices.  Further it is a movement away from a definition of wellness that is defined by “symptom reduction”  toward the ability to fully participate in community. Links to the studies discussed in the interviewAssertive community treatment for the severely mentally ill in West LambethTom Craig and Soumitra Pathare, Advances in Psychiatric Treatment (1997) vol 3, pp. 111-118.Public Education for Community Care:  A New Approach.The British journal of psychiatry:  the journal of medical science.  May 1996.  Pp. 441 – 447.Soumitra Pathare, Julian Leff, Geoffrey Wolff, Thomas K J Craig       

 Psynergy operates four facilities or campuses – Morgan Hill is the first one, which is discussed in the interview.  In addition, they operate Greenfield Monterey County, Tres Vista supported living at the Morgan Hill campus and Nueva Vista in Sacramento.  On deck is the proposed Vista de Robles campus in Sacramento.  In this interview, we talk with Lynda Kaufman who is the Director of Government and Public Affairs and Michael Weinstein, Chief Financial Officer, who is one of the founders of Psynergy. You will hear about how Michael Weinstein cultivated his vision of what a congregate living community should offer – a high standard of cleanliness, nutritious fresh food, an attractive and safe living environment, access to medical and clinical supports, an orientation toward creating a place of healing  – and how that unwavering vision separates Psynergy from other adult residential facilities we might visit in the state today.   Lynda will take you on a visual tour of the campus at Morgan Hill.  Contrasted with tours that some of us have taken of board & care environments where the properties are held together with duct tape and bubble-gum, and residents sit in the courtyard all day long, smoking cigarettes and sipping from 7-11 Big Gulps, Psynergy's campus offers a striking contrast.  You'll hear about a living room with leather couches for residents to enjoy, a courtyard with a barbecue and gazebo to gather outside, and a hospitality desk in the lobby.  How do they accomplish this?  Lynda and Michael will share some insights into their business model.The Psynergy leadership team is interested in talking with people who might be interested to invest in this type of “housing that heals” in other CA communities.  If you want to start that conversation, reach out directly to Lynda at lkaufmann@psynergy.org.  Reports on the state of the Board & Care system in CaliforniaState of CaliforniaCALBHB/C Issue Brief: Adult Residential Facilities (calbhbc.org)Vanishing board-and-care-homes leave California residents with few options - CalMatters LA County1074299_h.12.18.2019_Report-AgendaofNovember12_2019.pdf (lacounty.gov)LA Cityhttps://clkrep.lacity.org/onlinedocs/2020/20-1203_misc_2-4-22.pdf GeneralFor every bed lost a person is displaced: California's continuing board & care crisis – Accoglienza: lessons for AmericaNo Time to Waste: An Imminent Housing Crisis for People with Serious Mental Illness Living in Adult Residential Facilities (accoglienza.us)     

Dr. Roberto Mezzina headed the Dipartimento di Salute Mentale in Trieste until his retirement in late 2019.  Both of the California delegations that visited Trieste (in 2017 and 2019) were graciously welcomed by Dr. Mezzina and his staff in our quest to understand the culture and principles that make this system so noteworthy.   Within those two delegations were representatives from the Los Angeles Sheriff's Department (LASD), harboring a deep desire to embrace a more human-focused posture on how to come alongside people with mental illness, both in the county jail system and in the community.  The Department is also interested to lean into guiding principles of the U.N. Declaration of Human Rights – which is espoused by the Italian system – as a framework to guide how people with mental illness are cared for in our society.In April 2022, Dr. Mezzina was invited to Los Angeles at the behest of the L.A. Sheriff's Foundation to come alongside some specialized divisions in the Los Angeles Sheriff's Department:  the Homeless Outreach Services Team (HOST) and the Mental Evaluation Team.    Dr. Mezzina also toured the remarkable program that was initially started in 2016 at Twin Towers to provide a more caring and therapeutic environment for the most seriously mentally ill patients in the jail.  Under the leadership of the Sheriff's Department and the Department of Health Services Correctional  Mental Health division, this program, described in an article which appeared in the Christian Science Monitor,  has expanded.  (See website created by the Mental Health Assistants for more information about this innovation.)Dr. Mezzina's visit to Los Angeles coincided with the filming of an episode of the CNN documentary series, “Life with Lisa Ling.” This episode (to be aired in the show's next season) will focus upon the mental health crisis in Los Angeles County.  The producers and host of this show participated in some of the outreach and engagement conducted by the LASD HOST Team and Dr. Mezzina.   This interview was conducted in person in the podcast studio at Verdugo Sound on the way to the airport.  Dr. Mezzina also provides an update on the changing political climate in Trieste – a topic that was introduced in a podcast interview that can be found in Season Two, Episode Seven.

 This interview will regale the history of a mental health pilot from the early 90's that remains as relevant today as the day it was started.   Back in the day, the Wright-Bronzan-McCorquodale Act of 1988 (known as AB 3777) funded – from the state's general fund -- three Integrated Service Agency programs for mentally ill consumers.    The most well-known of these was MHA's The Village in Long Beach (Mental Health America) which became a model for the Mental Health Services Act (Prop 63) which would follow about ten years later.  This pilot featured two study groups.  The Village coordinated and supported the 24/7 whole-person life needs of 120 consumers, randomly picked by the independent evaluator.  The budget was based upon a per-capita allocation of $15,000 per person per year, paid quarterly in advance.  Within this budget, Village staff (think “community integration managers” as opposed to case managers) had to cover all costs associated with inpatient care, outpatient care, vocational support, community engagement, whatever was required.  By contrast, the control group was serviced through the usual and customary public mental health system; a clinical model.Ragins and Pilon will talk about the remarkable staff culture that evolved and the stunning outcomes associated with the pilot.  Higher levels of employment, lower levels of hospitalization and the like.  The evaluation report is summarized here.True payment reform is required if the public mental health system is going to make a difference in the lives of the people it services.  Recovery is possible, but people need to be supported in all aspects of their life, not just with medication and clinical interventions.  The Guests: Dave Pilon received his doctorate in Social Psychology from Harvard University in 1981.  From 1989 until his retirement, he served in various roles at Mental Health America of Los Angeles (MHALA), including as its CEO from 2009 until 2017.  For over 35 years he has consulted in the design and transformation of mental health programs and systems throughout the United States, New Zealand and Japan.  Most recently he has served as the lead consultant to the L.A. County Department of Mental Health for the TRIESTE Pilot.He is passionate about creating better ways to serve the most vulnerable among us, particularly people with serious mental illnesses. Mark Ragins calls himself a recovery-based psychiatrist.  He worked for 27 years as the medical director at the MHALA Village in Long Beach.  Most recently, he's been serving on campus as the only psychiatrist at CSU Long BeachDr. Ragins website features a number of resources and writings from the recovery mindset about which he is so passionate.  He has recently published a new book, Journeys Beyond the Frontier:  A Rebellious Guide to Psychosis and Other Extraordinary Experiences.   

