Heart Forward Conversations from the Heart
The American mental health system is broken beyond repair. Rather than trying to tweak a system which fails everyone, it is time to commit to a bold vision for a better way forward. This podcast explores the American system against the plumb line of an international best practice, recognized by the World Health Organization (WHO), in Trieste, Italy. The 40-year old Trieste model demonstrates how a community-based treatment system upholds the human rights of the people served. The Trieste story is anti-institutional and models the therapeutic value of social connection. Topics will address contemporary challenges in the American failed mental health system as contrasted with the Italian approach toward accoglienza – or radical hospitality – as the underpinning of their remarkable culture of caring for people. Interviews will touch upon how the guiding principles of the Italian system – social recovery, whole person care, system accountability, and the human right to a purposeful life – are non-negotiable aspects if we are to have any hope of forging a new way forward in our American mental health system. This podcast is curated and hosted by Kerry Morrison, founder and project director of Heart Forward LA (https://www.heartforwardla.org/). Heart Forward is collaborating with Aaron Stern at Verdugo Sound as the technical partner in producing this podcast (https://www.verdugosound.com). Kerry Morrison is also the author of the blog www.accoglienza.us.
Heart Forward Conversations from the Heart
Lessons learned from the mid-90's Village Integrated Services Pilot and why they're even more relevant today: A history lesson with Dr. Mark Ragins and Dr. Dave Pilon
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.