Greetings, MindSite News readers.
In today’s Daily, one Orange County residential program for people with severe mental illness shows how treatment across the country could work in the future. Experts offer first steps on helping loved ones with hoarding disorder get treatment. And, actor and activist Joaquin Phoenix implores omnivores to consider not only the conditions of animals across our nation’s factory farms, but also the workers tasked with processing them for our consumption.
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Since 1989 the John Henry Foundation has offered a residential treatment setting for residents with severe mental illness, who live in bungalows on an open campus. Photo: The John Henry Foundation
Kartar Diamond was blindsided by the mental health issues that her son, Noah Silver, encountered in his teen years. As far as she could tell, his childhood offered no indication that he would one day be diagnosed with severe mental illness. In fact, ask anyone who knew him then, Diamond told the California Health Report, and they’d concur he was intelligent, joyful, and musically gifted — taking up both bass and acoustic guitars and later teaching himself to play drums. But when Silver became a teen, she said, things changed. His pleasant personality morphed into one rife with moodiness and rebellion. Worse still, he fell into delusions of grandeur, including ones in which he declared himself a great spiritual leader and believed that every musician in Los Angeles sought to steal his ideas.
Making things more challenging, Silver (a pseudonym used to protect his identity) was plagued by years of misdiagnosis. His mother went from being told he was “going through a teenage phase,” to him being diagnosed with social anxiety, then bipolar disorder. Finally, a psychiatrist landed on the right diagnosis — schizophrenia — when Silver was 17.
But if arriving at the right diagnosis was tough, securing the proper help was harder. For just over a decade, Silver lived in nine board and care facilities, had five hospitalizations, stayed briefly at a recovery center for formerly incarcerated people and, like many people with severe mental illness, even experienced homelessness. But seven years ago, Silver’s life shifted again — this time for the better.
That’s when he was able to move into an Orange County residential program for people with severe mental illness run by the John Henry Foundation, a nonprofit organization serving people with schizophrenia. He sat on the waitlist for three years before receiving a room in 2019. “I feel really grateful that he’s there,” Diamond said.
Stories of trauma are far more common than stories of triumph for people with serious mental illness, which 1 in 20 Americans experience every year. California’s history of psychiatric care stretches back to 1853, when the state’s first psychiatric hospital opened as the “Stockton State Insane Asylum.” Decades of abuse, including lobotomies and electroshock therapy, partly fueled a deinstitutionalization movement in the mid-20th century, though systemic problems in “locked” facilities persisted.
In Silver’s case, his various stays in board and care institutions brought no improvement and, at times, harmed him. His experiences had been so poor, Diamond said, that she was surprised when he agreed to try the John Henry Foundation at all. But “even in the fog of his mental illness,” she said, “he could recognize that it was a really nice, clean place”. Residents at John Henry live in bungalow-style dorms with access to courtyards, recreational spaces and on-site clinical and medical staff.
Programs like the one run by the John Henry Foundation and another led by Psynergy Programs, which runs six facilities throughout the state, offer care through a unique model: They are open-door residential communities staffed to meet the complex needs of people with multiple diagnoses.
Unlike the locked facilities and hospitals where Silver stayed before, open-door programs allow residents to leave the grounds to pursue typical life activities like attending college. These programs were highlighted by mental health advocates Teresa Pasquini and Lauren Rettagliata in their 2020 Housing that Heals report as models in California worth replicating. They offer what so many families have struggled to find — a place where stability, dignity and real treatment can coexist.
As John Henry Foundation’s Clinical Director Andrew Kami sees it, effective treatment begins with stability. Getting to know the person behind the diagnosis helps the clinical team address symptoms like anxiety, panic attacks and delusions through therapy. “We try to establish some understanding and a shared relationship,” Kami said. “Then from there, that’s when we’ll start to get a bit more of the information around how the things that they’re experiencing impact their lives.”
Strong relationships and care for the whole human being — including their mental, physical and social health — is critical, added John Henry Foundation Medical Director Dr. Rimal Bera, because very ill people often stop treatment when they begin to feel better. Considering the life expectancy of people with schizophrenia is 20 years lower than average, a trusting relationship helps ensure that crucial provider instructions to remain in ongoing care are followed.
Despite John Henry’s success, access to such well-rounded care remains limited for people with severe mental illness. The program has a cost of $4,250 per month, and the foundation has an extensive wait list, highlighting the state’s perpetual shortage of psychiatric professionals and residential beds.
Meanwhile, Diamond is grateful for the stability and growth she’s seen in her son’s wellbeing. Recalling something upsetting that happened to her, she noted that Silver called her the next day to check in. “ When somebody’s deep in their own psychosis, they only care about themselves and their own needs,” Diamond explained, “and to have him show that kind of interest in somebody besides him and show empathy, that was like the old him.”