 John Foot is a professor of Modern Italian History at the University of Bristol in the U.K.  He is an expert on the life of Dr. Franco Basaglia, the visionary psychiatrist whose lasting impact on the Italian mental health system continues to inspire the world.We will explore Professor Foot's journey into this avocation, which was sparked by  the chance viewing the film San Clemente (1982) while on a trip to Trieste.Professor Foot is author of Franco Basaglia:  the Man who Closed the Asylums. He is a co-editor of compendium of essays about the impact of Trieste in other counties that emanated from a symposium held in Oxford in 2018.  It is titled Basaglia's International Legacy:  From Asylum to Community.We also explore in this interview the plan to translate into English a book that was originally published in 1968, L'istituzione negata (The Negated Institution), which had seminal impact on advancing the Basaglian revolutionary school of thought in Europe and South America.  That one man could have such profound impact on advancing a human-centered, community-based system of care for people living with mental illness is astounding.  This interview will provide some insights into Basaglia, who is relatively unknown in the English-speaking world.   Other resources associated with the interview:Documentary (1968)   I giardini di Abele  Book (1969) Morire di classeDocumentary (2013)  Dentro le proprie mura  

Guyton Colantuono is the executive director of Project Return Peer Support Network, a position he has held since 2014.  He has spent more than 25 years working in the field of mental health and has led a multitude of programs including those addressing homeless outreach and shelter, transition-aged youth and employment development.He has an unwavering belief that “people are people first” and a label is not a destiny.  His lived experience as a survivor of homelessness, drug addiction and mental illness has fueled his passion for a whole-person approach throughout his career. Particular emphasis will be placed on the unique offerings of a Peer Respite Home, to which he applies the metaphor of a “bed and breakfast for someone experiencing a mental health crisis.”  He and his team of peers oversee Hacienda of Hope in Long Beach, one of two peer respites in all of Los Angeles County, and one of five in the state of California.We'll talk about how peer respites naturally adopt a posture of radical hospitality in welcoming guests, and how this is a stunningly less expensive bed to provide than those associated with psychiatric hospitalization or the county jail.  Peer respite is the ultimate in trauma-informed care, and we'll make a case for increasing the availability of these beds as a resource for providing care for people living with a mental illness not only in Los Angeles County, but throughout the state. Resources Definition — Peer Respites'Peer respite' homes aim to be alternative to psychiatric wards - Los Angeles Times (latimes.com)The Effectiveness of a Peer-Staffed Crisis Respite Program as an Alternative to Hospitalization | Psychiatric Services (psychiatryonline.org)Impact of the 2nd Story Peer Respite Program on Use of Inpatient and Emergency Services | Psychiatric Services (psychiatryonline.org)Report from the Auditor of the State of California.  Lanterman-Petris-Short Act.  California Has Not Ensured That Individuals with Serious Mental Illness Receive Adequate Ongoing Care.  July 2020 

Dr. Tom Insel is a psychiatrist, a neuroscientist and an influential voice in the national conversation that is gaining momentum around the failures of the American mental health system and the need to do better for the humans that are suffering as a result.  His new book, released in February 2022, is a worthy read, Healing:  Our Path from Mental Illness to Mental Health.  In this episode we talk about how his life journey informs his current work and advocacy as he enters this chapter in his life.  He speaks with a certain humility about how assumptions he made early in his career, or even while head of the National Institute for Mental Health, have changed as he has spent time with families and people with lived experience.  His eyes were further opened to the challenges in our communities as he toured the state on a listening tour in behalf of California's new governor, Gavin Newsom.He speaks with eloquence about the profoundly simple idea (yet hard to implement or fund in our current system) to focus on People, Place and Purpose to support an individual's recovery from their mental illness.   Dr. Insel joined our delegation in September 2019 when we attended the international mental health conference in Trieste Italy and he shares some memories from that experience. Additional links and resources:Thomas Insel, the ‘Nation's Psychiatrist,' Takes Stock, With Frustration - The New York Times (nytimes.com)https://www.theatlantic.com/ideas/archive/2022/02/american-mental-health-crisis-healing/622052/Additional articles from his website:Press — Thomas Insel, MD (thomasinselmd.com) Finally, Dr. Insel is part of a team that has created a new information source MindSite News.  From their Mission Statement:  MindSite News is a new nonprofit, nonpartisan digital journalism organization dedicated to reporting on mental health in America, exposing rampant policy failures and spotlighting efforts to solve them. We seek to create and sustain a sense of national urgency about the workings and failings of the U.S. mental health system and to impact that system through our reporting, making it more equitable, effective, transparent and humane in its care for individuals and families struggling with mental illness.

Savanah Walseth is a student at Loyola Law School and was most recently a program manager for the L.A. County Department of Health “Housing for Health” Program.  At a young age, she is guided by both lessons learned “in the trenches” given her experience in homeless outreach and engagement for People Assisting the Homeless (PATH), but also in programmatic work managing the COVID response in L.A. County.  During the past two years, she was managing the county's response involving testing, street medicine, outbreak management and contact tracing among the homeless population.    Savanah is a graduate of Reed College in Portland. The topic of this podcast interview is drawn from a paper written by Savanah for a Mental Disability Law Seminar in late 2021.  The paper is entitled:  Grave Disability:  Seeking Restructure through New Definitions. This interview will provide a basic primer on the California law that governs involuntary hospitalization, the definition of grave disability and conservatorships, the Lanterman Petris Short Act, passed in 1967.    We will touch upon the fact that this type of conservatorship differs from the widely publicized conservatorship that Britney Spears was subjected to for nearly 14 years.  That is called a probate conservatorship.  This 2021 article from CalMatters does a good job distinguishing between the two types of conservatorships. Savanah's goal in her law career is to be a civil rights litigator – focusing upon housing and disability rights, especially in the intersections of homelessness and mental health.

