An episode of Changing the Conversation podcast.
“There are people that have created those pathways for themselves. We have national leadership now. That national leadership may not have occurred if it were not for the local programs that were funded…10 years earlier.”
April 27, 2026
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Livia Davis (Host) (00:06):
Hello and welcome to Changing the Conversation. I’m your host, Livia, the Chief Learning Officer at C4 Innovations.
(00:14):
Today’s conversation is part of a podcast series called Learning From Our Recovery Elders to Inform Our Work as Recovery Leaders, where we invite recovery leaders to share their wisdom. Our aim is not only to preserve our guest’s invaluable insights, but also to inspire current and future leaders as we work to continue to expand access to recovery.
(00:38):
My guest today is Laura Van Tosh. She’s calling in from the state of Washington. Laura is a longtime mental health peer activist who has been active in the peer movement since 1985. She has informed many policy initiatives and received many awards. And she’s also the founder of the Mental Health Policy Roundtable that we will talk about a bit more today.
(01:03):
Hello, Laura. Thanks for joining us today.
Laura Van Tosh (Guest) (01:06): Wonderful to see you. Thank you.
Livia (01:09): Laura, you’ve been working as a mental health peer advocate for many years. Could you start by letting our audience know how you got involved in policy development?
Laura (01:21):
Certainly. Well, back in the mid ’80s, I was offered a position to actually move to Philadelphia and direct a street outreach program for people who are homeless and mentally disabled. The street outreach program was actually funded by the National Institute of Mental Health (NIMH). It was the only peer-run program at the time that received that kind of funding, which was really amazing and I had the opportunity to build from the ground up to help people on the streets of Philadelphia come off the streets and move into permanent housing as well as access employment and peer support.
(01:58):
All of us on the team were formerly homeless and also had mental health or substance use challenges. And we were recognized at the national level for the work that we were doing, which actually had an impact on local policy originally. Our challenge was to show that people with behavioral healthcare issues could impact the workforce, again, helping people who were homeless with mental health disabilities.
(02:23):
And we were able to achieve that goal through research. And the policy shifted at the city level where peers were able to access positions to work and help people in the mental health system in general. And so that policy, my work actually and our work as part of the team, really influenced local policy, and then eventually state and federal policy when our work was acknowledged at the national level for helping people again with homelessness and mental health access. So that was really an interesting opportunity and an original step for me and also this great team that I worked with to help people end their homelessness and begin their new lives, if you will, working in the field and providing peer support.
Livia (03:10):
Well, that’s amazing. There’s so much to learn from just right there. And so, you were really impacting the system by doing outreach side by side with non-peers in these outreach teams. But you also mentioned research. So, was there an evaluation component to what you were doing?
Laura (03:29):
Yes, there was, actually. It was actually a fairly small funded program overall. Again, in the mid-1980s, the grant total was somewhere in the amount of $120,00- $125,000. And you might be shocked nowadays with that amount, but that was actually kind of an annualized … It was a demonstration program under the National Institute of Mental Health, and they had a Community Support Program under that, and that’s where this project was originally funded.
(04:01):
There was a small portion that was mandatory to spend on evaluation. And yes, we had a fairly basic evaluation model. We of course counted the number of people that we were able to assist. We had surveys to indicate how our services were possibly different than non-consumers or non-peers. And then we had an overall evaluation of our effectiveness in the city. There was a qualitative component where we interviewed people who were influenced by the program in one way or another, either a partner at the community level or an actual person who received the services that we provided. So, there was low-level evaluation, really nothing extremely scientific, but enough that it hit some of the points that the NIMH wanted to find out from our program.
(04:51):
The results of that, by the way, had an impact on the Community Support Program funding a batch of peer-run programs in the future. In the next funding cycle, there was actually a group of 13 programs. I actually helped do an evaluation of all those programs, by the way. I was an independent contractor. This was long after I left the homelessness program. And Paolo del Vecchio and I conducted a fairly detailed evaluation of those 13 programs.
(05:23):
It was a retrospective. So it was after their funding had ended, they were granted this contract to take a look at those programs. And then from there, the community support program funded additional peer-run programs called the COSP (Consumer-Operated Service) Program, which had more heavy-duty evaluation conducted by peer PhD researchers.
(05:48):
The program that I ran, by the way, was called Project OATS, like the cereal, Outreach Advocacy and Training Services, for people who are homeless and mentally disabled. So I’m very happy to say that I think the outreach program that I directed actually did leave some seeds for new programs in the future.
Livia (06:07):
For our listeners, this demonstration pilot that you were the lead of really set the stage for a lot of SAMHSA, so the Substance Abuse and Mental Health Service Administration’s grant funding later is what I heard. And I just want to connect those dots for the audience. So thank you.
