America’s Mental Health Crisis: Philanthropy’s Bold Action Plan

Margaret Flinter (00:00)
Recorded on location at Aspen Ideas Health in Aspen, Colorado.

Mark Masselli (00:12)
It is estimated that more than one in five US adults live with mental illness, according to government statistics.
How is the philanthropy sector keeping up, with this challenge? We'll learn more about that today.

Alyson Niemann (00:27)
We issued a, you know, a challenge two years ago to philanthropy to increase the funding to mental health
addiction and wellbeing to 35 billion annually, by 2035.

Margaret (00:38)
Our guest today is devoted to answering these questions. She's Alyson Niemann, she's the CEO of Mindful
Philanthropy.

Alyson (00:46)
What we're hoping to do is have all of those state tables learn from each other. So we've set up a kind of a
community of practice for those state tables to continue working and learning from one another.

Margaret (00:56)
And this is Conversations on Healthcare.

Mark (01:09)
Alyson Niemann, welcome to Conversations on Healthcare.

Alyson (01:12)
Thank you. It's a pleasure to be with you, Mark and Margaret. Thanks for having me.

Mark (01:15)
You know, we have spent a lot of time on our program, focused in on mental health issues, over the years.
You're here to really bring a sort of a new element to the discussion, really trying to catalyze mental health
funding in this area. Maybe you could talk a little bit about the work that you're doing. it sounds so exciting.

Alyson (01:33)
Absolutely. Well, I'll start just by telling a little bit about how we came to be 'cause I think the story is relevant.
so in 2019, there were a group of funders that had come together and had seen the lack of funding that was
going to mental health addiction and wellbeing. And they each had a unique perspective on this. one of the
funders in particular was, an executive with Vanguard. He had been one of the early employees and had done
numerous C-suite rotations, throughout the company's history. He was retiring at the same time that
unfortunately he lost his son to the opioid crisis. and, you know, he started thinking about, you know, how can I,
how can I support opioid, the opioid crisis and addiction, and, you know, how can I support the solutions? and
was really starting to go deep in that when he met these other funders through a fellowship he was doing at the
Center for High Impact Philanthropy. and they challenged him to think bigger, you know, to think about the
systems that we're interacting with addiction, to think about the co-occurrence of addiction and mental health
issues. and to think about what would actually move the needle on overall mental health and addiction. So they
first commissioned a report to be done through the Center for High Impact Philanthropy at Penn. And it was that
report and the research that showed that it was 1.3% of foundation giving that was going to mental health
addiction and wellbeing. And so, you know, and that was at the time, about $500 billion of philanthropic
funding going to the field. So it was a very little amount, given that, you know, the statistic that you, you cited at
the beginning of the show, every family has a story of mental health and addiction. Every community is affected
by this. And we know that, you know, there's a Lancet study that tells us that over half of the world's population
will experience a mental health condition by the age of 75. So, you know, the need that is in our families and in
our communities is not commiserate with the funding needed to solve for the issue. So they found it after the
report was published, they thought, you know, we don't just wanna report sitting on a shelf. We, we need to
activate this into an organization that is going to, actually advocate for and catalyze funding to mental health
addiction and wellbeing. So we've been at it now five years. We just celebrated our five-year anniversary.

Margaret (03:50)
Congratulations.

Alyson (03:51)
Thank You. and we move pretty quickly. We're bold. We take risks. and we do that through some of the
traditional philanthropic l levers like convening. We convene philanthropy all over the country, to reduce the
silos to accelerate learning with experts. we, we give guidance. We have over 19 pieces of guidance that are out
in the field now, at the intersection of mental health and, you know, and, women's health, youth, the criminal
justice system. And, you know, and our goal in this is to illustrate that, you know, all of philanthropy has a role
to play in this. I remember when I first started this work, I, all these people would say to me, you know, mental
health is such a niche issue, and you know that you must, you must not work with very many people. And I said,
no, mental health is, it affects, yeah, it affects all of us. And it's so intersectional to, you know, economic
mobility and criminal justice, poverty, youth housing, everything. So we also uplift solutions. so whether it's
public private partnerships, nonprofits doing the work, we uplift those for philanthropy to scale those solutions
and to give more funding.