 Lee Davis is currently the chair of the Alameda County Mental Health Advisory Board.  In her official bio, she indicates that she is a Civil Engineer and Journeyman Electrician by profession.  She comes to her work on the Advisory Board as a woman with lived experience of a mood disorder.  In this interview, we explore three themes about which Lee is passionate:  1.      The case for involuntary treatment2.      The lack of capacity in our so-called continuum of care3.      Her assertion that the failure to invest in the requisite infrastructure to treat people and promote their recovery is morally wrong and socially debilitatingIn addition,  we explore Lee's extraordinary life journey, about  which she writes with remarkable vulnerability in her blogs.  Being Bipolar. Maybe it is my unisex name. Maybe it is… | by Lee Andrea Davis | MediumThe Continuum of Consciousness; a Bipolar woman's perspective on Delusions | by Lee Andrea Davis | Medium Other organizations she references in this interview: Alameda County Families Advocating for the Seriously Mentally IllArticles about the February 2022 sleep-in organized by FASMI with which Lee was involved.Families of the Mentally Ill Call for Better Treatment Not Better Jails in Alameda County – CBS San Francisco (cbslocal.com)Oakland: Protesters sleep on sidewalk, demand mental health care (mercurynews.com) Link to the annual report for the Alameda County Mental Health Advisory Board

I am grateful for good advice I received when I started this podcast in the summer of 2020:  break your podcast into seasons.   For a small operation like Heart Forward, this allows for breathing room and the opportunity to plan and curate guests that are worth listening to! So, we've taken a six-month break since our last episode was uploaded in August 2021.    We are ready to launch a 10-episode season on March 14, 2022.This season, I am grateful to have identified a studio in Glassell Park in Los Angeles where I can record my interviews in person.  Words cannot express my appreciation for Peer Mental Health who, for the first two seasons, came alongside me with technical advice and a digital editor, Paul Robinson, who was instrumental in bringing 19 episodes to the Buzzsprout platform.For Season Three, my home is Verdugo Sound in Glassell Park, and I am grateful to have the support of Aaron Stern as my audio engineer and editor.  The theme remains the same:  The American mental health system is broken.   Our guests are invited to help us understand the practical impact of this failed system or offer ideas for change.   We continue to be inspired by the global best practice in Trieste Italy.  We do not give up hope. Please come on back on March 14, 2022! To support this podcast:  Heart Forward LA - Main Giving Page (networkforgood.com)Grateful for listeners and supporters!

This episode tackles the gnarly tangle known as our public mental health funding system.     So many questions I had.  Why is there a chronic shortage of mental health treatment beds at every step of the continuum?  Why do people get released too early from the hospital when they would benefit from long-term care?  Why are mental health clinics limited in the services they can provide to their clients?  Why are there no measurable outcomes applied to how funds are invested?I curated ten observations about the system from my vantage point as a concerned layperson and asked Alex Briscoe to respond.  He does a masterful job of providing clarification to either refute, affirm or amplify upon these observations.     Alex brings 13  years of experience working at the Health Agency in Alameda County, seven years as director; a $700M agency with over 6,000 staff members.    He helps reduce to layman's terms a complicated system that is tied to very stringent requirements associated with federal Medicaid policy (known as Medi-Cal in California) and compounded by the complications associated with the two different state actions to disburse state funds to localities (referred to as “realignment” in 1991 and 2011).  Added to this mix are funds authorized by voter passage of Prop 63 in 2004, otherwise known as the “millionaire's tax” which funds the Mental Health Services Act.   Alex Briscoe's current role is that of Principal at  the California Children's Trust and that is where you can reach him.  Here is a glimpse into their history and impact.  Articles about Alex, his origin story and his accomplishments in this spaceCommunity health: taking smart steps (sfgate.com)Health as a Foundation for Social Justice and Racial Equity – California Children's Trust (cachildrenstrust.org)As Need for Mental Health Care Surges, A Funding Program Remains Underused – California Health Report (calhealthreport.org)Behind California's Troubled Mental Health Care Funding System (imprintnews.org) General reference sources pointing to public mental health financeA Complex Case: Public Mental Health Delivery and Financing in California (chcf.org)CalAIM: Behavioral Health Proposals (chcf.org)MH-MAA-Implementation-Plan-Revised-7.1.21 (ca.gov)  This interview brings to a close Season Two.  This podcast is entirely supported by listeners and supporters of Heart Forward LA, which allows us to maintain an independent voice.  Please consider a contribution of any amount to help underwrite Season Three, planned for its launch in January 2022.   

  Jackie Lacey served as District Attorney for Los Angeles County from 2012 to 2020.    She was both the first woman and the first Black person  to serve in this important role.   A District Attorney is an elected official, and their role is to represent the people in prosecuting crimes in the county.  In 2014, DA Lacey initiated a committee to look at the nexus of the criminal justice system and mental illness.  As you will hear from this interview, she was encouraged and supported and mentored by many people.  In particular, she mentions Judge Steven Leifman who is known for his crusading work in this space in Miami-Dade County.   She also gives considerable credit to the Los Angeles chapter of the National Alliance for Mental Illness (NAMI) and their participation in the task force.The resulting report – Mental Health Advisory Board:  A Blueprint for Change --  was issued on August 4, 2015  and was  acclaimed as an important guide to move forward on key initiatives to not only change the manner in which crisis response calls are handled by law enforcement (who are really not equipped to play this role in the mental health space) to imagining a different way forward to either divert people struggling with mental illness from the criminal justice system or place them in supportive housing upon release from jail.  Among several changes initiated (including a robust Crisis Intervention Training commitment made  by the dozens of local law enforcement agencies throughout L.A. County), the Office of Diversion and Re-entry (ODR) was created which has led to positive outcomes in reducing recidivism and stabilizing people leaving the criminal justice system.As the report states on page one: “the jail environment is not conducive to the treatment of mental illness.”   Heart Forward is grateful that Jackie Lacey displayed the leadership and courage to take this on.

