In 2008, the Hogg Foundation hired two consumers as full-time program staff. It’s changed the organization to its core.
Tammy Heinz was three years into her job as outreach program director for the Mental Health Association of Tarrant County when she came out as a consumer of mental health services. It wasn’t planned. She’d been dealing with serious depression since she was in high school. Over the years she’d been in therapy and treatment programs in Texas, Vermont, and New York. SSRIs were her friend. The whole deal. What she’d never done was explicitly bring that personal experience into her professional work in community mental health.
Then came an evening in the fall of 2004. She was giving one of her usual talks, this time to a diverse group from a local university. It was about the range of mental health services and supports available to the community, and about how much of a difference it can make to have the courage to reach out for help.
“A man raised his hand and asked me if I had any personal experience with this,” remembers Heinz. “I didn’t know what to do. I was immedi - ately nervous. But I realized I couldn’t lie, and I thought, ‘What have I got to lose? These people don’t know me.’ So I said, ‘Yes, I have.’
“He asked if I would mind talking a little about my own experience, and I thought, ‘Well, yeah, actually I would, but okay.’”
So Heinz told her own story, and it changed everything. She stayed an hour and half longer than she’d anticipated. Everyone in the audience stayed as well. People talked about their own mental health challenges, about their families, about their lives in a way Heinz had never experienced before outside of a clinical setting.
“By telling my own story, I realized, I had opened a door for other people to be more open about their experience.”
From that point on, Heinz regularly incorporated her own lived experience of depression into her outreach work, and she continued to witness how powerful an impact it could have.
Even then, however, she couldn’t bring herself to tell her supervisor about what she was doing, or about her own struggles.
“Finally she brought it up,” says Heinz. “One day she came into my office and told me that she was hearing from a lot of people about how great these presentations were, about how great it was that I was sharing my own experience. Fortunately, she was a very forward-thinking person. She said: ‘I’m really glad you’re doing that. I think it’s really smart.’”
With the support of her supervisor, Heinz launched a peer support program focused on recovery in Tarrant County, so that more people with lived experience would have the opportunity to recover and to use their personal stories to help others.
Even then, when a friend forwarded her the job posting at the Hogg Foundation for Mental Health for a Consumer and Family Liaison, she hesitated. It was one thing to bring her personal experiences of being a consumer into a job that wasn’t itself premised on being a consumer. But to apply for a job where that would be at the core of her professional identity? That was scary.
“So much of my recovery had been about recognizing that I was more than my symptoms, not defined by a diagnosis,” she says. “The prospect of getting a job primarily because of my lived mental health experience was hard to process. I was afraid that I would lose the professional legitimacy I had studied and worked so hard to achieve. Even after everything I’d been through, I was nervous about coming out into the world so visibly as a consumer versus being seen as an educated mental health professional.”
Eventually, Heinz worked through the uneasiness. The encouragement of her partner was huge.
“He helped me recognize that all of my experience was valuable, including my educational background, my professional experience and my personal experience of living with a mental health issue,” she says.
The idea of being closer to her sister and the potential increase in salary were attractive. And there was the opportunity, with the Hogg Foundation, to spread the practices and perspectives of the recovery movement to a much broader audience of people than she could ever hope to reach in her current job. So she applied.
Stephany Bryan was working as the sales and marketing director of a metal stamping company in San Marcos when she got the call that would come close to destroying, and end up saving, her life. It came from the front desk receptionist, who told her that she had some visitors.
“I said I’d be out in a second,” says Bryan. “I didn’t think much of it. I had people coming by all the time to market their wares.”
At the time Bryan was 38 years old. She’d been married for 20 years to a husband who was violent to her and their three children. She was severely depressed. Her husband was using drugs to self-medicate. He suffered from undiagnosed post-traumatic stress disorder. She would later be diagnosed as suffering from major depressive disorder. The kids were showing multiple symptoms of trauma.
To that point, however, Bryan had been able to hold things together, on the surface.
She walked out to the lobby and saw a sheriff ’s deputy, and a case worker from child welfare. They asked her if she was Stephany Bryan.
“Yes I am,” she said.
She was handed an emergency order from a judge authorizing CPS to remove her three children from the home. They would pick up the two older kids at school, and they would go to her house to get her younger son, who was three.