Hoarding disorder is more common than you think. Here’s how to help
In 2024, shortly before her father died, Madison Lovelle entered his home for the first time in 17 years. They’d shared a loving, supportive relationship for the entirety of her 40 years, but like many children of hoarders, myself included, she preferred to spend time with him elsewhere. The mountain of things inside his home just made it too unsafe, unsanitary and uncomfortable for a visit. Now, though, her dad was ill: Following a stroke, she was there to take care of him. His hoarding disorder made care difficult. “He was upstairs, and he could not get downstairs,” she told USA Today, but had begged her not to call EMS because he didn’t want strangers in his home. “And honestly, I don’t know that they would have been able to get through there,” she said.
“You can’t make sense out of it, but there was this connection to the stuff,” Lovelle said. “He genuinely was worried about that stuff going in the trash. And it really did cause him a lot of anxiety.”
Hoarding disorder is more common than most people realize, and is estimated to affect between 2% and 6% of the population according to the International OCD Foundation. Stigma keeps many families silent and struggling alone. Symptoms are most prevalent in adults 55 and older, and tend to grow more severe with age. Caring for her father, Lovelle faced challenges that scores of other families quietly confront, often without the support or resources to effectively help their loved ones.
Clinically, hoarding disorder falls under obsessive-compulsive and related disorders. It affects executive functioning and organizational ability, making it nearly impossible for people with hoarding disorder to stop collecting things or let anything go. “It’s not laziness. It’s not being a slob. It is a psychiatric issue,” explained Anne Pagano, a clinical social worker and founder of the Hoarding Disorder Resource and Training Group in Westchester, New York. Some people with hoarding disorder even experience “clutter blindness,” meaning they genuinely cannot see what others see in their living space.
Hoarding disorder can take root in childhood or be triggered by trauma, and often runs in families with both genetic and generational components. “Our parents teach us what to value, what to not value,” said Mary Dozier, an associate professor of psychology at Mississippi State University who studies hoarding. Sometimes the inheritance is literal, she said, with surviving family members left to clean up a hoarded home becoming so overwhelmed that the cycle simply moves into the next generation.
Experts suggest that loved ones looking to help avoid one of the most egregious errors that many well-intentioned people make: clearing out a person’s home without their permission. It’s the worst thing a caregiver can do, Pagano said, and can cause acute distress without resolving the underlying issue.
Instead, Pagano and Dozier recommend gentle, boundary-focused conversations that include a clear expression of concerns and safety risks while inviting the patient to confront their hoarding habits. Dozier also offered questions that focus a patient’s current goals and guide their cleaning and decluttering. Do they want to age in place? Move to a retirement community? Cook more at home? Each endpoint requires specific work that can make the conversation feel less like an attack and more like support.
Loved ones should also note that hoarding disorder carries a high relapse rate, meaning that even after a home is cleaned out, the work isn’t over. Regular check-ins from family members, friends or case workers are essential to keep clutter from building back up. “Having that oversight or that supervision really is mandatory, or else there’s going to be a slippery slope,” Pagano said. “It’s not a quick fix.”
In other news
The hidden mental health crisis inside factory farms: When we talk about factory farms and slaughterhouses, the conversation usually centers on animal welfare. But Oscar-winning actor and activist Joaquin Phoenix wants to know: ‘What about the workers?’ Rounding out Mental Health Awareness Month last week, he wrote a guest column for Variety citing a growing body of research on the psychological toll facing the nation’s food processors. Many of them are undocumented, migrant or otherwise marginalized, and have little access to mental health care and even less power to speak out against their working conditions.
On any given day, a single worker may be tasked with butchering hundreds or even thousands of animals at a relentless pace driven by production quotas, with little time to pause or recover. “Research and firsthand accounts link this kind of labor to heightened anxiety, depression, emotional numbing, and symptoms consistent with post-traumatic stress,” he writes. Many workers report feeling detached, irritable or haunted by what they witness on the job. Yet these realities are rarely acknowledged in broader conversations about workplace mental health — and new federal rules proposed by the Donald Trump administration, intended to increase slaughter speeds, would only make things worse.
“Addressing this issue requires more than awareness. It demands structural change,” Phoenix writes. “Employers must be held accountable for providing safe working conditions and meaningful mental health support. Policies should ensure that all workers, regardless of immigration status, have access to care without fear…At its core, this is about dignity. The people who process the nation’s food are not expendable…Their mental health is not secondary to their productivity—it is fundamental to their well-being and to the ethical integrity of the systems we rely on.”
Successfully applying the process of external review for mental health care: Last week, for its most recent episode of Paper Trail, a podcast from the investigative team at ProPublica, reporter Duaa Eldeib detailed her journey with Teresa, a ProPublica reader. Teresa’s husband had been denied medically-necessary and urgent mental health treatment by their insurance company, and they were appealing.
Eventually, the couple deployed a tool called external review, a free process in which an independent medical expert evaluates the insurer’s decision. If the independent reviewer determines that the denied care was necessary, the insurer is compelled to reverse their decision and pay for services. As a warning, the 40-minute episode contains graphic descriptions of attempted suicide. Should you prefer to read about their experience, the 2025 article from which the podcast built its audio story can be found here.