 I will say for the organizers, great timing. I think everybody will remember that they were here for this particular conference and they will remember this particular panel discussion because there are also a memorable things happening, dare say just half a mile away. So we have a great panel that's focusing on leveraging peers and community supports. I'm very excited about this particular panel and that we now not only have leaders that have been working with peers, community health workers, promotoras, but they've actually been in the front lines in terms of being care providers themselves. As I reflect in terms of my own story, some of you may know I'm a family practice doctor and my first professional journey was becoming a family practitioner at a community health center in Oakland, Chinatown. And one of my first patients, frankly, was a 45-year-old Chinese man immigrated from China with his wife, who I think I saw this patient in my first week of practice at the community health center. And he was very stoic, robotic almost, and shortly understood that not only was he on psychotropic medications for schizophrenia ostensibly, but also was completely deaf and had had a very traumatic series of events as I learned from his wife. Part of the series of events that led to his psychosis was being a victim or traumatized through the cultural revolution in China. And as I also learned, his wife, who was with him all the time, was also dealing with breast cancer. I'm fortunate enough to be able to communicate in the language, but I don't write Chinese, and certainly I'm not living with them on a day-to-day basis in terms of understanding their journey. The point being is I think when we think about community health workers and promotoras, it wasn't just the fact that this individual was suffering from some serious mental illness, but there's a whole constellation of events and circumstances that community health workers, peer networks, are really attuned about, i.e., being an immigrant coming from China, trying to understand and navigate through the health care system, what it means to deal being a breast cancer survivor, how to deal with the welfare system, et cetera. These are not issues that are defined in terms of the person's particular diagnosis, but defined in terms of what their condition is, and that's why I think our panel is here to be able to elaborate on that. So we do have a really stellar group of panelists today, and I'm going to introduce them very briefly according to how they're going to present. Our first presenter will be Kyrus Jan Myrick, who's now the Chief Peer Services Director, the Chief of Peer Services for the Los Angeles County of Mental Health. Myrick was formerly the Director of the Office of Consumer Affairs for the Center for Mental Health Services at SAMHSA, and we've heard her before, actually in this setting, as I was mentioning, Ms. Myrick has a Master's Degree in Organizational Psychology from the California School of Professional Psychology of Alliant International University. Our second speaker, who I'm very pleased and honored to be a close colleague of is Dr. America Braca, who's the Executive Director of the Latino Health Access, a Center for Health Promotion and Disease Promotion Prevention located in Santa Ana, California, and Latino Health Access has not only a national, dear say, global reputation as being one of the leading organizations that have really developed a cadre of community health workers, principally serving the Latino community, but not broadening ever more in terms of other communities. Notably too, and I don't know if America would have said this, but America's been author of a book and very appropriately titled, Recruiting the Heart, Training the Brain, which is available on Amazon.com then, and I would highly recommend America's book is so encouraging and energizing with regards to how we think about community health. Our last presenter will be Talitha Arnott. Reverend Talitha Arnott is a founding member of the National Action Alliance for Suicide Prevention and its Faith Communities Task Force. And frequently, Reverend Arnott is a speaker on faith communities and their intersection with mental health. She's led the National Weekend of Prayer for Suicide Prevention, and she has a degree with the Yale Divinity School and Pomona College. So I think we're very much going to learn from our esteemed experts here. So as the previous format, we're going to entertain each presenter, providing some remarks for about 10 or 12 minutes, and then certainly as you hear from them, I hope you're tweeting, but also think about the kind of questions that are really probably the most interesting aspects of these workshops and really getting us interacting. So I'm first going to hand the podium over to Ms. Murray. Hello, how are you? Yeah, you just sounded so excited. Okay, great. I have no idea how this works. Oh, duh, it's like a giant green forward button. Do you think maybe? Okay, so I'm going to talk a little bit about peer support and what I've been doing in my life as well as what I'm doing now in Los Angeles County. Being mindful, I've only been in Los Angeles County for one month and 26 days and a couple of hours, but we'll subtract the time I'm here, so maybe it's 25 days or something like that. So the first place I always like to start is how people enter into mental health care, and many people have seen this slide. It's the easiest way for me to talk about it. It does pertain to my own lived experience of having a diagnosis of a mental illness that a lot of times we're talking about, and these would be considered now social determinants of health, right, but I didn't have that language before, and then coming and going, could you help me with my social determinants of health? No, so basically I was really talking about having a life, having a house, having a social life, getting on with my friends, and what would happen is the focus would be primarily on the mental health symptoms and the professional care, and all that other stuff was like, we'll talk about that later, let's get those symptoms down. And I'm like, yeah, but no, I really, really, this is really, really important to me is working, for example, having a challenging job and working, I'm getting on with my family and having friends, was the most important thing to me, even though I might have been very quote unquote symptomatic. And so what really ended up happening, and I think what we're trying to look at is how do you take care of that whole person no matter what may be presenting in front of you is you're always gonna be working with that whole person. And what I had found out is that it's very hard for people to kind of understand what you're talking about when you're going through it, which is very much this, it's really hard for