In May 2021, five former directors of the regional mental health departments in Friuli Venezia Giulia  issued a letter to sound the alarm that “the Trieste mental health model is under threat.”   That letter was translated into multiple languages, and started the chain of events that are unfolding with respect to raising awareness and voices to advocate for protection of a system that inspires the world. Dr. Roberto Mezzina, who headed the Dipartimento di Salute Mentale (DSM)  in Trieste until his retirement in late 2019, helps us to make sense of these fast moving events in the region.     In less than two months, much has been accomplished – the “sleeping giant” of global support for this model is waking up.  From petitions in multiple languages, to media attention, to the rallying of services users and their families,  actions taken to weaken or dismantle this system will not occur without the whole world watching. Dr. Mezzina provides some historical context about Law 180 – “Basaglia's Law” – and its evolution in Italy.  He also describes the current changes in the political climate that impacts the Friuli Venezia Giulia region, where Trieste is located.  He encourages us to pay attention and to sign the petition. Thought it is a simple gesture – it matters – and most appreciated are the supportive comments that you can offer which help to keep them motivated in their advocacy. Here are some recent articles for context:6.22.21  Article in The Independent‘An unfolding nightmare': Trieste's pioneering mental health system under threat, say campaigners | The Independent6.21.21  Article in British Medical JournalTrieste's mental healthcare model is under threat, claim supporters of the community based approach | The BMJ6.15.21  Editorial in Domani  (article is easily translated online)Italian:  Basaglia è il fantasma di Trieste, ma non la sua realtà (editorialedomani.it)  (Basaglia is the ghost of Trieste, but not its reality)6.11.21 Article in Il Manifesto  (article is easily translated online) Italian:  Trieste, il concorso che tradisce Basaglia | il manifesto  (Trieste, the contest that betrays Basaglia) Here is a link to the petition: Petition · International Mental Health Collaborating Network: SAVE TRIESTE'S MENTAL HEALTH SYSTEM · Change.org Here is a link to my blog:  We are all Friends of Trieste: Your help needed to save mental health system [Update as of 6.22.21] – Accoglienza: lessons for America Guest:  Dr. Roberto Mezzina, International School Franca and Franco Basaglia: Vice Chair European Federation for Mental Health; former director of the WHO Collaborating Centre, DSM, Trieste Italy.

Anthony Ruffin is a gifted and compassionate crisis worker who relentlessly seeks to establish trust with  the most vulnerable people living on the streets.  His career spans working with both nonprofit organizations and the Los Angeles County Department of Mental Health.  He gives homage to a mentor who many were privileged to know during her amazing and courageous life of caring and service,  Mollie Lowery of Housing WorksIn this interview, we are going to gain vicarious insight into Anthony's approach and see the realities of this human  crisis through his eyes.  Anthony has visited Trieste twice and he will compare and contrast how people with mental illness are cared for in that community in comparison with the U.S.  Articles that have shined a light on Anthony's compassionate approach:A true L.A. hero: For people dying on L.A. streets, he offers help, and he won't take no for an answer - Los Angeles Times (latimes.com)The Fight to House Hollywood's Sickest Homeless - The Atlantic'It's almost like a death watch': Severely ill homeless people are at risk of dying on the streets of Hollywood - Los Angeles Times (latimes.com)Homelessness: A walk along Skid Row in L.A.—block by bleak block (calmatters.org)Should California expand what it means to be 'gravely disabled'? - Los Angeles Times (latimes.com)

Rarely has such a diverse group of people been convened to discuss innovation in the jail setting.  This panel occured on April 22, 2021, and was co-sponsored by the UCLA Center for Social Medicine and Humanities and Heart Forward LA.The power of Zoom – captured as an audio file for this podcast – presented an opportunity to hear about the origins and outcomes of a collaboration between the L.A. County Sheriff’s Department and Correctional Health Services nursing and mental health clinicians which began in 2016. You will hear from officials involved in conceptualizing the pilot and two inmates who have lived embedded in these pods for four years and wrote a book about their role as “mental health assistants.”  Our academic panelists provide a broad overview of the tragedy of incarceration of mentally ill inmates in the U.S. and why policymakers must make community-based treatment a priority to end the endless cycle of homelessness and incarceration of people with serious mental illness.  PANELISTS INCLUDE: Craigen Armstrong, Mental Health Assistant Adrian Berumen, Mental Health AssistantDr. Philippe Bourgois, Distinguished Professor of Anthropology and Director of Center for Social Medicine, UCLABruce Chase, Assistant Sheriff, Custody Operations, LA County Sheriff’s Department Joan Hubbell, Mental Health Program Manager, Twin Towers Correctional Facility Jeremy Levenson, PhD Candidate UCLA Anthropology, Center for Social Medicine; Medical Student Mount Sinai School of Medicine Moderator: Kerry Morrison, Founder & Project Director, Heart Forward LA

2020 will go down in history for many things, including the significant push for a diversion of mental health related calls from law enforcement to a different model.  The CAHOOTS program, initiated in Eugene, Oregon, has captured the imagination of many throughout the country who are looking for a tested approach which shifts the burden to a peer-led team.  CAHOOTS stands for Crisis Assistance Helping out on the Streets and was started in Eugene, Oregon in 1989.  It originated as a collaboration between a local nonprofit clinic and the city and has grown into a 24/7 service.  Multiple vans serve the city and offer an alternative to the traditional reliance upon first responders of police or paramedics which can often be a traumatic experience for all involved.  Ben Adam Climer, who started his career working in homeless outreach in Los Angeles, moved to Oregon in 2014 and worked on the CAHOOTS team for five years, first as a crisis worker  and then as a trained Emergency Medical Technician (EMT).  Climer is now consulting with a number of local jurisdictions who are looking to shift crisis calls away from the traditional law enforcement response to specialized teams with clinical workers, trained crisis workers and/or peer responders.   Climer walks us through how CAHOOTS is dispatched in Oregon and describes the types of calls they are uniquely equipped to handle.   He also shares data about the positive outcomes, both financial and human in scale.  Most noteworthy is the importance of de-escalating situations by not resorting to forceful interventions and avoiding costly hospital and jail interventions. To contact Ben-Adam ClimerBen Adam Climer | LinkedInArticles:CAHOOTS: A Model for Prehospital Mental Health Crisis Intervention (psychiatrictimes.com)Huntington Beach latest to create non-police team to handle mental health, homeless issues – Orange County Register (ocregister.com)You Tube:(153) Los Angeles CAHOOTS Presentation - YouTube

