The Hogg Foundation’s Engagement Report 2014 is now hot off the presses! The Engagement Report is our biannual update on some of the most noteworthy developments in the recent life of the foundation, our grant activities, strategic priorities, and recent milestones and achievements. The current edition is quite a stylistic departure, featuring gorgeous photographs by veteran Texas photographer Wyatt McSpadden, an essay on the history of the foundation by William S. Bush, and a pair of essays by our communications director, Daniel J. Oppenheimer, that tell the story of the foundation’s recent strategic turn toward consumer- and recovery-oriented grantmaking. With this mixture of information, visuals, and storytelling elements, this edition of the Engagement Report has something for everyone.
The full Engagement Report can be downloaded here.
The following is a reproduction of the introductory essay by Dr. Octavio N. Martinez, Jr., executive director of the Hogg Foundation.
Dear Friends and Colleagues,
75 years ago, when Ima Hogg devoted her brother Will’s legacy to establishing the Hogg Foundation for Mental Health, she had a simple but profound vision of the kind of future she hoped the foundation would help bring into existence.
It was a future in which people with mental health challenges would be treated with respect and dignity, and mental health would be seen as indivisible from all other aspects of a flourishing and healthy life.
Over the decades, Texas has come some distance toward realizing that vision, in no small part thanks to the work the Hogg Foundation and its allies have done.
There’s still a long way to go, however, and it’s a testament to the farsightedness of Miss Ima’s vision that the future we’re hoping to achieve, from our vantage point in the second decade of the 21st century, looks very much like the one she envisioned at our founding.
At the heart of our vision, as we see it now, is a person, family, and community-centered mental health care system in which:
- Voices of consumers and their families are at the center of the conversation.
- Recovery and wellness are the goal for everyone.
- Physical and mental health are treated as indivisible aspects of the whole person.
- Health equity, and cultural and linguistic competency, are the rule rather than the exception.
These aren’t the words Miss Ima would have used in 1940. Nor should they be, if we aspire to be as innovative and far-seeing in our time as Miss Ima was in hers. Yet they remain in the spirit of what she lived, believed and worked toward. And our commitment, to serving the people of Texas, remains inspired by her lifetime of dedication.
In this engagement report, we’re exploring that tension—between our origins, our evolution, and our future—in two ways.
One is through the lens of our 75th anniversary, and its theme of Past, Present, and Future. The past is represented by an essay from historian William S. Bush, on the founding vision of the Hogg Foundation.
The present is alive in the extraordinary portraits of our grantees shot by photographer Wyatt McSpadden, who has been documenting the soul of Texas for more than three decades.
And we peer into the future with current and former members of our National Advisory Council, who give us their take on the future of mental health in America.
Our other approach in this report is to take a deeper look at one particular facet of how the Hogg Foundation has evolved over the past few years, in rather unexpected ways. We do this through a feature on how the hiring of our two consumer and family liaisons, Tammy Heinz and Stephany Bryan, has helped locate the consumer voice, and the principles of recovery, right at the heart of everything the foundation does.
As you read through the report, I hope you’ll get a better sense of who we are, what we’re doing, and why it’s been such a privilege and honor for me personally to serve as executive director of the Hogg Foundation for the past six years.
I also hope you’ll be inspired to become an ally of ours, if you’re not one already, in the ongoing effort to bring into being the Texas that Miss Ima envisioned all those years ago.
Dr. Octavio N. Martinez, Jr.,
Hogg Foundation for Mental Health
In recent days, there have been a number of news stories on the use of solitary confinement in the criminal justice system. The brunt of the news coverage strongly suggests that policymakers are beginning to reconsider the widespread use of this psychologically debilitating punitive practice. Now, our own Dr. Octavio N. Martinez, Jr., executive director of the Hogg Foundation, has weighed in with an important op-ed in the Houston Chronicle that we hope gets wider attention. A highlight:
Prisoners with mental illness are especially ill-served by solitary confinement. As a psychiatrist, and the executive director of a mental health foundation, I find it hard to imagine a worse prescription for those with mental illness than to put them in the most haunting and psychologically oppressive spaces in the already destabilizing context of incarceration. It’s a recipe for further trauma and psychological disintegration.