Mark (04:59)
All under the name of Mindful Philanthropy…

Alyson (05:01)
All under the name of Mindful…

Mark (05:02)
How did you come to that name?

Alyson (05:03)
You know, that was the founding team. So there were about, you know, six or seven individuals that were part
of the founding team, funders and researchers, and they spent a lot of time thinking about that. I came to this
work about two months after the organization was launched as, that's my background is kind of building and
scaling, nonprofits and organizations. but it was a very intentional choice that, you know, if we want
philanthropy to be intentional, we want it to be strategic. We want it to be effective and efficient. But it also is a
little bit of a play on words because, right? We're talking about the mind and we're wanting to be mindful about
the work that we're doing.

Margaret (05:39)
Well, you, you cite that statistic there, perhaps up to half of all people will experience some form of distress in
their lifetimes, and a low level of funding. And one of the challenges it seems is it is in many boxes, right?
There's severe and persistent mental illness. There's more situational episodic, there's children's mental health,
there's all the social issues that come with having a severe, mental illness and the economic ones. How do you,
how do you decide where to align your resources? Or have you, identified on that huge continuum of what may
fall under the category of mental health and mental illness? Where are you putting most of your efforts, or is that
an ongoing challenge? And, and I would add to that addiction, which in most, states anyway, there's a whole
separate infrastructure for addiction. One for mental health and then one for children's mental health, just to
make it really challenging.

Alyson (06:35)
Yes. Yeah. You're highlighting a number of issues. And, you know, I would say that, we align our work and the
definition of our work with the WHO's definition of mental health. and we take a pretty broad view of mental
health. so we're not just talking about mental illness or, you know, the, or the absence of mental illness. We're
really thinking about health promotion. We're thinking about that mental health continuum from promotion, you
know, all the way through to recovery. And, and so we take a, a very broad approach as we're engaging
philanthropy to also think about those who are most underserved and most in need, those with severe mental
illness. but also thinking about, you know, how do we swim in, you know, upstream, the most upstream and
think about where does, you know, mental health start. you know, it starts within, you know, the parent, the
caregiver relationship. It starts with, you know, that, infant mental health. And so we, we do try to take a broad
approach, I would say, in terms of the ways that we are engaging philanthropy and guiding philanthropy. you
know, we, we take a little bit of an iterative approach where we're, we're putting research and our strategic
guidance out into the field, but we're also listening to the field and seeing, you know, where is there movement.
You know, you can always, I, I always think the principle of like, go where there's movement, right? Where you
can have the most, you're not having to push the rock totally uphill. You know, you're, you have a little bit of
force behind it, right? And so, we've done surveys with funders on what are the issues they wanna work on,
where's the, the most traction? and so we're always working in those areas, but then we're also guiding and kind

of pushing and giving calls to action, you know, for philanthropy. And, and one example of this would be, 83%
of the funders that we work with that are in our network. We have about 1100 funders that are in our network
currently in all 50 states and 12 countries. and about 83% of those in our network want to, or all are already
funding youth mental health. And, and so, you know, that's a, that's a pretty big issue that has received a lot of
attention. But I would say that the majority of funders right now are really focused on adolescent mental health,
or even up to that age of 10, you know, and that has been considered maybe upstream, somewhat. And we've
really been working with funders to think more upstream about that, you know, that mother child diet, that
strong start to life. How can we influence those life outcomes and giving the tools and the resources for the
entire family unit and the ecosystem that's surrounding perhaps the youth.

Mark (09:07)
But you're not really trying to pick winners or losers. You're helping people along their journey and trying to
cultivate their interest in mental health, providing mental health, which has also set a sort of a, a remarkable
goal, of what should be spent, in this area. Tell us a little bit about that as well.

Alyson (09:25)
Yeah. We, a few years ago, you know, I said that we, we are bold. It's a, it's a value that we hold. in 2021, we as
a team decided that, you know, if we were going to take on mental health, then we needed to be willing to take
risks. of course, measured risks as a small nonprofit. but we needed to be bold. And so we issued a, you know, a
challenge two years ago to philanthropy to increase the funding to mental health addiction and wellbeing to 35
billion annually, by 2035. And that sounds, when we think about current levels, of funding, that sounds
astronomical. but when you actually think about if it's investing the right amount of money in the right places,
and we think about the US population in 2035, the projections You know, it's really only an investment of about
a hundred dollars per US citizen. And if it's invested in the right places, it could actually produce, you know,
incredible savings and economic productivity, you know, and wellbeing across our entire ecosystem.