Vincenzo Passante is a psychologist who lives in London but hails from Trieste, Italy.  He was raised and educated in Trieste, which gives him a unique vantage point to contribute given the mission of this podcast.    In this conversation,  we compare and contrast the system in Trieste against the vision behind mainstream mental health care in the UK. Vincenzo left the British National Health Service after two years of disillusionment. He worked in a crisis service and then, briefly, for a psychotherapy service. While in both settings there were amazing, talented professionals, the structure of the service was organized around deeply institutional rules which left very little space to the value of human subjectivity, a key ingredient in the Trieste system. Astonishingly for him, during this period he found out that virtually nobody there knew about Trieste and the possibility of helping people in a different way. Vincenzo – who speaks both English and Italian fluently – has had the benefit of not only studying  philosophy in high school and during his Psychology degree at university, which adds an intellectual bent to his view of the world, but he is quite knowledgeable about the writings of Dr. Franco Basaglia.  As Basaglia sought to close the asylums in Italy, he had a clear vision for a community-based system of care which focused upon the wholeness and dignity of the  people who depended upon that system for treatment and support.   He has also been able to read some of Basaglia’s  seminal writings that have yet to be translated into English.  So, this conversation affords us the opportunity to do a deeper dive into Basaglia.  Vincenzo started a podcast in 2019 to spread awareness about Basaglia’s views and their practice in Trieste (and elsewhere). He wanted people to know how health and illness can coexist dialectically within people and society, without the need for separate institutions to exclude those who do not fit.  The podcast -- called A Place of Safety?  --  because that is how the  British system describes institutions who exclude people from society, affords him the opportunity to challenge the British approach to mental health treatment and educate people about a better way.  Perhaps, he thought, a good way to start is to reclaim the meaning of words and talk about a vision of “safety” that does not endorse violence and exclusion. ArticlesAn intellectual emergency in UK mental health services by Vincenzo Passante Spaccapietra - Asylum MagazineSocial mediaFacebook Twitterhttps://www.youtube.com/channel/UChIqzfr0zDkGO63SidfDwOA

Alex Barnard is an assistant professor of sociology at New York University, and received his PhD in sociology from the University of California, Berkeley in 2019. He is writing a book, tentatively entitled "Mental States," that examines why people with similar illnesses have very different trajectories between institutions of care and control in France and the United States. His work uses interviews, on-the-ground observations, and archives to examine why these countries developed very different mental health systems starting in the 1960s and the consequences of these choices in clinics, social service agencies, courts, and in the lives of service users themselves.  Since 2018, he has been working on a parallel project focused on analyzing the evolution and functioning of California's conservatorship system, which provides intensive, legally-mandated services to people with severe mental illness deemed as unable to meet their basic needs. He has written a report, "Absent Authority, Absent Accountability" aimed at helping to identify how to get professionals the resources, information, and coordination to make conservatorship a positive tool of transformation for vulnerable Californians.   Links for this episode Professor Barnard’s website Absent Authority, Absent Accountability:  Exploring California’s Conservatorship Continuum From the “Magna Carta” to “Dying in the Streets”: Media Representations of California’s Lanterman-Petris-Short Act Contact information: Ab8877@nyu.edu Twitter

Barbara Wilson, LCSW, has had a distinguished career in social service and helping people for over 50 years.   She is well-known in Los Angeles County as a tireless advocate for improved services to people coping with serious mental illness and the families who care for them.  She also is credited for being one of the first in the state to sound  the alarm approximately seven years ago that a precious housing resource for people with mental illness was slipping away due to the fiscal realities facing board and care operators whose rent revenues were not keeping pace with escalating costs.In this interview, Barbara walks us through an important chapter in California’s history.  Any young student in social work would do well to sit at the feet to learn from this wise woman.  Policy makers interested in  reform should take heed.Barbara describes the role of a psychiatric social worker during a time where they had the responsibility –and the authority -- to partner with people and take into consideration their whole life needs.    This is exactly what they do in Trieste, and still do in Trieste.  This is why people don’t slip through the cracks in Trieste.    In the 1970’s, there was a statewide system in place to serve people with mental illness, with very few bureaucratic layers.    She was assigned to the 90044  area code.  As she describes this, it reminds me of the “micro-areas” in Trieste where one social worker has a broad command of the human needs in his or her assigned catchment area.   So, in fact, it appears that once upon a time, in California,  we did provide a social  safety net that involved social workers looking out for the interests of people.Barbara was  responsible for the re-entry of people coming out of the state hospital system back into the community.  She describes the origin of the board and care system, where well-meaning people would open their homes to guests.  The unravelling of these safety nets occurred in the 1980’s.    We hear about the increasing bureaucratization – social workers moving into desk jobs --  and the dismantling of a system that bestowed a sense of trust upon social workers to do the right thing for their clients.Feeling overwhelmed by the needs of the people she was trying to serve and the constraints of a system that was taking away her freedom to serve them,  she took an early retirement as the 1980’s came to a close. After raising her family, she re-entered this space, urged on by desperate families looking for help and advice on how to navigate an increasingly broken system in behalf of their loved ones.  We’ll hear how Barbara’s life seemed to go full circle; the whole person safety net care she provided as a public psychiatric social worker in the 1970’s now became a skill she could rely on as she started her own business (now a non-profit) Mental Health Hookup.  The message:  we can do better, because we used to.  Tomorrow’s leaders are encouraged to listen and learn from the past.LinksMental Health Hookup Facebook link(2) Mental Health Hookup | Facebook Report co-authored by Barbara Wilson:A Call to Action:  The Precarious State of our Board and Care System  Serving Residents Living with Mental Illness in Los Angeles County  

We ended Season One as the pandemic held its grip on our country in the middle of December.  Now, a little over four months later, the sun is shining more brightly.  There is a vaccine.   The scary Covid surge has abated and we have a functioning government that is making public health,  returning to school and jumpstarting the economy  a priority.So, I am ready to return to our conversations.   The theme remains the same.  The American mental health system is broken and voices for change will be featured each week.  We are inspired by the global best practice in Trieste, Italy.We are going to explore more provocative topics this season:  old-fashioned social work, California's Lanterman-Petris-Short Act, the world-view of Dr. Franco Basaglia, how the CAHOOTS mobile crisis response model really works and how it can be adapted to local jurisdictions, how do human rights apply to the treatment of people with mental illness in American society and more.First episode airs on April 30, 2021.To support this podcast:Heart Forward LA - Main Giving Page (networkforgood.com)This podcast is produced in collaboration with Peer Mental Health.

