So, I'm looking forward to a really important conversation this morning about the exciting intersection of technology, mental health, and philanthropy. Tech is changing how we provide health care and creating great wealth. Our social discourse is more focused on mental health and mental illness, and there's increasing interest among philanthropists and potential donors in mental health in how to achieve a genuine impact. Our panelists will help us explore these issues with an eye toward helping psychiatrists understand philanthropy and philanthropists better, helping philanthropy identify the most worthwhile targets for giving and social impact, and helping APA and the profession think about how to position ourselves to leverage this moment. I'm Rick Summers, clinical professor of psychiatry at the University of Pennsylvania and treasurer of the APA and a member of the board of the APA Foundation. I'm going to introduce the members of the panel this morning and then turn it over to our facilitator. Before I do, I want to mention a couple of things. The session is recorded this morning, which is great, but it does mean when we get to Q&A, we want everybody to use the microphones. So I'm pleased that my colleague and friend, Joe Pyle, on the end here, will be our facilitator. Joe is the president of the Thomas Scattergood Behavioral Health Foundation, a Quaker-based philanthropic organization in Philadelphia. He has more than 20 years experience in behavioral health, serving eight years as chief executive officer at various institutions, including Meadowood Behavioral Health System, Northwestern Institute of Psychiatry, Malvern Institute, and Friends Hospital. Joe's on the board of the Friends Behavioral Health System, the National Association of Psychiatric Health Systems, and the Delaware Valley Health Care Council. I'm going to introduce everybody and then we can really turn it over and start the conversation and mix it up together. Lyle Sakoway is a partner at the Bridgespan Group San Francisco office and philanthropy practice. Since joining in 2015, he's supported a broad range of efforts to unlock additional philanthropic capital for racial and economic equity, including the 1954 project, the Asian American Foundation, the Audacious Project, and Policy Links Winning on Equity campaign. He works with philanthropic platforms and individual donors to define goals and strategies, design sourcing and selection processes, support portfolio organizations, and continually improve their giving over time. Caroline Fenkel co-founded and serves as chief clinical officer of Charlie Health. Caroline is a graduate of the Bryn Mawr Graduate School of Social Work and Social Research and after extensive clinical experience, helped to launch Charlie Health in 2020. They are now the largest virtual IOP provider for young people and their families and they operate in 23 states. As an entrepreneur of a technology-driven mental health organization, she brings the provider and clinician perspective to this conversation. Tom Inzel, a psychiatrist and neuroscientist, has been a national leader in mental health research policy and technology. From 2002 to 2015, Tom served as director of the NIMH. He served as special advisor to California Governor Gavin Newsom on behavioral health issues and has co-founded several startups, including Humanist Care and most recently, Mental Health, which is a startup helping people with serious mental illness engage in psychosocial supportive care. He's the author of Healing, Our Path from Mental Illness to Mental Health and a member of the National Academy of Medicine. And last, we have Raul Andrews, who is the executive director of the American Psychiatric Association Foundation. Prior to taking on the leadership of our foundation, he was in the private practice of law and held a variety of management positions at the AARP over 15 years. Raul is the recipient of a 2023 U.S. Presidential Lifetime Achievement Award received from President Biden, a 2022 Hope Center of Harlem Innovation Award, and he also serves, in his spare time, as 135th president of the Bar Association of the District of Columbia. So it's my pleasure to turn it over to Joe to start a conversation with this really outstanding panel, and I really want to thank the panelists for coming from near and far to be part of this conversation. Thanks, Joe. Thank you, Rick. Before I get started, I wondered maybe if we had anything that folks from the audience wanted to get out of the panel this morning. What value you're being here, and if there's anything in specific that you have a question for anybody, do you want to tee it up in the beginning so maybe that they can all spend some time answering it during the presentation? Does anybody want to raise their hand and start this panel with a question? Sure. Do you want to step over to the mic just so we can? So one thing about access to care that's always perplexed me is why employers who pay for insurance for their employees don't do more to insist that insurance companies reimburse or create networks or do something so that their employees can get access to mental health care. Okay. Well, hopefully we'll weave that in. Anyone else? Thank you. I'd be curious on some comments, the differences between venture capital and philanthropy and what the sort of what is expected of you in that. Perfect. I think Tom's got that queued up. Hi. I'm Steve Chan. I'm the chair of innovation at APA. We're responsible for the mental health innovation zone programming, and my question is what is the current state of sponsorships and sort of donations, particularly for mental health technology initiatives? The impression we get is that this is certainly leveled off or decreased significantly this year. Okay. Great. Appreciate that. Anyone else? All right. Those are three great questions to get us started and get the panel to be doing a little bit of thinking before they make their presentations. I wanted to start out with, first of all, I need to thank Rick, as he was the foundation's first grant. I met Rick 20 years ago, and we made a small grant to the psychoanalytic society, and what I'll tell Rick now is that if he were to come and ask for that grant today, the answer would be no. So the foundation got a whole lot more sophisticated, and not to say that Rick's project wasn't worthwhile, but we've evolved. So as we were getting ready, am I clicking this? Is that what I'm doing? Sorry about that. I'm ruining Tom's presentation. And Tom and the panel will spend a little bit more time on this, but I was intrigued in looking at the data about where philanthropic giving is, and this is really just from foundations. On an annual basis over the last several years, going back to 2018, there's over $80 billion in philanthropic giving. That's not individuals, it's just foundations. What's interesting about that is 20% of that spend goes to healthcare, and then only $20 billion goes to healthcare, and only $1 billion of that $80 billion goes to mental health and substance use disorders grant making. And I started to think, what is wrong with us? What is our diagnosis? So I'm big on audience participation. So what is the diagnosis of our field that we're only able to get $1 billion of $80 billion? Does anybody want to offer a diagnosis? You're mostly, I think, all clinicians. I ran through a few, but I'm not sure they're in the latest version of DSM-5. But I just said, I started to think, well, what is our diagnosis? And is this about how poor we are in our storytelling, which I think folks will get at, or is this really that we're not driving the kind of outcomes that we're seeing philanthropic foundations looking to fund? So I think it's either about our storytelling, or it's about how poor our outcomes are. Iola? I'm sorry? I said neither. It's stigma. You can't get a family to acknowledge that their children have borderline, or that they have a mental illness. And then they don't want to give money to tell their neighbors or their friends. OK. So I think we can, hopefully, the panel will get to the issue of stigma and bias. I would add, it's not only that mental health doesn't capture that proportion of philanthropic giving, but also, as it was shown in a paper I published, I got a response from NIH. Mental health does not capture government funding proportional to the burden of illness. And they say, I published a paper in Circulation Research about this that NIH responded to. And so this is not just philanthropy, but government as well. OK. This is great. This is all things that I'm hoping our panel will address in their comments. If you look, and if you handle one mental illness, you never connect it to the public health savings. You walk around and see all these people on the street. It's mental health. Who's paying for them to get food on the street and hospitalization? I don't understand why we don't connect it to money. OK. Cost to taxpayers. All right. Before I turn this over to Tom, just a few more comments on my part. One, I really hope today that we're centering race, gender, and culture in our conversations. I think that's critical. I think as a field, we've lagged behind on that. And I think we are beginning to catch up. But I think it needs to be a constant theme in our work. I think another piece that I hope our panel will touch on is this notion of leadership. I think that we all need to lead in this space. We can't be passive. I think one of the hopes that I think we'll have conversation on is, what should philanthropy not be funding? And maybe we'll address some of the issues related to stigma as part of that. I think the other piece is that we kind of have to get outside of our day jobs and our heads. And I know our panel will talk about that. I think that maybe the last two comments that I think are important to recognize is the role that the pandemic played in accelerating change. 