If you wanted to pick an institution to deliver healthcare, the prison system probably wouldn’t be your first choice. Or your 10th. But in the U.S., people experiencing mental health emergencies are all too frequently propelled into confrontations with police and pulled into the criminal justice system. Many end up in jail or prison, among the most stressful of environments imaginable, and likely harmful for people with mental health conditions.

This criminalization of mental illness has been a slow-motion emergency for decades, and mental health advocates have long called for the separation of mental health treatment from the criminal justice system.

Decriminalization of mental health is currently the central programmatic mission for the Sozosei Foundation, established in 2019 as the philanthropic arm of Otsuka America Pharmaceutical, Inc., a subsidiary of Tokyo-based Otsuka Holdings, a global healthcare company with sales of approximately $11.7 billion.

After study and input from numerous sources within the mental health community, including caregivers and people with lived experience, foundation leadership has decided to focus much of their funding efforts on the impending rollout of the new 988 suicide and mental health emergency phone number. The 988 system, passed by Congress as the National Suicide Hotline Designation Act, and signed into law last fall, calls for the nationwide implementation of the hotline by July 2022.

“We’re looking to pitch a big tent to welcome lots of different diverse voices, including the voices of people with lived experience, lawyers, judges, practitioners, psychiatrists, you name it,” said Melissa Beck, executive director of Sozosei. Before joining the foundation as its first ED, Beck served as head of the Educational Foundation of America. “Our belief is that with a non-law-enforcement response to a mental health crisis, you don’t end up in jail.”

Although suicide hotlines exist, in a crisis, many people simply dial 911. That can bring the police and thrust a sick person into the legal system rather than the healthcare system. Mental health disorders strike 1 in 5 Americans of all groups, but criminalization and lack of access to care disproportionately impact people of color. Sozosei cites some telling statistics on its website: According to a 2017 report by the Bureau of Justice Statistics, approximately two-thirds of women in prison and roughly a third of men in prison report having been diagnosed with a mental health disorder. Of those who enter jail each year with a serious mental illness, an estimated three-quarters have a co-occurring substance use problem.

Sozosei recently announced the commitment of $1 million in grants to 10 organizations working to make the impending nationwide rollout of the new 988 emergency phone number a success. Grants in this first round went to groups focusing on advocacy, research and workforce development. The recipients are: American Foundation for Suicide Prevention, Council of State Governments Justice Center, Inseparable, Kennedy Forum, National Alliance on Mental Illness, the National Council for Mental Wellbeing, the Path Forward for Mental Health and Substance Abuse, Research Foundation for Mental Hygiene, The Trevor Project, and the University of Chicago Health Lab.

Mental health advocates throughout the country hope the three-digit 988 number will be easier to remember than existing hotline numbers and reduce the use of 911. But beyond the immediate emergency response to a person in crisis, leadership at Sozosei Foundation believe that a well-designed 988 system could catalyze deeper change, helping communities to build a continuum of care and resources that support people with mental health in the longer term.

Setting up a phone number won’t be much help unless those calls are answered by trained mental health professionals, who then have appropriate resources to deploy to address the situation. That will be a funding focus for Sozosei going forward—the organization’s next RFP will seek to support work to build a bigger and better mental healthcare workforce. The organization expects to ramp up grant totals in the coming months to about $4 million.

Significantly, the law calling for the implementation of the 988 hotlines has left a lot up to the states and localities. “There are lots of opportunities to improve the way we respond to mental health, and that is the promise of 988,” Beck said. But the peril of 988, she said, is that some implementations won’t be successful, and may even create new problems.

We will continue to follow philanthropy’s activity around the 988 initiative as communities around the country gear up to implement it, staff it, and integrate with local health resources.