This is the second of a two-part conversation with Dr. Roberto Mezzina and Dr. S. P. Sashidharan that brings Season One of this podcast to a close.Roberto joins from Trieste Italy where he served for 40 years in the Dipartimento di Salute Mentale, and most recently headed their world-renowned mental health system. Dr. S.P. Sashidharan calls in from Glasgow and both were part of a small delegation invited to Los Angeles in September 2018 to tour our systems as part of a collaboration between Trieste and Los Angeles County.In this interview, we complete the recollection from their September 2018 visit to Los Angeles. They discuss a meeting that was organized with parents of loved ones with mental illness. We discussed how families are marginalized in the American mental health system and how traumatic that may be for all involved. They also discuss their impressions from spending time with members of the Mental Evaluation Units for both the Los Angeles Police Department and the Los Angeles Sheriff’s Department. In Trieste, the last entity one would call for a mental health crisis is law enforcement, but in the U.S., law enforcement has been pulled into this, not by their design. In this case, what they observed was compassionate and professional.We also explore the closure of forensic hospitals in Italy and the transfer of individuals into small therapeutic communities. Finally, we touch upon the respect paid in Trieste to human rights for people with mental health problems – a concept which is not particularly prevalent in our American system. And in this time of Covid, all people may be experiencing the pandemic of loneliness. Social connections are frayed; there may be lasting lessons and sensitivities that come out of this collective experience that may inform reforms in the future. GuestsDr. Roberto Mezzina, International School Franca and Franco Basaglia and former director of the WHO Collaborating Centre, DSM, Trieste, Italy.Dr. S.P. Sashidharan, Institute of Health and Well Being, University of Glasgow.Financial Support To donate to support the expenses of producing this Heart Forward podcast, a contribution of any amount is appreciated:Heart Forward LA - Main Giving Page (networkforgood.com)With appreciationOur collaborating partner Peer Mental HealthTechnical support and podcast editing: Paul RobinsonResourcesWorld Health Organization (WHO) Quality Rights InitiativeMental health at the age of coronavirus: time for change (nih.gov)Information about September 2018 trip to Los Angeles and evolution of the partnership between LA County and Trieste.

There is much to be gleaned from this very rare opportunity to have two extremely thoughtful and committed psychiatrists in the same Zoom room. Dr. Roberto Mezzina joins from Trieste Italy where he served for 40 years in the Dipartimento di Salute Mentale, and most recently headed their world-renowned mental health system. Dr. S.P. Sashidharan calls in from Glasgow and both were part of a small delegation invited to Los Angeles in September 2018 to tour our systems as part of a collaboration between Trieste and Los Angeles County.Before they share recollections from that Los Angeles visit, Roberto and Sashi describe their early career and how they discovered Trieste as young psychiatrists in the 70’s. Roberto had the opportunity to work alongside the visionary Dr. Franco Basaglia as he crusaded to close the asylums in Italy and create the community-based system of care. You will hear about how the Trieste system is recognized by the World Health Organization and learn about the commitment to human rights in their approach to care. In Trieste, there are no locked doors and no reliance upon restraints. They believe la libertà è terapeutica– freedom is therapeutic. Listening to this from an American context will be challenging because their views sound almost radical given the human-centered approach. Sashi will raise the notion of an “Anglo-American blind spot” insofar as how psychiatry is viewed. As he says, “we have become inured to our practices which constantly and repeatedly deny people of their liberties.”Sashi and Roberto will describe their experience seeing restraints used in the psychiatric hospital and the shock of walking through Skid Row (described by Roberto as an “open air asylum”) in one of the richest nations in the world. But most compelling is their reaction to the plight of mentally ill inmates chained to furniture at L.A. County Twin Towers. Yet, they have not given up on us, and continue to offer encouragement. They saw bright spots during that week which are referenced: in particular Anthony Ruffin and the L.A County DMH HOME Team, the Downtown Woman’s Center and The Center in Hollywood (recalled as the “Sacramento Center” by Sashi). They were impressed by the compassion and expertise demonstrated by the Mental Evaluation Units for both the Los Angeles Police Department and Los Angeles Sheriff’s Department. They call out the leadership of Dr. Jonathan Sherin, embracing the values of change as head of the county’s mental health department. Guests:Dr. Roberto Mezzina, International School Franca and Franco Basaglia and former director of the WHO Collaborating Centre, DSM, Trieste, Italy.Dr. S.P. Sashidharan, Institute of Health and Well Being, University of Glasgow. ResourcesThe Man Who Closed the Asylums, by John Foot Trailer to movie about Dr. Franco BasagliaC'era una volta la città dei matti (Once upon a time there was a city of the crazy people)Note: there are subtitled versions available Information about September 2018 trip to Los Angeles and evolution of the partnership between LA County and Trieste.

Far too often in American communities, people living with mental illness are marginalized from community supports and experience the debilitating impacts of social isolation, loneliness and even the downward spiral into homelessness or incarceration. Imagine the countervailing impact of a welcoming place to go – where everyone knows your name – as the theme from “Cheers” reminded us. This is Fountain House and in this episode, we will hear about how the clubhouse movement offers an alternative; the promise of the therapeutic benefits of social connection and the dignity of vocation and purpose for people living with mental illness in our communities.Dr. Ashwin Vasan, M.D., Ph.D., is the President and CEO of Fountain House in New York. An expert in public health policy and political and social advocacy, as well as a primary care physician and academic, Dr. Vasan is committed to improving the lives of vulnerable people. He was hired in September 2019 to lead the advancement of Fountain House’s work around mental illness, homelessness, criminal justice, healthcare, and social welfare for marginalized people and communities. Fountain House in New York City was the first clubhouse established in this country back in 1948. As stated in their mission: Fountain House is dedicated to the recovery of men and women with mental illness by providing opportunities for our members to live, work, and learn, while contributing their talents through a community of mutual support.Heart Forward LA is partnering with Fountain House to imagine the possibilities of bringing the clubhouse movement to Los Angeles. It is no coincidence that several decades ago, Fountain House also inspired people in Trieste as they were imagining how to plant the ethos of the clubhouse culture throughout their entire city. Resources mentioned in this episode:Dr. Ashwin Vasan, CEO of Fountain House, on CDC Study: This is a mental health crisis and we need to act. | Fountain HouseCoronavirus a new challenge for many with mental illness (msn.com)

