April 27th, 2011
Next week, Mental Health Month begins. Paul Gionfriddo, who has his own blog, “Our Health Policy Matters,” wrote this post. He is the former president of a foundation in South Florida.
The United States has the highest rate of mental illness in the world. According to Mental Health America, one in four Americans has a diagnosable mental illness each year. Half of us will have one in our lifetime.
The average age of onset of mental illness is age fourteen, and it typically takes ten years after symptoms first present for mental illness to be diagnosed.
The consequences of mental illness can be devastating. Mental illness accounts for 55.7 million ambulatory care visits per year. Serious mental illness, including schizophrenia, bipolar disorder, and severe depression, can reduce life expectancy by twenty-five years or more. Up to 64 percent of jail inmates have mental illness. Up to 25 percent of the homeless population has serious mental illness. These statistics challenge us to act directly and decisively.
However, states cut mental health budgets by almost $1.6 billion between FY2009 and FY2011, according to the National Alliance on Mental Illness. Many states are likely to make further cuts this year.
The philanthropic community can’t replace these dollars, but it can do three things to respond. Many funders are already doing excellent work in these areas.
Invest in mental illness prevention
While the popular perception is that mental illness cannot be prevented, the reality is the opposite. The National Institute of Mental Health (NIMH) makes prevention an integral part of its vision.
There are environmental factors associated with mental disorders, just as there are with any chronic conditions. Those factors include physical abuse, sexual abuse, psychological abuse, and living with family members who are substance abusers.
In 2008, state child protective services agencies found that 772,000 children were the victims of maltreatment. Many of these kids will develop mental illnesses as a result.
Exposure to violence can cause mental illness in both children and adults. According to the National Institutes of Health/Friends of the National Library of Medicine, post-traumatic stress disorder, or PTSD, affects more than 7.7 million American adults. The U. S. Department of Veterans Affairs says that more than 30 percent of Vietnam veterans, 20 percent of veterans who have served in the most recent Iraq War, and 11 percent of veterans of the war in Afghanistan have PTSD.
Preventing environmental exposures has been an effective strategy for funders. The state of Washington-based Council for Children and Families has made grants throughout that state to fund parent education, home visiting, parent support, and crisis intervention. The United Methodist Health Ministry Fund, located in Hutchinson, Kansas, has just awarded more than $752,000 in grants to five community partnerships specifically targeting young children for mental illness prevention strategies. The Health Foundation of Greater Cincinnati has funded a number of inmate-related programs.
Invest in the integration of mental health, primary care, and other specialty care treatment
We know that integrating high-quality health and mental health care leads to better health outcomes for people with mental illness, and so it is increasingly common to find examples of integrated care initiatives spawned by foundation grants.
The John A. Hartford Foundation’s $11.1 million IMPACT (Improving Mood—Promoting Access to Collaborative Treatment) initiative, the John D. and Catherine T. MacArthur Foundation’s Initiative on Depression and Primary Care (which is winding down), and the Robert Wood Johnson Foundation’s (RWJF’s) Depression in Primary Care Initiative (which has concluded) are three examples of major foundations’ efforts in the past decade to promote integrated care.
There are many targeted local examples, too. The Austin, Texas, integration initiative, called E-Merge, originally funded in 2001 by a three-year grant from the Hogg Foundation for Mental Health, is an ongoing integrated care initiative of Travis County’s community mental health provider and federally qualified health center network. In it, mental health providers in community health centers work side-by-side with primary care practitioners. (Here is a link to a webpage showing the Hogg Foundation’s work over the years in the area of integrated health care.)
The Palm Healthcare Foundation, in Palm Beach County, Florida, gave a 2010 grant to the Mental Health Association of Palm Beach County to apply E-Merge concepts to a broader provider audience. In addition to working with safety-net providers, the association’s Be Merge program now offers training and online toolkits to primary and specialty care providers, along with referrals to collaborating mental health professionals in private practice.
The Milbank Memorial Fund released a report entitled Evolving Models of Behavioral Health Integration in Primary Care (May 2010). It summarizes a number of publicly and privately supported integration initiatives springing up around the country.
Invest in policy education and mental health advocacy
Education is the key to changing the way policy leaders and members of the public think about mental health and mental illness. Policy initiatives are often influenced by either of two perceptions—fear of people with mental illness or a belief that the underlying condition is behavioral, not medical.
The philanthropic community can help change these perceptions.
The Maine Health Access Foundation is already doing its part. It provided funding to the Maine Children’s Alliance to produce a 2011 document entitled “A Guide to Challenges in Children’s Mental Health: The Views of Maine Stakeholders,” an informative twelve-page summary of the perspectives and policy recommendations of eight organizations involved in children’s mental health in the state.
As is the case in Maine, many nonprofits around the country are doing excellent work in the mental health field. Whether they work in prevention, treatment, or public education, it is not hard to find them—as the funders referenced in this post have done—and to support their efforts.
May is Mental Health Month–a good month to rededicate ourselves to the notion that, together, we can end the mental illness epidemic in our lifetime.
Mental Health America is the national group behind the tradition of celebrating Mental Health Month in May. Visit this website for more information: http://www.mentalhealthamerica.net/go/may.