Margaret (10:25)
So was this part of the Accelerate summit that you recently held, and what, what came out of that summit? It
sounds aligned to this round’s goal setting. But tell us about that. And that was bringing all your funders
together, right?

Alyson (10:38)
Yes. Well, I'll, maybe I'll back up this. The reason that we actually issued this call to action was, I think it was
about three years ago, we did some focus groups with funders, and we did a survey with funders, and we asked
them what the barriers were to funding mental health. And we were, we were somewhat surprised by the
answers, that we received. We, we heard from them that, you know, we honestly, we just don't know what's out
there to fund. Okay. So, you know, we need to be able to uplift those solutions. We also heard, we don't know
who the funders are that are funding, so who are our peers that we can collaborate with, that we can work with?
we, we don't know who the leaders in this field are because, you know, you haven't seen major investment in
mental health the way you had with, you know, education and other climate and other sectors. and then we, you
know, we also heard there aren't spaces for us to meet and to convene and to come together to work on this. so
those were some of the issues, the barriers that we heard from funders. And we were already working on a
number of them. We had already started convening philanthropy in various settings, whether it was around topic
areas, issue areas. we had already started a convening of principles, that's known as Activate. It's a community
of principle level. and we were already, you know, trying to platform some of the funders that had been
longstanding within the field. But one of the things that, and, you know, we, they had heard, we, we heard from
them that they didn't have a vision, you know, for like, what could we do together? And so that was really where
the 35 billion came from, was thinking about there has to be a call to action. And, you know, I mean, with any
data point or any call to action, you're never gonna get it perfect. Sure. But we felt like it needed to be
something that was almost, you know, on par with Physical health. If we say that physical and mental health are,
you know, equal and intrinsically linked, then it needed to be on par with what we're thinking about with
physical health. and so then we, as we had been convening principles and, and others in the field, there was this
need to bring more and more people together. And that's where the idea for Accelerate came from. and we just
hosted it in April for the first time. we had over 110 entities there about, you know, 70, I think 78 funder
funding entities. And it was an overwhelming success. Isn't that great? I think it illustrated that one, we really
wanna do this work in community, that even though we're talking about isolation and connectedness, we need to
practice that ourselves within the field. and we heard, you know, that I would say within the survey, we had
heard from people that, you know, the community is important, but the work that Mindful is doing, you know,
this, 80% of those that attended said, you know, mindful has helped guide our funding. And 60% said they've
actually helped us increase the funding to the field.

Mark (13:20)
Well, that's, that's wonderful. So important. You know, we're here in Aspen, Colorado, and Aspen Ideas Health,
and, you've been talking at the conference, one of the sessions is follow the money for good. Yeah. And, which
is a great topic. And, tell us what you've been sharing.

Alyson (13:37)
Yeah. You know, I think, back to our, our conversation earlier in the session about what is mental health? And I
think primarily even when we think about measuring the money, most of the measurements, you know, we
know that in 2022, there was about $2.3 billion that was going to mental health addiction, really mental health
and addiction. And it was mostly in clinical care settings. And one of the things that we're really encouraging
philanthropy, as I mentioned, to go upstream. And so we have to think about what are communities and what are
community solutions, that are coming from within the communities themselves, and how are we shifting our
mental models, you know, about what mental health is. So it's not just getting care in a, in a clinical care setting,
but who are other providers? Because we have a workforce shortage. So who are the other providers that can
deliver care? It could be that, you know, through the commu-, you know, community-initiated care model that
maybe it's barbers Maybe it's clergy. You know, maybe it's other frontline workers. and that we're reserving the
clinical care model in the setting for those that are really do need it so that the system isn't overwhelmed. so
we're talking about investing in communities and the solutions that they are bringing that are also culturally
relevant, competent, led by the communities. and we're thinking about also lived experience, like what is the
role that those with lived experience in the communities have to play? So whether it's peer support and peer
coaching models have been proven incredibly effective, especially in times of crisis. so those are some of the
things we were talking about in that, in that session.