20 years ago, I was at Friends Hospital in Philadelphia. And we were providing telehealth services to Temple Children's. And I remember we were doing it over DSL lines. That just shows you how old I am. And we got a lot of blowback about using telehealth, telepsychiatry back then 20 years ago. And many a clinician at the time would say, I could never see telehealth as a worthwhile solution. Well, the pandemic radically changed that. And now I talk to colleagues and they say, I may never go back to practicing in the office. So I think we have to think about disruption as an important part of that. And I think the pandemic was key in disruption. And I guess my last comment before I turn it over to Tom is that my kids played hockey. And everybody always used to use the Wayne Gretzky analogy. Skate to where the puck is going. And I think the panel today will talk a lot about where the puck is headed, not where it is. So I appreciate everybody's initial involvement. And I'll turn it over to Tom to do some contextual setting and get this started. Thanks, Joe. And thanks to all of you coming at this very early hour. As Joe has already shown, we really want this to be more of a conversation. But just to get us started, I thought it would be helpful to provide, as he said, some sort of historical context for where we are. Because it's a really interesting moment to be having this conversation. Mary Woolley, who runs Research America, when she talks to people who are trying to raise money, says, well, all that matters, as Joe just said, is the narrative, getting the narrative right. And the narrative she always uses, and it's worked really well in cancer, heart disease, diabetes, and many other places, is to say, look where we were. That was then. We got a certain amount of funding. Look where we are. That's where we are now. And how much we've done. Imagine what we could do going forward with more funding, more investment, more commitment. And that's actually the narrative I want to follow in three minutes or less to give you a sense of the context we're in now and where we could go. So in terms of where we were, let's say, a decade ago, or maybe, yeah, roughly a decade ago. I think I like to, when I think about philanthropy, divide it into three columns, research, services, and policy, as the three areas where, if I were an investor, I'd be looking. I think it's fair to say that in that decade, or 10, 15 years ago, most of the philanthropy was actually in the research category. And it was a few high-net-worth individuals, Jim Simon, Ted Stanley, some very wealthy people in the psychedelic science funding consortium, who drove a remarkable amount of science. Not really very much in the services arena, although there was a little bit from some family support, but actually foundations, as Joe mentioned, have largely not been in this space. There's a great piece written about two or three years ago by Ken Zimmerman, who's now at Fountainhouse, where he showed that the foundation support, only about 1% of it overall goes to mental health, which was, I thought, an amazing indictment of our failure to really tell the right story. Even then, I think the stunning thing is, when you looked at the whole landscape, we're talking about a few hundred million dollars that were going into this behavioral health space a decade ago, and probably the most interesting story is the psychedelic science funding consortium, which found an area that government had not funded at all, foundations had not funded at all, but a few wealthy families got together and literally built a scientific field that didn't exist before, and now has got enormous venture capital, private equity, and every other kind of investment behind it. So where are we now? It's a really different time, absolutely different, and it's different because not only what gets funded, but who's doing the funding. On the what side, we have now very robust support, not only for research, but for services and for policy, which just weren't there a decade ago. On the who side, massive investments. So venture capital has put over $12 billion. When you add together, these are rock health numbers, 2018 to 2022, I'm assuming with 2023 that number could easily surpass $15 billion. And again, just as a reference point, if VCs are putting in $2 billion a year to generate new companies in behavioral health, that is the NIMH budget. $2 billion is a lot of money. The NIMH budget, of course, 70% of it is for existing grants. Only about 30% goes to anything new. So this is real money that was not available before. We have private equity coming in. Lifestance was purchased for $2.4 billion two years ago. There's a couple of other great examples of that. And then we have the aggregators. You have One Mind, you have Brain and Behavior Research Foundation, who are also finding themselves with more funding than in the past. The other huge change is the advent of families who have now made massive commitments. Steve and Connie Balmer, Steve and Alex Cohen, McKenzie Scott, with the help of Bridgespan, which you'll hear more about in a minute, the Huntsman family, Mark Rapoport, who runs the center, is with us here. Many others. But each of these are over $100 million alone. And some of them, like the Balmer gift to Oregon is a $440 million gift. So these are really big, big new investments. McKenzie Scott has done a remarkable amount for many of the nonprofits in this space, whether it's Crisis Text Line or National Council. I guess it's not really a nonprofit, but NAMI, Mental Health America, Fountain House, many, many others, has really changed the game. So there's a lot happening there, and mostly in the areas of youth mental health, somewhat in digital health largely, though in providing clinical care. We're still a little weak, I would say, on the policy side. There are efforts certainly around parity and state reforms. We have organizations like Inseparable that have a state strategy that's really interesting, using the same strategy that the Inseparable founder used to do the marriage equality movement. He's building a movement for mental health state by state. Very interesting to see. But actually, I would say under-resourced and underpowered still by philanthropy. But you're beginning to see the Commonwealth Fund, RWJ, McKenzie's now in this mix. There's much, much more happening. The conversation, I think, for this morning is where are we going? Has Joe teed us up? What's next, and what can we do? And I think this is still a great discussion to have. I think in terms of the what, it's a different world. To me, generative AI is, along with older versions of AI, which I'll call natural language processing, but those two together really are the biggest breakthroughs for mental health, in a sense that maybe MRI and CT scans were for neurology or other parts of medicine. These are massively important new opportunities that are just emerging. We haven't actually seen them play out yet, but they will, and they will either with us or without us. The development of a whole range of digital tools undoubtedly will be important. The key, and this is to points already made by some of you, is that the federal government is in this space like never before. Well, more probably than any time since 1963. The Bipartisan Safer Communities Act from last June puts $9 billion into the CCBHC system. That means that between now and the next couple of years we're going to have now for the first time since the 60s a federally funded national network of centers for serious mental illness at a very, very high investment level. This is unprecedented really since the 60s. I'm not sure we've learned all the right lessons from the 60s, but suffice it to say it's a huge opportunity for philanthropy to think about how do we build public-private partnerships, how do we take advantage of what government is doing to create national networks, create data centers, to create opportunities to actually do things in a new way. We can learn a lot I think from what the oncology community, particularly child cancer centers have done there. On the services side, I've put up here a whole bunch of what needs to be done, and I'm sure we could talk about many more things. Global mental health is obviously an emerging area of need and interest and opportunity, but what I would want to suggest to you, and this is to Joe's question, is that we just think differently about how philanthropic dollars are used. I think it's going to be really important to think about them as catalytic dollars, to think about not just the return on investment the way we have, because I think we've thought a lot about the I in the ROI and much less about the R. One of the places that I want to make sure we go as a community is not only to expand the investment, but to make that investment more accountable. We're actually creating a focus on outcomes and even paying for outcomes in a way that we haven't. The last thing I'll say is I think whether it's through social impact bonds or whether it's through new financial mechanisms that we develop with governments or with large investors, this is a great opportunity to begin to make huge changes in what we do and what gets paid for. I want us to be thinking, and this is to the question that was brought up already, how it is that we can make sure that the federal dollars that are going into healthcare are increasingly available for this community, for the behavioral health community. The questioner was exactly right. What's so extraordinary is that with the $4.3 trillion in healthcare in the United States, we still don't have either public or private insurance paying for the very things that we know are most critical for people with serious mental illness to recover. It would be unthinkable if I told you that for people in chronic renal failure, we as a nation have decided that they will go to community-based organizations supported by philanthropy and often staffed by volunteers. No, we don't do that. We have dialysis centers that are paid very well by both public and private insurance, and people get very highly professional care because it's very heavily reimbursed. There is an opportunity as a philanthropic community to start making investments to force that change, to say, hey, wait a minute, we need to start paying for the things that work and not just for the things we've