Back to Guidebook

Executive Summary

This guide profiles seven philanthropic foundations that are solving problems in mental health and substance abuse today. For each foundation, there is a description of its approach, some of its most influential initiatives, and how its efforts fit into the broader mental-health landscape. Most of these subjects have a local focus, and a long view on bringing improvements to their communities. One—the Well Being Trust—was created in 2016 to promote mental health across the nation.

The field of mental health has long struggled with definitional issues, and our understanding of the complex ways that brain, environment, and experience interact to create a psychiatric status is rapidly changing. Some analysts focus on hard molecular, genetic, and neurocircuit markers of illness. Broader approaches include factor like life-purpose and meaning. The philanthropists profiled use a range of definitions and demonstrate that it is possible to help people even when experts don’t fully understand the nature of brain health and disease.

Many observers question whether mental illness and substance abuse are different or interconnected conditions. Because they share many symptoms and effects, and because many useful solutions address both problems, both are included in this paper.

The Philanthropy Roundtable’s review of this field was undertaken in response to concern among philanthropists. America is in the midst of a serious crisis in mental health, as seen in statistics on substance abuse, suicide, medication of young people, and other topics. Our members are receiving proposals from every sphere of society asking for assistance. Funding is requested for counselors in schools, screening in workplaces, and new approaches in family services. Nonprofits tackling unemployment, homelessness, crime, family decline, and other issues are seeking help with mental-health aspects of their work.

Many donors want to avoid being reactive and piecemeal in their giving and need ideas, examples, and history to make them more informed grantmakers. This guide summarizes some of the key ideas, important statistics, and notable actors animating contemporary mental-health philanthropy. This guide is illustrative, and should not be read as a definitive survey, or as an endorsement of any single strategy.


Diseases and deaths of despair

America is experiencing an epidemic of “diseases of despair,” a term coined by economists Anne Case and Angus Deaton in 2015 to include drug disorders, alcohol-related diseases, and suicide. In a widely read paper, Case and Deaton showed that “deaths of despair” were responsible for an unprecedented drop in life expectancy in America.1 This drop has now continued for three straight years, comprising the longest sustained decline in life expectancy in a century.

Deaths of despair doubled over the past 15 years, and if left unchecked are predicted to double again in the next decade. Every year 127,500 Americans die from drug- or alcohol-induced causes or suicide. That means 350 people lost every day, 14 per hour, one person every four minutes. By comparison the annual death toll from the HIV/AIDS epidemic in its very worst year was 50,877. The number of Americans killed in all driving accidents every 12 months is 37,000.2

U.S. suicide rates are up among all groups but have risen sharply among certain groups like rural populations, poor whites in middle age, and young teen girls. Deaths of despair appear dependent on place, suggesting a possible linkage between these deaths and the breakdown of social capital in some communities. The epidemic is worsened by a fragmented and broken mental-health delivery system unequal to meeting the demands of those suffering.

Mental illness now causes more disability in America than heart disease, cancer, or stroke. Mental- and substance-abuse disorders constitute the leading cause of years lived with disability.3 People with psychiatric disabilities constitute the largest and most quickly expanding subgroup of beneficiaries receiving Supplemental Security Income payments.4

Almost one in five Americans currently has a mental-health diagnosis. This includes mild to moderate cases of anxiety, depression, or substance use. One out of 20 people has a condition that significantly impairs daily functioning.5 An estimated one out of 12 Americans uses drugs or alcohol in ways they want to stop.

Mental illness is a chronic disease. It generally starts in young people and persists throughout life, absent effective treatment.6 Seventy-five percent of mental afflictions show up before the age of 24.

Looming behind these statistics is a great deal of human suffering. And many other social problems that philanthropists are trying to solve in their communities are aggravated by mental illness. Things like economic failure, family violence, homelessness, and imprisonment are markedly higher among Americans with psychiatric afflictions.

In the pages that follow you will encounter some thoughtful approaches to addressing this serious and growing problem.