How much has changed in a year.
A year ago, I wrote in a guest commentary for Inside Philanthropy that mental illness and the broken system intended to address it are among this nation’s dark secrets. And I continued by asking: Where is the philanthropic community?
At the heart of my piece, which emerged from more than a year’s worth of inquiry in the aftermath of my son’s death due to his mental illness, was that mental health had been strikingly ignored by major philanthropy, yet was ripe for philanthropic engagement. That piece was written in the immediate aftermath of George Floyd’s murder and the first wave of COVID deaths.
Since then, our attention to mental health has been transformed: Take Simone Biles’ brave stand at the Olympics to protect her mental and physical health, or the tragic death of Rep. Jamie Raskin’s son Tommy, or senior McKinsey executive Lenny Mendoca’s explanation of why he stepped down as chief economic and business advisor to California Governor Gavin Newsom. These events comport with what so many of us have felt and shared with friends and family at kitchen tables and on Zoom calls.
Over the past 12 months, I have been engaged with a set of policy experts, philanthropic veterans, persons with lived experience, advocates and practitioners under the auspices of the Mental Health Strategic Impact Initiative (referred to as S2i) to dig deeper into what might be done. Drawing on their wisdom and insights, three things have become clear:
- The mental health consequences of COVID and the racial reckoning are staggering and will have ripple effects of almost untold magnitude in the coming years, especially in Black and brown communities and others historically marginalized.
- The collective trauma we have all experienced has expanded the potential for change as unprecedented need and open discussion about mental health triggers widespread and bipartisan interest in responding.
- The moment’s transformative potential can be seen in the most significant increase in public resources and policy reforms in a generation, even as the pandemic has exposed the nation’s pre-existing tattered approach to mental health.
Realizing the potential of the moment requires many of the most important tools philanthropy has to offer—leveraging public dollars for sustainable change, connecting movements and ideas (such as racial equity and mental health), advancing innovation by supporting natural experiments and assessing results, and furthering the leadership of those most impacted by current policy and practice.
And, of course, the moment requires bringing to bear leadership and engagement around racial equity and inclusion—increasingly prevalent in other fields—on this one. The mental health fallout from the past year has put into sharp relief how a universal experience can affect all of us while imposing disproportionate harms, burdens and risks on communities of color. Same storm, different boats, indeed. But it also provides clarity on how we all benefit if we fix what is particularly broken for people of color.
In the face of this, philanthropy is inching toward greater engagement with a few notable major announcements like the Ballmer Group’s recent $38 million investment in mental health workforce and crisis response in Washington State, Morgan Stanley’s $20 million investment to create the Morgan Stanley Alliance for Children’s Mental Health, and Dallas billionaire Lyda Hill’s $10 million prize to the Meadows Mental Health Policy Institute to transform Texas’ treatment of depression.
We have also seen new, emerging donor mental health initiatives, such as Pivotal Ventures’ Upswing (youth and mental health), Mindful Philanthropies (engaging a broad array of funders), Sozezei (focused on the decriminalization of mental health), and the Behavioral Health Innovation Fund (formed by Nick MacPhee and other Pacific Northwest funders after a year-long learning journey).
There is also growing philanthropic attention to the increasingly obvious reality that mental health needs to be integrated into other philanthropic priorities like ending mass incarceration, expanding life opportunities for low-income families, promoting economic mobility, advancing education equity and achieving meaningful healthcare for all. For example, in one of the leading philanthropy-backed efforts to end the use of jails as the default provider of mental health services, Alternatives to Incarceration has prioritized community mental health supports in its effort to create a “care first, jails last” justice system in Los Angeles.
These efforts are praiseworthy, but still barely move the needle. According to pre-COVID data, only 1.3% of overall foundation funding went to mental health. (New data breaking down philanthropic giving during COVID is not yet available.) And philanthropy’s commitment to include mental health in efforts to “build back better” for young people and their schools, workers and their jobs, and hard-hit communities seeking to rebuild is, at best, only nascent.
So let me turn to how philanthropy can seize the moment.