been paying for. To Joe's original point, with all the money that's being spent, why are we not seeing more impact? Part of it is because of what we pay for and the need to make a change there. I'm going to stop and make sure there's plenty more time, but turn it back to you, Joe. Yeah, just before you sit down, Tom, does anybody from the panel want to ask Tom a particular question about points he made? I think we want to get on. Well, I have one. You mentioned about accountable investments. If you think about the audience, and I'll make this claim that folks are working in clinical practice here, how do they need to be more accountable to be able to drive those accountable investments? What should the field be doing? Yeah, I think the field, let me break that into two quick parts. The academic field has grown up on NIH investment. NIH investment is not contracts, it's largely grants. Those are awards. Those are not accountable. You get the money, you do what you want. I remember Bob Wright, who was the person behind ARPA-H and who ran GE for a long time and then started Autism Speaks, once berated me when I was an NIMH director. He said, how many grants have you canceled for poor performance? Because if the number is zero, I know you're not doing your job. He's right. I do think there's an issue around accountability in the academic community and generating a sense of urgency and relevance and a response to the public health need. I would say for the clinical community, I think the issue there is a little bit different. That is that we've had this sense that the way that progress happens in medicine is that academics do research and then we wait 17 years to implement that research to go from research to practice. That doesn't work, and it's not really 17 years in behavioral health. It's never. It's absolutely never, which is one of the frustrations I had at NIMH. Why are we developing better and better treatments when no one uses the previous research that we had? So the issue there, as Greg Simon, who was on our NIMH council, said to me once, this is the wrong question. It's not research to practice. It's practice to research. So what I would think is the opportunity is for clinicians who are engaged, and you'll hear some of this, I think, from Charlie Health, begin to think about, hey, we're in the business of actually improving what we do. We want to build a learning health system the way we have in other parts of medicine. And so we are collecting data. We are measuring what we do. We are looking at outcomes, and those outcomes are shared in such a way that the whole community is beginning to learn to get better and better. That's what we need to be doing. So it's not research to practice. It's practice to research. That's how change takes place. We learn this in cancer care. We learn this in diabetes care. We learn this in maternal care, in so many parts of medicine that we have not learned it yet in behavioral health. Thank you, Tom. Lyle, do you want to step up? Yeah. Well, I was going to say. Oh, you have a question for Tom? Yeah. Tom, did you want to speak to the difference between philanthropy and private investing? In the mic. Why don't you ask your question to them? I just want to make sure everybody else has a chance. We're good on time. I was inviting Tom to share more about the differences between philanthropy and private investing and what they're looking for in the space, which we'll come back to, because that was a question that came up. Can you all hear me OK? OK. I'll get a little closer to the microphone. There we go. OK. Hi, everyone. As Rick mentioned, my name is Lyle Sakauye. I'm a partner at the Bridgespan Group. And for those of you who aren't familiar with us, we are a nonprofit organization that advises both nonprofits and philanthropists to increase their impact. And so in the context of this conversation, I'll be talking a little bit more specifically about individual donors, right? So less about the institutional foundations, which is what Tom was talking about, and more some reflections not on what any one donor has been thinking about, but some of the things that we've observed about how to engage high-wealth families and individuals in a conversation about supporting mental health work. And so the first thing I'll say overall is just I think we see a pretty wide variation in the reasons why people are engaging in philanthropy, right? So you might think about some folks who are really thinking about their legacy or their brand, and the reflections I'm going to share are mostly about the folks who are really focused on impact, right? So it's a little bit different when you're considering a gift that might be a bequest or a naming gift versus the kinds of system transformation that we're talking about in this conversation. And one of the patterns that we've seen is that donors are primarily interested in five kind of criteria that they use to evaluate opportunities that are connected to impact. These are kind of broad categories that you can get much more specific about. But first, they're looking for something that's going to push on a really important problem or opportunity. And I think in the context of mental health, that's pretty clear, right? I think even for folks who aren't paying that much attention, the notion that there is a crisis in mental health outcomes and behavioral health is not a surprise. The second thing that they're frequently looking for is a track record of success and a credible solution. And I think this is one of the areas where, frankly, it's pretty tough, right? I think for people to understand what good looks like in the context of mental and behavioral health. And I think, again, folks in this conversation will be talking more about the mix of what that means from the perspective of where you started, right? Is it about people not understanding what works or is it about a challenge in delivering the outcomes themselves? And I think that it's a mix of both. And I'm curious to engage the other panelists on this. The other three criteria that people are looking for, one is around leadership and organizational capacity. I wouldn't say that that's something that's specific to mental health per se. Similarly with financial health, people are generally looking for organizations that have a stable revenue model, clear cost controls and things like that. And I will say that this is one of the areas where policy work has really been critically important, right? Because if a philanthropist is looking to support a community organization or a service organization that has a healthy financial model, that depends a lot on what its state is doing. And it's usually a government conversation more than just relying on philanthropy. And then the last criterion that people are looking for, and they'll use different words to define this depending on where they're starting from, but is the work going to serve the people that are most marginalized? Or to put it another way, is there an equity lens to the work? And I think that this is coming out of a growing reflection that if you don't design for folks who are hardest to serve, then you won't reach those people, right? And I think that it's been really interesting for us to reflect on work with donors who hold a wide variety of political views, that there is a version of that rationale that does make sense to a lot of people, right? When you take it out of the language that might be most politically polarizing, it's not actually that controversial when you look at the data that we should be talking about race and sexual orientation and class and other forms of intersecting or compounding challenges that people are facing, that we should be talking about what works for those communities if we want to see a population level change. It's just a matter of math. And so I think one of the things that we have found in talking to folks about this is that when we are working with folks who are deeply, deeply steeped in community or who are leading clinical organizations, it can be challenging to step out of what you see as your day-to-day work and have a conversation with someone who doesn't really have the context about the issues that you all are facing or the solutions that are available. And I think that one of the most challenging pieces about that is that to the point about stigma, I think one of the things about mental illness that I think makes philanthropy interested in it is that it does happen to everyone, but I think there's a danger in extrapolating that we all have, right? A danger of extrapolating from your own personal experience to what impact requires or what other people might be experiencing. And so the ways in which mental health shows up differently for people who might be in a position to donate significant resources is quite different than the people who might be experiencing severe mental illness and who are unhoused, right? And so I think one of the most important things that folks who are frontline providers can help donors to understand is that there are some similarities between what they might have experienced or a family member has experienced and what others, but there's also some pretty significant differences. And that context, I think that oftentimes we'll use the phrase, you know, water is wet to a fish, right? Or water is not wet to a fish. Similarly, I think for many people in clinical practice, there are a lot of things that you all take for granted that donors don't necessarily understand, right? And I think they have challenges or barriers to asking some of those foundational questions about what's really going on when we're talking about mental and behavioral health. So I think the last piece I wanted to say before opening up to conversations and questions was, I think from our perspective, when we talk to families who are sophisticated private sector investors about their philanthropy, the conversation pretty radically changes when you switch from a business investment to a nonprofit investment. And I think that part of that is about people just wearing a, you know, quote, unquote, different hat in the