Paul Golding + Alexandra Sagov

Dr. Lisa Belisle:

Paul Golding is the Executive Director of Family Hope, a mental health resource agency located in Scarborough. He has served in a number of senior roles in the public health advocacy, higher education and social services fields. Alexandra Sagoff has a Master's in social work and has worked in the mental health field for over 20 years. She has been with Family Hope since 2017. Thank you for coming in today.

Alexandra Sagov:

Thank you for having us.

Dr. Lisa Belisle:

Paul, I'll start with you. You came to the United States in 1990 after getting your education and your early background in the United Kingdom. Why the United States?

Paul Golding:

Why not, let's see back then in 1989 I finished up a long term contract in higher education and I worked as doing a computer project for a library and I was offered a chance to come to Seattle and and set up a database for a biomedical research company. And so that gave me the opportunity to get a green card and but it took a little while because you know, bureaucracy and by the time I got through all the necessary hoops that startup company had gone under. But I got a green card out of the deal and I went to the the embassy and they said well you've got a green car, find a job. So it was, you know, very different time. Anyway, so I took a job with the American Lung association doing computer and database work and then slowly evolved up the food chain to do marketing and development and all sorts of other roles and then went into higher education with at the University of Washington, Portland State. Took an up, took a trip out to Boston looking for work, came up to Portland, fell in love with it, and have been here pretty much ever since. So. And I took a job then with Day One, an adolescent substance abuse agency. I worked there for a while, then the center for Grieving Children, then Stepping Stones, which was the. It used to be called Main Adoption Placement Services, and most recently landed at Family Hope. So, yeah.

Dr. Lisa Belisle:

How about you, Alexandra? You're originally from the Boston area?

Alexandra Sagov:

Yep, I grew up in Boston and I came to Maine. My mother has had a summer home in, in Kennebunk for about, gosh, now it's 37 years. And when she retired up here, I'm a single mom. And so my wonderful son and I came up here and I spent a year as a volunteer in Service to America with the United Way of York County. And that really gave me an idea of what I wanted to do, which was to be a social worker, both clinically and community oriented. So I went to the University of New England and got my master's degree, and I've been here ever since.

Dr. Lisa Belisle:

The work that you're doing with family hope is very interesting and very necessary, also difficult. And the people that are coming in for services generally have complicated situations that you're working with. So you've chosen to frame this as Family Hope.

Paul Golding:

Right.

Dr. Lisa Belisle:

How are you able to continue to have that sense of hope in the midst of. Well, we'll start with you, Alexandra.

Alexandra Sagov:

Yeah, you know, it's. I've always believed that no matter how difficult a situation is and no matter how small you can move forward, it can always get better. The people who come to us are obviously in very difficult situations, but I find that even just having a place to come to feel like you're working with a seasoned clinician who really cares is right away it makes them feel better. And my goal when I'm working with people is I don't let them out the door unless they feel hopeful. And that's really my goal. And in all the people that I've worked with, I've been overwhelmed by the gratitude and also the ability to make some changes, to connect people with services, to help them make difficult decisions, whether it's with how they're going to structure their will, what they can and can't control, and also if it's about grieving the child they wish they had versus the one they do. So it's an extraordinary organization and it's a mental health service that has never existed in the history of mental health. And so it's a constant that I think we're presenting to society that might take a while for people to actually grasp that this can exist. So it's very rewarding and exciting.

Paul Golding:

Well, Alex tells exactly what we do, how we came into existence. Our founder, Donna Betts, she went through this as a parent of an adult who her adult son was mentally ill and she struggled to find the correct diagnosis for him to get services in place. And because of the various challenges that we have here in Maine and we do throughout the United States, in sort of diagnosis and accessing services and working with adult onset mental illness, she found it extremely frustrating. And unfortunately, her son died to suicide. And so to try and make sense of that truly horrific situation, she founded Family Hope and was incorporated in 2012. And after five years at the helm, she stepped down and is now doing something else with her life. And so Alex and I represent to some extent the next wave of people who come in, pick it up. You know, it was an agency, it was in, in good shape. We inherited it, but it was. And, and it had, you know, it being in a sort of testing and development sort of stage. I mean, it was a strong program. And now we sort of feel like we're sort of the next wave of that as we sort of try and expand services, get the word out about who we are and what we do. And we've seen in, in the last, I think in the last year we saw an Eightfold increase in the number of families that we serve, which of course puts pressure on us to find the funding because we don't charge for services, because we don't need people who are struggling to navigate a paucity of services anyway to then have to struggle to find the resources to access what we do. So that's how we came into existence. And so the next way for us is to sort of expand our board, expand our capacity to support the increase in services that we're seeing and try and break down the stigma associated with mental health, advocate for a greater understanding of it, work with families to navigate services both for their identified patient. And the thing that Alex talks about so well is that what is unique, I think, to Family Hope is that we start by trying to Address it on a family level. And the view that I say is that if properly supported families, they're the natural supports of the mentally ill person. And if properly supported and educated, family members can not only not do the wrong thing when they've got someone, but do the right thing. And so the affected others, the families, they need the support in order to best support their loved ones. Because we're dealing with a chronic situation, we're not dealing with acute illness by and large, we're dealing with people, people that have chronic mental health problems. So once that impacts the family system, it's a permanent change. And families are very good at dealing with short term crises and they focus on the loved one. They may in fact get them services and they begin to do better. But it's impacted the family in a way that they now need support going forward. And so we are unique in that sense that at least here in the States, you know, it's predicated on some, some good research that came out of Canada and it's a model that waxes and wanes in Britain depending on various government fundings for those kinds of services. But it's the notion that, you know, we should support the family, not just the patient. And so that means, of course, that every, every phone call is different, every family situation is different, different. And one of the things that we're trying to do at Family Hope with the model that we inherited and the one that we're developing is to not have, not to replicate the kinds of cultures that many social service agencies have where the frontline staff get burned out. You know, so you work closely with one family, from soup to nuts, and then move on. And we try not to have a heavy caseload where you're not doing very much for anyone. One you're just trying to keep things going for an hour a week, indefinitely. What we try and work closely with the family until, as Alex says, suffering is reduced and relieved and people feel hopeful. And a lot of that is making referrals and suggestions and connecting people to support in the communities and hearing back from them, whether that works or not, and then trying some other stuff and then moving forward. So it's intensive, but it's not long term. I mean, many of the social service agencies that we have here in town, they'll open a client and that client may be on their books for years. And because they're, you know, great people are doing great work with them, but they're not get, the families aren't being supported, they're not getting connected to other Resources. And so they're moving them an inch at a time, and we're trying to move people a mile very far outside.

Dr. Lisa Belisle:

I think, about the need that we have in the state and really across the country, maybe across the world. I just happen to know about our own state, and I wonder how possible it is to help people in this intensive way in large numbers.

Alexandra Sagov:

So one of the goals of Family Hope is what we eventually love, is to have this in every county. One of the unique ways in which we operate is they are welcome to come to the office and meet with us. I can meet them in the community. I can go to their homes. And I think one of the struggles and something that we want to look at would be great if we could get funding is to really be able to quantitatively and qualitatively be able to really document and tie it into. How does this help? Right? And so anecdotally, everybody that we talked, I mean, not one person has ever said, oh, that's a terrible idea. And so one of the things that Paul and I are looking at are what are the barriers, right, that people are dealing with that aren't being addressed? And so when you have adults, and this is true, I think, in every state here, is that you have the right to be mentally ill. And, you know, that's a fact. And that's often something that's very painful for parents to recognize that they don't have any rights to information, to doctors. And so, you know, we have families who are literally held hostage for. I have one case, eight years with over 30, with probably the most serious case of OCD, obsessive compulsive disorder I've ever seen. I mean, really. And so one of the things that I was struggling to try to do because he can't leave the house is how am I going to get a clinician to come in and have eyes on him and perhaps even be able to medicate him enough so that his anxiety decreases. He can then go out into the community and get main care and get on an ACT team, which is an intensive outpatient treatment. And so I did talk to some psychiatrists, and I said, okay, what would it take, right, to be able to get you into that house? And it was money. It was about because these people don't have insurance, they wouldn't be able to bill for their time there. And then if they had to travel. And so what I said to them is, what if I got a grant that would actually pay you to do that? And would you also be willing to do it on a sliding scale. So these are the kinds of concepts, right, that have not, they're not out there in any way, shape or form. And so these are, you know, I'm very excited and also a little fearful that people won't get, you know, sort of the value of it. And what we're asking, right, is for them to suspend disbelief, to invest in it and then see what the results are. So that's an example of sort of how we're looking to address barriers that haven't been addressed before.