somebody to walk that walk if they haven't walked it themselves. And that's the nature of peer support. Even though I have psychiatric care, a psychiatrist, and a therapist, it really is having somebody who understands that journey and has walked that path that really helped to engage. I'm a giant nerd, I'm sorry. They who really helped to engage me into treatment, care, and the other supports and to leading to my well-being. When I started, before I even started in the field, I was actually working in a completely, well I wasn't even working, I was on disability, but I was in a completely different field. And I started going to these mental health conferences. And what was really interesting about the mental health conferences is that I saw lots of people up on stage, like me, but not like me, talking about their recovery journey, how they got better, the things that they were going through. And in the audience would be all of these African-American, Latino folks, but up on stage would not be those folks. And I actually really thought for many years that recovery was not for me, that there was no way that I could ever achieve what these folks were achieving, because I didn't see anybody who looked like me. Even though the symptoms may be the same, even though they may be talking about some of the same things, it was really hard for me to understand why there were so many of us in the audience, but I didn't see anybody up on stage. So I actually mentioned that to somebody, and I said, you know, is there any, and this is when I was back in LA years ago, and I said, is there anybody that kind of looks like me, and I don't see many youth, by the way, either, are there any young people so that when we look up and see these examples of people getting better, and I'm just gonna say recovery's simply people getting better, are there any, is there anybody who looks like me, and I was introduced to this lovely lady, Jackie McKinney, the person remembered and said, oh, this lady's gonna be in California in Los Angeles speaking, I will remember to introduce you to her, and I'll never forget hearing her speak. Now, she's the age of my mother, so in many ways we're peers, and in many ways I was like, wow, okay, this is different. We were not peers, but when I heard her speak and heard her tell her recovery story, that's actually when I knew recovery was possible for me. That's the essence of peer support, that's the essence of why telling that story with intention is so important and why we're moving forward with what we can do with peer support around the country. So I'd also first like to talk about what is peer support? We use, I came in LA and they're using the word peer for everything in life, you know, if you've got a red shoe on, you're a peer, if somebody else has a red shoe on, and I'm like, what are you talking about? Like my job is a peer workforce, peer and paraprofessional workforce. So I really had to say, well, let's stop and talk about a definition of peer support. So the definition here is a peer provider, you know, who uses that lived experience of recovery from mental illness and or substance use, plus skills learned in formal training to deliver services and behavioral health settings to promote full mind, body, recovery and resiliency. So the settings can be anything from community mental health centers, hospitals, which are both forensic and civil settings, residential, IMD, board and care, peer respites, community centers, libraries, barbershops, jails, prisons and community-based organizations. So we don't necessarily need to think narrowly about a peer supporter isn't a community mental health center running a group or working one-on-one with a person. Does not have to be that narrow, it actually can be quite broad. And again, you'll find different types of titles and terms used for peer supporters. So there's been a long evolution of peer support. Again, this is not something new. Back in 1999 is the first Medicaid billable peer support service. And then in 2001, Georgia trained 35 present and formal mental health consumers for their first class of certified peer specialists. So in 2007, the Centers for Medicaid and Medicare Services issued a letter to state Medicaid directors authorizing to bill Medicaid for mental health peer support specialists with certain criteria, meaning there has to be supervision, care coordination, training and certification. And they established this because there is an evidence base for peer support in a mental health model of care. So in 2013, CMS advanced that, expanded that definition, clarifying that peer-to-peer support can include peer-to-peer relationships, including parents, legal guardians of Medicaid eligible children. And in 2013, the VA exceeded the goal of the executive order to hire 800 peers and they actually hired at that time 815 peers vowing to add 100 per year. So somebody else had spoken about and I think Dr. Manderscheid also gave some contextualization around the number of states that have peer support. So it is 43 for mental health, 13 for substance use. And in California, we have a Senate Bill 906 which is sitting on the governor's desk and either if it's signed and not vetoed or even unsigned, as long as it's not vetoed, it will go into law by September 30th which is what we're hoping will happen. All right, so I don't wanna forget, a lot of times people hear peer support and the concern is, oh, that's just people with lived experience. So we are also thinking of people with lived experience, family, caregivers, parents, youth, older adults, veterans, but the common denominator is they all have a lived experience of a mental health issue or navigating the mental health system themselves or in relation to that person. Some of the work that's been done in this area, and again, this is what we found at the Substance Abuse and Mental Health Services Administration is that because each state could define itself, according to CMS, what training and certification needs were for the workforce, we were told it would be really helpful if SAMHSA could at least help with some guidance. We didn't have to direct, but if we could help with some guidance around what are some key elements around peer workforce and peer core competencies. So using a very broad stakeholder process, we developed through the Bringing Recovery Supports to Scale Technical Assistance Center Strategy, everybody repeat after me, okay, forget about it, is brass tax, that's the easy, most people know it is brass tax, the first national set of core competencies for the peer workforce that is for both mental health and substance use, and that whole array of people I talked about, people with lived experience, family members, caregivers, parents, and youth. Again, these are guidance, they are not directives, it's not a you-shall, and