The philanthropic opportunity
In many respects, the fundamental reasons why philanthropy should step up its funding of mental health that I laid out a year ago remain just as true today: (1) the compelling economic case, (2) mental health’s connection to social and racial justice, (3) the breadth, power and diversity of public voices challenging mental health stigma and exclusion, and (4) the emerging ecosystem of mental health change agents.
What has shifted over the past year is how quickly and substantially philanthropy can make a difference. Here are several examples.
Leveraging New Public Resources and Policy Shifts for Long-Term Change
The pandemic response has led to an unprecedented increase in public resources and policy reforms. Congress provided more than $3 billion in the American Rescue Plan (ARP) for additional mental health and substance use disorder investments and changed policy to integrate mental health into K-12 education and other areas. At the same time, the federal government authorized tele-mental health, galvanizing its potential to expand access.
Yet these funds and initiatives have often been hitched onto severely strapped public and nonprofit entities lacking the capacity to deploy, assess and adapt them. Thus, there is a deep need to provide technical assistance and support to those on the front lines, to advance success by networking these organizations with experts in relevant fields, to determine what does and does not work as these approaches are deployed, and to scale and sustain what has been shown to work. These new resources and rising public attention need to be a down payment toward the transformation of mental health systems and approaches.
To provide one example, the ARP provided an additional $140 billion for K-12 public education, and, for the first time ever, made mental health an eligible activity for these funds. This recognition of the extreme mental health challenges that students, teachers and staff have experienced (and will bring back into the school setting in-person) could help advance new approaches for school mental health. In Texas, for example, the state legislature recently authorized youth mental health professionals in the state’s medical schools to provide tele-health services to the state’s K-12 public schools. However, the ARP funding is only available for two years. It thus runs the risk of being used for short-term and one-off interventions rather than what is needed over the long term, especially as schools confront the enormous challenges around bringing back students, teachers and staff.
A broad set of organizations, such as the Jed Foundation and Steve’s Fund, are seeking to partner with and advise states, school districts and others on how to create and implement impactful long-term plans that advance equity, engage community and effectively deploy technology. This is needed at virtually every level, as reflected in California’s recent $4.5 billion school mental health initiative. In such circumstances, philanthropy is needed to translate significant allocations of public resources into informed policy and practice. Philanthropy can provide the connective tissue to link what is tried to what works, and to make what works sustainable.
Help Advance Racial Equity and Inclusion in this Change Moment
Widespread attention to racial equity and inclusion in the aftermath of George Floyd’s murder is one of the most notable developments in philanthropy in the past year, coming alongside sizable investments in Black-led organizations, tools to address long-baked racial disadvantage, and an increased understanding of how white supremacy undergirds policy and practice. Philanthropy can apply all of this to the mental health field.
As a starting point, in the same way philanthropy at large has increasingly focused on the leadership and inclusion of those most directly impacted, there is immense potential in the mental health world to advance the leadership of both people of color and those with lived experience of mental health conditions. Also required is increased philanthropic attention to the disproportionate pandemic impacts on the mental health of Black and brown communities, as Barbara Ricci of Mindful Philanthropy helpfully fleshed out in a recent IP piece, including several leading examples of efforts to do so.
Just as significantly, it is imperative to incorporate behavioral health (which refers to mental health and substance use disorder responses together) into cutting-edge racial justice transformation efforts, as is occurring with criminal legal system reform. Drawing on the substantial energy to remake police practice after George Floyd’s murder, communities of color, policymakers, advocates and public officials are now advancing ways to end the default use of police and jails (as well as emergency rooms) when a mental health emergency arises. In doing so, the connection between justice reform efforts and the remaking of the behavioral health crisis system is increasingly evident—as is the role philanthropy can play.
This was possible pre-COVID, especially following Congress’ authorization of a new three-digit dial number (988) for public health emergencies, scheduled to go into operation in July 2022. But COVID-19 accelerated the timeline. With the National Alliance on Mental Illness, Mental Health America, Kennedy Forum and other leading mental health advocates continuing to fight for sufficient resources and appropriate policy at the state and federal level, the ARP authorized the first-ever use of Medicaid dollars for crisis services and significantly expanded other federal resources to support public health approaches to crisis response. The adoption of 988, substantial local police reform efforts, and these new resources and policies could help transform one of the most obvious arenas where racism can infect social policy.