Laura (06:24):
Sure. And one other thing that’s really important that no matter what kind of grant or contract you might have to start a program, it was enough back then. Again, this was 1985 dollars. I also worked in a nonprofit, so there were other resources available, so there was a lot of overhead that I didn’t have to worry about. So there were actually real dollars for real services. But also I was able to get continuation funding after the three years were over. The State of Pennsylvania picked up the program and fully funded it. And that had a lot to do with the evaluation that we conducted. So that’s to encourage people to really think about evaluation and how the power of looking back at your work can have an impact on future funding. So that was very, very exciting.
(07:11):
The outreach supervisor that worked with me on Project OATS was elevated and became the director of Project OATS. And I moved on to coordinate a national clearinghouse in the same nonprofit that we were all a part of. So it provided an empowerment tool for staff to continue to work on those programs and also to have a career path in terms of supervisors being able to get elevated into management kinds of positions in the nonprofits. So I was really happy about that.
(07:46):
Also, for people who have an ear out for SAMHSA nowadays, the National Institute of Mental Health spawned SAMHSA. So yes, SAMHSA did not exist, but eventually the Services Administration, if you will, at the end of SAMHSA’s title, was created out of NIMH so that there could be more services funded like Project OATS and many, many other programs that NIMH was funding at the time.
(08:13):
That was also a bit of a political policy move in a way to create an avenue for more services dollars that still had research. As you know, SAMHSA still conducts research on programs, but this was more of a clear line of resourcing that occurred back in the early ’90s when that actually happened.
(08:32):
And NAMI, the National Alliance on Mental Illness had a lot to do with that happening. They wanted more basic research funded to look at cures and other means of supporting people with mental illness and addressing research dollars and research directing to actually find out more information about new medications and, again, curative kinds of services that NIMH could fund. And a lot of peers were involved in that advocacy, by the way. So, this is early, early days, but it was very exciting.
Livia (09:10):
I just love to have folks connect those dots back to that Philadelphia program. And I think also there’s a lesson there about ensuring that we add evaluation to as much of these program services as we can, right? Because it just shows just how much power, how much that was leveraged for future policy initiatives, just like you point out. That’s very exciting. Thank you for sharing that.
(09:34):
So a lot of your work, of course, has focused on ensuring that people with lived experience and expertise are meaningfully involved in developing policy. Can you talk a little bit more about that? What are the benefits?
Laura (09:50):
Absolutely. Well, one of the clear benefits actually in terms of recovery is just being involved in discussions and leading programs perhaps or being involved on a research team. What really improves one’s chances at recovery and being involved with others is a very peer support kind of activity. And that really, I mean, I have to say that I had had some mental health bumps in the road where I ended up needing to be provided services and take a bit of a timeout. And I think that being involved in peer policymaking and just being part of the peer community really helped me realize that if I need those kinds of timeouts and opportunities for wellness, that I can in fact do that and take care of myself.
(10:40):
So, I think recovery and working with other peer groups is really enhancing. And in terms of recovery opportunities, being involved in policy helps to open up avenues for new input and new opportunities for engagement. So often people with mental illness or who identify as having a mental illness are not included in those discussions. And I think just being at the table, the opportunities for engaging in policy just further improves the opportunities that people with mental illness can be impacted by programs that are discussed, or research agenda that’s created. And I think the other main benefits of that, it’s really inclusion, and that really has a lot to do with people being able to live their lives in the community and participate in these kinds of opportunities.
Livia (11:35):
And certainly, I mean, if you have a chance to think through a policy where it might end up, what might be the effects long-term, unless you have the lived experience there to say, “Okay, but if you’re changing X, Y, and Z policy, did you think about what that might be from our experience trying to access the service?” Because so often policymakers may not see the full consequence of a policy. And so, having that lens there is so critical to think about what does it look like? What are the effects once implemented?
Laura (12:07):
And I think we don’t talk enough about, I mean, it’s easy to say it improves your recovery, but in many ways, I mean, it does. But it also helps other people who, like you say, are not influenced or affected by mental illness directly to understand that we move on quickly and need to get things accomplished when we have to realize that recovery is a process. We have to inquire, as you indicated, and include as we both are talking about, and all of that really helps make policy even more impactful. I’m hopeful that we can do more of that at the national level.
(12:44):
There was a couple of historical bills, by the way, that were passed by Congress. This is legislation one in the State Mental Health Planning Act is what it was called. That was the original law and paneling of the state mental health planning boards really had an impact on policy because there was a percentage of peers that needed to be appointed to those bodies, 51% families and consumers, as they called it. And those boards create policy and decide on funding issues at the state level. So that’s a high-powered group usually. The planning boards is challenging to make sure that there are enough people on the boards that are consumers or families. So training is really important at the grassroots level so people can emerge and serve on these state bodies.
