BIRMINGHAM, AL (WBRC) - The lesson was an action plan for forgiveness. They talked about forgiving others, forgiving the world, but most of all, forgiving themselves.
"We've been through a lot," Trinity Mcguffie told the group. "We did things we regret, especially with our illness," she said.
The 20 or so adults in the room nodded in agreement. They were gathered for a group therapy session tailored for people living with serious mental illness.
Mcguffie led the group, but she is also one of them. Diagnosed with major depression at age 16 and later bipolar with schizoaffective disorder, Mcguffie is also one of an estimated 7.9 million adults in the United States with co-occuring disorders of mental illness and drug addiction.
"I felt normal when I used drugs," Mcguffie said. "You have to get clean from drugs and alcohol before you can start your journey to getting better mentally," she said.
Mcguffie's journey took her to hell and back before she finally got her life under control in the Christian recovery program at the Foundry Ministries. She'd tried to get clean before, but it was the Foundry's faith-based approach to healing that Mcguffie said helped her finally turn the corner in her addiction and mental health.
"It's the faith that got me through," she said. "Believing in myself and believing God would help me."
She graduated in 2016 from the Foundry women's recovery program, where we interviewed her in a reporting partnership between WBRC and HuffPost, examining the complex issue of access to mental healthcare in Alabama.
Mcguffie was recently certified as a recovery support specialist with Alabama's Department of Mental Health. WBRC also caught up with her at the 1920 club, a drop-in socialization center in Birmingham where she helps facilitate group therapy on Mondays. The group is among many free activities available at the 1920 club, which is open Monday through Friday, 10am-3pm.
Mcguffie, 37, brings a dry sense of humor and grit to her job. She moderated the therapy session in a steady voice while seated at one of the tables with participants. The adults who attended often applauded each other, with Mcguffie listening intently when they shared. More than once, she punctuated a participant's statement with "Ah, yes!" and "Go on with your bad self!" The mood in the room was uplifting. Mcguffie told me her new career helping others with mental illness gives her life a purpose that she only recently realized.
"It is so great to give back," she said. "I've been in their shoes."
While still at the Foundry, Mcguffie was hired by J.B.S. Mental Health Authority, the regional organization charged with planning, coordinating and developing public mental health services in Jefferson, Blount and St. Clair Counties. Mcguffie sees herself in many of her clients.
"I see a lot of sadness," she said. "I see a lot of hopelessness, like they'll never get better."
Mcguffie understands that feeling, but also believes people suffering from mental illness don't have to settle for their sickness. She tries to pass that encouragement on to those who need it, and because she too lives with mental illness, she's a credible witness to recovery.
"You have got to work on a daily basis to get better," she said. "You have to believe you can get better because there's hope if you believe in yourself."
Mcguffie brought herself to the Foundry in 2015 when she was at the end of her rope. 18 years of drug abuse had taken a toll.
"I was completely broken, out of my mind, just sick," she said.
Mcguffie knew about the Foundry because she'd entered the program years before, but dropped out after a week. This time she was ready to do the work.
"I had been to other programs and they didn't give me the foundation that I needed," she said.
She wanted her recovery to be lasting and felt a spiritual element was essential. Brandon Lackey, chief program officer for the Foundry Ministries, said this is what sets their program apart. He explained the 12-month residential recovery program takes a holistic approach, tending to a participant's mind, body and spirit.
"We believe that if you ignore one of them, it's at the detriment of the other," said Lackey. "We believe that many other programs kind of miss one of those and it jeopardizes a complete and total permanent life transformation."
Participants engage in counseling, case management and work readiness and the curriculum they follow, called The Genesis Process, is based on the Bible. The recovery program is designed for men and women who are struggling with life-controlling addictions, but Lackey said most people who apply also have some type of mental health diagnosis.
According to a study by SAMHSA, the Substance Abuse and Mental Health Services Administration, people with mental health disorders are more likely than others to experience alcohol or drug abuse. 18% of adults with a mental illness also have a substance abuse disorder.
Even though the Foundry is not a medically-based program, many people struggling with mental illness come to them for help.
"We don't diagnose, we don't prescribe and we don't treat mental illness, but we do help people who have mental illness," explained Lackey.
Participants pay a one-time entrance fee of $995 that includes housing, meals and transportation. Unlike the public system of mental healthcare, faith-based facilities like the Foundry receive no state or federal funding. In addition to the entrance fees, they rely on private funding, donations and support from churches. Lackey said he thinks it's a great value for an experience that runs much longer than the typical 90-day recovery program.
"It's really an amazing story of how the faith-based community does more with much less," Lackey said.
There are many differences in a faith-based recovery program like the Foundry vs. an evidence-based, state-funded facility, like the Aletheia House in Birmingham. Where faith-based counselors use lessons from the Bible, evidence-based practitioners rely on scientific modes of treatment, like cognitive behavioral therapy.
The approach to psychiatric medication is perhaps the biggest distinction between the two approaches. Participants in the Foundry's program must adhere to a list of approved medications, with restrictions on some addictive psychiatric medicines. Lackey said the list was developed by outside doctors and is designed to protect participants who are working to overcome addictions. Many of the banned drugs have significant mood-altering capabilities with a street value, that could be bought, sold or traded among addicts.
If someone already taking one of these medications applies to the Foundry, Lackey said they'll begin a conversation with the person's doctor about whether an alternative medication is possible. If it's not, the Foundry refers the individual to another program.
"Where we want to help as many people as we can, we also have to consider the concerns of the group," Lackey explained. "We are not the answer for everyone."
Trinity Mcguffie traced her long history of illicit drug use back to Xanax, one of the first medications a doctor prescribed for her depression when she was a student at Hayden High School in Blount County. She immediately began abusing it.