they're really helpful for training, certification, job description, doing skill development, so they're very helpful in a number of different ways. The other thing is, oh, sorry, yeah, data, we'll talk about data, they're also peer practice guidelines that were developed through partnership between addiction and mental health peer disciplines that operationalize peer performance, expectations, skills, knowledge in the workplace. So the data is really important because a lot of times when people talk about peer support, and I'll read it still in the newspaper, Politico, New York Times, whatever, is that, wow, there's no evidence base, or why are you using these and spending money here versus spending money on more psychiatrist or more nurses or what have you? And the reality is nobody is saying that peers should replace anybody. Peers can be used alongside of in conjunction with, and that's the cool thing about my job now in Los Angeles and why I'm really enjoying it, is that I work along five other disciplines. We are the Office of Discipline Chiefs for each of the disciplines that provide behavioral health care and to create a multidisciplinary, integrated, collaborative workforce that is hard-forward based on recovery, resiliency, reintegration, and relationship. All right, so if you don't understand what all this is, then you can just look at these great info briefs about the role of peer support. They're really cool because they are one-pagers for each area of peer support that provide definitions, information, and outcomes for each of the supportive areas. So some of the outcomes, of course, are decreased hospitalization, increased self-esteem, increased self-confidence, decreased in psychotic symptoms, decreased in substance use and depression. Those are just some of the outcomes and data that comes from peer support. Really quickly, the outlook for us is we don't have a labor code, so it's really hard for me to say how many peer supporters are there in the country? I don't know. I'm even having a hard time finding how many are in California, in LA. Also, we are trying to distinguish between what is a peer support specialist and what is a community health worker, what are their roles, how are they similar or different? And again, it's not that one is better than the other, one should replace the other. They can be used for different reasons and always, of course, for the person who's receiving services to be able to identify. Lastly, peer support specialists do need supervision, so I am looking forward in the future to who's gonna be providing supervision right now? We would love to see peer supporters be able to be identified as qualified behavioral health specialists so that they could provide the supervision and that we're involved in the movement towards use of technology and understand how to use technology partnering in the development of technology. And thank you. That's all I have. Good morning. I am America, a CEO of Latino Health Access. And I wanna share with you that as I was thinking about this presentation, I went back to my times practicing medicine in Venezuela in rural Venezuela, not to talk about Venezuela because that's another soap opera. But it was when I was exposed to the concept of community workers. And I remember being a recent graduate and having to deal with issues that I thought and I always was involved with community issues, but even after that experience, I was a young professional thinking that medicine was the solution for everything. Only to learn that I would be seeing the same patients over and over and over because the real reason for their conditions was not medical. It was related to water, it was related to mosquitoes, it was, and right now that's what we are seeing, a lot of malaria, you know, if the electricity fails, it fails the chain that protects vaccines. So, and et cetera, et cetera. I could be talking to you about, you know, and how little really can you do when we are not paying attention to the circumstances that shape health. I had a great experience yesterday when I was checking Facebook. I have been in Facebook two weeks. And that's because I need to promote my own organization to say you have to be in Facebook. So I don't know really how it works yet, but it was a great surprise to see a lot of friends, former participants in our organization that have created this incredible support group through Facebook. And yesterday I was surprised by one of those comments, one of them said, time to say goodbye. And all of a sudden, I see all of these answers saying, are you okay? What can we do? And then she said, well, no, my sister is leaving. But immediately the whole network activated, but the network included a participant in our diabetes class who came blind. And now she can see, and we did a lot of work, and then she went into our mental health, what we call emotional wellness programs. And then she went into volunteering and she became an activist for healthcare. And that was one. Then the other one was she came suffering of depression. She's part of our support groups, but now she's also a volunteer helping other women in the community. And she helps translate when they go to court and they are victims of domestic violence. And the other one also came because she didn't want to leave. She didn't have the energy to continue living. And that other one helped her. So, and so forth. And that entire network is now in Facebook helping each other. Which is a game to somehow connected to, are we talking about mental health or mental illness? Really? I mean, as we think in a workforce, this is a workforce to treat illnesses? Or are we talking about a workforce to make this nation healthier in our emotional health? Because if we want to have a healthier nation, the proposition for the workforce has to be different. Not only who needs to be involved, but also who needs to supervise and what is the role of community and my mom and your dad in this picture. My dad is 94. And he was having problems with his balance. He fell. And we connected, something that actually we connected before, but we didn't do anything about it, which is a medication that he was taking that was making him confused. So he fell. Well, I'm troubleshooting from the United States to Venezuela, no? Imija que hago y what do I do y todo? And then my mom couldn't get in touch with me. That morning, finally we got in touch and she says, your dad didn't make sense at all, like at two in the morning. So what was happening, mom? He said he had a meeting that he had to go to Caracas for a meeting. So how did you manage? I didn't know what to do. So finally I said the meeting was canceled. And he went to bed. So again, there is so much value. Where does mental health happens? I think those are the basic questions. Where does it happen in a