conversation. But I also think people genuinely hold a higher bar for philanthropy than they do for their business investment. And I think that's partially because it's harder to evaluate oftentimes success when you don't have a metric like profitability or growth that you can look at. But I think there's some more fundamental mindset barriers that people have when it comes to philanthropy. And so I think one of the really exciting things about the increased private investment is that there is more room for innovation. There's more capital getting deployed because we would, and we would like to see that happen on the philanthropy side as well, right? That people have significant resources to pursue innovation, to try new things, to take some of the research and translate it into practice in the way that some businesses have. And so I think that's just something that is a reflection from us that there are very, very different rubrics that people are using for for-profit and philanthropic investment. Okay. Thank you, Lyle. Why don't you stay up there? Does the panel have any questions for Lyle? Raul Andrews, APA Foundation. Thank you, Lyle, for the presentation. When you're advising donors, particularly institutional donors, about mental health needs, how do you solve the riddle of the separation, the intentional separation between physical health and mental health? Because a lot of the challenges is that our system is set up to solve the problem of physical health, and it hasn't really responded to the need. So do these questions come up, or how do you work through them? Yeah. I mean, I think it does come up. I don't think we have a solution per se, but I think one of the things that can be helpful, and you can hear this a little bit in what Tom was saying in his remarks, there are some helpful analogies, I think, from the physical health field and the progress folks have made that can help people to understand what we're talking about, right? And so one example of this is that one of the interesting opportunities that some philanthropists have been interested in is how do you enlist a much larger group of individuals and kind of baseline understanding of mental health, right? Thinking community health workers or peer support specialists, and the idea of thinking, okay, if I go to see someone for one problem, it would be nice if they were also on the lookout for another problem. That makes a lot of sense to people, I think, and so I think there's a real opportunity to use the analogies from the physical health space and recognizing that it's not like that's completely solved either, right? And so I think that's the one pitfall, I think, that we have with some of those conversations, but it's definitely fruitful. Tom, did you want to add? Yeah, you bring up a point, Lyle, which I think is worth maybe digging into a little bit more for the group. It's a really interesting point, which is that if you're depending on high net worth individuals who have an N of 1 personal experience with mental illness, and you're hoping that they're going to be able to fix the problem that we're facing as a field, we're challenged that way because the issues that we care about are, yes, we want to look at people who are in the deep end of the pool, but they may have been incarcerated, they may have been homeless, they may have had a whole range of experiences that, frankly, very privileged families who are able to put hundreds of millions of dollars into philanthropy may not be able to relate to. How do you manage that particular problem? Yeah, it's a huge challenge, and I'll say on a couple of fronts. One is on the severity or the compounding or intersecting factors that might be driving a particular set of outcomes. The other is along the lines of similarity bias. Even in the leadership of the organization, we see pretty significant disparities in people's ability to fundraise and to have a conversation with a donor who is used to looking for people who are like them in whatever way and correlate their own traits with what will make a successful leader of an organization. So I think one of the ways in which that's shown up most profoundly is thinking about culturally responsive care or culturally competent care, depending on how you want to describe it, in the sense that people are used to funding things that make sense to them. And I think one of the things that's been really profound about conversations with donors is that one of the narratives that you might internalize as a high net worth person is that in your philanthropy, you should have the answer. You should have a strategy. You should have value add beyond your resources that you should be bringing to the conversation and justifiably not wanting to feel like a walking checkbook, if you will. And I think one of the challenges has been helping people to live into a different narrative, which is to say, as a donor, you don't have to have the answer, and you don't even have to fully understand the entire solution, but you do need to understand who has the expertise to actually solve the problem that you're talking about. And so I think a lot of it has been about opening up the opportunity for donors to not be the expert and to value the expertise of people who are frontline providers who have direct experience and say, you know, it's okay if you don't entirely understand every part of an organization's model. Just like if you were investing in a business, you probably don't understand everything that's happening at that business, and that's okay. So I think there's a little bit of that humility. I think that it comes from both an invitation for donors to be a little bit more vulnerable or have a different relationship with their philanthropy and sometimes some challenge, right, to say that sometimes this work might not look like what you would design if you, donor, were running this organization. So I think it's a little bit of both. Can I just ask you one additional question? You've done some writing on racial bias in philanthropy and also on big bets. I wondered if you could comment on those as well. Yeah, so the intersection between racial bias and big bet philanthropy, it's what you would expect, right? So most of the gifts are going to the people who have the most power up identities in our society. A few years ago, we did an analysis of the gifts that are $10 million or larger from philanthropic organizations. And a majority of the gifts that were going to BIPOC leaders went to one organization, which was the Harlem Children's Zone. And Jeff Canada is amazing. And there's a lot of other people out there who've got some really good ideas. And so I think that a lot of the ways that we see bias show up in philanthropy are compounded when we have big gifts. And I think one of the interesting pieces that has shifted in the past couple of years in particular is a real openness to the notion that people who are closest to the problem, defined however you want to define that, have a differential ability to understand what the solution might be. And I think that's opened up a different conversation about whose perspective and whose expertise is most valuable. And I think there's still a long way to go in terms of the amount of investment that's available to folks who do have deep social networks with donors and their ability to access capital, build an organization that is competitive, has data and metrics and plans behind their solution, versus folks who might be really struggling to get the startup capital needed to build an organization and deliver on their mission. So it's definitely compounding. I think that, and then when you add to that a space like mental health where donors already don't totally understand what's going on, I think it can really muddy the waters even further. Thank you. Caroline, do you want to jump up? Hi everyone. This is so exciting. I'm here. I just want to thank Rick for asking me to join this panel. It's a really great conversation for us to be having. So my name is Dr. Caroline Fenkel. I'm the co-founder of Charlie Health. We are a fully virtual intensive outpatient treatment program. We're specializing in youth mostly, 11 to 31-ish. And our mission is to essentially tackle the youth mental health crisis. To go back to this idea of a nice analogy. Myself and my co-founder worked at a residential treatment program. Lots of recidivism when it comes to residential treatment and inpatient. And we would frequently be on the phone with a mom whose kid tried to commit suicide or who's cutting themselves. They're sitting in the emergency room. They've been sitting there for six hours. There is no psychiatrist on staff. There is no social worker. And if there is, they're with 15 other patients. And they call myself or my co-founder since we work for this beautiful, incredible residential treatment program, crying, asking us, can I get my kid in? To which we would frequently say, what is your insurance? Number one. Number two, we would have to explain what their max out-of-pocket is. Which would oftentimes be in the tens of thousands of dollars and number three, we have about a two-month wait list. And that's what we could do for them. And it was really sad and it made us burn out and it made us want to search as much as we could for another solution. Only about 7% of the nation has access to a brick and mortar IOP and of that 7%, there's about a six to eight week waiting list. So again, imagine for a moment that you're in a crisis, you call 911 and you're like, hi, I'm in crisis, I want to die or somebody's coming after me, like my depression is coming after me. And they're like, we won't be able to make it there for another six to eight weeks. Do you think that you'll be okay until then? This is just something that is never going to happen in physical healthcare. When teenagers are in an emergency room, they've been there for call it five days, oftentimes there is nowhere to discharge them except for once a week therapy, which again, imagine for a minute, you got into a car accident, you're in the ICU, you've been there now for three days and the doctor walks in and says, okay, your