By Moryt Milo
(June 8 General Meeting)
When Teresa Pasquini and Lauren Rettagliata released their “Housing That Heals” paper in May 2020, the study struck a nerve in the mental health community, and the women knew why.
“There was so much truth in what we were saying,” Teresa said.
A truth that advocated for local, state, and federal policymakers and community partners to think beyond the Housing First model and to focus on building a continuum of care, with housing as part of a larger framework for those living with serious mental illness (SMI). A model based on a prevention/intervention plan to help “flatten the harm curve by providing the right care at the right time in the right place,” Teresa said.
Both Teresa and Lauren have sons who live with serious mental illness. Lauren also has a son with intellectual developmental disabilities (IDD). The women have watched for decades as the mental healthcare system in California has failed their families and so many others due to its flawed system of care.
“I was involved in the IDD community for 40 years, and every meeting was about planning. It’s time to stop planning and start solving the problem through action,” Lauren said. “Those with serious mental illness are falling through the cracks. The IDD community has designated dollars, but that’s not the case for those with serious mental illness. I don’t want to go back to the way it was—with state institutions—but those with serious mental illness are being stripped of their dignity and respect.”
Both women served as commissioners on the Contra Costa County Mental Health Commission.
Teresa also played an integral role as a founding member of a behavioral health partnership with Contra Costa Regional Medical Center. She worked with the public hospital to change the way its staff engaged with patients and families in the behavioral health department. It became a national model for patient/family/hospital partnerships.
“It was my most meaningful work because we broke down barriers about how families like ours work with staff, patients, and their families behind the locked doors of both Psychiatric Emergency Services and our Psychiatric Inpatient Unit,” Teresa said.
Another meaningful moment involved her participation at the prelaunch of former Congressman Tim Murphy’s Helping Families in Mental Health Crisis Act. The media event was sponsored by the Treatment Advocacy Center. There, Teresa and two other families from California told their stories of failed mental health care and the tragic consequences.
The Basis of Advocacy
Teresa’s son, Danny, was diagnosed with schizoaffective disorder in his teens and placed on a Lanterman Petris Short (LPS) Conservatorship at age 19. Until recently, he had spent the majority of his adult life in locked long-term care psychiatric facilities known as IMDs, or Institutions for Mental Disease. Today, he lives in an open residential treatment facility in Morgan Hill—but it took twenty years.
“Even though I had resources and my full-time ability to navigate a maze in one of the most integrated healthcare systems in the country, it was still a nightmare,” Teresa said.
Teresa hit the same roadblocks that other parents encounter when seeking help for their SMI loved ones. Teresa joined every organization from local to national to “shatter the silence, shame, and status quo,” in the mental health system. Then in 2013 Lauren joined the Mental Health Commission in Contra Costa County and the two became fast friends and formed an alliance. Back then, their energy, and that of other families, focused on the adoption of Laura’s Law, but as their partnership grew so did their goals.
Teresa forged partnerships in the public sector, working with community mental health, psychiatric emergency services, law enforcement, and detention departments. As she did so, her anger lessened while her advocacy strengthened. And she never apologized for speaking on behalf of the most vulnerable and forgotten, which included her son.
Lauren saw the ugly, abusive side of board and care facilities when she lived in Texas. There, she successfully worked to procure state funding to create group homes with supportive, quality care. When Lauren moved to California and her youngest son was diagnosed with a serious mental illness, she discovered the frustration and heartbreak of not being able to help her adult child. Like Teresa, Lauren became privy to the state’s broken mental health system at its core.
Together, Lauren and Teresa wanted to educate society-at-large through the eyes of a mom.
“The individuals who see homelessness on the streets don’t understand that every one of these people is part of a family. They don’t understand what drove them to homelessness, and what prevents the family from rescuing them from the streets,” Teresa said. “But Lauren and I understand because we have watched our sons become lost in the fiscal shell game of the California Mental Health System.”
Looking for Answers
The two women decided to search for the key that would open the doors to changing the system for those with SMI. Their quest for answers would eventually become the “Housing That Heals” paper. In 2019, they spent a year traveling throughout California, visiting various facilities that ranged from a Mental Health Rehabilitation Center to a Peer Respite Center. Their benchmark was based on the “Institute of Medicine’s criteria for what a healthcare system must fulfill to deliver quality care,” according to The Paper. They logged over 3,000 miles and visited twenty-two facilities.
The women found several facilities that provided a blueprint for SMI care, but also discovered that many would not admit individuals with a difficult history. This left those with the greatest need for a continuum of care program relegated to few options and often back on the streets or in shelters.