clinic? Does it happen in your office? In the same place where mental health happens, that's where recovery happens. Recovery happens in the families. Recovery happens in every street of this nation and this world. Every time we fight a stigma, every time we are willing to hear how you see the world, recovery happens. Emotional wellness happens when I can be me and still be part of you. So it is a different thing. And when we think in this upstream downstream and all of this terminology, I love what you said. I mean, this is whatever. Who knows in my community what social determinants of, they don't know that. They don't even talk about social justice. That's not the language we use, but we know what are the conditions that are making us sick. They can say I'm tired of this. I can't stand that. I am up to here. I just wanna die. I don't wanna leave anymore. That's how people talk. And there are circumstances. I cannot pay the rent. I have issues with my partner. The kid that says my dad doesn't like me. The one that says I'd rather be with my friends or I don't wanna leave anymore. The one that is being rejected by peers in the school. There are many things happening in our communities. So as we're thinking in the workforce and the role of community workers, we first need to say, well, what is what we are talking about? And we probably are talking about all of it. We think in this upstream downstream metaphor of the river that you probably have heard in which down here you have the little pool of water at the end of the river and kids are swimming there and people are swimming there and then there are a lot of rocks coming from the mountain and they are being hurt and they are bleeding and we are all putting stitches on their heads. And we continue. Well, now we need a helmet factory and now we need more stitches. Now we need something to clean the blood. Now, but when are we going to think upstream? Are we going to continue just here doing that or there is going to be a moment in which we say, where are these rocks coming from? And the idea is not to go and find out where the rocks are coming from and abandoning this. The idea is to work in that continuum where we all have a place and it has to be all of it. There are not enough resources in the planet to deal with the mental health of each of us if we only think in a medical model. It's impossible. We are not going to solve that. We all will need a medical professional. Each of you will need one. Each of you and save one for me. Right? So one per each and maybe we can do it for each other but I mean that cannot be the solution. In communities where you have other issues, where you feel excluded, where your voice doesn't count and then you have this group of people working on Facebook and you have a bunch of community workers that came to Latino Health Access to help, to help because they had diabetes and they were grateful to help because they had, they were victims of domestic violence and they were participants but then we saw and we heard their voice and the voice of wisdom, the voice of wisdom that is provided by people with their own life experience but not to underestimate their experience. They bring perspective. They are strategic. They know what works. They can have conversations that are profound and they put the time in building relationships long term and also they go deeper and as you go deeper in the relationship you are going to tell me tomorrow what you didn't tell me today because now we are in a space of trust and these promotores will find you. They will find you in your house. They will find you in the street. They will find you in Facebook. They will find you. Not because we need the numbers but because we need to find you because without you we will not build a better community. We need you as much as you need us because in this we are all together. They ask me, why is a need to have more mental health in America? Well, you tell me. You tell me how it looks when you don't have it and tell me if that is the picture that we want for this nation and then we will see the urgency to go beyond the walls of a clinic. And why we stay in the clinic with our model? Well, because we grew up in institutions that fragmented ourselves. Each of you know that what makes sense is to include the community but we don't know how to work with them and we don't but we are community. We are community. It's almost like we don't recognize ourselves and when we want to work with communities we can't because they don't have the degree. But you know what? Your mom doesn't have the degree and you don't have the degree to deal with your sister. So there is a role for community but it's not going to happen until we open that space and stop saying that if they are not certified and they don't have the degrees and if they don't know how to put boundaries, I don't care about the boundaries. Please do not have boundaries if you see I want to kill myself. What is the role of boundaries? Are we going to repeat like parrots? Models are not working. And then they inform the strategy and then we need to relearn. We need to unlearn and relearn how to engage with them. How do we work with them so they can be part of the team? Not bringing the peers, bringing the community workers and then supervising in all ways and telling them what to do. So if you know what it needs to be done then you do it, you don't need community workers. If you bring the workers, let them guide, let them inform the strategy. So this is not about how to train promotores but how to train a workforce to include communities in their thinking to rethink the mental health strategy. So the people impacted by emotional problems, illnesses need to be part of the solution. Communities need to be part of the solution. We cannot talk about equity in healthcare as an afterthought. You know now we are going to do equity to them. You don't do equity to people. Equity happens when the people affected by inequity is at the center. And the only people at the center in this conversation are the professionals, mental health workers that will not bring equity to this picture. So training has to be redefined. We are talking about learning on learning, co-training and co-learning in this new paradigm. We are talking about training supervisors and institutions that want to do this work so they don't bring a worker and think they are doing community work. And we are also rethinking power relationships inside understanding the depth of how power is played in our institutions. And I will stop there. Clicker, but I'm not going to use the podium. Thank you both, all three of you, thank you so much. It's a real honor to be on this stage with you and to try to dovetail what I'm going to say, picking up on both what the three of them have offered and also what we've already heard