Miriam Feldman – one of the strongest women I know -- recounts her journey as the mother of a son struggling with schizophrenia. She points out that as a mother, you tend to worry about child abduction or car accidents. Nothing prepares you for serious mental illness. From her book: “This is the story of how mental illness unspools an entire family…it exposes the shortfalls of our mental health system, the destructive impact of stigma, shame and isolation, and, finally, the falsity of the notion of a perfect family.” Mimi lived across the street from me, and her son is the same age as mine. I did not know about this story until I read her book!Why does this have to be such a secret? And why does it have to be so hard? In this interview, you’ll hear about the things that must change if we are going to interrupt this tragic cycle of illness, despair, hospitalization and derailed dreams. Fortunately, Nick did not end up homeless or incarcerated, but this is too often the circle of life for people with mental illness in our country. Nick’s story adds to the growing chorus that this must change in America.Mimi’s 2020 book is called He Came in With It: A Portrait of Motherhood and Madness. Her website is a treasure trove of her art, her blogs, information about her book and resource information for families and friends trying to understand mental illness and how to navigate this space.Here is a “TED-type” talk she recently gave as part of a NAMI Washington State “The Brainpower Chronicles” event in November, 2020.https://www.youtube.com/watch?v=k4Jc8k8NKHM&t=127sLink Article in LA Yoga October 2020Instagram handle: @mimitheriveterLinks to other topics referenced during this interview.About NAMI | NAMI: National Alliance on Mental IllnessSchizophrenia and Related Disorders AllianceBring Change to Mind HIPAA – the Health Insurance Portability and Accountability ActGould’s Farm

David Israelian joins Kerry Morrison in a conversation that explores his passion about the importance of work, vocational rehabilitation, and purpose for people living with a mental illness in our communities. David is the founder and CEO of Peer Mental Health and co-founder and CTO of Painted Brain. Painted Brain has developed an effective clubhouse model for art, media, and tech group interventions for psychiatric populations that have been shown to increase connection, trust, and decrease anxiety. Peer Mental Health was launched in August 2019 to create virtual community-based and workforce solutions to address the digital divide and access to care via telecommunication platforms. Peer Mental Health is the collaborating partner for this Heart Forward podcast. In this candid conversation, David will share how his personal journey has informed his life’s work to create opportunities for peers to pursue purposeful careers and test their capabilities in the disciplines of technology and the arts. One emerges with a profound appreciation for the role that peers play in coming alongside others because they have walked the walk – often they’ve experienced hospitalization, incarceration, isolation, homelessness, and survived attempted suicide – hence they can help to inspire those on their recovery path to create solutions for others and serve as a beacon of hope.Links to topics mentioned: AnaVault Painted Brain Virtual Fundraiser January 23, 2020To contact David Israelian:david.israelian@peermentalhealth.com

Imagine if your job was to live 24/7 with mentally ill inmates at L.A. County Twin Towers. The L.A. County Jail system is arguably is the largest mental institution in America with close to 5,000 inmates incarcerated. In this interview, we talk with Craigen Armstrong and Adrian Berumen who have lived embedded in the Forensic Inpatient Program (FIP) Step down unit for over three years. As general population (not mentally ill) inmates, facing potentially long prison sentences, they are part of a remarkable L.A. County pilot to incorporate incarcerated peers into the role of “Mental Health Assistants.” Adrian and Craigen self-published a book this past August bout their experience. It is called The Solution: Mental Health Assistants and it shares all that they’ve learned about how to care for mentally ill patients in the jail. They hope their experience will inspire other county systems to adopt this approach and they are generous in sharing the curriculum they have developed. This pilot was awarded an achievement award by the National Association of Counties in 2020. As described: this program is a collaboration between Los Angeles County Sheriff’s Department and Correctional Health Services nursing and mental health clinicians…Patients at risk of requiring inpatient services are provided increased intervention in their housing unit with the goal of increasing medication compliance, improving socialization, attention to self-care and developing trust with healthcare providers. This interview will provide a glimpse into life inside the jail and open your eyes to the tragedy of how the American mental health system too often relies on our jails to provide the “beds of last resort” for people who cannot get a foothold into housing and/or stable treatment in a community-based setting. Having lived in this environment since 2017, Adrian and Craigen have a lot of insights into a better way to do incarceration of seriously mentally ill patients/inmates, and more importantly, they have a vision for a “post-incarceration” residential community. That vision – New Life Creating Community – would help to stem the recidivism of mentally ill inmates who are released and with very little treatment or sustained support, are enticed by meth, or lose ground and end up in jail again and again. But, that will be a conversation for a future episode!We are grateful to the team at L.A. County Twin Towers – involving the Sheriff’s Department and the Jail Mental Health Division – for supporting this work and granting access to interview Adrian and Craigen for this podcast. To contact the authorsLetters can be written as follows (must use booking numbers)Craigen Armstrong #4805708Adrian Berumen #3651882 Use this address and only send a letter on paper with no staples, attachments of photos. Envelope must not have a metal clasp. Terminal AnnexPO Box 86164Los Angeles, CA 90086 Emails are checked by family memberscraigenarmstrong@yahoo.comberumenblessed@gmail.com Social mediaTwitter@AdrianBerumen14 Instagram@rightsideprofit (Craigen)@adriangreatstuff (Adrian)