(13:35):
The other bill that was about a year later was the Protection and Advocacy Program for People with Mental Illness. It was called PAIMI, P-A-I-M-I. And that created opportunities at the protection and advocacy offices at the state level to make sure that abuse and neglect was investigated and overseen obviously to end those practices at the state level, typically in public facilities, which primarily included state hospitals. They ended up expanding the PAMI purview and include community programs now in places where the PAIMI legal teams at the protection advocacy level could look at local programs and make sure that people are getting served, people’s rights are being protected, and all of that that goes into the P&A program at the state level.
(14:28):
Those boards also needed to have consumer and family voices as well on their advisory boards. Those two things happened within a year or two of each other. It was the late ’80s and it opened up these large opportunities for people, especially in states like New York or California, the large, large states that have a lot of resources where they need to make funding decisions. Being involved on those boards was actually prestigious at that time. And people brag that they were on those boards and they probably needed quite a bit of time to learn about the system.
(15:04):
I used to attend the meetings in the states where I lived, Pennsylvania, Maryland, and Washington State, just to learn how the system was designed by going to those public meetings, but they’re still public. And it’s a great place, even if you’re just Zooming into one of these meetings, to learn about what your state design of programs are, implementation, issues that could be occurring at the state level or the local level, new funding opportunities that could be available.
(15:35):
And you don’t, again, need to be a “member”, but if you’re interested, you can submit your name when they have the membership drive and get training and actually sit on one of those boards. Again, that was a policy avenue for peers that otherwise would never have existed.
Livia (15:53):
I love those concrete examples that folks can take as a result of this podcast if they’d like to try to be involved. Whatever state you’re in, you can find out what are those boards and then how can you get trained in how to participate.
(16:08):
Could you share just a few more examples of how mental health peers have been involved in shaping mental health policy? Because I know that you have a lot of history and background on that.
Laura (16:18):
Thank you. And I learned from the veterans. I learned from the people that we’re all learning and reading about today. Two issues that may have been even happening simultaneously, but the creation of Offices of Consumer Affairs at the state level and the other was the Surgeon General’s Report on Mental Health. And those were two fairly large areas that multiple peers had been involved in.
(16:46):
But there was a handful of really, more or less, of peers that were called upon by the scientific editor of the Surgeon General’s report, Dr. Howard Goldman. I actually worked with him. He was my boss at one point. He also is a mentor currently, even still after knowing him more than 20, almost 30 years. And at that time, he held a lot of influence over the creation of the Surgeon General’s report, and he wanted to include peer voices in the creation of chapters and within the report, the research design, and also to develop a core of peer reviewers who could read sections of the report.
(17:30):
So he had a planning board of peers, and three or four peers were on this planning body that he created, and they were very involved. Larry Fricks, who has passed on, but he was very impactful in terms of developing peer support specialists around the country. And he was a national leader in that regard. He was on the planning board, and he came in with a list of peers to come and write for the report. So people were given homework, really, to develop sections and chapters and review panels. So that really was a wonderful opportunity.
(18:06):
It was also the first time that the Surgeon General even had a report on mental health. There had never been one, which is kind of surprising. The famous one was on smoking, so people do remember that. There was a section that the Surgeon General did feature later on substance use disorders, and that was again, never developed before and had this wonderful opportunity of creating a section on that.
(18:33):
That was one definitive and really exciting opportunity for peers. And I think we made a big difference. There was actually a whole section that I was involved in writing on consumer and family influence in mental health and behavioral healthcare. Luckily, it was nice that there was a chapter developed for peers and families in that kind of a report.
(18:57):
Later, and really during that whole process, and Larry was involved in this too, because he was a director of the Consumer Affairs office in Georgia. So, he was one of the originals. And I had been working in Maryland, and I was at the Mental Hygiene Administration, and they asked me to develop a report to create an office of consumer affairs.
(19:20):
So I spent a little under a year developing a report with stakeholders that came in and met monthly and had a really participatory process around developing a plan for this Consumer Affairs office. And one of the things that I did was survey existing offices around the country. And at that time, there weren’t as many as there are obviously today. Almost more than half of our country now has a consumer affairs office at the state level. And I surveyed at that time, there were under 10 of them, so I had a really good perspective. And they were somewhat regionally located around the country, so I had some interesting differences I could look at and focus on. That data was included in the final report. And we mirrored many of the goals and objectives for the Maryland office based on the information that we learned from these other states.
(20:16):
I was able to stand on shoulders, if you will, of other people that created these offices. And it meant the world to me to be able to find other places that had them because we were not reinventing the wheel. We had something different than these other offices, but the structure of them was very much alight. And so that really helped keep our direction going strong, that we had some evidence that we could call upon for creating the office that we created.