“The first thing I said,” remembers Bryan, “was that we needed to make a plan to get my youngest son at home, because my husband was with him. ‘He will not let you take that child,’ I told them. So we made a plan. We got my son from home, got my daughter from high school, my other son from kindergarten, and were able to reunite at a shelter in New Braunfels before they separated us again.”
Bryan and her kids were eventually relocated to separate shelters in Austin. She was told that she had a year to demonstrate to the state that she was capable of taking care of her children and regaining custody. In the meantime they would be in foster care. She was devastated, but also grateful.
“Having your kids taken away is a traumatic thing to a happen to a family,” she says, “but I knew I was sick. I couldn’t take care of my kiddos in the mental state I was in at the time. It was like how they tell you to put the oxygen mask on yourself first when the plane starts to go down. I had to do that.”
From her base at the battered women’s shelter, where she stayed for seven months, Bryan began rebuilding her life. She quit her sales job in San Marcos, which required a lot of travel, so that she’d be available for every therapy appointment, every doctor’s visit, and every court hearing her kids had. She began cleaning—apartments, houses, whatever space anyone would give her to clean—so that she could afford a home in Austin for when she got her kids back. She went to individual therapy and group therapy for battered women.
She also began advocating for herself and her family.
She had to advocate to make sure her kids, two of whom were diagnosed with severe emotional disturbance, weren’t cut off after only 12 sessions of therapy. She also had to fight to make sure that getting them back wasn’t contingent on reuniting with her husband.
“At the time the state was hell bent on reuniting families,” she says. “They thought the progression should be that I go back to live with my husband, we get better together, and then we get the kids back. I said no, I won’t do that. I won’t go back to that environment. I was like an addict who finally got clean. I couldn’t imagine going back to it.”
Bryan proved such an effective advocate that not only did she succeed, at the end of the year, in getting her kids back on her terms, she caught the attention of the children’s director at the local mental health authority, who asked if Bryan would be willing to join a parent advisory council. Soon Bryan was running parent support groups, and then doing occasional contract work for the county, helping parents whose kids were in the system to navigate the bureaucracy.
Two years later, when Travis County applied for a systems-of-care grant from the federal govern - ment, she was asked to be part of the grant-writing team. When the grant was awarded, she was hired full-time as the parent coordinator for the project, and was finally able to close down her cleaning business. By the time she applied for a job with the Hogg Foundation in 2008, to be one of two consumer and family liaisons, she’d accumulated almost 20 years of professional experience in the mental health field.
Perhaps the most important lesson she learned, however, came very early in the process, not long after she’d gotten her kids back from the state. She was giving a ride home to one of the kids whose mother was in the support group she ran. Bryan’s youngest son Sean was in the front seat. The other boy, who was about his age, was in the back seat. She asked him how things were going.
“He said, ‘Things are going okay, but Mom said if we didn’t behave, we were going to have to go to the shelter.’ That’s when Sean turns around and says, ‘I lived at the shelter.’ And he says, ‘You did? Was it okay? ’”
“Yeah, it was okay,” Sean said. “I learned how to take a shower. I got my own bed. The main thing I didn’t like was they made you eat fish sticks all the time.”
“I love fish sticks,” the boy said.
“Then you’re going to be fine,” said Sean. “I’m sitting here listening to these two children, and one, who is my son, is able to reflect this young man’s truth back to him, and make a huge difference just by doing that. It was so powerful. That’s a lot of what I’ve been doing ever since.”
a process of integration
In November of 2008, Stephany Bryan joined the Hogg Foundation for Mental Health. Two months later, Tammy Heinz became the second “Consumer and Family Liaison.”
It wasn’t a frictionless moment for the two women, or the foundation.
“I don’t think any of us knew exactly what was going to happen,” says Bryan. “Most jobs you take, there’s already a well-defined set of responsibilities and expectations. In this case we just had the short job description. Beyond that none of us knew exactly what that meant.”
Octavio N. Martinez, Jr., who had just taken over as executive director of the foundation a few months before, remembers it as a moment pregnant with both optimism and uncertainty. The foundation had been talking the talk on the importance of the consumer voice for a number of years, but this was the first major step toward putting it into practice.
“We all believed that it was an important step for the foundation to take,” he says. “What exactly it would look like, however, we didn’t know. There was no other mental health foundation out there that had done anything like this.”
The first year in particular was a complicated one. Heinz and Bryan had to get to know each other, and feel comfortable working together. Both of them had to feel out what their roles were in the foundation, and how outspoken to be when they perceived that the consumer perspective was being ignored, or that they weren’t being treated as equals.