Philanthropic investment could be pivotal here. Currently, as multiple local efforts experiment with different approaches, the field struggles with the uneven application of data and metrics to determine what is most effective, uncertain adoption of the new federal resources by states and localities, and power imbalances as states adopt legislation related to 988. As all of this plays out, there are emerging efforts to empower local communities, especially communities of color and persons with lived experience of mental health conditions. In this regard, the From Harm to Health report created by Fountain House, the Center for Court Innovation, the Technical Assistance Collaborative and the Haywood Burns Institute reflects a commitment from diverse organizations to prioritize racial justice and the voices of people with lived experience in developing policy and influencing debate. (S2i incubated this project, which the Ford Foundation funded.)
Especially given the active policy and practice formulation taking place, philanthropy can support community leadership and advocacy, help with assessment and scaling of best practices, and advance cross-system coordination and sustainable approaches. In particular, there is an active need to connect criminal justice reformers with mental health and substance use disorder advocates and experts.
Advance Equitable Innovation and New Ideas
COVID has upended settled expectations about much in our society—how work and schooling should be undertaken, what this means for cities and the economy, and how we can advance equity and inclusion. As this takes place, the pace and consequences of technological change will continue to pose opportunities and challenges. Philanthropy can help build the capacity and set the table so that mental health is incorporated into thinking about the “new normal.”
To provide one example, the COVID crisis turbocharged the development of virtual tools to advance mental health. Estimates of the number of tech applications relevant in some way to mental health range from a low of 10,000 to a high of 100,000. Last year, venture capital investments in mental health start-ups increased to $2.4 billion, nearly tripling total investment in 2019 and easily surpassing the budget of the National Institute of Mental Health (NIMH).
This digital revolution can offer potentially life-saving interventions, incentives and insights that advance mental well-being. Tele-health and other tech innovations can overcome some of the existing system’s structural problems, such as shortages of mental health professionals in rural and poor urban areas. At the same time, the use of technology, as made manifestly clear during the pandemic, is also a contributing factor to the mental health crisis. The many new products on offer frequently lack evidence of value and are all too often designed for richer, whiter and healthier groups. There has been little concentrated attention to whether the new technology helps those most in need and the organizations that serve them, or simply further tatters an already-frayed safety net.
Philanthropy is well-equipped to help here. The substantial investments philanthropy has made in addressing the potential and impacts of technology could be extended to their intersection with mental health, including how they can (but need not) advance equity and can (but need not) cause harm. In particular, it is critical that mental health technology take into account race and disability.
Effective philanthropic approaches can be deployed toward these goals. There are significant opportunities to grow effective and emerging mental health organizations through long-term and flexible support, to invest in idea development and innovation, and to prioritize advocacy, communications and other infrastructure that both strengthen the mental health field and integrate mental health into initiatives in other areas.
Addressing philanthropic reluctance
As most of us who have experience in philanthropy know, grantmakers tend to journey slowly into new areas, especially those fraught with stigma and unfamiliar institutions, acronyms and pathways to change. In my piece last year, I noted two primary reasons for philanthropic reluctance in the mental health field: (1) its complexity did not make for a simple focus for reform efforts or an easy entry point; (2) the diverse perspectives of foundations fragmented the potential for collective philanthropic action and change at scale.
What is striking about revisiting those premises a year later is how much philanthropy has demonstrated that when there is will and leadership, they need not be obstacles. Instead, they offer the opportunity for funders to act in keeping with what philanthropy at its best aspires to be: the social venture capital for society’s most challenging and enduring problems. The philanthropic response to COVID and to the racial reckoning reflect philanthropy’s potential to engage potent and complex issues, and to come together in doing so.
At its best, philanthropy is about the exercise of imagination—what the poet Mary Oliver advises when she writes, “Keep some room in your heart for the unimaginable.” Philanthropy’s task is to translate such visions to the ground level through the hard work of change-making.
Philanthropy has taken the preliminary steps on this journey when it comes to mental health, and is now afforded a moment in which its resources, will and leadership—properly deployed—can be transformative.
In that respect, my final words from a year ago are even more salient today: “Given the potential that exists, it is worth not just the imagining, but the investing.”