What is the Role of Philanthropy in the Decriminalization of Mental Illness?

Dear Friends,

Last month, at the invitation of The Kennedy Forum , I delivered a keynote titled, The Philanthropic Role in Funding Mental Health at the Alignment for Progress Conference. Today, I share a recap of that keynote for your consideration and feedback.

I began by reflecting upon the life and legacy of Dorothea Dix, one of the original philanthropists to focus on the decriminalization of mental illness. After witnessing the abhorrent treatment of people with mental illness in a Massachusetts jail and in other states across the nation, Dorothea, with inherited wealth, set out to build a framework for community-based treatment.

Known by many as the mother of the asylum movement, Dorothea understood that access to community-based mental health treatment was a local issue that would benefit from federal support. Dorothea successfully advocated for care in communities in 30 states and persuaded Congress to pass the nation’s first federal legislation to fund mental health in 1854. This law sought to designate federal land upon which to establish hospitals for those with mental illness. However, President Franklin Pierce refused to sign the law as he believed that mental health — along with other forms of social welfare services — were matters best addressed by the states and not the federal government.

It took nearly 100 more years for the federal government to act on mental health policy when, at long last, the?National Mental Health Act?was signed into law in 1946.

Today — about 200 years since Dorothea first bore witness to the criminalization of mental illness — have we lived up to her vision of decriminalization and community-based care?

Sadly, I believe the answer is no.

In 2023, our nation’s three largest mental healthcare providers are not hospitals or medical centers. They are jails: Twin Towers Jail in Los Angeles County, Cook County Jail in Chicago, and New York City’s Rikers Island Jail. Yet jails and prisons are not built, financed, or structured to provide mental healthcare services. ?

How can we build a world where mental illness is not a crime and live up to Dorothea’s vision of community-based care? Specifically, what is the role of philanthropy in these efforts?

If we are ever going to see real progress toward Dorothea’s vision, I suggest that we rethink how philanthropic resources are deployed along with what is being funded.

With this in mind, I am happy to share my top 10 philanthropic opportunities, which weave together ideas on how and what to fund in order to increase access to mental healthcare in the United States:

1. Support advocacy efforts. Join the fight to ensure parity and other critically important system reform efforts, without which even the best direct service programs will fail.
2. Don’t shy away from litigation. There has been a great deal of progress using the power of the Americans with Disability Act?to decriminalize mental illness, as well as litigation enforcing parity, and more. Additionally, invest in legal services organizations and others fighting to increase access to care.
3. Invest in the internal capacity-building needs of nonprofits so that they can do their best work. This means supporting overhead and administrative costs through a lens of abundance rather than scarcity.
4. Be brave. Seize the moment to respond to the national mental health crisis and the ongoing criminalization of mental illness by deploying resources that advance risk and controlled experimentation.
5. Break down needless siloes. Align for progress, as the criminalization of any type of healthcare is the criminalization of all healthcare.
6. Center the concept of sozosei, which means creativity in Japanese, and consider the important role of the arts, culture, and communications. We need to change the narrative that people with mental illness are dangerous and that jails and prisons are appropriate treatment centers. Use your own voice and change the conversation — as the?Foundation?aims to do in the podcast Call Declined, which launches later this month on November 27, 2023. Listen to the trailer here.
7. Recenter empathy, compassion, and kindness across all your work: your processes, your systems, and your strategies. Be patient, kind, and helpful at every turn.
8. Embrace science. Invest in evidence-based treatment, scientists developing new treatments, and access to those treatments.
9. Collaborate. Create time and space for convenings, support the efforts of others to convene, and participate in big-tent opportunities, as we never know where breakthrough ideas will emerge.
10. Remain curious. Invest in research. This means funding data collection tools, the implementation of databases, and grants to connect work in the field to researchers so that we can understand how and if interventions work and how to course correct.

Without mental health, there is no health. Philanthropy has a significant role to play in ensuring access to mental healthcare in communities in order to decriminalize mental illness. Let’s continue the conversation together at upcoming Sozosei Foundation events:

• Sozosei Summit Solution Lab: 988 and Other Numbers — What the Data Tells Us So Far. March 1, 2024. Virtual registration to open in January 2024.
• Sozosei Summit to Decriminalize Mental Illness. April 16–17, 2024 in Philadelphia. Registration to open in February 2024.

Warmest Regards,

Melissa M. Beck, Esq.

Executive Director

Sozosei Foundation