Heart Forward Conversations from the Heart

 John Foot is a professor of Modern Italian History at the University of Bristol in the U.K.  He is an expert on the life of Dr. Franco Basaglia, the visionary psychiatrist whose lasting impact on the Italian mental health system continues to inspire the world.

We will explore Professor Foot’s journey into this avocation, which was sparked by  the chance viewing the film San Clemente (1982) while on a trip to Trieste.

Professor Foot is author of Franco Basaglia:  the Man who Closed the Asylums. He is a co-editor of compendium of essays about the impact of Trieste in other counties that emanated from a symposium held in Oxford in 2018.  It is titled Basaglia’s International Legacy:  From Asylum to Community.

We also explore in this interview the plan to translate into English a book that was originally published in 1968, L’istituzione negata (The Negated Institution), which had seminal impact on advancing the Basaglian revolutionary school of thought in Europe and South America.  

That one man could have such profound impact on advancing a human-centered, community-based system of care for people living with mental illness is astounding.  This interview will provide some insights into Basaglia, who is relatively unknown in the English-speaking world.  

Other resources associated with the interview:

Documentary (1968)   I giardini di Abele  

Book (1969) Morire di classe

Documentary (2013)  Dentro le proprie mura

Guyton Colantuono is the executive director of Project Return Peer Support Network, a position he has held since 2014.  He has spent more than 25 years working in the field of mental health and has led a multitude of programs including those addressing homeless outreach and shelter, transition-aged youth and employment development.

He has an unwavering belief that “people are people first” and a label is not a destiny.  His lived experience as a survivor of homelessness, drug addiction and mental illness has fueled his passion for a whole-person approach throughout his career. 

Particular emphasis will be placed on the unique offerings of a Peer Respite Home, to which he applies the metaphor of a “bed and breakfast for someone experiencing a mental health crisis.”  He and his team of peers oversee Hacienda of Hope in Long Beach, one of two peer respites in all of Los Angeles County, and one of five in the state of California.

We’ll talk about how peer respites naturally adopt a posture of radical hospitality in welcoming guests, and how this is a stunningly less expensive bed to provide than those associated with psychiatric hospitalization or the county jail.  Peer respite is the ultimate in trauma-informed care, and we’ll make a case for increasing the availability of these beds as a resource for providing care for people living with a mental illness not only in Los Angeles County, but throughout the state.

Resources

Definition - Peer Respite

'Peer respite' homes aim to be alternative to psychiatric wards - Los Angeles Times (latimes.com)

The Effectiveness of a Peer-Staffed Crisis Respite Program as an Alternative to Hospitalization | Psychiatric Services (psychiatryonline.org)

Impact of the 2nd Story Peer Respite Program on Use of Inpatient and Emergency Services | Psychiatric Services (psychiatryonline.org)

Report from the Auditor of the State of California.  Lanterman-Petris-Short Act.  California Has Not Ensured That Individuals with Serious Mental Illness Receive Adequate Ongoing Care.  July 2020

Dr. Tom Insel is a psychiatrist, a neuroscientist and an influential voice in the national conversation that is gaining momentum around the failures of the American mental health system and the need to do better for the humans that are suffering as a result.  His new book, released in February 2022, is a worthy read, Healing:  Our Path from Mental Illness to Mental Health. 

 In this episode we talk about how his life journey informs his current work and advocacy as he enters this chapter in his life.  He speaks with a certain humility about how assumptions he made early in his career, or even while head of the National Institute for Mental Health, have changed as he has spent time with families and people with lived experience.  His eyes were further opened to the challenges in our communities as he toured the state on a listening tour in behalf of California’s new governor, Gavin Newsom.

He speaks with eloquence about the profoundly simple idea (yet hard to implement or fund in our current system) to focus on People, Place and Purpose to support an individual’s recovery from their mental illness.   

Dr. Insel joined our delegation in September 2019 when we attended the international mental health conference in Trieste Italy and he shares some memories from that experience.

Additional links and resources:

Thomas Insel, the ‘Nation’s Psychiatrist,’ Takes Stock, With Frustration - The New York Times (nytimes.com)

https://www.theatlantic.com/ideas/archive/2022/02/american-mental-health-crisis-healing/622052/

Additional articles from his website:

Press — Thomas Insel, MD (thomasinselmd.com)

Finally, Dr. Insel is part of a team that has created a new information source MindSite News. 
 
From their Mission Statement:  

MindSite News is a new nonprofit, nonpartisan digital journalism organization dedicated to reporting on mental health in America, exposing rampant policy failures and spotlighting efforts to solve them. We seek to create and sustain a sense of national urgency about the workings and failings of the U.S. mental health system and to impact that system through our reporting, making it more equitable, effective, transparent and humane in its care for individuals and families struggling with mental illness.

