[This post originally appeared on Mindful Philanthropy]
Our world is rapidly changing. We are living in a time of disruption and layered crises that are contributing to a decline in our nation’s well-being. From our youth to our seniors, more of us are struggling, and more of us are dying early. In facing these rising challenges, philanthropy has a leadership opportunity to make an unprecedented impact on mental health and well-being outcomes that can benefit every part of our society.
Mindful Philanthropy and Well Being Trust reflect on the trends that have brought us to this point, shifts in the mental health landscape, and compelling areas of opportunity for philanthropy to create lasting change forward. This is an opportune time for philanthropy to envision, engage, and invest in a re-imagined mental health system and the vital community conditions essential for all Americans to thrive.
A Brief History of Mental Health Care in the U.S.
Historically, our society has shrouded conversations about mental health and addiction challenges in expressions of blame, stigma, secrecy, and fear. As a result, mental illness and addiction were not addressed within the mainstream medical system for centuries. The birth of modern mental health care dates to the early nineteenth century, which was marked by a shift from imprisoning the mentally ill to placing them in asylums, hospitals, and other facilities, away from the rest of society. This move toward hospitalization led to the development of a state-based asylum system. Eventually, in the 1950s and 1960s, the development of the first antipsychotic medicines and signing of the Community Mental Health Act spurred the process of deinstitutionalization of those with mental illness. However, this process brought about new challenges.
Dr. Tom Insel, a national mental health expert and advisor to Mindful Philanthropy and Well Being Trust, describes these historical shifts in his recent book, Healing: Our Path from Mental Illness to Mental Health. “In dismantling the earlier flawed system, we created a new crisis,” Insel writes.
The stated goal of the Act was to integrate the mentally ill into the rest of society and support their treatment in community settings. However, underinvestment in integrated systems of community care and the community workforce to staff it, led to people with severe mental illnesses often not receiving effective care, nor sufficient help integrating into society. This contributed mightily to a rise in homelessness and poverty, and placed even greater strains on the array of support services at the local level.
Today in our communities, those struggling with serious mental illness are joined by ever more Americans struggling with their addictions, and increased rates of anxiety, depression, and suicidal ideation. This is most prevalent in our youth, seniors, LGBTQIA+, and people of color across all ages. COVID-19 further highlighted how inequity in care access, as well as lack of access to the vital conditions for intergenerational well-being, contributes to mental health challenges and increased disparity. This recognition, alongside increased understanding about how the brain works, and our bio-psycho-social-spiritual nature as humans is leading to an ever broader array of healing modalities and access points. Yet, millions still go undiagnosed, or cannot access meaningful affordable care, and/or what is offered does not work for them as co-producers of their own health.
Today’s Challenges and Future Solutions
The unprecedented rise in mental health challenges is being contributed to by our society undergoing a series of major disruptions. Factors such as the COVID-19 pandemic, sustained racial injustice, lack of economic opportunity, political polarization, and climate change have further exacerbated already rising rates of anxiety and despair, with youth and people of color bearing the greatest brunt of these forces.
Amidst these co-occurring challenges, we also see bright spots everywhere bringing cause for hope. Mental health and addiction are emerging from the shadows as national priorities and at kitchen tables—shedding some of the stigma and blame they have been steeped in historically. Increased philanthropic attention has brought fresh funding, innovation, de-risking of proof points, and new cross-issue funder mental health initiatives. A growing focus on the intersectionality of mental health, equity, and social justice have also brought increased attention to the vital conditions for well being, historically known as the social determinants of health that shape mental health outcomes.
Every day, we hear from funders who want to help, but don’t know where to best start or how to assure impact. In the coming decade, funders have a vital role to play in our nation’s mental health by shifting the focus of our mental health efforts from a primary focus on sickness care and crisis to integrating prevention, healing, community support, and recovery.
This approach starts with seeing people as whole persons, and taking a systemic view of the factors that contribute to mental health and well-being. Well Being Trust’s Framework for Excellence in Mental Health and Well-Being is a guide for change-makers who seek to improve mental health outcomes and promote well-being for all Americans. The Framework provides a comprehensive approach to understanding and acting comprehensively on the multiple factors that influence mental health and well-being. The Framework calls funders and partners to work together across three areas: Community, Care, and Coverage to increase mental health outcomes in a holistic, integrated way.
