Heart Forward Conversations from the Heart

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 homes

Blog 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 Barnard

Article about passage of SB 43 (Eggman D-Stockton) to expand definition of grave disability passed by CA State Legislature on 9/14/23. 

Op-ed in Los Angeles Times Sept 2023:     California needs new rules as it forces more mentally ill people into treatment

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 1990

Corporate Cookie on Santa Monica Blvd 1995

DMH E-News 9/29/16

Accoglienza blog on The Importance of Work to Our Identity 2019

Revisiting 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.org

Mental Health 'Catastrophe': Few Options for Residents as Care Homes Close | KQED

Homes 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 Projections

Excellent 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 Initiative

Podcast 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 interview

Assertive community treatment for the severely mentally ill in West Lambeth

Tom 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 [email protected].

Reports on the state of the Board & Care system in California

State of California

CALBHB/C Issue Brief: Adult Residential Facilities (calbhbc.org)

Vanishing board-and-care-homes leave California residents with few options - CalMatters

 LA County

1074299_h.12.18.2019_Report-AgendaofNovember12_2019.pdf (lacounty.gov)

LA City

https://clkrep.lacity.org/onlinedocs/2020/20-1203_misc_2-4-22.pdf

 General

For every bed lost a person is displaced: California’s continuing board & care crisis – Accoglienza: lessons for America

No Time to Waste:  An Imminent Housing Crisis for People with Serious Mental Illness Living in Adult Residential Facilities 

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 focusses 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 Beach

Dr. 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.