"I ended up overdosing on it in high school and was expelled for drug use," she said.
That opened the door to more experimentation; Mcguffie used marijuana, pills and meth, but over the years graduated to crack cocaine and eventually heroin.
"I got very strung out," she explained. "When I wasn't high, I was in the bed. When I wasn't in the bed, I was manic, doing something wild," she said.
As Mcguffie struggled with drug addiction, finding the right psychiatric medication to treat her mental illness seemed impossible. Some meds made her feel numb, some seemed to do nothing to quell her symptoms.
When she entered the Foundry, Mcguffie went off her meds completely, and said she did well for about two months. Then, she had a meltdown.
"I started hearing voices real bad and started thinking people were after me," she said.
The Foundry sent Mcguffie to the hospital where she stayed for seven days. Doctors prescribed a monthly antipsychotic injection called Abilify, which Mcguffie still takes today. She said that hospital stay, facilitated by the Foundry, allowed her for the first time to find a psych med that worked "like magic."
Lackey said the Foundry has a good partnership with UAB and other medical providers to act quickly when a participant is in distress. By the time participants arrive at the Foundry, most have lived lives marked by chaos, with little to no schedule or structure for years, according to Lackey. Once they begin to live a clean and sober "Godly" lifestyle, eating and sleeping regularly, "you begin to see the light come back into their eyes," he said.
Lackey has also seen some Foundry participants reduce or eliminate psychiatric medications, even if they've taken them for decades.
"I have seen over the last 16 years of doing this kind of work, that people can be completely and totally set free from all of their life controlling problems," said Lackey. "I'm not going to limit what God can do."
Mcguffie said the Foundry finally gave her the skills to not just rely on medicine. Through prayer, relationships with mentors and studying the word of God, she said graduates of the Foundry consider it a second family.
"They helped us find ourselves," she said. "You'd be surprised how much love can start to heal."
(Trinity Mcguffie, outside the Foundry's recovery program, where she got help for drug addiction and mental illness.)
Alabama ranks near the bottom in a study of access to mental healthcare across the United States.
The study by Mental Health America in 2014 put Alabama next to last in the nation when it comes to factors like access to insurance and treatment, as well as quality and cost of insurance.
Dr. Richard Craig, Executive Director of J.B.S. Mental Health Authority, said as state resources have dwindled, the availability of acute mental healthcare in Alabama has shifted to community systems, which carry a heavy caseload.
"I will tell you that the system as it's now in place is not sufficient to meet the need," Craig said.
When Craig began his career as a licensed psychologist in 1984, Alabama operated 14 mental illness institutions. Today, it operates four. Craig said this was mainly the result of the state cutting $40 million from the Alabama Department of Mental Health budget after the 2008 recession. With Bryce Hospital in Tuscaloosa as the only remaining facility left for broad psychiatric inpatient care, the wait time can be months. There's also less space. Bryce currently has 268 beds, it used to have 350.
J.B.S. Mental Health Authority operates multiple programs focused on two populations: adults with severe and persistent mental illness, such as schizophrenia and bipolar disorder, and children with serious emotional problems. Craig said the public system of care is not set up to serve people with less serious mental health issues, like PTSD, anxiety or depression.
"The state dollars are so scarce that the money is not there to support the entry into care for somebody who's experiencing a mild level of a mental illness," Craig said. "That's a shame. I wish that were not true," he added.
This is where faith-based recovery programs enter the picture. The Alabama Association of Christian Recovery Ministries represents 14 of the most well-established programs available for people with substance abuse and mental health needs, including the Foundry.
A conservative estimate of bed space available in these programs is 2000, which means they can often get people into recovery quicker than facilities in the state-funded system, according to Lackey.
"The role the faith-based community plays far exceeds anything that our state agencies can provide," said Lackey.
As faith-based care has grown in Alabama, Lackey said the synergy with evidence-based programs has improved, but there is room for greater collaboration. The Foundry has worked to develop relationships with other agencies and recognize the effort they're all making to help people who are largely marginalized in Alabama.
"We may completely disagree with a mode of treatment or care, but everyone is so individualized," said Lackey. "One of our biggest tasks is to connect people to the place where they can get the help that they need."
Dr. Craig said faith-based programs like the Foundry provide a valuable adjunct to the public system of care and their approach can be life changing.
"I have seen and known folks personally who went to faith-based care practitioners and did great, turned their life around," he said.
Each person interviewed for this story expressed a concern over the stigma of mental illness, which remains a major issue in Alabama. Lackey recognized the stigma he had placed on the mentally ill when he began working with the homeless population 16 years ago.
"It really fell away once I began to get to know them," he said. "The difference between mental illness and not having mental illness is such a razor thin line."
Dr. Craig emphasized that mental illness is a "no-fault" disease and encouraged people to help those who may be experiencing a need for mental healthcare.
"Offer kindness and support," he said.
Mcguffie experienced the stigma internally, for years refusing to believe that she needed help. She described binging on illicit drugs, repeated hospitalizations for overdoses and suicide attempts and refusing to follow through on treatment plans.
"I didn't want to accept it," she said. "It's a hard thing to accept when you're mentally ill."
Mcguffie's message to others: help is available and no matter what type of program, the most important thing is that people who need it find it. Although she works for the public system of mental healthcare, she would recommend a faith-based program for anyone who needs help. She believes the love and support she received at the Foundry saved her life.
"Having mentors and people believing in you and pouring into you and praying for you," she explained.
"I knew God could turn my life around," she added. "I couldn't do it myself. You've got to believe in something bigger than you."
If you or someone you know has a mental health issue, the following organizations can help: