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

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

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

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

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

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

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

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

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

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

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