Dr. Dave Pilon talks with Kerry about his journey through the world of community-based mental health. In talking with him, one gets a sense of how our life experiences, over decades, can come full circle to tie everything together. Most recently, Dr. Pilon was the author of the proposal outlining a bold five-year mental health pilot, submitted to the state of CA in 2019, inspired by the WHO-recognized community-based mental health system in Trieste, Italy and adapted to an American context. Not only was he inspired by Trieste, but his vision was also informed by his seminal work at The Village in Long Beach, the site of a fascinating study in the early 90s. That state-funded study documented how an integrated service system, geared to whole person care with a per-capita budget, led to noteworthy recovery outcomes for the participants. Topics to explore will include psychosocial rehabilitation, the elements of recovery, and how we all benefit by helping people with mental illnesses to find belonging, purpose and true inclusion in our community. Biography: Dave Pilon received his doctorate in Social Psychology from Harvard University in 1981. From 1989 until his retirement, he served in various roles at Mental Health America of Los Angeles, including as its CEO from 2009 until 2017. For over 35 years he has consulted in the design and transformation of mental health programs and systems throughout the United States, New Zealand and Japan. Most recently he has served as the lead consultant to the L.A. County Department of Mental Health for the TRIESTE Pilot. Dave has presented numerous workshops on ethics and leadership issues in psychosocial rehabilitation as well as on the development of performance measures for social rehabilitation programs. He is passionate about creating better ways to serve the most vulnerable among us, particularly people with serious mental illnesses. Resource guide:Chandler, D., Meisel, J., Hu, T.-w., McGowen, M., & Madison, K. (1996). Client outcomes in a three-year controlled study of an integrated service agency model. Psychiatric Services, 47(12), 1337–1343. https://doi.org/10.1176/ps.47.12.1337 Chandler D, Hu TW, Meisel J, McGowen M, Madison K. Mental health costs, other public costs, and family burden among mental health clients in capitated integrated service agencies. J Ment Health Adm. 1997;24(2):178–88. Crossref, Medline, Google Scholar Los Angeles County Department of Mental Health. The TRIESTE* project: *true recovery innovation embraces systems that empower [Internet]. Sacramento (CA): Mental Health Services Oversight and Accountability Commission; [updated 2019 Apr 30; cited 2020 Jan 29]. Available from: https://mhsoac.ca.gov/sites/default/files/documents/2019-05/1054552_TriesteConceptPaper-4-18-2019FINAL.pdf

Liberation psychologist Dr. Mary Watkins is the co-founder of Pacifica Graduate Institute’s MA/PhD specialization in Community, Liberation, Indigenous, and Eco-Psychologies in Santa Barbara. Her 2019 book, Mutual Accompaniment and the Creation of the Commons, challenges us to come alongside people in relationships grounded in “horizontality, interdependence, and potential mutuality.” Her book explores examples where radical hospitality and intentional community have created communities of resistance and places of recovery for people marginalized by their disabilities or social status. Franco Basaglia’s vision and how it played out in Trieste is explored in her book. She imagines a model of mutual solidarity which has the potential to help us navigate the complex dynamics of a society that is more dis-unified than unified.Biography: Mary Watkins, Ph.D., works at the interface between Euro-American depth psychologies and psychologies of liberation from Latin America, Africa, North America, and Asia, promoting peacebuilding and social and environmental justice through the teaching and practicing of critical, dialogical, and participatory approaches. She is chair of the M.A./Ph.D. Depth Psychology Program at Pacifica Graduate Institute, co-founder and co-chair of its specialization in Community, Liberation, Indigenous, and Eco-Psychologies, and founding coordinator of community and ecological fieldwork and research at Pacifica. She is the author of Mutual Accompaniment and the Creation of the Commons, Waking Dreams, and Invisible Guests: The Development of Imaginal Dialogues, a co-editor of Psychology and the Promotion of Peace, and a participatory research team member of the community education project In the Shadows of Paradise: Testimonies from the Undocumented Immigrant Community in Santa Barbara. She is co-author of Toward Psychologies of Liberation, Talking with Young Children About Adoption, Up Against the Wall: Re-Imagining the U.S.-Mexico Border. She has worked as a clinical psychologist with adults, children, and families, and has also worked with small and large groups around issues of immigration, peace, alternatives to violence, envisioning the future, diversity, vocation, and social justice. Her present community-based work is with asylum seekers in detention and with prison education initiatives. In 2019 she received the award for Distinguished Theoretical and Philosophical Contributions to Psychology, Society for Philosophical and Theoretical Psychology (Division 24, American Psychological Association). Resource guide:www.mary-watkins.net

Lauren Rettagliata and Theresa Pasquini, AKA as “ Moms on a Mission,” took a CA road trip in 2019 to search for housing solutions for people with serious mental illness. “Housing First” is not a viable option; their loved ones require a full system of care that provides care before, during, and after homelessness, crisis, hospitalization, or incarceration. Housing That Heals is a prevention and intervention plan that will systemically flatten the harm curve for those who live with serious mental illnesses. Part Two of this two-part interview takes us on the 2019 road trip where they traveled 3,170 miles to visit 20 distinct residential facilities or home settings throughout CA. We will specifically talk about five of these locations that were particularly noteworthy and satisfy the six values identified by the Institute of Medicare (safety, patient-centered, equitable and the like).The places to be discussed include:John Henry FoundationGarden Park ApartmentsEver Well Integrated HealthPsynergyCalifornia Psychiatric Transitions More information about each of these facilities and organizations can be found in their report below.Resource guide: Housing that Heals Facebook page Housing that Heals: A Search for a Place Like Home for Families Like Ours. By Teresa Pasquini and Lauren Rettagliata, May 2020.Some of the terms discussed:IMD ExclusionanosognosiaconservatorshipFollow on Twitter@rettagliata@tcpasquiniSpecial thanks to Peer Mental Health for their technical support.

Lauren Rettagliata and Teresa Pasquini, AKA as “ Moms on a Mission,” took a CA road trip in 2019 to search for housing solutions for people with serious mental illness. “Housing First” is not a viable option; their loved ones require a full system of care that provides care before, during, and after homelessness, crisis, hospitalization, or incarceration. Housing That Heals is a prevention and intervention plan that will systemically flatten the harm curve for those who live with serious mental illnesses. Part One of this two-part interview introduces us to Lauren and Teresa and their families and the struggle to advocate for care for their now adult sons. Also to be discussed: how CA arrived at this place and insights into public policy, financing, law and the inadequate housing continuum that exists for people with severe mental illness Resource guide: Housing that Heals Facebook page Housing that Heals: A Search for a Place Like Home for Families Like Ours. By Teresa Pasquini and Lauren Rettagliata, May 2020. Follow on Twitter@rettagliata@tcpasquiniSpecial thanks to Peer Mental Health for their technical support.

Welcome to Heart Forward: Conversations from the Heart. The American mental health system is broken and voices for change will be featured each week. We are inspired by the global best practice in Trieste Italy. If they can treat people with such kindness, then so can we. Be encouraged. First episode airs on October 7, 2020.