How Philanthropy Is Moving the Needle on an Innovative Approach to Mental Healthcare
Collaborative care, a team-based approach to mental healthcare, has a cult following among some healthcare experts — but many people have never heard of it. The name is clunky but the approach is simple: The model integrates mental health and substance use disorder screening and treatment into primary care, so patients can receive support at their routine doctor’s appointment.
Research has demonstrated that collaborative care works. As the American Psychiatric Association put it, “Over the past decade, the integration of behavioral health and general medical services has been shown to improve patient outcomes, save money and reduce stigma related to mental health.” (Behavioral health is an umbrella term that includes both mental health and substance use disorders).
But despite its proven effectiveness, most people who need behavioral health support don’t have access to collaborative care. According to a recent analysis, the model is available in all 50 states, but access is limited: Less than 1% of the nearly 60 million adults and children with mild and moderate mental illness who could benefit from collaborative care received those services.
Path Forward, a coalition of healthcare purchasers, clinician associations, health systems, philanthropists and health-related nonprofits, is working to change that. And philanthropy — both national and regional — is playing a key role. The Goodness Web, a national funder that focuses specifically on youth mental health, is supporting Path Forward’s efforts to boost awareness of and access to collaborative care nationwide. And in areas of the country where the model is flourishing, support from regional philanthropy is proving crucial.
Anna Bobb, the executive director of Path Forward, highlighted the role of philanthropic support. “Obviously, philanthropy can’t do it alone, but it can show bright examples of success, and that’s what we’re focused on,” she said. “If you have these bright examples, it creates a virtuous cycle, and you’re able to scale it even further.”
Collaborative care as a mental health entry point for philanthropy
Awareness of the mental health crisis may be growing, but help for those who are suffering continues to lag. Barriers to care include inadequate insurance coverage, high out-of-pocket costs, fragmented care, and a shortage of providers. The Trump administration is making a bad situation even worse by eviscerating funding for mental and behavioral care. And while a growing number of funders are making mental health commitments, just 1.7% of philanthropic funding went to mental health as of 2022, according to Mindful Philanthropy.
Before Anna Bobb joined Path Forward, she explored some of the factors that keep funders away. She was part of a team that interviewed behavioral health grantmakers and summarized the findings in a 2023 article for The Foundation Review, titled “Philanthropy’s Uneasy Journey into Mental Health Grantmaking.”
Bobb, along with co-authors Robert J. Reid, Mallet R. Reid and Ximena Murillo, described their findings in a post for Alliance: “Every single grantmaker we interviewed expressed uncertainty about where to even start serving mental healthcare needs. Discouraged by the lack of entry points, an existing scaffolding to build on, or even actionable expert advice, many felt hamstrung in their efforts.”
Bobb believes that collaborative care provides not just an entry point and a scaffolding, but also the framework for widespread systems change, making it a good fit for funders concerned about mental health. Philanthropy can, for example, support public education and advocacy around collaborative care, including legislation like the COMPLETE Care Act, which would promote the adoption of the collaborative care model in Medicare. Funders can also provide funds to support implementation, the largest cost for health systems that wish to adopt the model.
Path Forward’s work to promote collaborative care complements The Goodness Web’s multilayered approach to youth mental health. The Goodness Web provides a few large, multi-year commitments to a diverse array of organizations that effectively address the youth mental health crisis. In 2022, The Goodness Web made a three-year, $1.8 million gift to Path Forward.
“When you’re trying to move forward policy, you need a few different coalitions,” said Celine Coggins, The Goodness Web’s executive director. “Certainly, you need to engage the public, and some of the organizations we work with do that. But you also need the ear of decision makers in Washington and in states. To get there, you need exactly what Path Forward provides, which is a strong coalition of actors working together to advance viable solutions. Path Forward coalition includes a number of industry experts as well as the purchasers of healthcare. It includes the American Psychological Association, but you also have people making the purchasing decisions.”
At the same time, the model is backed by a convincing body of evidence. “The research on collaborative care shows that it both decreases long-run core costs in the health insurance system and improves outcomes for the patient,” Coggins said. “Having those two together is a really big deal, because you’re heading off problems in a preventative way.”