Paul Golding:

And so I think, you know, you're trying to, as Alex says, you use the data and the experience of your clients to try and bring about a systemic shift in thinking. Providers are there. When I go out and talk to people about, I go out and talk to case managers and clinicians about who we are and what we do, the phone rings off the hook. I make a presentation and my phone is ringing as I leave the meeting. People trying to access that because they themselves know that I have a family, that if they, if you could just spend a few hours with them, that would help my client tremendously. So, you know, there has been, there's a lot of buy in at the executive level. When I go out and make presentations to various providers around town, they get it. But the traction to access, to bring that, to bring those services in house really comes from frontline staff, frontline staff who are working with the clients so that those are the people that we try and go and educate. Now the challenge of course is, you know, the more the phones ring, the more expensive it gets. And so, you know, funding is always a challenge. We have a fundraiser next week at the Westin and we hope that, you know, people will come and, you know, enjoy the night. We write grants, we do appeals, we have a board that, you know, doing all those things. So we're just like every other non profit. But our view, I think in the long run is that we'll be able to take the quantitative and qualitative experience that we have and translate that into policy and to try and get the Department of Health and Human Services or other providers to partner with us and to find ways to ultimately like, bring about that systemic change. And I think that that will come. I have faith in that because I worked at the center for Grieving Children for many years and that was a new idea. When that idea came along of peer support for kids. This center here in Portland was the third such one in the country. There's now over 350 such centers around the country, there's a national alliance. I had the distinct honor of being the president of that for a while. And one of the things that we used to hear when we get together for conferences and. And stuff was that we needed big funding in order to sort of make that happen. And the New York Life foundation got behind bereavement. There's an organization that makes a lot of money, and many of their employees were tired of going out and giving checks to families after being a horrible loss and not knowing how to better help those families. So the New York Life foundation got behind the national alliance. We're looking for that kind of both here in Maine and on the national side. Looking for someone that, you know, some industry partner perhaps who sees that, you know, maybe the pharmaceutical companies can take a step back and say, look, you know, it's not just medication that, you know, medication is an important part of this. Psychiatrist and psychologists can step back and say, it's not just our corner. I mean, I think, you know, that will come. You know, I think that will come in America, I think, you know, and then when it. When it happens, it'll happen fast and it'll happen big. But, you know, we. That's a big part of what we're doing. We're just trying right now to, you know, replicate the Alexes of the world in every. Every county in here in Maine, you know, and so, you know, we don't need millions of dollars to do that. We need thousands of dollars to do that. But we always have our eye on the fact that, you know, we could, you know, we. We have something that's unique here. It's eminently learnable, eminently replicable, easily trainable, you know, so I think from that point of view, you know, it will come. And it's to Donna's credit, our founder, that she put something together that has that potential. And now we've got to put a foot on the gas, bring in more money, get more people, and that it will catch fire. I mean, that's. I genuinely believe that, you know, we have. We have a passionate board and we have. And unfortunately, there's a lot of need. So, you know, if we can do things differently and. And it's. It works. The word will get around.