With the 84th Texas Legislature now in session, we can think of no better time to try to influence the public discussion around this important issue. Give the op-ed a look, and let us know what you think!
by Rick Ybarra
Now that I have your attention!
The Dallas Morning News article included in the Feb. 2, 2015 Mental Health Daily titled, “Cost of Care: The U.S. health care system is bleeding green” is an excellent read! Two compelling graphs (continuous rise in health care costs 1999 to 2014; 2013 per capita health care spending in developed countries) illustrate that the current financing model used to pay for health care in the U.S. (news flash!) is not only expensive but simply unsustainable.
We collectively spent just under $3 trillion for health care in 2013, translating to a cost of $9,255 per person. It is estimated that health care spending accounts for 17.4 percent of the nation’s economy.
Why? Well, there are lots of factors in play, but one of the main reasons is that our prices are so much higher — hospital costs, overhead, doctor’s visits, medications, medical devices, and salaries of health care professionals, particularly specialty providers. The other key factor is that we are in worse shape than previous generations. Our diets contribute to chronic health conditions such as obesity, diabetes and hypertension. Smoking and excessive use of alcohol also play a role. Place matters. People are living longer, with worse health. And let’s not forget the Social Determinants of Health!
How did it all start? The article takes us through a brief history of how and where it all started, from the beginning of hospital insurance to health insurance to the 2010 Patient Protection and Affordable Care Act (ACA). Interesting history to familiarize yourself with.
The ACA intends to provide a health insurance safety net for the uninsured and underinsured, many of whom have multiple chronic health conditions. We often hear, “they just need to pick themselves up by their own bootstraps (Texas talk).” That can work – provided you have boots, much less boots with straps!
We have been paying (yes, all of us) all along for persons with chronic health conditions to access health care who have no means to pay for it. It contributes to the rise of health care premiums for those of us fortunate enough to have health plans, access to a network of providers, and the financial ability to manage the co-pay. The saying,”If we don’t pay (invest) now, we’ll pay later,” never rang so true.
The article accurately points out that most of what we pay health care providers relies on a business model known as fee-for-service. Each provider or practitioner is paid on the basis of services rendered. It’s a system that has been called into question most recently because it creates an incentive to provide more care and often unnecessary care. Think about it: which provider stands to earn more, the one who sees you three times a year for a health condition, or the one who sees you three times a month (36 visits a year) for the same health condition? Which one costs more?
Policy implications are highlighted in the article. Many folks, due to high deductibles or inability to make the co-pay, are putting off until tomorrow what should be checked today. Could this mean higher expenses down the road? Of course, if you’re lucky enough to survive it.
In the months ahead, the “Cost of Care” authors will examine more closely the factors driving the cost of care and the exciting financing experiments and innovations happening around the country in an effort to contain and control health care costs. I’ll be on the lookout for the next article. I hope you will too.
The Hogg Foundation is excited to announce that, on February 5, 2015, we are hosting a public forum: “How the Public Mental Health System Can Help Prevent Violent Tragedies.” The featured speaker is Dr. Joel Dvoskin, a forensic and clinical psychologist and a nationally known expert on the relationship between mental illness and violence. He is also the lead editor of Using Social Science to Reduce Violent Offending, which recently won the American Psychology-Law Society’s 2013 Book Award. Dr. Dvoskin is a strong advocate for taking a public health approach to violence prevention, one that addresses the root causes of the problem without needlessly stigmatizing persons with mental illness.
Here’s information about the event:
“How the Public Mental Health System Can Help Prevent Violent Tragedies”
Thursday, February 5, 2015
2:30 – 4 p.m.
Texas Capitol • 1100 Congress Avenue • Austin, Texas 78701
Legislative Conference Center, Room E 2.002
We will also be live streaming the event on our YouTube page. To view the live stream go to: https://www.youtube.com/watch?v=O06jaYJ5DRc. The live stream starts at 2:30 p.m., Central Time.