insurance is up, we're taking out the breathing tube, we're taking out the IV. And by the way, in one week from now, a nurse will visit you for one hour, that's it. Now in physical healthcare, you go from the ICU down to the hospital, down to a rehab, down to physical therapy, seven, six, five, four, three, two, one days a week, right? And that's to avoid having any kind of a relapse, let alone sending somebody home when they're in extreme distress, when they're going through this. So myself and my co-founder, we got sick of it and decided to disrupt the mental health system, if you will. She did approach me in 2019 about this idea of what if we took IOP virtual, to which I said, telehealth is really stupid and it doesn't work. And she was sort of like, I was, of course I was and I'll tell you why. Because I did my dissertation on the use of technology in a therapeutic setting. And I went into my doctorate program and I was like, I'm gonna design an app and it's gonna be amazing. We're gonna track like mood and I'm gonna design this app and I'm gonna come out and I'm gonna be famous and amazing and rich and it's gonna be amazing. So I go into my dissertation and I do focus groups with 40 different social workers, mostly in private practice. And I say, so what do you guys think about technology? And their response, and by the way, I'm like, so what do you think about like an app, using an app in therapy? Their response was, I hate telehealth. And I was like, no, no, no, we're not talking about telehealth actually. We're actually talking about like the idea of bringing an app. They're like, well, all that I know is that when my patients go away and I do FaceTime with them, I don't get to see them in person. And my dissertation ended up turning into something very different. I'm sure that those of you know about what happens in focus groups. And suddenly now I'm writing a dissertation on how much providers hate telehealth. Now, interestingly, prior to the pandemic, what the research shows us is that patients loved telehealth and providers hated telehealth. And it's so funny because I look back now and the people who are in my focus group don't have offices anymore. They are fully virtual. They have no interest in going into it anymore. As soon as like, you brought up such a good point, which is this idea that like COVID thrusted us into having to, you wanna survive, you wanna pay your bills, you're gonna have to do telehealth, deal with it. It's funny when the pandemic hit, I was running a brick and mortar IOP and I went to sleep, it was like Tuesday, March 24th, we were like in person. Wednesday, March 25th, we're fully virtual. I go to sleep, I'm crying myself to sleep. I'm like, there's no way that this is gonna work. I did my dissertation on this. There's no way that kids are gonna show up. I'm like, I'm gonna have to lay off all of my staff. Like, these are people who I love. You know, you love your team. Like, these are the people that I love. And we wake up, we open up the Zoom, we had 100% participation, higher engagement, better outcomes. Why do we have better outcomes? Good point on the family stuff, right? Which is parent participation and treatment, single largest indicator for positive outcomes. I'm a parent, I have to drive a half an hour to a brick and mortar IOP. I have to go and pick up my two other kids. I have multiple jobs. Like, I'm not gonna make it to family sessions once a week, but when we have like, the computer is in the home, it's the same as wraparound services. You're like, hey, Susie, is mom in the other room? She's like, yeah, no problem. You know, brings mom in. As soon as mom steps into the room, and it's so easy, there's no commute, there's no nothing, all of a sudden your outcomes change significantly, right? Because now she's part of that conversation, it's huge. Another big part of what we saw was that when we were utilizing technology, individuals who struggled with things like being trans found themselves being able to put their pronouns and their preferred names into the Zoom space. We found that individuals who have significant and severe trauma or attachment issues felt like they were able to be vulnerable and share because they were sitting in the comfort of their own home, petting their cat, you know, and that for them was what they were able to suddenly do. And so I think that for us, I myself became a telehealth convert, obviously, and as soon as we launched this, we started to recognize what a huge gap that there is in the medical industry, specifically in mental health, between once-a-week therapy and inpatient 24-7 care. It just doesn't really exist. And the brick-and-mortar model does not work. It just doesn't work because there aren't enough out there. And for kids who are in rural areas, for kids that are in urban areas, and by the way, they also don't take Medicaid. So one of the things that we recognized, myself and my co-founder Carter Barnhart, was we are sick of having to tell people about their max out-of-pockets. We're sick of not taking Medicaid. So we made it a mission as part of Charlie Health is that we're gonna help underserved populations. We hired a director of BIPOC programming. We realized that individuals who are BIPOC are oftentimes struggling with very different issues than the kids that we're treating that are in rural areas. And, you know, one of the things that I think is the most exciting of what we use tech, and then I'm gonna be quiet, is we know that the crux of human suffering is isolation and loneliness, and we know that connection is the antidote and the answer. And when I would run brick-and-mortar IOPs, I would frequently have an 18-year-old struggling with marijuana dependency, dabbling in opiates on the weekends, sitting next to a 13-year-old struggling with anxiety and school refusal. And why would they sit in the same room in the same group therapy session? Because they happen to be in a 30-minute radius of that brick-and-mortar. They happen to take the same insurance. Their parents happen to be able to pay the max out-of-pocket or the deductible, and that's why they're all sitting in that room. Well, first of all, they're not gonna connect to one another. They're gonna feel a lot more feelings of loneliness. And they also are getting an intervention that is not meant for both of those people, right? The intervention has to be completely different. One of the things that we recognize as we started Charlie Health is we can scale this infinitely, and we can match our clients to other clients that look and sound like one another, and then deliver the specific intervention to them. So when a client comes in, we put in different variables into a matching algorithm, which is all like tech-based, and it changes throughout time, and it really measures the outcomes of each group cohort to then see if maybe we need diverse individuals that are there. I'll explain that in a moment. But, you know, really the goal is to hear the words, me too, I've been there, I know what that's like, and then deliver the intervention specific. So, for example, we have a group of 14 to 15-year-old females who struggled with significant trauma who are getting trauma-focused CBT. And that's the curriculum for their group, and they meet for three hours, three days a week, and they just hear the words, me too, I know what that's like. We also do all sorts of, we do art therapy, and music therapy, and yoga, but ultimately they get at least one to two hours of trauma-focused CBT, right? Because that's the intervention. We have a group of 16 to 17-year-old males struggling with marijuana dependency. They're getting motivational interviewing. That's their curriculum. They all get it, they're all there. Me too, I know what that's like, et cetera. We have, you know, I can go on and on about our individualized cohorts, but the point is is that utilizing and leveraging tech in this way of being able to infinitely scale, being able to have an algorithm that puts our clients with other clients that look and sound like one another, and making sure that they're getting that intervention that they so desperately need, and then taking Medicaid and being in network with all of the payers. The payers love us, obviously, because we're saving them a ton of money, because the truth of the matter is is that the kids that we're treating, 50% of them have attempted suicide at least once in their life. 57% of them have been to an inpatient or residential treatment program at least once in their life. 16% have been to three or more, right? So these are very expensive members of the payers, and we're providing them something that they can get in their home. We're providing them quality care. And I just wanna hit on one more thing that Tom said, which is, you know, research that we're doing is quality research, right? That's what it is. It's a quality improvement, and so it's exactly what you said. We're taking practice and then changing our programming based on what we're seeing with our scores, which is really, like you said, it's so important to be able to do that, and being able to recognize that when we see the data very clearly, we can change and create very meaningful proposals to better what we're doing, and it becomes a flywheel, right? It just gets better and better the more data that you collect, the more that you're able to change that algorithm, the more that you're able to change the type of interventions that you're doing, the more that you're able to change the curriculum. And yeah, two things about philanthropy. One is I work with an organization called YANA, You Are Not Alone, and really what that is fighting for is to help individuals who don't have the means to pay deductibles and pay for max out-of-pockets, and who don't have the means to get a laptop, for example. We treat individuals who are on reservations, they don't have a laptop, they don't have a hotspot. We work with them to get those types of access, but to essentially decrease barriers, increase access, and then I also am on the board of a program called Be a Part of the Conversation, which does all prevention throughout