With one in five Americans experiencing mental illness each year, there is a significant opportunity for philanthropic leadership to help address the needs of these vulnerable individuals and provide support for their families. Despite a variety of approaches to funding mental health interventions from a vast array of donors, one funding area receiving increased attention and scrutiny, particularly in the aftermath of the pandemic, is youth mental health.
With books such as “Bad Therapy: Why the Kids Aren’t Growing Up” by Abigail Shrier and “The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness” by Jonathan Haidt, there is much discussion about how philanthropy and direct service providers can effectively increase the overall well-being of our youth. Others such as Lenore Skenazy and Camilo Ortiz are gaining traction with research backing up the need for greater independence and freedom for kids to prove their resilience and prevent mental health related challenges.
Philanthropic efforts in the area of youth mental health take varied paths and a foundation that has successfully funded youth mental health efforts for over 25 years is the Sidney A. Swensrud Foundation. Esther Larson, senior director of programs at Philanthropy Roundtable, recently discussed the foundation’s funding strategy behind their youth mental health focus with Trustee Nancy Anthony, who is also a board member for several other organizations, and Bob Anthony, executive director of Adolescent Wellness, Inc., who also chairs the Mental Health Initiatives Rotary Action Group.
The following interview has been edited for length and clarity.
Q: How did the foundation decide to invest in youth mental health?
Nancy and Bob: Over the years our extended family and friends’ families experienced challenges related to mental health at all ages, for which we were unprepared. The resources we found were unsatisfactory. It was obvious that access to help and affordability did not exist, much less early treatment and prevention.
Q: What are your funding priorities in mental health – and why?
Nancy and Bob: Our priority is affordability and access to early mental health treatment and prevention for youth. But we now know that the path to achieving that includes parent education and community support.
Over the past 25 years, we’ve funded resources and curricula to provide specific support for parents, families and providers as well as workshops for parents, clergy, teachers and school staff and nurses. The wide selection of curricula we funded include a starter kit for schools focusing on adolescent mental health and wellness, depression prevention, peer mentoring and more.
Most recently, the Building Bridges of Understanding program, which bundles both patient and parent education with continuing medical education for pediatricians, has proven to provide affordable access to early treatment and preventive behavioral health care.
Q: How did you come to know about the Building Bridges of Understanding program, and what makes the project so compelling for you?
Nancy and Bob: We participated in the concept discussions for the Building Bridges of Understanding program and facilitated its pilot in Naples, Florida. The previous pilot sites of Boston Children’s Hospital, Children’s Hospital Los Angeles and Connecticut Children’s Hospital were documented in peer reviewed articles so we knew it worked well in urban areas and could be replicated. We wanted to see it proven in a more rural setting. Here in Naples, the family doctors joke that unicorns are more common than child psychiatrists. The nearest pediatric psychiatric inpatient facility is across the state in Miami or four hours north in Tampa.
The pilot implementation in Naples delivered:
- Continuing medical education to manage all mild and moderate cases of anxiety, ADHD, depression or disruptive behavior disorders
- Patient and parent education in the form of Guided Self-Management Toolkit for Families that allow treatment with minimal time demands on the doctor
The project is compelling because it effectively ends the waitlist for care before starting treatment. Before this project, the average delay between first symptom and first treatment was 10 years. No staff additions to the existing pediatric primary care providers were needed but youth in Collier County can now start treatment the same day they screen positive for behavioral health challenges. This three-minute video summarizes one family’s experience with the program.
Q: How do you consider impact and success metrics in your mental health-related funding strategy?
Nancy and Bob: The various program resources we fund tend to be pilot programs with great promise for effective results. They have projected outcomes, and several have met or surpassed the projected success metrics. For example, one school-based mental health pilot reduced emergency pediatric psychiatric evaluations by more than half.
The related depression awareness curriculum routinely improved – for all students in a grade – knowledge of depression, confidence in seeking help and reduced negative attitudes. However, the impact was limited because it was not widely adopted. Most school programs designed to scale simply require too much staff time to be realistic.
Building Bridges of Understanding was different. It was not a pilot but an improvement in implementation. Training primary care doctors with the basic skills of psychiatry has been available for a decade but that alone did not end the wait list to begin treatment. Doctors still made referrals out of their schedule onto a third-party waitlist because they did not have adequate time to provide the elements of ‘talk therapy’ for mild mental health cases. This program translated evidence-based treatments into convenient training not only for the doctor but also for the patient and, importantly, for the parent.
Education for the parents allows them to partner in treatment, reducing the time burden for the doctor. This allows for implementation to now be practical without adding staff. Roughly 1,500 primary care providers have implemented the program to date, which has improved care for 1.5 million youth. Peer-reviewed articles document the metrics through the pilot phases, and the program is now released nationally.
Collier is the first county in Florida where the majority of primary care providers have completed the training. The percentage of primary care providers feeling competent and confident in treating all mild and moderate mental health cases increased from 49% to 99%. They routinely prescribe the indicated ‘Guided Self-Management Toolkits for Families’and the relative volume of medications they prescribe has shifted lower for ADHD and higher for both anxiety and depression. With this success about 10,000 youth in the county will be receiving behavioral health care by the end of the year.
Q: Are there any foundations or donors who have been instrumental in impacting your approach and thinking in mental health giving?
Nancy and Bob: Over the course of our 25-year journey of funding in the mental health-related space, we often feel frustrated to find few foundations effectively supporting affordability and access to mental health-related care and find even fewer foundations that are targeting early treatment and prevention. With increased mental health awareness and discussion, we believe there is a lot of opportunity for philanthropy to provide leadership and support to the growing conversation around mental health.
Q: What lessons have you learned in your journey of giving in the mental health area and what recommendations would you give to other funders considering donating in this area?
Nancy and Bob: We find that without intentionality, hospitals and other organizations tend to reinvent the wheel if you let them. Factors ranging from the pride of ownership to basic budget protection can spark more competition than collaboration among nonprofits. Therefore, it is up to the funder to identify which effective solutions already exist and to determine whether they can be scaled, replicated or localized to their specific context.
Based on our 25 years of funding in this area, we recommend focusing on accelerating implementation. We have found that medical innovations languish for 15 years before they are widely adopted. Over the past two decades, many evidence-based interventions have been created for early intervention and treatment, yet few are widely adopted. We also recommend that funders specifically identify and outline what they want to accomplish, define very clear deliverables for those goals and delineate a timeline and a fixed communication schedule with the provider.
Q: Anything else you’d like to share with the Roundtable community?
Nancy and Bob: If your funding strategy involves youth, we highly recommend that mental health-related programs prioritize parent or caretaker involvement. These individuals are so vital to the mental health equation that to ignore them is detrimental to the overall care and well-being of the youth involved. If any donor is interested in connecting with us to share notes or best practices in the area of mental health, we welcome the opportunity to learn from and share our experiences.
If you are interested in learning more about how Philanthropy Roundtable supports donors committed to addressing our nation’s mental health crisis, please contact Esther Larson, senior director of programs at Philanthropy Roundtable here.
