Mental Health in the Community
Profiles of Leading Funders
Well Being Trust
Well Being Trust is a nonprofit established in 2016 to advance mental, social, and spiritual health in California and across the country. One year after its creation the Trust released a seminal report called Pain in the Nation. It launched a social-media campaign focused on teens and tweens. It has developed partnerships with nine health systems that are administering care for high-cost and high-needs patients.
The story starts with the Sisters of Providence and the Sisters of St. Joseph. Nuns from these two orders came to America more than 160 years ago with a few hundred dollars in their pockets to do the healing work of Jesus for the poor and vulnerable. Over many generations, their ministry grew into today’s Providence St. Joseph Health—a Catholic network of hospitals and clinics operating in seven states stretching from Alaska to Southern California to Lubbock, Texas.
With the merger of Providence and St. Joseph in 2016, Well Being Trust was established as an independent public charity with an initial seed endowment of $100 million. The Trust’s charge is to focus on the many elements outside of the traditional medical-care system that influence whether people will flourish.
Trust CEO Tyler Norris co-founded a sobriety and employment organization for the homeless when he was in his early 20s. Thirty-plus years later, the organization is still thriving. Norris subsequently founded more than a dozen social-entrepreneurial efforts that touched more than 500 communities. Now his mission is turning the tide on diseases and deaths of despair and improving psychological well-being.
The Trust’s Pain in the Nation report, which garnered substantial attention, pointed out that more than 1 million Americans have died unnecessarily in the past decade from drug overdoses, alcohol misuse, and suicide. It called for a national strategy to help Americans facing “pain, despair, disconnection, and lack of opportunity.” Sixty promising programs offering prevention, early intervention, and effective treatment were reviewed in the report.
The Trust defines mental health broadly. Its community transformation strategy emphasizes affordable housing, improved schools and lifelong learning, jobs, neighborhood improvement, and other factors that extend far beyond individual treatment, or even health as traditionally defined. It encourages teaching the young life skills, thinking patterns, and emotional regulation that it says can head off problems and build resilience. It hopes to help people coping with early trauma and stress bounce back from adverse events and use their lived experience as a fount for leadership.
Even within the health-care industry, Well Being Trust promotes a broad approach. It wants to fold integrated (mental and physical) health prevention and early-intervention efforts into traditional primary-care clinics and other community and clinical settings, and experiment with a vast range of recovery tactics.
One of the first projects backed by the Trust is the Whole Person Care initiative in Napa County, California. This pilot program, funded within California’s Medicaid system using a national waiver, serves high-cost, high-needs patients with a mix of physical health care, behavioral health care, housing support, food supplementation, and other supports. The pilot targets homeless or near-homeless individuals, including heavy users of emergency rooms. Many of these individuals have disabilities, serious mental illnesses, or substance-use disorders. This sprawling program requires the involvement of nine agencies, including the county health department, the housing authority, the police, and more.
The philosophy underlying this approach is that identifying high-cost and high-needs patients, intervening earlier, and investing in social supports cuts the total health spend. Public-assistance programs can be restructured to spend more on lower-cost elements like nutrition, housing, and behavioral health and to save money through the resulting decrease in emergency-room visits typical of high-needs patients. The Trust partners in this work with the Institute for Healthcare improvement, a 25-year-old national think tank, which provides analysis of health-quality initiatives.
WBT is pressing for policy reforms that would require insurers, employers, government, medical providers, and other entities to assure mental-health and substance-abuse care is in “parity” with care and coverage for other physical conditions. Working with iHeart Media, which owns 800 radio stations around the country, the Trust is training DJs to talk about mental health, suicide, and substance misuse on their programs.
Well Being Trust is one of a small number of funders seeking to reframe our understanding of mental health at a fundamental level. Its leaders wish to change the nation’s definition of mental health to one that embraces social, emotional, physical, and mental states. If voids in today’s culture are not filled with social connection, economic opportunity, family repair, and hope, this nonprofit argues, more violence, anger, substance misuse, and self-destruction will result.
