Heart Forward Conversations from the Heart

In 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:

1. 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)
2. 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 NGOs
3. Collaboration 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.

Dr. 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, Luna 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 Hollywood

Our 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 scale

Quality of life measure

Brief inventory of thriving

  Clubhouse International:  Mental Illness Recovery - Clubhouse International (clubhouse-intl.org)
Dec 2020 Interview with then CEO of Fountain House, Dr. Ashwin Vasan.

In Part II of this interview with Adrian Berumen, an inmate at Corcoran State Prison (in the interview, he was at Calipatria,  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 System

Website which documents the work of the  Mental Health Assistants
To contact Adrian Berumen, BU 1415
CA State Prison, Corcoran

4001 King Avenue

Corcoran CA 93212

To support this podcast - you can donate HERE.&nb

 In this 2 -part interview with Adrian Berumen, an inmate at Corcoran State Prison (he was formerly at Calipatria),  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 System

Website which documents the work of the  Mental Health Assistants
To contact Adrian Berumen, BU 1415
CA State Prison, Corcoran

4001 King Avenue

Corcoran CA 93212

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 homes

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