Mark (15:08)
And Margaret, you know, Alyson just mentioned barbers, but we know in the domestic violence area Sure.
Hairdressers, it played such an important role, in terms of…

Margaret (15:17)
Peer-to-peer, just peer to peer support. And assistance in getting help. But I, I'm also, thinking as Alyson talks
about communities and the perhaps shortage of workforce, that's a very real and present issue. It's, and it's, I'm
sure you have come across in your discussions, the United States does a good job of figuring out how to kind of
name and measure, but not so much manage the issue. So the whole issue of mental health, professional
shortage Yeah. Areas, right. All over the country, 125 million people, I think live in a mental health professional
shortage area. So you have this real issue of pipeline, of the range of people that you need from addiction to the
clinical therapists and the, the medical therapist, psychiatry, for instance, what's your engagement with the
current mental health, professional, for lack of a better word, the mental health professional workforce, we'll call
it at large? Have you engaged them? What are you hearing from them about pipelines and training and shortages
and how that's affecting people?

Alyson (16:17)
Yeah. No, it's a, it's a very real issue in thinking about how we address, you know, the mental health care system
in the United States. And, it is one of the priority areas that we mention in one of our pieces of guidance that we,
where we think funding needs to be directed. and we, you know, we don't define workforce as just that clinical
setting. Sure. Again, it's pure, it's, you know, it's a broad range, and we are seeing some really innovative
solutions. So funders are, you know, funding new career ladders, new forms of certification, you know, that
we're seeing across the country. So I would say there's lots of pilots that are happening. I think, you know, we
know that with the pandemic, there were, you know, some restrictions that were lifted around, you know, kind
of licensure and, across state boundaries and lines. And, and telehealth really took off, which was huge,
especially for those, that's Been a sea change. Yes. Especially for those rural areas that, you know, we know that
there's 64% of counties in the US have a shortage, and it's a lot, a lot of them are in rural areas. So that was huge
for rural. and I think for workforce, you know, what we're, we're seeing right now is even some of the
unintended consequences from telehealth, you know, that it's, you know, clinicians who are doing telehealth
who maybe have back-to-back to back, you know, appointments, and then they're experiencing burnout and it's
wearing on their own mental health. So we're very engaged in this issue. we actually are, in the fall launching a
little bit of a, a strategy around, a number of issues that we've highlighted for the field. And workforce will be
one of them, you know, that we're gonna uplift more with more intentionality.

Mark (17:48)
You know, I'm wondering about the work that you, you do, it's in the private sector, but there must be some
interface, with the federal government, the state government. We're just talking about regulations that pretty

much happens at the state level. Where you have lots of issues to deal with. And in the federal level, you have
lots of, investment that's going on, and that might change, but right now there's a lot of investment going on.
What's, what's the conversation like, with those players and the role that mindful philanthropy is playing?

Alyson (18:16)
Yeah. Well, you know, I would say we have a, we're, because we do have funders in all 50 states that we work
with, and a lot of our place-based efforts started in, in Montana, mental health is a very place-based issue.
Funders that fund it are place-based. We see very few national funders. I mean, there are, and there are more
emerging, taking on kind of that leadership role that I mentioned earlier as a, you know, kind of a, a, a gap in
this field. but, you know, one of the examples of the work we've done was in Montana when we brought
together a group of about 20 funders, and we helped them do some work in, in, in assessing the gaps around
youth mental health in the state. we formed a policy working group. one of the funders in the policy working
group, you know, gave it a very small investment. Like we're talking, you know, it was between 60 and $70,000.
And we had a short window where we mobilized, you know, not just, you know, grassroots efforts to call
legislators during that legislative session, but we brought in our policy partners that we work with, and that were
able to bring in lobbyists. And that very small investment returned to $300 million public trust around youth
mental health in Montana. So that was a huge win. But, you know, we partner with our policy partners that are
doing important work in this space. you know, we, there's, there's clasp and there's inseparable, and, there's the
Kennedy Forum and all of the ones that are doing great work. And so policy is not our expertise. We never
claim to be an expert. And, you know, we manage so much of, you know, the field, but we, we have strong
partnerships. Well, And one of the, and you know, just to moving forward, I think one of the things we are
doing is that we, you know, we have, just like in Montana, we helped to nurture this group of funders that came
together. We've been working with those place-based efforts in about 10 other states, where there's been funder
tables and collaboratives that have come together. And we're helping to launch even more of those. Our goal is
to launch over, to have 40 of them up and running in the next few years. And mindful is providing that
connective tissue Among those funder collaboratives to learn from each other. There's been great work in
Georgia around reimbursement rates, that the funders have led with, you know, state, legislators and policy
experts that have come in, like Alex Briscoe. And so that is really important work. And what we're hoping to do
is have all of those state tables learn from each other. So we've set up a kind of a community of practice for
those state tables to continue working and learning from one another.