Philanthropy has a unique opportunity to lead the way in catalyzing, convening, and co-investing. Philanthropy is uniquely qualified to create proof points for larger public funding and de-risk innovative ideas that can break through decades of stalled progress. The time is now. Here are five key areas for philanthropy to lead the way in redesigning our country’s way of addressing mental health, addiction, and well-being:
- Youth mental health: Funders must act now to help bolster youth mental health and support the development of healthy life trajectories. Mindful Philanthropy’s Thriving in Schools initiative provides funders with a starting point for helping all youth thrive, from early childhood all the way to transitioning to adulthood. Strategies such as supporting comprehensive mental health education in schools, addressing trauma, and providing linkages to care in and through the education system are all ways to help. Philanthropy can also champion youth voices and empower them to lead the way for change as advocates.
- Crisis systems reform: With the launch of the national 988 mental health crisis hotline in July 2022, funders have a unique opportunity to support the creation of robust crisis response systems in locations around the nation that support people with mental health challenges in their most vulnerable times. An effective crisis response means opportunities to connect people with needed care, avoiding unnecessary criminal justice involvement, and averting further trauma. In addition to crisis call/contact center hubs, a full crisis response continuum of care also includes mobile crisis teams and integrated crisis stabilization options. Stay tuned for the release of Mindful Philanthropy’s latest guidance on how funders can support the launch of 988 and the development of a robust crisis response system.
- Mental health workforce: Mental health workforce shortages and high levels of burnout are top barriers to improving our nation’s well-being. Funders can play a role in growing the workforce pipeline, mitigating burnout, and retaining talent. Providence’s No One Cares Alone program for its 120,000 caregivers is a model rooted in caring for and supporting its health care workforce. Growing the mental health workforce also includes expanding peer support programs and navigators that create bridges to community care and supports. Peers can reach people where they are, and understand the challenges they are facing. When properly trained, they provide a vital—and often overlooked—resource for the mental health workforce. More broadly, initiatives such as StrengthIn.us and Mental Health First Aid help community members recognize the signs of mental illness and substance use and know how to respond. Care that originates in the community is vital to building the skills of people such as teachers, coaches, first responders, barbers and beauticians, and faith leaders, who can serve as the first line of support for those struggling.
- Integrated care: Integrating physical and mental health as well as social needs, breaks down the silos that prevent appropriate diagnoses, care coordination, and effective treatment and supports. Most mental health treatment still happens in primary care settings, where patients often go first for help. As the field shifts to caring for the whole person, funders can support strategies such as co-locating clinical and community services, embedding mental health professionals within other settings such as schools, and providing mental health training to other care and community professionals. Since mental health and addiction and social needs have often been treated independently, integrated and coordinated whole person care is crucial for outcomes.
- Equity and social determinants of health: Intersecting forces such as lack of economic opportunity, homelessness, food insecurity, incarceration, and racism often co-occur with mental illness, but are not always addressed in an integrated way. Decades of public health research also reveal that equitable access to the vital conditions for well-being and social determinants of health—from physical factors such as housing and jobs, to social factors such as connectedness and civic muscle—are far larger contributors to mental health outcomes than medical care alone. These factors disproportionately affect outcomes for communities of color and other populations that are systemically othered and excluded. Most widely used mental health models today were not developed by communities of color, nor with these populations in mind. This needs to change. Culturally informed models that are developed for and by the communities they serve are essential to improving mental health outcomes for communities of color and other populations. Read more on Mindful Philanthropy’s recent blog on how to identify and support culturally informed mental health models.
We envision a world in which philanthropy and impact investors across all sectors—from education to housing to jobs to climate change—invest in “co-benefit” solutions that integrate mental health and well-being so that all people have equitable access to the resources and community conditions needed to flourish. We are calling on philanthropy to join us in engaging, and investing in a re-imagined mental health system, and in the vital community conditions that are essential for all Americans to thrive. We see this vision as within reach.
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