Heinz remembers a day, about six months in, when she and Bryan came to the conclusion that there was something about their titles that bothered them.
“We were doing the exact same work as every other program officer, but we weren’t program officers,” Heinz says. “It felt stigmatizing.”
She and Bryan requested a change in title. But their supervisor Lynda Frost, director of planning and programs, suggested that it was important to have the title of consumer and family liaison out there in the world as a tangible symbol of the foundation’s commitment to consumers.
“We agreed with that,” says Heinz. “We just thought we should be program officers as well. Heinz, Bryan, and Frost went to Martinez and proposed that they use both titles. He made the change immediately.
“Since then we’ve been program officers and consumer and family liaisons,” says Heinz. “It sounds like a small thing, but it’s not. It’s about us being integrated fully into what and who the foundation is.”
In the last six years, that process of integration has gone far beyond what anyone anticipated when Heinz and Bryan joined the foundation. Two multi-million dollar grant initiatives are dedicated to training certified peer specialists and placing them on health care teams throughout Texas, with one more major initiative in the works, and a number of smaller initiatives ongoing.
All three of the last Robert Lee Sutherland seminars—the foundation’s flagship conferences—have been on topics related to the philosophy and practices of “recovery,” which is a concept that is deeply informed by, and embedded in, the consumer movement.
In 2013, the foundation provided scholarships to hundreds of consumers and certified peer specialists throughout Texas to come to Austin to attend the Alternatives conference, a national mental health conference organized by and for those in the mental health consumer/peer recovery movement.
The foundation’s newest initiative, Advancing Peer Support in Integrated Health Care, brings together the peer support concept with one of the foundation’s longest-standing programmatic commitments, which is to nonprofit community health centers in their efforts to integrate physical and behavioral health care into a seamless whole.
The initiative, which is the first of its kind in the nation, will fund the planning and implementation of peer services in integrated care settings, as well as the training of the staff at these organizations in the concepts of recovery and peer support.
“On the one hand, the goal is the same one that’s driven our support for integrated care over the past decade,” says Martinez. “It’s what we call the triple aim. Improving the patient experience of care, improving health outcomes, and reducing the cost. There’s also another purpose to the initiative, however, which is to change the culture of mental health care settings across the board so that consumer voices are heard and valued. We’re hoping to export what we’ve learned, internally, about the value of consumer involvement.”
Perhaps the best evidence of how much the foundation has changed is the degree to which the consumer perspective has come to inform those initiatives and programs that aren’t primarily consumer-focused.
A good example is the four-year, $10 million Transition-Age Youth and Their Families (TAYF) initiative, which was the largest initiative launched by the foundation in 2014. The goal of the program, which is funding eight organizations in the Houston/Harris County area, is to identify and address the mental health needs of transition-age youth and their families.
In many respects it’s a traditional grant program for the foundation, which has a long history of funding services and supports for youth in the Houston area. The grantees are long-time allies of the foundation: Baylor College of Medicine, Communities In Schools of Houston, Disability Rights Texas, Easter Seals of Greater Houston, Family Services of Greater Houston, Harris County Protective Services for Children and Adults, Houston Department of Health and Human Services, and Star of Hope Mission.
This time around, however, four of the eight grantees are implementing youth peer support programs as part of their activities. All eight are required to involve transition-age youth in the planning and development of their programs, and the foundation’s evaluation of the program, which is funded by a separate grant, will include youth in the evaluation process.
“We’ve come to see that a genuine commitment to the consumer perspective deepens our capacity to have an impact in everything we do,” says Frost.
For Martinez, reflecting on the past six years, the lesson isn’t that the value of consumer involvement has become more important than other core values of the foundation. It’s that the process of incorporating the consumer voice is the latest chapter in a much longer story of how the foundation has evolved while remaining true to its vision.
“The goal is always the same,” says Martinez, “we’re working to build a person, family, and community-centered mental health care system in Texas. We’re working toward a future in which people with mental health challenges are treated with respect and dignity, and mental health is seen as indivisible from all other aspects of a flourishing and healthy life. That’s what Miss Ima and her brothers wanted when they endowed the foundation. That’s what the other executive directors have been working toward, going back to Robert Lee Sutherland. It looks and sounds different at different times, but the overarching story is one of greater inclusion, broader coalitions, and, I hope, perpetual humility. We don’t always know best. We have to keep asking, and listening, and changing.”