Savanah Walseth is a student at Loyola Law School and was most recently a program manager for the L.A. County Department of Health “Housing for Health” Program.  At a young age, she is guided by both lessons learned “in the trenches” given her experience in homeless outreach and engagement for People Assisting the Homeless (PATH), but also in programmatic work managing the COVID response in L.A. County.  During the past two years, she was managing the county’s response involving testing, street medicine, outbreak management and contact tracing among the homeless population.    Savanah is a graduate of Reed College in Portland.

 The topic of this podcast interview is drawn from a paper written by Savanah for a Mental Disability Law Seminar in late 2021.  The paper is entitled:  Grave Disability:  Seeking Restructure through New Definitions.

 This interview will provide a basic primer on the California law that governs involuntary hospitalization, the definition of grave disability and conservatorships, the Lanterman Petris Short Act, passed in 1967.    We will touch upon the fact that this type of conservatorship differs from the widely publicized conservatorship that Britney Spears was subjected to for nearly 14 years.  That is called a probate conservatorship.  This 2021 article from CalMatters does a good job distinguishing between the two types of conservatorships.

 Savanah’s goal in her law career is to be a civil rights litigator – focusing upon housing and disability rights, especially in the intersections of homelessness and mental health.

Lee Davis is currently the chair of the Alameda County Mental Health Advisory Board.  In her official bio, she indicates that she is a Civil Engineer and Journeyman Electrician by profession.  She comes to her work on the Advisory Board as a woman with lived experience of a mood disorder.  

In this interview, we explore three themes about which Lee is passionate:  

1.      The case for involuntary treatment

2.      The lack of capacity in our so-called continuum of care

3.      Her assertion that the failure to invest in the requisite infrastructure to treat people and promote their recovery is morally wrong and socially debilitating

In addition,  we explore Lee’s extraordinary life journey, about  which she writes with remarkable vulnerability in her blogs.  

Being Bipolar. Maybe it is my unisex name. Maybe it is… | by Lee Andrea Davis | Medium

The Continuum of Consciousness; a Bipolar woman’s perspective on Delusions | by Lee Andrea Davis | Medium

Other organizations she references in this interview:

Alameda County Families Advocating for the Seriously Mentally Ill

Articles about the February 2022 sleep-in organized by FASMI with which Lee was involved.

Families of the Mentally Ill Call for Better Treatment Not Better Jails in Alameda County – CBS San Francisco (cbslocal.com)

Oakland: Protesters sleep on sidewalk, demand mental health care (mercurynews.com)

Link to the annual report for the Alameda County Mental Health Advisory Board

I am grateful for good advice I received when I started this podcast in the summer of 2020:  break your podcast into seasons.   For a small operation like Heart Forward, this allows for breathing room and the opportunity to plan and curate guests that are worth listening to!

 So, we’ve taken a six-month break since our last episode was uploaded in August 2021.    We are ready to launch a 10-episode season on March 14, 2022.

This season, I am grateful to have identified a studio in Glassell Park in Los Angeles where I can record my interviews in person.  Words cannot express my appreciation for Peer Mental Health who, for the first two seasons, came alongside me with technical advice and a digital editor, Paul Robinson, who was instrumental in bringing 19 episodes to the Buzzsprout platform.

For Season Three, my home is Verdugo Sound in Glassell Park, and I am grateful to have the support of Aaron Stern as my audio engineer and editor.  

The theme remains the same:  The American mental health system is broken.   Our guests are invited to help us understand the practical impact of this failed system or offer ideas for change.   We continue to be inspired by the global best practice in Trieste Italy.  We do not give up hope.

 Please come on back on March 14, 2022!

 To support this podcast:  

Heart Forward LA - Main Giving Page (networkforgood.com)


Grateful for listeners and supporters!

This episode tackles the gnarly tangle known as our public mental health funding system.     So many questions I had.  Why is there a chronic shortage of mental health treatment beds at every step of the continuum?  Why do people get released too early from the hospital when they would benefit from long-term care?  Why are mental health clinics limited in the services they can provide to their clients?  Why are there no measurable outcomes applied to how funds are invested?

I curated ten observations about the system from my vantage point as a concerned layperson and asked Alex Briscoe to respond.  He does a masterful job of providing clarification to either refute, affirm or amplify upon these observations.     

Alex brings 13  years of experience working at the Health Agency in Alameda County, seven years as director; a $700M agency with over 6,000 staff members.    He helps reduce to layman’s terms a complicated system that is tied to very stringent requirements associated with federal Medicaid policy (known as Medi-Cal in California) and compounded by the complications associated with the two different state actions to disburse state funds to localities (referred to as “realignment” in 1991 and 2011).  Added to this mix are funds authorized by voter passage of Prop 63 in 2004, otherwise known as the “millionaire’s tax” which funds the Mental Health Services Act.   

Alex Briscoe’s current role is that of Principal at  the California Children’s Trust and that is where you can reach him.  Here is a glimpse into their history and impact. 

Articles about Alex, his origin story and his accomplishments in this space

Community 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 finance

A 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 Independent

6.21.21  Article in British Medical Journal

Trieste’s mental healthcare model is under threat, claim supporters of the community based approach | The BMJ

6.15.21  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 Works

In 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)