For Coggins, supporting collaborative care provides a concrete way for philanthropy to tackle mental health. “For many in philanthropy, the goal is systems change, but breaking down a right-sized chunk where you can actually define what the outcome goal would be and then get to it is hard to identify,” she said. “I think collaborative care in the behavioral health system is a good example of the type of systems change that we want, and that philanthropy can help catalyze.”
Collaborative care is a growing model, but its reach is still limited
The concept of collaborative care was developed in the 1990s, but gained traction after 2017, when the Centers for Medicare and Medicaid Services established billing codes that allowed providers to receive reimbursement. Private insurers began providing coverage and payment for collaborative care at around the same time. Medicaid programs in 22 states have activated the codes, in no small part, Bobb said, because of state-level advocacy by the American Psychiatric Association, a founding partner of Path Forward.
But one recent analysis found that while the collaborative care model has grown 10-fold in recent years, it is concentrated in just a few regions of the country. The study was commissioned by Meadows Mental Health Policy Institute on behalf of Path Forward and in partnership with the American Psychiatric Association and was conducted by Milliman, an independent global healthcare consulting firm. The Meadows Mental Health Policy Institute, which was created by the Meadows Foundation, is also a coalition member of Path Forward.
Andy Keller, the president and CEO of the Meadows Mental Health Policy Institute, underscored the benefits of the collaborative care model with a powerful statistic: “If every American suffering from depression had access to the collaborative care model, we estimate that approximately 14,000 lives could be saved each year from suicide,” he said.
Regional funders: expanding access to collaborative care
Becky Cienki has seen the effectiveness of the collaborative care model on the ground in Michigan. Cienki is the director for behavioral health and special projects at the Michigan Health Endowment Fund, which has been providing behavioral-health-related grants since 2016. That experience has convinced Cienki and her team of the efficacy of incorporating mental health and substance use care in the primary care setting.
“People often and usually present first in primary care with their behavioral health needs,” Cienki said. “And there is less stigma attached with getting behavioral health support in primary care.”
Sarah Wasil, the Michigan Health Endowment Fund’s program officer for behavioral health, described the typical experience for patients with mental or substance use issues. “Alternatively, if the primary care setting doesn’t have that integrated care, they have to refer people out. People fall through the cracks. They often don’t follow up. It’s just harder to make sure that patients actually receive those mental health and substance use disorder services.”
Blue Cross, Blue Shield of Michigan has played an important role in the expansion of collaborative care in that state, according to Cienki. “On the commercial side, they’ve led the way on reimbursements for collaborative care,” she said. “Not only has Blue Cross done a great job of leading that work, but they’ve also supported some training and technical assistance, as well.”
Regional funders have also had an impact in Texas, where the Meadows Mental Health Policy Institute report found that the collaborative care model has been adopted widely. The Meadows Foundation has supported the model in Texas, as has Lyda Hill Philanthropies; that momentum in turn drew in funders focused on meeting local needs, like the Amarillo Area Foundation in the Texas panhandle, according Bobb.
Bobb emphasized the role regional funders can play in increasing access to collaborative care. “Creating change in a health system is very, very challenging, and with mental health, it’s even harder,” she said. “But regional funders often have really good relationships with their health systems because they’re often already donors and they’re able to give incentive gifts and implementation gifts to kind of spur this practice along.”
Momentum for collaborative care — and a long way to go
Terms like “collaborative care” can seem wonky or abstract, but for Cienki it’s important to look past the jargon to the impact on people’s lives.
“The important part is that, right now, people aren’t getting the care they need,” she said. “We know from our last behavioral health access study that 32% of the people with a mental illness in Michigan weren’t being seen, and only 28% of Michiganders with a substance use disorder received any care that year. So there is a desperate need to improve access, and one of the best ways to do that is through partnership with primary care.”
Bobb shares Cienki’s urgency. ”We’re only reaching 1% of the people who could be benefiting from collaborative care, and we think 60 million people could be helped by this. So it’s wonderful that we have this momentum. Now we need to roll up our sleeves, because we have a long way to go.”