Margaret (20:44)
Well, you've taken on such an enormous, issue, and it's very logical how you're following it out. And I'm, I'm
curious whether another arm of it is really those local funders recruiting the people who are gonna be the
advocates in their community. And maybe that's a piece of what you're talking about, but whether it's,
convincing boards of education to allow absolutely. School based health centers to have mental health, or,
recognizing that the people most likely to be in your homeless shelter or sleeping outside, on a freezing cold
night, are people with a mental illness and fear of being inside, where they don't know if the voices they're
hearing are real or not. Those are extreme examples, but you need advocates in the local community. Is that kind
of training and mobilization, which is almost like political campaign mobilization in a lot of ways. Part of what
you're looking at doing,

Alyson (21:31)
You know, it's actually not. I mean, our, you know, the work that we're doing is really focused on enabling the
funders to find those partners locally in their communities to fund their work. there are great local partners that
are doing work like that. And so, you know, our goal, we're, we're never gonna be a national entity that's kind of
coming in and, we work at, at such a high level in terms of that national connective tissue. So we're, we're
always encouraging funders to think about those partners locally that can help them implement the work, that
can advocate on the ground for the work. And, you know, I think our goal is just to help them support the
funders. And support the funders be the best partner. What does it mean to get in the trenches and be a good
partner at that level?

Mark (22:11)
Tell us about a five-year trajectory. What, what's the game plan? 'cause it sounds like you're very intentional
about the work that you do and, so what, what's the next five years look like in terms of the, the design of, of the
work that you're doing? And, you're at this important inflection point, I think, where so many people are
recognizing red states and blue states. We all face the same set of issues. We need to work together.

Alyson (22:37)
You know, well, great timing on the question because we just finished a strategic planning process, that our, our
board is really excited about. And so, you know, I mentioned the barriers earlier, and we've spent a lot of time,
you know, producing, you know, tools as a field catalyst that is building this field of mental health philanthropy.
Our goal is to, you know, is to really strengthen the funders. And, and we've laid out five issue areas that we
think funding should go to. But one of the things that we're doing over the next five years is co-creating with the
funders. You know, where should, what are the strategies and what are the specific investments, that need
funding that are gonna actually move the needle at a systems level. So we, you know, we'll be going all in on,
workforce, as I mentioned, that is one that we can't ignore. I think it's one that AI is already having a lot of
influence on. We know that, you know, one of the uses of AI is companionship, you know, reducing social
isolation, and therapy diagnosing. So that will be…

Margaret (22:38)
Veteran affairs has done a great job with that. Many institutions have.

Alyson (23:42)
Yeah. So that will be one. Another one that is really interesting, that's an emerging field that we have been
paying close attention to, we're deep in it, is around community. And I think, you know, the former surgeon
general, Dr. Murthy did a great job of bringing this to the forefront. but we're looking at it in, you know, that
kind of belonging and meaning and wellbeing. We partnered actually with the Aspen Institute on their
belonging, meaning wellbeing and purpose work. so that's one where we are, you know, we just released kind of
a, a portfolio of nonprofits that are doing work just because it feels a little bit squishy, you know, commu-. It's
like, what does it mean by community and how do you build community? and then the big one where we're
really, helping funders to, it goes back to the 83% is around youth, but how do we break it down where funders
can be really intentional, strategic, and that we can also create, some long-term impact on life outcomes. So it's
around youth mental health, but we're dividing it into, you know, what is, what do youth need around that strong
start to life? So zero to five, that mother child dyad. The second is, you know, around playing and growing and
developing those life skills that are needed, whether it's resiliency and agency grit, you know, for kids to build
those, those muscles before they move into their teenage years. And then third bucket is around, digital
wellbeing. Something that we can't ignore, you know, our children, I have a 16 and an 18-year-old, you know,
they live in a digital age. And so, this is where we're going all in with philanthropy on these, kind of five areas,
but really it's three that we're being intentional and strategic about.