this morning. My name is Talitha Arnold. I'm the senior minister at the United Church of Santa Fe which is part of the United Church of Christ which is a progressive Christian denomination located in Santa Fe, New Mexico. I've been there for 30 years but I've served about six different congregations in the time that I've served there because there's so much turnover in Santa Fe that it's rebuilding the church every five years. Prior to that I was an associate minister for a church in Middletown, Connecticut just down the street from Wesleyan where some of the Kaiser Permanente staff went to school and before that I was the associate chaplain at Yale University for working with students and faculty in the town as well. I grew up in Arizona and as Dr. Wong said I went to Pomona College. I majored in political science and religion, the two subjects that my grandmother had told me never to talk about in polite company but I never, I mean I wasn't, both my mother and my grandmother could test that I didn't always take their good advice and never intended to go to ministry at the time that I was going to school, at going to college, my friends, my peer groups, they were not going to, they weren't going to, you could go live on an ashram, you could go live on a kaboots but if you set foot inside a Christian church you were somehow seen as being suspect and I certainly had no intention of going to seminary but that's a whole other long story. Also had no intention of ever getting involved in mental health issues even though mental health issues were at the very core of my family and I'll share a little bit of that story in just a moment. But I'd like to, what I'm focusing on today is the role of faith communities in mental health. So in addition to being a local church pastor for almost 40 years, I also, as was mentioned, have been a founding member of the National Action Alliance for Suicide Prevention which is a private public partnership sponsored by HHS, SAMHSA, Department of Defense and Department of Veterans and then also the private sector. In fact we just had a meeting here yesterday in this very space. And Pam Hyde who was at that time the director of SAMHSA is a member of the church that I serve in Santa Fe and she was the one who got me involved with it. Why do we need to include faith communities in mental health care? For all the reasons that these three people talked about as well as others before them. Mental health issues affect people across faith traditions as well as across age, gender, culture, all of that. And it's not, it doesn't exclude any particular group of people. Faith leaders in faith communities are very much on the front line. That the research shows that more often than not someone who is in a mental health crisis or has a family member who's in a mental health crisis will seek out a faith leader prior to, more so than seeking out a therapist of any kind. Why? Number one, we're accessible. Number two, we may be culturally relevant and all three of you have talked about that in the communities that you were a part of. Number three, we're cheap. And number four, we are. I mean, you don't have to, and number four, there's not the stigma to the, it's not the same as calling up a therapist or calling up a mental health clinic and saying, I'm in trouble or my loved one's in trouble, I need to make an appointment. I hear about people's mental health issues while the kids are being picked up from the youth group. I hear about their mental health issues when we're standing in the line at the potluck or as they casually go through the line at the end of the service. So that clergy are very much on the front lines with all of this. We care for the whole person and we also care for families, which is another big aspect of it, that we work with people across generations, but we also work with people in a whole variety of settings in the church as well. We interact with people from, we have people from different workplaces, including mental health professionals and as I should have added, based on what I've been hearing today, I should also have included in that, I have a number of primary caregivers, I mean primary physicians in my congregation as well, as well as specialists, people who work at the hospital, people who are in public education. We have people who are on the front lines in mental health issues in a whole variety of ways in addition to the mental health professionals that it might be a part of the congregation. And most importantly, mental health crises are a crisis of faith. Nine times out of 10, the person is also dealing with where is God in the midst of this? If I have a broken leg, if I'm suffering from diabetes, if I have some other kind of complete, or what would be seen as perhaps only a physical disability, I can say, well, I will get peace of mind. I will adjust to my condition. But what happens when it's the brain, when it's the mind that is causing the distress? And where is God in the midst of that? Mental health crises are oftentimes spiritual crises. But to be honest, sometimes faith traditions and faith leaders and faith communities have been more a part of the problem than of the solution. There are some traditions where mental illness has been seen as a sin, a moral failing, God's judgment or a test of faith. And even in the more progressive spiritual traditions, like the one that I grew up in, United Church of Christ, there's been silence and secrecy around mental illness and also suicide. I know that for a fact. My father in the spring of 1953, when my mother was four months pregnant with me and they had three other children, was a biologist with the Fish and Wildlife Service. He'd come out of World War II with what now would be considered PTSD. It was called battle fatigue, shell shock, whatever at that time. Eight years later, the symptoms erupted. He brought the whole family back to Washington, DC to, he wanted to meet with the Secretary of the Interior at the time because his research wasn't being published. He wasn't allowed to do that. And in response, I don't know all the details because I wasn't born yet, he was arrested trying to climb the fence here at the White House. He was committed to St. Elizabeth Hospital. My mother at that point moved back to Arizona within about a week because she literally had no place to live because my dad had been working on wildlife refugees and they were living in government housing. She moved back to Arizona to live with her mother on what she thought was gonna be a temporary basis. My father was transferred from St. Elizabeth to Oregon and then finally down to Southern California to a VA hospital there, which is where he was from. And two years later, not knowing, I don't know all the details, he somehow was allowed out on a pass and died by gunshot wound. Two