the Philadelphia area for substance abuse specifically. So I speak a lot there, and obviously it's an incredible organization. I wouldn't be on the board if it wasn't. So that is all that I want to say, but I'm sure there's questions. Do any of the panelists have a question? Caroline, that's great. Could you just help us think about, in terms of telehealth, it sounds like you've gone through quite an evolution in the way you think about it, but where do you think it's going? So if we could run the clock forward 10 years, what will a telehealth session look like? You mentioned scale, you mentioned matching, getting Medicaid payment perhaps. Are there other, well, does telehealth 2.0 look very different than telehealth 1.0? I don't know how many people are gonna want to hear this answer. All right, I'm just gonna say it. I really believe in my heart that Mark Zuckerberg is from the future, and I believe that the metaverse is going to be a thing for telehealth. And I think that when he does, his whole goal is to get these goggles into 100% of homes in the next five years. You guys are laughing. See, you're making fun of me. This is cool. We should talk about it. Gosh, it's so funny. People just make fun of the metaverse, but it's actually a real thing. Those of you who have actually done it probably have experienced it. It's fascinating. But the answer to your question is I do believe that there is a time where you will be able to see a person's facial, like facial, the way in which they're moving their face in a much clearer way than on Zoom to help you with the gestalt type of therapy that you need to be doing. And if you are able to put something on that helps you to see if you're doing this or opening up or not, those are the things that I think would be really incredible in Telehealth 2.0. I can tell you that for us, the couple things that we're looking forward to in the next year, which are like less than 2.0, is being able to have, essentially, we have a patient portal, but being able to have really clear data for our patients so that way when they take any kind of a qualitative measure, it can be immediately sent to them. And then they can very clearly see the way in which their mental health symptoms are decreasing, which helps to empower them. And everybody here knows about measurement-based care. But in addition to that, being able to send notifications, being able to remind them to take X, Y, and Z is something that I think we're really excited about. I love how Tom's leaned forward in this conversation because I was reminded, I think what you, one of the conversations, this might be back a decade ago when you went to Google, you were looking at how speech patterns could inform clinicians in terms of making better diagnoses. I wonder if 2.0 is, what are those support tools that make clinicians better? What are those subtleties? I don't know if I've done a hatchet job on that work, Tom. I guess there's a lot to say here, but I think the key for this audience is that the role of philanthropy could be to make sure that all of that ends up in an open access platform so it doesn't get owned by Mark Zuckerberg and it doesn't become monetized in a way that you never really know what's in the black box. But I do think because diagnostics and biomarkers don't really get paid for very well and there's not really a huge market cap around those kinds of tools, thinking about a philanthropic effort, and maybe this is the next billion dollar effort for philanthropy, that could create just what you said. I love what you said. Actually, I think it's great. That creates kind of the next generation of telehealth so that all that information, speech, voice, face expression, blink rate, sensor data, all that stuff is available to the patient, to the provider, even to the payer in real time. And actually, if it sounds like it's total science fiction, there's a company in the UK that's already doing this, has done it with 100,000 people and 500,000 hours of therapy and has shown that as they've gotten more and more data and they give real time dashboard feedback to patients and providers, the outcomes get so much better. I just wanna, before we turn it over to Raul here, just wanna leave with a thought that we can come back to in the opening piece. I thought, Caroline, your comment about what the consumer wants versus what we want. Maybe we can come back to that. I think philanthropy also is looking for that impact at the consumer level. So maybe we should talk about that a little bit more during our questions, just the role of consumer in where we head with philanthropy. So really appreciate your comments. And we'll get Raul up and then we'll get back to you all for questions. Good morning. Let's give all our presenters a great round of applause. Applause So, for the last 20 months, it's been my privilege to serve as the executive director of your foundation. Many of you are aware of the foundation. Some of you are supporters of your foundation. But all of you brought time and attention and talent to this room. And for that, your foundation is deeply grateful to you. This is a problem we have to solve. We are a nation and a global world in crisis. But some of the problems that are being discussed here today were true 2,500 years ago. I just come to you back from Rome, and I studied what was happening with Caligula and Commodus and Tiberius and the things they were struggling with. But because they were walled off on Capri, nobody would really deal with the situations they were dealing with unless the Senate had other ideas. The mission and vision of your foundation as we try to unpack what can be done, what's next, is really to focus on promoting the mental health and well-being of individuals and communities where we live, learn, work, worship, and play. Why do we do that? Because mental health care works. And it has to work in all those domains. What are the three things, or the three-legged stool, that drives your foundation? Your foundation serves as a thought leader. And so one of the ways that we bring thought leadership to bear is to bring members and friends of the foundation in assembly like this. Most of you have been to many annual meetings before, but you've probably never seen more signage from your foundation at an annual meeting than you've seen this time around. For those of you who attended the opening session, you saw a Madison Avenue worthy video, our anthem video for our new campaign to come, to change the paradigm and to focus on mental health literacy. Part of the problem of a broken system is that we've got dialects around mental health and well-being. And so everybody's talking past one another and change doesn't come or outcomes get worse, and we don't understand why that happens. It is because we haven't invested the time. We haven't invested the money. And we haven't demonstrated the will to really learn, unlearn, and relearn everything we ever thought about mental wellness. It starts with mental health literacy. The second leg of our three-legged stool is convening. What you may not have known, but what you should know, is that in addition to this session, your foundation is hosting 14 scientific sessions at this annual meeting. Within the framework of those 14 scientific sessions, we have resident fellows who are actively engaged in 49 sessions across the whole meeting. So one of the things we're doing is growing the pipeline, and we're nurturing the pipeline in concert with health systems all across North America so that we have the capacity to learn, to relearn, and to unlearn everything we ever knew about mental wellness in a woke world. I may be too old to be woke, but I'm awake, and I understand what's happening out there. And then the last thing that we do is we serve as a micro-philanthropist. Your foundation operates on a $10 million budget. We have an endowment of about $68 million. I don't know what the Fed did today, so don't check me on that number, but every time the Fed does something, I lose a night's sleep. But the reality of it is we're investing directly in community-based organizations because our view is you're not going to learn, unlearn, or relearn everything we ever knew about mental wellness unless the people, the patients, and caregivers trust are the ones that bring them to care. And so yes, we could go out and do direct service, but we probably couldn't do it well. But we see organizations like the HOPE Center of Harlem. So on May 18th, while the foundation team and I were flying to San Francisco, we were actually doing a youth mental health crisis in Harlem at the same time funded by MTV for Mental Health Action Day. Things that you didn't know but should know that your foundation's doing so that we can build the mental health literacy to get different outcomes. So one of the things that we've learned about philanthropy, and I thank Lyle in particular for his remarks. Philanthropy does not fund organizations who have needs. They fund organizations they believe can meet needs. But if you don't have the right literacy infrastructure, again, what we're writing up in the way of grants and grant reports don't necessarily member or mirror what is happening to the patients in the caregiver community. And that's why when we talk about depression, we can put the statistics there. But it doesn't mean the same thing to a philanthropist than it does to the patient or the family caregiver. We can talk about high anxiety. I was a cutter at 13. I was a cutter at 13. I used to eat the nubs off my thumb to the point where now I still don't use fingernails. I cut all my fingernails off, and that was a part of the therapy I underwent 40 years ago. Well, a little more than 40 years ago now. But the reality of it is I don't bite anymore. Now, nobody noticed in my house that I was eating the nubs off my fingers because I was an athlete. And so they just thought that was just wear and tear on the hands. People didn't wear gloves for every sport in the 20th century. So now I'm in the summer. I'm getting my Jeffro Bodine bowl of cereal. And for those of you who are not, that was Beverly Hillbillies. And you