Margaret (25:16)
Well, you obviously brought a lot to the position. You were not formed just by the position, and we understand
that you spent, several years working in Russia and leading initiatives there. Tell us a little bit about what you
were doing and what helped, prepare and strengthen you for taking on this role.

Alyson (25:33)
Yeah. You know, as you get older, you reflect on, you know, what were those inflection points on my, in my
life? And, I think when I was in my, probably late twenties or early thirties, I, I think I was somewhere at a, a
retreat that someone had encouraged us to do a reflection exercise on, like, what is our purpose? Like, how do
you know that you were, you know, uniquely wired to do something? And I remember thinking back to when I
was 10 years old, I had this very clear picture of when I was 10 years old. And, it's kind of embarrassing now to
tell this story, but I, I was in fifth grade and I had started this like ecology nonprofit and had mobilized my
elementary school to, you know, recycle. And we were planting trees and doing all this beautification ecology
work. So I'm dating myself around the ecology work, so that's not what it's called now. and I think that was my
first memory of, you know, knowing that I was uniquely wired to see a social issue area and think about
solutions, and then mobilize people toward those solutions, and that that was my best contribution. Yeah. So
that has repeated itself time and time again throughout, you know, my college, years and then through now I've
been in nonprofit for nearly 25 years. It's taken me to, to Russia, you know, I've worked with faith-based
nonprofits. but in every single one of those, it's been doing what I just described. And it's been scaling efforts,
it's been turning efforts around, but really thinking about and dreaming about the possibility, of what could be,
and how do we affect and create change.

Mark (27:10)
You know, you talked a little earlier about the, Montana as being an exemplar. Any organizations that you've
been keeping an eye on? I know it's a, a big country with a lot, but any, anything that our listeners might want to
take a, a gander at and, learn a little more about? At, at a, perhaps at a community level?

Alyson (27:29)
Yeah. At a community… there's so many good organizations. You're gonna make me pick a few, but, there's
11,000…

Mark (27:34)
Which of your children do you like the best?

Alyson (27:36)
Yeah, Exactly. Exactly. You know, there's 11,000 nonprofits that are doing, and those are just the ones that
identify as mental health. But since we're here at, at Aspen, and there are a few of them that are here that we've
supported and recommended to funders, I'll mention those. Okay. so I would say, you know, black Outside and
Boys in the Wood have been two organizations that are specifically working with the black population to
incorporate nature, to give access to nature and green space. and because we know that, you know, especially in
urban areas, that that lack of green space can be challenging, especially for trauma affected youth. And they're
doing a phenomenal job in that. They, and they also have a great partnership together. So they exemplify kinda
that partnership, but thinking more holistically about, you know, mental health and, and physical health and
trauma. so I would say they're doing great work. there's also, you know, if you're thinking about the front lines
and community, you can't ignore, you know, kind of faith communities. It's a lot of work that's bubbling up
absolutely. Right now. Very. I, so, you know, I think reboot, so we haven't talked a lot about addiction on here,
but Reboot recovery is one that, we're really impressed with and they're doing a lot with addiction and veterans.
and that's just to highlight a little bit more of addiction here. But, there's so many good nonprofits out there, and
our message to funders is, you know, there are a lot of good solutions out there, but they need funding at scale.

Margaret (29:02)
Well, Alyson Niemann, President, CEO of Mindful Philanthropy, thank you so much for joining us today.
Thank you for your incredible work. And we wanna thank of course, all of our audience for being with us today.
Remember to join us on X and Facebook, send in your comments, share your thoughts with us, so important that
we keep this message going, and I hope that you'll be disseminating results from your work in the near future.
Thank you so much for joining us.

Alyson (29:27)
Thank you for having me. Thank you.

Margaret (29:32)
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