days later, it was ruled a suicide. My family didn't talk about that. I learned about that when I was 16 years old. He'd always died of result of things that happened to him during World War II. My church did not talk about it. I was 28 years old before I heard the words, suicide, schizophrenia, mental illness, preached in a sermon. And that was when I did it myself as an associate minister at First Congregational Church in Middletown, Connecticut. So even the progressive churches had been silent about it, at least up until the last 10 or 20 years. And what it feels like is that when the church can't talk about it, when the synagogue can't talk about it, when the mosque can't talk about it, it feels like God can't deal with it either. Mental health issues are oftentimes spiritual issues as well. However, the good news is that things are changing. Even some of the more conservative religious traditions, whether in Christianity or Judaism or Islam or others, are finally seeing that mental illness is a matter of competency. It's a brain disease. It's not a moral failing or a sin. And that it's not a reason for shame or guilt or God's disapproval in any of those things. The silence is being broken and clergy and other faith leaders are beginning to see their role as partners with other mental health professionals. And also the research is showing that faith communities provide major protective factors when it comes to mental health issues and especially suicide prevention. We provide connection and community, not only the wider community of the congregation itself, but the communities within the communities. Choirs, youth groups, parents groups, older adults groups, study groups. Some place where in the words of the old TV show, cheers, you wanna go where somebody knows your name. And if you don't show up for a couple of weeks, somebody's gonna call and find out how are you doing? We provide connection and community. Research shows that helps with mental health. We provide educational opportunities, whether it's in our adult education programs, special retreats, a whole variety of venues that faith communities can offer. We do a number of different kinds of mental health based education programs at the church that I serve around the holidays. I do, we do series with providers from the Pastoral Care Center on keeping your sanity while keeping the holidays. We do extended grief groups. We're a small church, we're only 300 members. But we draw up on the wider community to get people in to talk about mental health issues. We did a whole series on how to talk to a therapist. Anything we can do to reduce stigma, to build bridges and to get people talking with one another is what faith communities can be about. We also provide a major protective factor as our narratives of hope. Faith traditions are built on stories of people overcoming adversity and finding meaning in life's hardships. As a young person growing up during the Civil Rights Movement, even though I'm Anglo, I'm white, the example of African-American persons, both children my age and also adults, putting their lives on the line in the hope of creating a new world gave me hope in my own family. We also have stories from our own faith traditions and we have stories from the community. Going back to what all of you talked about with regard to peer count, peer care, matching up older adults in the congregation with younger adults, matching up parents of teenagers with those whose teenagers actually made it through their teenage years, or two-year-olds with parents of two-year-olds or grandparents of two-year-olds, getting all that kind of peer support. Worship is pastoral care. Don't just set aside one day for the weekend of prayer for suicide prevention or one month for mental health, but weave it into, clergy can weave it into sermons and in prayers all the way through. We may not be able to name a specific person dealing with a specific condition, but I guarantee you if as a pastor or a priest or a mom or rabbi, you say, you praying not only for people who have cancer or heart disease, but people who are afflicted with mental illness or with schizophrenia or with depression, it opens up the door and it lets people know this is a safe place to talk about these things. Music, whether it's the singing of the congregation or the choir, research shows that number one, you get that much oxygen into you and your mental health is gonna improve, but also that choral music, congregational singing has a positive effect on people's mental health. Rituals, we provide structure for if somebody dies, and especially if somebody dies by suicide, the funeral and memorial service is an opportunity to address that if you have permission from the family to do that. But to show how you deal with grief and how do you deal with mental illness, worship opportunities provide that. And finally, it provides us leadership roles that a person is more than their illness. They are a leader of worship, they are a leader of singing, they're a leader and it provides another identity. Finally, advocacy. It not only helps change policy, it helps change the person. The church that I serve, we advocate in anti-bullying kinds of things, we've advocated for same-gender marriage and LGBT rights, we've advocated around racism and poverty issues, whatever we've advocated around reducing lethal means, whether it's gun violence or getting a bridge net off the Talos Bridge, all those kinds of advocacy things. Faith communities are involved in that as well. What do we need? We need ways to identify and strengthen what we're already doing. If you come in just with another program, it's not gonna work, but help faith communities identify what they're already doing that foster good mental health. Training, not just for the clergy, but for all the lay leaders, the nursery care workers, the choir director, mental health first aid, peer support, all those things that you're talking about here. We need those basic mental health training. Ways to develop partnerships with the mental health professionals and also how to know those who will respect people's faith. They don't have to be the same faith, but they sure don't need to see faith as a pathology as sometimes happens. And then ways to support mental health professionals in our own faith communities. Bottom line, it's a team effort between mental health professionals and other medical professionals and faith communities. We offer multiple protective factors. We need resources, training, and acknowledgement that we're part of that team. Thank you. Thank you. So, I'll just do a time check here. Cessy, we have about 10 minutes, you think? Okay. And obviously a powerful panel and coming across, I think we have folks from 3,000 miles away, but certainly some convergent themes. So I'm inviting people to come