used to get a big gumbo pot, pour all the cereal in, half a gallon of milk, and eat. And my mother sees my hands marred. It just freezes. Just doesn't know what to do. And I'm like, oh, don't worry about it. It's fine. It's fine. No, no, no. What's wrong with your thumbs? And I didn't even realize how much gnawing had happened. And once I couldn't gnaw it, then I would just keep picking it all the time. Just constantly picking my thumbs. I was so anxious to what can I be? What can I do? I wanted to be 14, 40, and 58 all in one day. I could not wait to get to wherever I was supposed to be going. I had no idea where I was going. And what we learned from Alice in Wonderland, if you don't know where you're going, any road will get you there. So I just want to let you know that the foundation is here. You're going to hear more about our First Step campaign, the Mental Health Care Works campaign. It has three components, and then I want to sit down, because you've waited a while to be heard, and I want you to have an opportunity to do that. So the first component of the Mental Health Care Works campaign really is impinged upon the notion, and the good doctor already has reminded us, it takes 10 or 15 years for the first step to mental health care. Whether that's the patient themselves or a loved one who gets them to care. We don't have, after what we've been through in this pandemic, another 10 or 15 years to wait. We have to accelerate that. So what we're not going to do, we don't use the word stigma in any part of our campaign. We're not Pollyannish, we're not naive that stigma doesn't exist, that fear and shame is not real, but diabetes. Nobody in America that I know of is having more fun than somebody with type 2 diabetes right now. They're doing conga lines, we're sitting in a scientific session. The reality, they know their A1C scores, and they know what to do, but they're living with what might be a chronic illness, or that something might lead to recovery. So our first step is just about the treatability of AMIs. It's just two years about treatability of AMIs where we're reestablishing mental health literacy around treatability, and how you can take the first step just to learn more about what's going on with you. The second component of the first step campaign is about behavior, and you already heard Dr. Edsel and Lyle talk about, well if I'm in the office anyway, or as Catherine says, if I'm on my device anyway, then I might as well tell the doctor who's in front of me what else is going on when they say, how you feeling today? Well, you know, my hip is just not what it used to be. Okay, but there's a psychological impact of that as well, and I know that cost, comfort, and connectivity are stopping me from getting the help I need. So we've got to talk about behavior, and that's going to be another two years. So again, when you come here in New York and I'm talking about awareness, about the treatability of AMIs, don't be mad, well you ain't got to speed this up at all. I had 2,500 years. I'm going to do it, but it's going to take some time. And then finally, the out years of our campaign, the goal is, the end goal, there is no health without mental health, and that we would have turned the dime just like HIV and AIDS did, just like diabetes did, just like cancer did. Now, if it doesn't happen in five years, are we going to just take our ball and go home? No, Joe, we're not going to do that. But if we all work together on mental health literacy and demonstrate that willingness to learn, unlearn, and relearn everything we ever knew about mental health and well-being, we can get there. And we're going to get there because we're going to hit them where they live, we're going to hit them where they learn, we're going to hit them where they work, we're going to hit them where they worship, and we're going to hit them where they play. And we're going to bring you along with us because it only happens because the membership wants us to have you. Thank you. Panelists, any questions? Now I know why we won the President's Lifetime Achievement Award. For his ability to speak at the podium that way. Before we turn it over to the audience, Raul made a really powerful comment that I don't want to get missed. We're talking a lot about the bombers, the huntsmen, the folks that are contributing hundreds of millions of dollars. But there is philanthropy, Scattergood is an example, that is on a much smaller scale than that. But the comment he made, and I think this is really important, is not about philanthropy meeting needs. If you have needs, it's organizations that meet needs. And I think when you're working with philanthropy, the key is, are you meeting needs of consumers? Or is this just an unfunded mandate that you're asking philanthropy to backfill? That's not going to raise you any money. Seeking to round out that social worker. But if you're talking about that you're meeting needs, philanthropy will pay attention to that at any scale. And I think that's a critical comment that Raul made that I don't want to be missed. And I didn't say it as eloquently as he did. But I really appreciated that. We've got about 15 minutes. I want to take about 10 minutes of questions from the audience. And then give everybody an opportunity to make a last comment here. So if you have got a question, or we didn't answer the question you asked in the beginning, if you could step up to a microphone and ask your question to the panel, that would be great. Sure, just jump up. Don't be shy. I'm Connie Hutzsteiner. I'm a psychiatrist. I just was wondering with the virtual reality work, if you have any thoughts about how that will affect people who sense a lot of loneliness. Because that's one thing about doing telepsychiatry, which I do myself and like very much, I worry sometimes about the fact that people can be living at home and living, never really actually having any contact with anyone. I was wondering what you thought about that. Yeah, I appreciate that. One of the best types of therapy that honestly doesn't get enough recognition in the literature is group therapy. And what we have found is it's not, for the teenagers that we're treating and the young adults that we're treating, it's not about which one's better in person or telehealth. It's about which one's better telehealth or nothing. Because for them, they're in rural areas where they have insurance that nobody takes or their brick and mortar in their area has a six to eight week waiting list. Now there's a lot of kids that we treat that would do better perhaps in an in-person treatment program. And if they have something available, we will do that for them. Because like you said, they struggle with isolation and loneliness. To speak about the individual stuff, I think encouraging them to get into a group therapy in some capacity or a support group is what combats that in a lot of ways. And I think that the virtual reality, when we think about it, we don't think about one-to-one. We think about entering in a group. So that way you see other people. But the teens that we treat, man, they say basically that once they go to a group and they're able to share in that group and hear others, they feel more confident going into the real world as opposed to just shoving them out the door and telling them to go to an in-person support group. Tom, do you want to add to that? Yeah. I think it's really interesting that Carolyn works with kids, and she's the one that would bring up all of these issues, because it's really clear there's a profound generation gap here. The digital natives, the kids who are under the age of 25 and grew up with all of this, this is their native habitat. This is how they get information. This is how they connect. And it's what they're most comfortable with. A couple of years ago, the beginning of the pandemic, three years ago, I founded a company called Humanest Care, which was really meant to provide social support, allowing young people to support each other. So it was a non-medical model. And about 18 months in, we had 6,000 students at the University of California, Berkeley, using this product. We asked them, you have a choice. You can either join an asynchronous group chat. These were kids who were sort of in crisis. Or with kids just like you, I'm not going to call them kids, students just like you, or we can hook you up for individual therapy with a licensed provider, kind of the medical model. 68% chose the asynchronous group chat. It's what they want. So we might want to do what we're doing, but we have to, at some point, understand that they're not buying what we sell. And we do need to think about, in the spirit of, as Joe said, of disrupting, that there's a different model out there that involves empowering people to help each other, kind of like an AA model, but online. And it's for this generation, that turns out to be much less expensive and much more effective. I think it gets back to the point of understanding what consumers want versus what our bias is that way. Tom, you're going to hear me say the same thing I said in the meetings when I would go to Washington, when you were there. Just before the philanthropy, in terms of the APA, 17 years to go from research to treatment. When I first heard that, I thought I would fall down. And that was 28, 29 years ago, and it's still the same. And if the APA is going to do something, I think you have to address the problem that the neurobiological findings are a secret to the psychological, social work world. And when you talk neurobiology, nobody wants to hear you. And if you don't get the neurobiology explained, you're just going around in circles. And I've been dealing with that for 28 years, because I've always found neurobiology starts to explain things. We were just here, and somebody told me, Tom knows I work with borderline personality disorder. Somebody in this meeting told me that you can't diagnose a child because they're under 18. When did you change that? In the year 2000. So I think you have to look at that. In terms of philanthropy, I have another question. We have siloed every single illness as a separate thing. So