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Heart Forward Conversations from the Heart

Author: Kerry Morrison

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The American mental health system is broken beyond repair. Rather than trying to tweak a system which fails everyone, it is time to commit to a bold vision for a better way forward. This podcast explores the American system against the plumb line of an international best practice, recognized by the World Health Organization (WHO), in Trieste, Italy. The 40-year old Trieste model demonstrates how a community-based treatment system upholds the human rights of the people served.The Trieste story is anti-institutional and models the therapeutic value of social connection. Topics will address contemporary challenges in the American failed mental health system as contrasted with the Italian approach toward accoglienza – or radical hospitality – as the underpinning of their remarkable culture of caring for people. Interviews will touch upon how the guiding principles of the Italian system – social recovery, whole person care, system accountability, and the human right to a purposeful life – are non-negotiable aspects if we are to have any hope of forging a new way forward in our American mental health system.This podcast is curated and hosted by Kerry Morrison, founder and project director of Heart Forward LA (https://www.heartforwardla.org/). Heart Forward is collaborating with Peer Mental Health as the technical partner in producing this podcast (https://www.peermentalhealth.com/about/). Kerry Morrison is also the author of the blog www.accoglienza.us.
21 Episodes
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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  
Season Two Trailer

Season Two Trailer

2021-04-2203:02

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.
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