to the microphones. We have two, one in the back, one in the front, as as people form their questions. Some of the themes I really heard were empowerment and not looking at community health workers promotoras. It's an extension of the healthcare delivery system, but actually very much at the core of thinking about how people take power into their own hands, define their journeys, define what the issues are for their families themselves and how to operate in that fashion, not being so centric to what the healthcare delivery system has been all about. One of the questions I have with regards to these issues around empowerment agency, recognizing the strength of individuals and the social network, we have all these folks that come from policy and healthcare delivery systems. What do you think is standing in the way to really unleash the power of peer support, faith communities and community health workers? What do we need to do to make a change? Okay, well, maybe I'll start. It's kind of funny when I do a lot of tweeting. Sometimes I'm tweeting out, is it about the policy or about the people? And sometimes I worry that our policies actually get in the way of doing what we want to do to be helpful to the people in need, that we're worried about what policy am I gonna break or what policy do I need to set up in order to do something? And I'm just like, well, for criminal's sake, just can't we do it? You know what I mean? And I worry that we get so bound by policy that it actually constrains our creative thinking about regardless of the policy. Yes, we do need policies, just like we need kind of red, green, yellow light so that we can pay attention to what we're doing on the road and how long we're speaking. But also, we do need that, but that shouldn't constrain us from being able to move forward and do some other things. Like being able to work in the community. I was asking, and I actually moved back to LA and I said, look, can we have a group of providers, peer providers, and others that have a vendor booth on Venice Beach? The people who are living on Venice Beach experiencing homelessness, using drugs and alcohol to solve their pain and issues that they're dealing with, they're not gonna come to us. They're just not. Oh no, we can't have a doc out there because you can't be outside and you can't, I'm like, oh my gosh. Well, they're not gonna come to us, so what do we do? So we buy a vendor booth, can we do that? And I was told, yeah, so okay, great. We're gonna buy some vendor booths and we're gonna be out on Venice Beach with the people as a coordinated team. And we don't have time to wait, so. Thank you. I think that it might also help to share stories of success. I think that we all want to be successful and have quality services and have results. When we hear this, I mean, once we share that, then there is the issue of policies, liabilities, how you make it happen, funding. Funding is a huge problem. We had experience with a partner in which our promotoras were in charge of reaching people with diabetes and mental illness. Our promotoras actually went to the houses of people and found several women, I mean, I will tell about one of them, that was in her bathroom with a four-year-old. She had diabetes, I mean, out of control completely and was there in a dark room for weeks. The promotora went there every day for several hours, helping her, being with her, trying to help her to just stand up and do something, just to engage in something. Finally, you know, it took us two weeks also protecting the kid. The kid was the one opening the door, talking to us, connecting with the rest of the family. Not only this participant was engaged with the mental health services, but she actually was able to also connect with the providers for the diabetes control. And we had plenty of stories that talk about that success, but the answer was this was a great result, but we don't have funding for promotoras. It was a pilot that ended there. Or we work with children as part of our mental health team. We talk about separating the person from the problem. The children are educators. We talk, I mean, there are many things happening and not only in my organization, in many other organizations, we don't hear those stories. I think that if we start doing that and finding ways, learning from the ones that have made it, our funding comes from the private sector, cooperation with our fundraising. Maybe another proposition would be for organizations to use their own funding, not just be dependent on reimbursement to try new things. So. Thank you. I think it's a really good question. I think the faith community question is complicated because there are just so many different faith traditions and different approaches to mental illness issues. So there's no one size fits all, not even within particular traditions. I mean, in the Christian tradition itself, within Protestantism, there's the progressives on one side and there's the evangelicals and some kind of mix in between. And how that gets played out is gonna be different across the board. But I think that one thing is that I certainly have found with the suicide prevention work and also with the mental health panel that I was on two weeks ago that was sponsored by SAMHSA and also by the Partnership Center, it was a White House panel on severe mental illness, that mental health issues and suicide prevention are at least one area where I think we can find some common ground these days. And so I think that trying to figure out what we can agree on even if we disagree on other things. Historically, and still to this day, there are faith traditions across the board that where faith leaders will say, well, you just have to pray enough and that'll be, and it'll be all be okay. And then on the other extreme, sort of like with my denomination or my tradition would be, that's for the professionals. So if somebody comes in for counseling, I'm not gonna do the counseling, I'm just gonna immediately refer them out rather than doing a both and. I don't do long-term counseling, but I sure as heck know who the counselors are, therapists, whatever, in my community so that we can have some kind of partnership. Because even if somebody's hospitalized, they're gonna come back into the community and we've gotta make sure we provide support for the family, for the people who are colleagues and coworkers and also for that individual. So it's really beginning to think about partnerships rather than somebody used the term silos earlier. It's not silos, it's that we are in partnership with one another and that just takes time and it takes trust. We do have one question here, so please Pat. And if you have someone you wanna direct the question to, you can do it as well. Hi, I'm Patricia D'Sau from Kaiser Permanente's National Mental Health and Wellness