Jolene McCaw Family Foundation
Jolene McCaw Family Foundation (JMFF) is a relative newcomer to mental health, having entered the field in 2015. In just half a decade, though, the foundation has built a strong partnership with a national organization specializing in youth mental health, nurtured a promising local nonprofit, and launched programs at 26 high schools and 13 colleges in the foundation’s home state of Washington to reduce psychological distress. Preventing suicide among the young by influencing school culture is now a major emphasis of this funder.
As her own children grew up, Jolene McCaw observed that today’s teenagers seem to be experiencing heightened levels of anxiety and depression. National statistics confirm her observation. Suicide recently passed homicide as the second leading cause of death for Americans age 15 to 24. Over two decades, the suicide rate among young teen girls (age 10 to 14) has tripled. In 2017, 17 percent of all high-school students said they had contemplated suicide.
People with psychosis sometimes attempt suicide as a result of their mental illness. However, otherwise healthy young people who are experiencing acute emotional distress can also be prone to what is sometimes called “impulsive suicide.” These suicides are not exclusively the product of long-held mental illness, but rather acute pain exacerbated by impulsive behavior. The risk of this type of suicide is greater in young people whose brains haven’t fully developed their impulse controls.
In 2013, McCaw and her foundation were introduced to two organizations—one national and one local—that share the same crucial insight: suicide is highly preventable among most young people. Simply putting time and distance between an adolescent in crisis and a means of ending her life is often enough to prevent a tragedy.
Two fertile partnerships
In a chance encounter on an airplane, Jolene McCaw sat next to Larry Lieberman, a board member at the JED Foundation. JED had been founded to create a national blueprint for suicide prevention on college campuses. Lieberman got involved after seeing evidence of increasing childhood distress. He had a connection to MTV, the music-television network that has surveyed young people extensively since the early 1980s. Lieberman noticed in these surveys that the percentage of young people answering “yes” to the simple question “Are you happy?” had hovered around 80-90 percent for years, until the early 1990s. Then something changed, and the rate dropped to 60 percent.
After their airborne conversation, McCaw investigated the JED Foundation. She started funding the group in 2014, then joined its board in 2015.
JED’s work on any college campus spans a four-year cycle of assessment, planning, implementation, and improvement. It all begins with a 130-question inventory of readiness, to establish whether the school has a plan in place for a suicide crisis, how well the school’s health clinic is equipped to handle mental-health problems, and so forth. A dedicated adviser provides technical assistance and connects campus leaders to experts. As schools make progress, they turn their attention to transforming the broader campus culture in healthy ways.Suicide recently passed homicide as the second leading cause of death for Americans age 15 to 24.
More than 170 schools, enrolling nearly 2 million college students, have now obtained the “JED Campus” seal of approval. JMFF made a large grant to JED to bring its program to 13 colleges in Washington. This was the largest single expansion of JED’s portfolio.
McCaw also catalyzed another expansion at JED. At the very first meeting between the organizations, McCaw asked, “Why aren’t we starting this process younger, when students are still at home with their parents?” This led to a new program. With McCaw funding, JED developed Set to Go, an online resource to prepare students emotionally and socially for the transition from high school to college and adulthood. The program launched in 2018 and is now distributed to high-school students, parents, and schools.
The foundation’s interest in helping at the high-school level connected it to a group called Forefront Suicide Prevention, housed at the University of Washington School of Social Work. Forefront has become a McCaw grantee and partner in reaching adolescents across their state.
JMFF funded the development of a comprehensive suicide prevention and emotional well-being program that Forefront uses to train parents, teachers, and school counselors, who are then taught to train other peers. This builds up a broad expertise in suicide prevention throughout each participating institution, and spreads lessons widely to many relevant parties. The effort continues for three years.
The foundation fully funded the training in a first group of 13 schools starting in 2015. Two years later it provided substantial funding for a second cohort of schools. The donors are tracking results carefully. The goal is to create expertise among administrators, students, and families that will endure long after the end of Forefront’s monthly coaching sessions.
With these two close partnerships, the Jolene McCaw Family Foundation is simultaneously pursuing national and local strategies. The two relationships reinforce each other. Discoveries, test results, and new findings made at one level allow the foundation to improve and more tightly focus its work at the other level. This has allowed a relative newcomer to mental-health funding to emerge as a leader in suicide prevention.