(20:47):
I ended up getting offered a job at the national level and leaving Maryland Mental Hygiene Administration. And then I moved on to the National Association of State Mental Health Program Directors, better known as NASMHPD, which is hard to pronounce. And they asked me also to be seated in a consumer affairs structure that they wanted me to fulfill at the national level.
(21:11):
So I did that work. It was very different than anything at the state level, but I was able to participate in national policy as a result of that. And that opened up 20-year opportunity to work in DC. So my career path took a different turn at that point, but it originated in many ways with Project OATS, which brought me to Washington DC a few times when we were invited to work on policy committees way back when.
Livia (21:43):
I love this journey. I feel, Laura, that I want to … I wish I could do a timeline, like a little design line that shows your journey and the journey has many branches and paints such an incredible picture of some of the history of the recovery and the peer movement specifically, but also of what one person can do. And I think part of what we hope to do with this series is to inspire people to become involved and to step up as leaders and to hear your story and your journey, I think can’t help but inspire people. I mean, look at what you’ve achieved.
Laura (22:20):
Thank you. It’s again, being shoulder to shoulder with so many other people, including the disability movement at large, working with cross-disability movements along the way. Many of the laws that I mentioned earlier were also running in tandem with other laws. In fact, the PAIMI program, P-A-I-M-I, the one that I mentioned earlier was actually created because there was a disability program for people with Intellectual and Developmental Disabilities, or IDD, already existed at the state level, but never for mental illness. So that’s what created the partnership.
(22:58):
Sometimes I think that I have had a lot of jobs, but they do make sense. And today, even there are people that have created those pathways for themselves. You have national leadership now, that national leadership may not have occurred if it were not for the local programs that were funded years earlier. I think it’s important for people who do want to have a higher level in terms of their careers to recognize that a lot of work was done before them, because some people may not follow the path that I had. They may just get an upper-level job in Washington DC not knowing.
Livia (23:37):
We applaud you and we hope that other folks will learn more about what you have helped to accomplish. And I hear you. There’s a lot of people who worked on this, but my goodness, what a history.
(23:50):
So Laura, what keeps you going? Because you’re still active. You don’t seem to have any signs of slowing down. So, what keeps you going?
Laura (23:59):
Well, it’s interesting with social media and people can … If you’re interested, people do contact me every now and again and either they want to know the history, or they want some help with what they’re doing and they’re making decisions about their plans, or they’re interested in a new program design, and they want to run it by someone. You can find me on LinkedIn and Facebook. But never judge people’s complete life based on looking at social media because I do take breaks and I do post deliberately. In other words, some of the things I share is really an encouragement for other people. It could be a meme to make people feel better but also encouraging it to get people involved. And right now, we have so many opportunities for people to get involved that even if I can’t be on a group or committee that I’m quote “advertising” on LinkedIn, at least I can spread the word that it’s happening.
(24:57):
What I really enjoy now at the local level, and I do some consulting work with Meadows Mental Health Policy Institute, which is a really interesting large, very large policy organization. I also work on the Mental Health Policy Roundtable, which brings together newcomers and veterans of the policy world. But also locally, I keep involved with local politics. People are just feeling like this is a new day here in Washington State, especially in the city of Seattle and the county that I’m in. I’m in a very large county. It’s a whole new day, with new policy being shaped and new ideas being crafted and opportunities again to really increase the recovery opportunities here. I’m just very excited about what we’re doing at the grassroots because that informs the national level and those are the kinds of things that kind of get me up every day and ready to go.
Livia (25:57):
I want to personally thank you, Laura, because I have learned a lot from you. I know I haven’t worked with you quite as much as I’ve hoped to, but you were on my radar early on when C4 Innovations got to be a contractor for SAMHSA, the Substance Abuse and Mental Health Service Administration, for a recovery TA center called BRSS TACS (Bringing Recovery Supports to Scale Technical Assistance Center Strategy) way back in 2011 that really allowed us to work with so many national subject matter experts and national organizations to advance recovery. And I’m so pleased that you could be on the podcast with us and share some of your journey and your wisdom and what you’re still up to. We very much appreciate it.
Laura (26:39):
Thank you so much and very excited about what you’re doing now. And I’m just grateful that I have the opportunity to talk with you, to share information and encourage people to get involved and be involved. This is a recovery opportunity for so many. Thank you again.
Livia (26:57):
Thank you. And to our listeners, join us next time on Changing the Conversation.
Lee Locke-Hardy (Producer) (27:04):
Visit C4innovates.com and follow us on LinkedIn and YouTube for more resources to grow your impact. Thank you for joining us.
(27:11):
This episode was produced by Lee Locke-Hardy and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.
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Listen to other episodes in the “Learning from Recovery Elders” series.