who becomes a substance abuser? When they get through with substance abuse, why did they become a substance abuser in the first place? What was underneath? And so if you want to go for something, you're either a substance abuser or a depression. There's a competition amongst these illnesses. And Tom, I owe you the hugest apology. You are 100% correct with RDoC. And RDoC explains all these illnesses. And when I walk around here and I say RDoC, Tom, I apologize. Nobody knows what it is. They don't know. I am walking around with RDoC information, because it explains all these illnesses in a different way, and nobody hears it. So somehow or other, we are behind what we're talking about and what we're expressing to the public. And if you don't get to the psychologists and the social workers, what are we doing? So I really appreciate your comments, and maybe, Raul, you want to address just one of those? I think we could probably spend another half hour, and I want to get to the two questions in the back. And Rick has a quick one, too. No, doctor. No, you're fine. Thank you. No, thank you for the feedback. One of the things that we've done, in part, to address your concern, is almost save the fall conference, the mental health service conference that we host in October of every year in Washington. So we are now a major partner, and we're going to be bringing more neurobiology to that conference that's sponsored by your foundation. Mark? Yeah. I just wanted to first commend you for this wonderful gathering. This has been tremendous. But I think that one of the things that we need to understand is the huge number of complex issues that you as a group just raised, the discussion of urgency, and that now, because of the COVID pandemic, we have a second pandemic. So we have an opportunity to actually mobilize others in ways that we haven't previously. Second point that you all made that I think could get lost in this discussion is the fact that philanthropy can only be part of the solution. And I think that that was a really important point. So for example, where I am and what we're doing right now in Utah, we have the philanthropy, the Huntsman family, but what we also have is the commitment of a university, the board of trustees, and the president, that mental health and substance use disorders is going to be a priority for that AAU university. And then the third thing that we have, and Stevie Ellison, who's one of our state representatives, is sitting next to me, has been tremendous support from the state of Utah that's allowed us to unify all of our crisis services, allowed us to create an app that is in over 880,000 students' hands, and that saves a life a day. It's the partnership that allows one to be creative. And then the third aspect of what you talked about that I think would be very easy to lose is the importance of value. And we as a field have done a terrible job, you know, explaining the value of actually what we do. We partner with the Sorenson Impact Center, which facilitates the monetizing of the social impact of what we do in our field. And if you think about the interventions that we have, and if you think about the cost of not doing those interventions versus the cost of the interventions themselves, we can demonstrate the tremendous value of the interventions that we do. But, again, that's a discussion that we don't spend enough time on, although you did raise it today. And I just wanted to highlight some of the points that you all... Really appreciate that. And I think we really could spend another, you know, hour on the value equation. So I really do appreciate that. So last question, and then Rick, I'll let you make a comment. Ken Thompson from Pittsburgh. Oh, hey, Ken. How are you doing? I'm going to use a very specific example to make a more general point. I'm involved right now in bringing a large group method of dialogic support and therapy from Brazil, invented in the favelas of Brazil. Now in 40 countries around the world, except the United States, until we brought it here. The process of that innovation, of developing that kind of peer-to-peer support, which is what this is, turns out to be extremely difficult without philanthropy. And to be honest with you, philanthropy at this point, I don't think has figured out how to take, Tom, some of the stuff you were just saying, to its heart and figure out how to pull those of us who are doing these kinds of innovations together to make this grow. We have a capacity here that I think other forms of what is now being called solidarity care to grow tremendously in the United States at this moment, given the needs, the concerns around social disconnection, the efforts to confront some of the challenges that COVID brought to us and that our society, in fact, is presenting every day. So I would call on us to think about how can we mobilize the resources for the level of innovation that's going to be required to move to a new frame. It's not a frame that excludes clinical care, but it is a frame that anticipates and is built on a community response. And I think there's an opportunity right now, and I'm wondering how we could move that forward. Well, just quickly, because we're running out of time, I think you and I can talk after mindful philanthropy, which is, I think Tom is familiar with and others here on the panel, is really working on trying to be an engine for those conversations. So we can circle back on that. Rick, and then I'm not sure we'll have maybe one minute for everybody. Thanks, Joe. So maybe this is a lightning round type question. We heard $1 billion philanthropy idea, open source, telehealth, 2.0, with kind of comprehensive rich data. I'm wondering if the panel could suggest, if I was a very, very high net worth individual who didn't know a lot about this and really wanted to hear the brain trust, what else would you pitch me on? That's a great question. Thirty seconds. Should we go in the same order? Okay. So I'll just build on the last two comments from Mark and Ken. I think first, think catalytically, like where can we put in money that can unlock lots of other funding? And to Ken's point, probably the most attractive area there is to go to the place where we're actually spending the most money right now and getting the worst results. And that's in the general area of serious mental illness, which is largely criminalized. So people are incarcerated instead of being in healthcare. On average, we're $110,000 per person per year to keep them in jail or prison. We can get much, much better outcomes for 30% of that. So I think there's an opportunity for philanthropy to change this really massive social injustice that's going on in this country around the incarceration of people with psychotic illnesses. That is something that philanthropy can have a real impact on and can do it urgently because the need's there. Yeah. I'll give a slightly different answer as the non-practitioner on the panel, but I think one of the things we observed when we looked at this space is that there's very little field infrastructure to deploy capital, to deploy philanthropy towards new solutions and innovations, which is very different than other fields. So if you think about the number of intermediaries like Mindful or Upswing, there's really not very many more, and they aren't currently in possession of the amount of capital you would want to see in a robust field that was at the scale of the crisis we're talking about. And so I would just say parallel to what other fields have done around communicable diseases and other kind of intermediary layer funding that's directed by experts that can actually go to the places that are catalytic, like what other folks are going to describe, I think is really critical. I'll make this very quick. If I had a billion dollars, I would focus a lot of my time on the supply. We do not have a demand issue. We have a supply issue, and we have to figure out and analyze why there are so few child and adolescent psychiatrists in this country, why are there so few social workers in this country, and how do we break down barriers, whether that's loan forgiveness, whether that's increasing the number of institutions that can train you, whether that looks like decreasing the types of barriers that you hit when you're taking your boards, whatever it might be, figure it out, because we need more supply with my billion dollars. I'm really excited about that. So $200 million goes to growing the pipeline, as Catherine's talked about, through our Resident Fellows Program, another $200 million in workplace mental health settings, where we know there are over 80 million people who are predisposed with coverage, but they don't get the help they need. And then for the balance of that money, PsychPro. Let's make this registry a reality, and let's turn PsychPro, Dr. Treasurer, into a public health registry engine for good, because I don't know what the C-6 can do, but I do lose some sleep at night over whether or not if some facet of the registry was part of the foundation, could we go to philanthropy and say, if you had a registry, and you were trying to solve a public health need, what could be done? Well, I just want to thank everybody for being here in what I think is a really important conversation, because I think ultimately it's what the people that we serve need us to do, is to be better at knitting together all this funding, whether that's government, philanthropy, and on the insurance side. So I just want to thank the panel. They've made me a smarter funder, and I hope they've made you smarter when you're going out to talk to foundations about raising money for the things that you value, and where you bring need to conversations. So Joe, I do have one favor of our audience. I need my photographers to come up to the front, and the panel's going to take a picture in the audience, standing right here. So if you can come around here, the panel, instead of having our back.

technology

mental health

philanthropy

healthcare

Rick Summers

Joe Pyle

Charlie Health

virtual outpatient programs

APA Foundation

public-private partnerships

AI

policy reforms