Alexandra Sagov:

I think one of the things that I. There are some natural partnerships that we're actually having trouble solidifying, and I'm not exactly sure why. So, for example, adult services at dhs, you know, adult protective Services. You know, I spoke to somebody there and she was. I can't believe we don't know about you, you know, this would be a great fit, but yet the referrals haven't come. One of the things that I will do with the family where there's a potential for either violence or suicide is I will call crisis with the family and I will also call the local police department and I'll say, listen, I want to give you a heads up. You know, we're not in an imminent situation, but if we call you, I want you to be able to immediately go and know, you know, whether this person is aggressive. Because sometimes the relationships with law enforcement and mental health have gone awry, although there is a lot of movement towards that. And so I had a recent sort of exchange with the York County Sheriff's Department, and they hadn't heard of us. And so what I liked about it was they invited us to come and speak. But what's difficult is, you know, because when you're a parent of an adult, if I was a therapist of that identified child, I can't give you any information. And so I have to imagine that there are people that are serving the clients that are. And when I was a case manager, I would get calls from hysterical parents. I can listen, but I can't respond. That would be a perfect opportunity. Or a police officer that was out on a scene to see, say, here's family Hope's card, call them. And I have yet to have an experience where a family has come that we have not gotten them into a better place. So that's my biggest concern, is about how are we not partnering, how are we not becoming part of the fold?

Paul Golding:

So that's but an interesting. To that point, just last week I was part of a panel discussion that South Portland Police Department put on and they had people from the crisis team from Opportunity alliance and someone from NAMI who's people we partner with, and the behavioral health professional, Dana, who's the. Who goes out with the police on those calls. And so Portland has it, Westbrook has it, South Portland has it. And that's very much on the cutting edge. That's not typical for Maine police departments and it's not typical around the country. But there's something is beginning to happen. So, you know, as Alex said the other day when she dealt with that family, so that's great. What's cool about that is we can call their police chief or their sheriff, have them talk to their peer, you know, the police chief of South Portland, they will say, here's how we're doing it, here's why we do it that way and we can again, you know, it's incremental. That's great. What I would love is that, you know, it's great when you do a piecemeal like that, but I would love that, that be part of the curriculum at the criminal justice academy. So, you know, you know, when I worked at day one, one of our colleagues, you know, from one of our programs was on the curricula there to talk about substance abuse, to get people to make referrals to the treatment network and into juvenile drug court. Because police officers have a lot of things going through their mind when they roll up on any scene, whether it's an accident or a crisis. But the more it's part of their thinking of diverting people into treatment, the better it is. So, you know, so it's common, but it doesn't happen. You know, you can tell we're impatient. It's just.

Dr. Lisa Belisle:

I don't blame you for your impatience because I feel the same way. I mean, I'm seeing more rather than less violence directed towards self and other with people who are traumatized, with people who are grieving, with people who have some sort of biologic mental illness. And it, and it can't come fast enough. You know, from my standpoint as a doctor, as a mother, as a member of the community, when we have not solved this problem and I, and I don't know what we're waiting for.

Alexandra Sagov:

Money, really?

Paul Golding:

