Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
In 2019, the healthcare company Otsuka launched the Sozosei Foundation, a philanthropic arm established to fund the decriminalization of mental illness. A year later, Melissa Beck became its inaugural executive director amid a global pandemic.
Beck shares that the foundation’s focus was conceived by Dr. William H. Carson, chair of the Sozosei Foundation Board of Directors. “All of us at the foundation believe that mental health is health and that the inappropriate use of jails and prisons as America’s de facto mental health system must be addressed.”
The Sozosei Foundation uses traditional and non-traditional philanthropic approaches to hasten the decriminalization of mental illness in the United States. That includes funding access to care, research, scaling diversion innovations, and arts and communication. “When I became executive director, I focused on moving with all due speed, thinking about how to turn this big boat out of criminalization out of the harbor and catalyze solutions once and for all,” says Beck.
The first step was to listen. “We talked to people with lived experience, medical professionals, judges, lawyers, nonprofit leaders, advocates and other funders.” Then, the foundation hosted a Global Solutions Lab, where 50 experts met virtually in May 2021 to help Sozosei glean more knowledge and perspectives and allow participants to vote on the foundation’s evolving grantmaking strategy. A subsequent report illustrates the most voted-on solutions. “Leading up to the meeting, we said, ‘Look, we want to call you all together because we have a framework of what we think will accelerate change — now it is time to crowdsource it and get your input.’”
Participants had homework ahead of the meeting and had to develop three ideas, helping the foundation arrive at the four strategies it now funds. Within those areas are also focus subsets. For example, under access to care, the foundation focuses on equitable implementation and operation of 988, building out the entire crisis care continuum, enforcing the federal Mental Health Parity and Addiction Equity Act, and ensuring Medicaid and Medicare are doing their part.
Beck points out that the U.S. government and philanthropies have historically underinvested in mental health, hindering access to care and the data needed to research opportunities and scale what works. “One of our observations is that private philanthropy and limited public dollars have choked the field,” she says. “As a result, there are inadequate resources to test and scale ideas, and often little research being done.”
Sozosei has set up a research strategy, both as a grantmaker and a convener, to give researchers “time and space.” “We want to allow the field to examine what we know, what we don’t know and what we wish we knew,” says Beck. The cornerstone of the research strategy is a 25-person research initiative that concludes in the summer of 2024. “A group of researchers is doing an enormous literature review, undertaking an iterative process looking at data standardization, data collection and continued gaps.” Not just of what exists, she emphasizes, but also of what is needed.
The word Sozosei means creativity in Japanese. Art, says Beck, informs the foundation’s work. “The work of rehearsal, of trying new things and of completion,” she says. Artistic processes and practices fuel social movements. “It’s letting one’s imagination open up to a creative and ideal future. That is philanthropy at its best.”
Beck says it’s the job of she and her colleagues to listen to grantee partners and other stakeholders and to be curious. Their expertise fuels the foundation’s push for social change. “We have to make the narrative shift to help society reject the status quo and join a movement to decriminalize mental health and create more access to care in the community.”
Shifting the narrative and pushing for social change involves funding journalists, writers and visual artists, including the Lemonada podcast Call For Help and The Returning Artists Guild, where art is at the center of a peer-led reentry program. At the end of November, the foundation is about to launch the next season of Call for Help, called Call Declined, which covers the lives of The Returning Artists Guild co-founders Kaimisha Thomas and Aimee Wissman.
Many of Sozosei’s grants also revolve around 988 implementation, advancement and communication. One grantee, the Research Foundation for Mental Hygiene, is exploring how people understand crises and how they determine whether to call 911 or 988. Another grantee is the Confess Project — a community-led initiative that began in 2016 to train barbers as mental health advocates — which used the grant to develop Barbers for 988. In 2020, Victor Armstrong, vice president for Health Equity and Engagement at The American Foundation for Suicide Prevention, shared with #CrisisTalk that people of color often seek guidance at church or the local barbershop. He said barber shops across the U.S. are joining the Confess Project. On average, barbers serve 100 clients monthly, helping this network of barbers increase awareness about 988 in the Black community.
Unlike many philanthropies, the foundation has quickly disseminated funding. “Most new executive directors will come on board and often take a year or more to determine how the money should be spent,” says Beck. “That’s just not how we operate.” She created the first strategic framework for the foundation soon after her tenure began in June 2020, which included funding for issues related to 988. “I wanted to get those precious resources out the door — so the first 10 grants we made in early winter 2021 were to organizations working collaboratively to move 988 forward on a national scale through education and advocacy efforts.”
Beck says, historically, philanthropies have been reluctant to fund pilots. “There’s often a culture of caution even though it’s not an area that necessitates caution but rather strategic partnership to support the cultivation of promising practices.” Pilots and innovations can change how crises are responded to and decriminalize mental illness. Law enforcement has long been the default mental health crisis responder and jail and the emergency department the provider. One of Sozosei’s grantees, Transform911, a University of Chicago Health Lab initiative, is developing a research-informed blueprint to transform 911 and ensure interconnectivity with 988 and diversion for people experiencing behavioral health (mental health and substance use) challenges.
Dr. Rebecca Neusteter, executive director at the University of Chicago’s Health Lab, told #CrisisTalk in 2021 that the current 911 system creates opportunities for blind spots influenced by systemic and personal racism and biases, where “the call taker role is to hear one person’s perspective of a situation and to treat it as though it’s true.” She shared that the system won’t change without “quality assurance measures and clear guidance and training around race equity and inclusion.” This affects who gets a law enforcement response, interactions that can turn lethal, especially for Black and Hispanic people and those struggling with mental health challenges. The Washington Post’s police shooting database illustrates that 27 percent of people killed in the United States by a police officer in the line of duty since January 1, 2015, were Black, 18 percent were Hispanic, and 20 percent were in a mental health crisis.
Beck hopes that more philanthropies will push beyond cultural reluctance to help decriminalize mental illness and make 988 — and the entire crisis continuum — an ongoing, long-lasting catalyst for change. “Right now, these colorful bouquets of ideas about how to respond to mental health crises and emergencies are growing across the nation,” she says. “I want to call on philanthropies to support these pilots and innovations.”
