Heart Forward Conversations from the Heart

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 (accoglienza.us)

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 (to be aired in the show’s next season) will focus 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.

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