Program. And first of all, thank you. Second of all, I didn't realize I'd have a soundtrack, that's lovely. That's how happy this was. But thank you. I really enjoyed listening to your personal and professional stories. Each one of you talked about mental health care that happens in a non-clinical setting and different non-clinical settings. So a peer support network, the Latino community, families, social networks, faith-based communities. But the one common denominator was that mental health care is definitely happening in those systems. And I was struck by the relative ease and openness that people have in talking about mental health in these different settings. And I wonder if you have any learning or insight about those dialogues that happen in your different settings that can be applied to the clinical setting. So Talitha, for example, you talked about the fact that in a faith-based community, there's less stigma, or more recently anyway, and people are more open to talking about things. So is there something different about the way that they're talking about it, or what can we learn in the clinical setting? Thank you. I think one of the things that happens is that if somebody is having a mental health issue, they're known in the community. They're part of the community. I mean, an example for me was a number of years ago, we had a woman who went into a severe postpartum depression after her second child was born. And we made sure, with the permission of the family, we made sure that that family got as many casseroles and such as anybody who'd come home with a broken leg. And so you try to normalize it in sermons. I'll talk about a person's struggles. Not, I respect confidentiality, but I'll talk about mental health issues in the same way I might talk about overcoming physical health issues. So all those kinds, those are some ways of sort of, I think in a community you can normalize it. And it's not a big, it's not a big bear hiding in the closet somewhere. So, Maris in America, I want to invite your response, but I also want to have enough time for one more question, so just keep that in mind. In clinical settings, and I'm doing this all the time, is language. I find a lot of times that I'm correcting how we talk about people with who have mental health issues. The new term is high-utilizer. And I'm like, really, they're utilizing our services a lot of times because we suck at what we're doing. But we're calling them high-utilizers, right? You know, stuff like that. So I think, so really I talk about how are we using language? Frequent flyer, I did not get a free flight because I was frequent flying. I didn't get anything free that I wanted. So how the terms that we use actually put us in this deficit position that don't make us want to identify, don't make us want to speak up, don't make us want to participate. So I think if we can switch our language to more person-centered, a person who has really complex stuff going on, you know, how do we help that person? That's a person who has maybe high or intensive need, not a person who's highly utilizing our stuff. So I think that's a start. We have ongoing anti-estigma work in our communities. We also, with this emotional wellness conversation in everything, we have the fitness session before our support group. We have this cooking class and then we have one-on-one sessions with the community workers. We have a campaign for rent control where we discuss the impact on mental health of not having housing. So we actually normalize. And then we actually, and we talk about what was your experience with mental illness? Well, I used to have an uncle that was in that room, you know, and he wouldn't come out because he was the crazy one. So we have these conversations. We try to open it up. Great. So we're gonna have one more question, and that's all, otherwise we'll have a bunch of hangry people. So please. Okay, and I don't wanna stand between people and lunch, so I'm happy to take my answer offline. But I'm working for the National Governors Association, my name's Sandra Wilkness, and so I'm thinking on a state policymaker level, which of course, I struggle to figure out how that fits here. But I wanted to say I'm very encouraged by your presentations. Thank you all for what you do. It's so important in building these community supports and linkages. I guess my one question is, as we think about building out the social support network, and I don't wanna get jargony, but one thing that we don't talk about as much as we think about where people live, work, and play is the social capital piece of it. So there's a support network piece, but then there's how do you help to build people's social capital so that they can continue to elevate and actually activate and be empowered. And I'm wondering if you all are running into any of those opportunities. So you get about a 30 second response to that. You can tell me later. I just want to probably only, so we can talk after this, in the social support concept, I wanna make sure that I share that promotoras are providers, that they have one-on-one sessions, that they have specific and structural activities they do with participants, that they document their work, that they set goals with the participants. So they actually are providers, they do home visits, they do follow-up, and they do the whole social determinants in the community. So it's not just a social support, they are at all levels. Yeah, I would say the same for peer support. I think the difference is understanding the difference between what we do is we try to connect people to their national supports in their community so that sometimes our policies and programs do get in the way that they're operating during business hours, and that's not when people really need us. So trying to break that sort of, yeah, we should be out in the community hanging out with people at the movies and so forth, helping them to build their own social capital rather than relying on even the peer to be that social capital for them. Two things, one is continually, we continually affirm that no matter what has happened to you or going on in your life, you are still a child of God. That's sort of bottom line, and second is in terms of developing social capital and goes back to what I said about leadership, that faith communities can provide a different identity to somebody. I'm not just my illness, but I am a church leader, I am a church builder, I painted that youth room, I did this prayer at the service. There's more to me than just my illness, and for me at least, I know in my own life that was, or my family's illness, that was empowering, both as a young person and also as a slightly older person. Well, I think it's very fitting that I think this was very inspirational, so thank you very much, and I think we'll break for lunch.