Their research also validated that significant funding for supportive services was not reaching the SMI population.
Since the passage of California Prop 63 in 2004, the Mental Health Services Act (MHSA) is supposed to provide counties with funding from revenues collected through a 1-percent income tax on personal income in excess of $1 million per year. This tax generates about $2 billion a year. Additionally, in 2016 a $2 billion bond measure, “No Place Like Home,” was approved to help provide permanent supportive housing for individuals in need of mental health services. However, over the years these funds have not funneled into designated services as mandated.
An article entitled As An Overhaul Of California’s Mental Health Spending Gets Shelved, One Mother Pushes For Reform (published July 2, 2020 through CapRadio in Sacramento) confirmed Teresa and Lauren’s argument and push for these unspent funds to be allocated as required to SMI individuals.
“California localities are required to allocate at least 51 percent of their community support and services spending to ‘full-service partnership’ programs, which are intended to serve people with severe mental illnesses,” according to the April 2018 California State Auditor’s report. This however is not happening, and the California State Auditors called out the Department of Health Care Services “for allowing local mental health agencies to amass $2.5 billion in unspent funds by 2016.”
The Mental Health Services Oversight & Accountability Commission that tracks the data shows that Santa Clara County allocated only 31.1 percent of its 2018-19 Full-Service Partnership funds, and during the last fiscal year, 2019-2020, only 1.9 percent of funds was applied toward Adult Residential Treatment facilities.
Other projects like Project RoomKey/HomeKey that are receiving $96 million from the state’s General Fund and through philanthropic support are leaving behind those with SMI in need of supportive housing services.
“We need to see that this vast amount of money pouring forth for homelessness reaches the serious mentally ill population,” Lauren said. “Housing That Heals is a system strategy, a quality improvement strategy, and a health strategy. We want to stop the suffering, the waste, and the waiting.”
The women emphasized that these partnerships must include a continuum of care from crisis to acute to subacute and an array of supportive housing that allows everyone to live and die with dignity.
Searching for Dignity
During their trip to twenty-two facilities, the women found three that highlighted what can be accomplished with the right vision and support.
California Psychiatric Transitions in Merced County is a 98-bed IMD that licenses its services to various counties within the state. It has a tiered system, with three facilities, one of which is part of the state’s court-ordered diversion program. This facility treats individuals who are incompetent to stand trial. Individuals receive intensive therapeutic treatment and training that prepare them for re-entry into the community, thus replacing a trip to the state hospital. The other tiers are for the nonforensic population.
The John Henry Foundation in Orange County is a therapeutic enclave that provides supportive housing and care to individuals with schizophrenia spectrum disorders. Up to 42 people may reside in this facility. Family interaction is a key part of the program. Lauren and Teresa were surprised by the Foundation’s level of transparency and willingness to share information. They learned the annual cost at John Henry was about $42,000 a year, half the cost of caring for that same SMI individual in jail or prison. The high level of care at John Henry was evident, said the women, and it demonstrated that quality supportive treatment can be achievable at a fiscally sound price point.
Psynergy, an Adult Residential Treatment Facility in Morgan Hill, is dedicated to those with SMI. The programs allow individuals to move out of locked facilities like IMDs or hospitals into community living. The program provides a team of licensed therapists, farm-to-table meals, personalized exercise plans, and equine therapy. Other facilities also made an impression, and Lauren and Teresa have recapped a number of them in their “Housing That Heals” paper.
With the pandemic and COVID-19 on the wane, the women are preparing to go back on the road through the state and across the country. One of their visits will be to Mental Health Systems Inc. in Southern California. The Fresno campus, once a former high-end resort, has been repurposed to include Assisted Outpatient Treatment, a residential treatment facility, permanent housing, and an array of outpatient and community-based services.
As their search for exemplary housing models continues, never far from Lauren and Teresa’s minds is what happens to their adult children after the moms die. It is a question that plagues all parents in this situation.
“We carry the fear about what will happen when we are gone and wonder if our sons will be left with “no place like home,” Teresa said.
“We know grassroots advocacy works,” Lauren added. “We dream of the day there will be a fluid continuum of care of Housing That Heals for those who live with Serious Mental Illness.”
In the meantime, these are two moms on a mission with no intention of slowing down until their dream becomes reality.
Click here to read the Housing That Heals paper.
To learn more about Teresa Pasquini and Lauren Rettagliata, watch this video.
To learn more about their advocacy work, reach out to email@example.com