The forum is free and open to the public, but due to limited space, registration is required. Please RSVP to conta.cc/1tN3JDn.
Light refreshments will be served. For more information, contact Colleen Horton at
(512) 471-2988 or firstname.lastname@example.org.
Hope to see you there!
by Rick Ybarra
Happy Holidays and Happy New Year!
One of my first reads back in the office was a thoughtful article written by Melissa A. Berman, chief executive officer of Rockefeller Philanthropy Advisors.
She articulates what many of us in health philanthropy reflect on: giving money through grantmaking is way tougher than it seems (a never-ending conversation with my colleagues at the Hogg Foundation). What makes it challenging are the tensions and trade-offs funders constantly struggle with to achieve thoughtful, effective giving and demonstrate impact.
Melissa and her colleagues at Rockefeller Philanthropy Advisors identified 10 tensions with which every strategic donor/funder grapples with. In this blog, I provide the viewpoint of a grantmaker’s perspective. These tensions are relevant to donors — and to grantmakers.
- Efficiency vs. effectiveness. It is important for nonprofits to be good, efficient stewards of resources. But clearly efficiency is not enough: A nonprofit must also be effective in its work and demonstrate impact. Don’t just look just at measures of activity or outputs (ex: how many youths at risk are being seen in a given program) but look at and ask for outcomes (ex: how many kids stayed in school as a result of that program vs. the norm for that group; improvement of scores; how many graduated to the next grade).
- Focus vs. flexibility. Funders can make huge impacts by focusing on a select few areas rather than spreading their funds minimally across many efforts, thus being more strategic in their grantmaking. “Going deep vs. wide.” Conversely, strategic grantmaking can limit funding options and result in missed opportunities. By focusing more on the outcomes and less on activities to support, funders can have a greater impact and contribute to causes that matters to funders. An obvious tension there.
- Capacity vs. capability. Is it better to affect the largest number of people or to do the best possible job for a smaller, targeted group? Huge tension there! A great program may help a small number of individuals but may not have the capacity to go to scale in order to reach many more people. Sometimes the best solution is for a funder to grant an organization with strong capabilities and capacities to achieve impact at a larger scale. However, that solution isn’t always feasible, so the funder may have to choose between a small, highly effective program and one that has the capability to advance their work to scale.
- Speed vs. thoroughness. Disasters often inspire a quick and large influx of grantmaking. Often funding is used to address immediate needs. However, this type of grantmaking can also reveal systemic issues that require more long-term, strategic thought and commitment that can lead to lasting change. Redesigning and strengthening organizational infrastructure and health-care systems are two good examples here.
- Solutions vs. systems. We are generally idea people. We often come up with what seem like great ideas and solutions to address pressing issues. However, many issues that grantmakers are trying to impact are systems issues, and the lack of infrastructure, capacity or accountability can often limit the effects of the solution and prevent it from being a sustainable, self-sufficient, and thus truly long-term solution.
- Unique vs. standard. Exciting and new vs. building on what works. A clear tension for many funders. Sometimes the biggest impact can come from simply improving a system that works and supporting its expansion, instead of reinventing the wheel.
- Independent vs. collaborative. The author presented an excellent example using the company Apple to illustrate her point. Funders sometimes find they can be more successful following the Steve Jobs model (working independently) than by collaborating with other organizations. Apple found that working independently allowed the company to innovate, test their ideas and bring them to market more quickly than meeting with stakeholders, being inclusive, and engaging in dialogues to achieve consensus. However, collaboration is necessary for solving large-scale systemic and social problems. Not even the largest philanthropic organization (Gates Foundation) has enough funding, resources or capacity by itself to create a health care system to benefit all people and communities in the US and throughout the world. You may want to consider when it makes sense and how you’d like to collaborate with other funders.
- Experiment vs. investment. Many funders view their grants as an investment with an expected ROI or social return. I believe that grantmakers should balance between ROI and being “risk takers.” Grantmakers should push for innovation and experimentation. The author uses the illustration of philanthropy as an experiment, with a thesis, methodology, protocol and results to assess. Many grantmakers are like scientists: we can accept and learn from failure if the experiment is well run. Think strong evaluation component!