Well, I mean, that's always the easiest answer. I mean, I've worked in public. I mean, I'm not going to disagree. You know, we'd certainly, you know, if someone wants to come down with a huge bag of money, we'll make a huge difference. But I also worked in public higher education for many, many years, and that was the one, the joke there. We used to sort of like sit around the room, as you know. Of course I worked in development because we didn't have enough money. But it was this idea, it was the one, the last thing in America that people would throw lots of money at in the vague hope that it would change things. And I think so. Resource is important, but Will is an incredible, you know, and, and smart thinking and joined up thinking and the resolve to make changes. I mean, if you look at the recent issue around the gun debate, which is a natural discussion to look at. So you've got people on one side of the argument are looking at the constitutionality of it. On the other half they're looking at access to weaponry and the scale of carnage that can be done by Weapons. And then it just comes polarized and then it goes away because it becomes a stalemate. And the thing that's interesting to me there is, you know, whether the issues are around who accesses guns and stuff, there has to be a point where the country transcends that and says we have to break out of what we've been doing. And I do feel. I do feel that there is. That that potential is there in the mental health field. Some of it is coming out of the opioid crisis that people have realized, how did we get to this point where, you know, we have, you know, an incredible number of deaths, you know, here in Maine? How did we get to it? How do we get out of it? And suddenly people change the way they think, and then. Then that leverage can happen. It. So when it comes back to sort of our mission, I. I do. I mean, to have three police departments, you know, in fairly close proximity, have behavioral health workers that go out on those kinds of calls and connect to services and to hold community forums is great. How do we do that on a statewide level? How do we join that? Well, it would be great if we had a governor that thought about things in those terms, if we had a, you know, a commissioner at the Department of Health and Human Services who thought about it in those terms rather than just purely in budgetary terms. And, you know, I'll give you a little editorial. There is a wonderful study being conducted, funded by the Lunder foundation, looking at a similar program, not the same, but a similar program to ours, that main behavioral health is doing, in which they are looking at how do they support families of folks, and they're tracking, you know, all the reduced costs in medication and hospitalizations and incarceration, that sort of stuff. And the Department of Health and Human Services has a great interest in what the outcome of that data is. Their specific question, as I was given to understand, is, will these people be off welfare? Will these people go back to work? Should we support. If we support mentally the families of the mentally ill people, Will those mentally people go back to work? Will they get a pulpit? And that's an interesting question, but it's one question, and I think it's not the most interesting. And I think it's. It tells you what the agenda is. You know, so there has to be a sea change in values, too. One in five or one in four people are going to experience mental health issues in their life here in Maine, across the country. So we have to think about it differently. We have to sort of view it differently. We have to. And we, Many, many people are mentally ill and live fully functional lives. They just have to, you know, take the medication, go to treatment, Alex, and talk about all that sort of stuff. But, yeah, we have to. We have to have a shift in values, you know, and that, that will come. Just no one talked about childhood bereavement 30 years ago. Now it's. It's a commonplace thing that you. When this, you know, when a kid, the kids experience bereavement differently, mental health will be dealt with differently. It will come. I mean, it's a cool country because it reinvents itself. Every generation just needs to sort of pick that as a priority and get on it. That's my soapbox right there, you know.

Alexandra Sagov:

You know, another thought that I had was, you know, Portland, when I first came here, the diversity level was zero. And now we have a huge refugee population. Actually, I volunteer at the Boys and Girls Club every Wednesday. And I, you know, it's like 90% African American, you know, or immigrant children. And it's, you know, it really let me know. And I also had a conversation with a friend who. They're refugees, and there's a first break. Schizophrenia. And I thought, you know, here's another area where culturally, language wise, so it's, you know, these are the kinds of things Paul and I are not exactly sure where we need to kind of have this conversation. We know that we can write grants. We know who natural partners may be, but there's always an organizational change, especially in nonprofit, when it's connected to budgets and political ideas. And I am impatient. I am not a process person. I am a vision person. And so, you know, that, you know, I'm just brimming with kind of hope and ideas. And yet, you know, I'm hoping that us talking about it today, you know, maybe it really inspire people to kind of say, you know what? These are great ideas. And it's not just about money. It's about support. It's about you. You know, when you're at church or when you're at a coffee shop, I mean, if I overhear people in a restaurant that are talking about this kind of stuff, I will approach them and say, you know, you know, I'm sorry for overhearing it, but, you know, I heard your pain and I just want you to know, I mean, even in a dentist the other day, you know, somebody asked me what I did, and I said, do you know of anybody where this might be appropriate? And so even just that, even just being able to refer your own friends to this. I think the more stories and the more people that were able to touch and the more opportunities we're able to tell real stories, that's my job, is to get you where your heart is. To imagine, like you said, I'm a mother, I'm a citizen. I mean, I believe that that's really what motivates people, whether we're Republicans or Democrats, we're parents, we're neighbors. And so that's really, you know, and this is the Love show. And I do believe that love is really what keeps us motivated.

Dr. Lisa Belisle:

So I've been speaking with Paul Golding, who's the executive director of Family Hope, and also with Alexandra Sagoff, who has been with family hope since 2017. As a social worker, I really believe in the work that you're doing. So I hope that people who are listening are going to ponder how they might be able to help out with this, because I think that this is really the time and I appreciate all that you are, all the efforts that you are putting forth.

Alexandra Sagov:

Thank you so much, Lisa. I so much appreciate it.