It's time to build a better behavioral health system

Our nation's collective mental health has been severely challenged since the start of the COVID-19 pandemic.

Now, as we begin to envision our post-pandemic future, it's important to take a step back and recognize that our behavioral health system needed improvements even before COVID-19, and that it's time for philanthropy to consider taking new approaches to funding and advocating in this area.

For more than a year, the isolation caused by the social and physical distancing necessitated by the pandemic and the ongoing stress created by the disruptions to our daily routines have impacted all of us — and those conditions have led to a massive spike in mental health issues. According to the Kaiser Family Foundation, an astonishing 41.1 percent of adults reported symptoms of anxiety disorder and/or depressive disorder in a January 2021 survey, nearly four times the average seen between January and June of 2019.

The toll has been especially heavy for our most vulnerable neighbors. Isolation has had a tremendous negative impact on the elderly and the young, while the daily stress of living through the pandemic has been especially intense for people of color, families living below the poverty line, the precariously housed, individuals with pre-existing physical or behavioral health problems, and single parents.

Foundations nationwide have recognized these risks and rallied to provide emergency funding to help support many of the urgent mental health needs created by COVID-19. The New York Community Trust (NYCT) — the community foundation where I oversee grantmaking in the areas of health, behavioral health, and biomedical research — has funded efforts to provide mental health counseling to frontline workers and technology to enable mental healthcare providers to connect with patients virtually and ensure that hard-to-reach populations receive the services they need.

These rapid-response efforts were, and remain, critical as we attempt to address the mental health crisis created by COVID-19. But we must now recognize that our system, as currently designed, is not built to accommodate the great need that already existed before the pandemic.

Prior to COVID-19, our systems for delivering mental health care were failing to help the majority of those in need of such support. In 2019, an estimated 51.5 million U.S. adults experienced a mental illness — roughly one in five people over the age of 18 — yet only 44.8 percent received mental health services.

This massive gap is largely the result of our healthcare system's lack of capacity to serve those who need help. Compounding the problem is the fact that even if there were enough trained providers to meet the need, many Americans do not have the means to afford it.

The human and economic cost of this failure is substantial. Each person with an untreated mental illness is a person who struggles to maintain steady employment and help support their family. Our criminal justice system is stretched beyond its limits, in large part because of the extraordinary number of incidents involving individuals who are experiencing behavioral health crises — the very challenges that also prevent millions of Americans from taking care of their physical health.

Imagine if we could rebuild our behavioral health system so it provided the ongoing care that's so clearly needed. Not only would we help those 51.5 million Americans with their mental health, we would create a better workforce, strengthen families, lessen the strain on our police departments and courts, incarcerate fewer people, reduce the number of people experiencing chronic physical health conditions, and increase lifespans. In other words, by putting a focus on mental health, we would be taking a critical step in addressing myriad social issues — and equipping our nation for a healthier and more prosperous future.

Yet for decades, despite our support for well-meaning interventions, both philanthropy and government have fallen short in addressing America's mental health crisis. Instead of improving mental healthcare systems, we've mostly invested in programs that address urgent needs and those in crisis — certainly an important aspect of care, but not the only one.

It's time to take a new approach. Philanthropy and government have an opportunity to join forces to make meaningful structural changes that will help millions of Americans who are not receiving the treatment they need to lead healthy, productive lives. And these changes are not as difficult, or as costly, as you might think.

For example, NYCT, along with Well Being Trust and the Sunflower Foundation, commissioned the Bipartisan Policy Center to study how to better integrate primary health care and behavioral health care. By taking steps to diagnose and treat behavioral and physical health in tandem, rather than separately, the center estimates that we can help improve outcomes for as many as a million Americans over the next ten years.

When I joined NYCT more than two decades ago, a mentor shared the adage “form follows finance.” A twist on the early twentieth-century architecture and industrial design principle of “form follows function,” it is perhaps more relevant than ever to the provision of behavioral health services.

The center's take on better coordination of care between behavioral and physical health is a clarion call for philanthropy to push for better coordination of delivery and financing systems. The federal government and several states have begun to advance models of care that prioritize outcomes over volume and pay for care that is delivered with this in mind.

This is a good start. But philanthropy must do more to ensure that its resources — modest as they are, compared with the country's healthcare spending, which by some estimates is almost 20 percent of our pre-pandemic GDP — ensure that financing aligns with a priority focus on coordinated care across all delivery systems, whether they be hospital- or clinic-based, or in community settings.

It behooves philanthropy to continue to pay attention to many of the root causes of mental and emotional distress that is so prevalent in communities across our country, often referred to as the social determinants of health — the conditions under which people live, work, and learn. Because historical inequities across the board — but especially within the context of race — have hampered such an approach, it is important that our funding address the complex challenges of inadequate insurance coverage, a stressed workforce, and the critical role of non-clinical providers in the delivery of services.

Finally, if America is to achieve a behavioral healthcare system that cares for those in crisis and enables them to manage chronic conditions, philanthropy has a critical role to play in advocating to ensure that financing actually supports such a system.

And for those of my colleagues who work at a community foundation or a grantmaking public charity that can legally engage in lobbying efforts, I entreat you to use that option. Let us imagine and work toward a healthcare system that covers the entire person — mind and body — and makes a healthier, more prosperous, and more equitable America possible.

Irfan Hasan is deputy vice president for grants at the New York Community Trust, where he oversees health, behavioral health, and biomedical research grants.