- Leader vs. organization. Strong, passionate, and charismatic organizational leaders are important. But not all strong, passionate and charismatic organizational leaders are good human assets managers. Strong leaders are important but funders should examine the organization’s strength and capacities — whether it’s full of talented, committed people with expertise and run well…or not.
- Ethical altruism vs. donor-driven priorities. The author cites that philanthropy supports arts, education and health care more than other countries do. And while some grantmakers believe that certain forms of giving are better than others (donor intent areas; many small grants vs. a few large grants; one-year grants vs. multi-year grants), most of us believe that philanthropy is intended to “do good.” To make things better for people, families and communities.
The author concludes that these tensions makes strategic philanthropy both difficult and rewarding. I agree! To work through these tensions, funders should evaluate which tensions are most important to them and their role of the funder as a change agent in philanthropy. You’ll have a better sense of which trade-offs you are willing to accept.
A well done article by Melissa Brown. Well worth the read!
by Ike Evans
As peer support continues to come into its own as a professional discipline, its most enthusiastic proponents are taking up the challenge of making sure that its innovative edge is not blunted. The ever greater elaboration of peer support standards and practices seems to go hand-in-hand with a deeply felt need to preserve the original concept’s disruptive promise.
Chacku Mathai, CPRP, director of the NAMI Star Center, spoke to all of that and more during his warmly received plenary address at Robert Lee Sutherland Seminar XVIII. On this episode of Into the Fold: Issues in Mental Health, our monthly podcast, Chacku drives home the point that peer support isn’t just a newer, better approach to treating the individual. In fact, it’s an all-encompassing ethic that aims at nothing less than systems transformation.
Chacku further throws down the gauntlet by arguing that peer support is rendered toothless if it doesn’t also take up issues of power and privilege:
Power — the loss of power, the loss of our ability as individuals and as a movement to speak for ourselves, was how we emerged in the first place. There is no way to have a recovery process emerge without a recognition of my self-determination, my sense of power, my ability to use that power. And then, as a leader in the peer support community or as someone who’s trying to deliver peer support, I need to be conscious of my own power and privilege, as well as my marginalization and sense of oppression, because those are all buttons that get pushed.
To hear this episode of the podcast as well as all of the others, click the iTunes logo. You can also find the RSS feed at this link.
Last month I had the privilege of attending the Thirtieth Annual Rosalynn Carter Symposium on Mental Health Policy. The theme for this year’s event was “Celebrating the Past and Shaping the Future.” Rosalynn Carter, the wife of former president Jimmy Carter, has long been a torchbearer for mental health. The Carter symposia were established in 1985 and have since become one of the most prestigious venues for national leaders in mental health to share ideas and collaborate on the most pressing issues in the field.
Along with her other accolades, of particular note is the key role that Rosalynn Carter played in the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which mandates that mental health conditions are covered by insurance at parity with other illnesses. So not only is Rosalynn a highly effective spokesperson for mental health issues, but she’s been a driving force behind real, systemic changes.
The highlight of the event was a familiar face: Dr. King Davis, former executive director of the Hogg Foundation, delivered the keynote address. His talk, which addressed the main theme of the event, was by turns thoughtful, humorous and provocative. The most important take-away from his speech is that policy progress cannot be passive but requires an activist approach, and that people must embrace a willingness to intervene in history to ensure the future that they hope for. Nothing about the current moment in mental health – the turn toward integrated health, the emergence of recovery-oriented approaches, the gains made in destigmatizing mental illness – came about through chance or inevitability, but by a willingness on the part of stakeholders to seize the historical moment. In particular, Dr. Davis noted these five challenges for the future:
- Convening a White House conference on mental health and substance use. It is time.
- We need to groom new leadership for the field.
- Paying particular attention to the merger of institutions and systems.
- Addressing evidence-based policies; do they exist?
- To partner, collaborate, and involve the risk takers, such as private foundations.
Dr. Davis’ address was sweeping in scope and a lot to take on board, but I think we’re up for the challenge!