Friday, January 21, 2011

But what about charity? Part 2

I began writing a few days ago about why I believe that charitable giving is not a substitute for robust government support, particularly when it comes to health care and mental health care.

In Part 1 of "But what about charity?", I noted that I've worked as a fundraiser for nonprofits for a decade, so I understand a lot about charitable giving in this country. I pointed out that the reason why charity alone is insufficient is because people's good intentions to donate or volunteer are often derailed by laziness or apathy, or are limited by very real barriers such as cost and time.

Why charity alone cannot address mental health needs

In this post, I'd like to address why charity alone can't address the needs of our mental health care system. In particular, I'd like to discuss a comment on another BlogHer blog, in which a conservative commenter said that in the wake of the Arizona tragedy, we should be looking at how to provide better mental health care in this country, supported by private funds. (emphasis mine)

My thought upon reading that comment was, "Private funds to meet the needs of the severely mentally ill in this country? Not likely." Working as a fundraiser, you gain an understanding of why people give to charity. There are several factors that inspire people to give, and unfortunately, mental illness lacks most of them. Please note, I'm not sharing these things to be cynical, just realistic.

Mental illness lacks the appeal of other charitable causes

1) People give to relieve urgent, immediate suffering. When people can visibly see suffering and recognize it as urgent, they are very motivated to give. That's why many people donate generously to provide aid after a natural disaster or tragedy--they know their gift will have an immediate and profound impact.

In contrast, the suffering of mental illness is often invisible, and both the conditions themselves and the treatment for them are long-term. People don't feel the urgency when they can't see the suffering, nor do they have the satisfaction of knowing that their gift donated today will relieve someone's suffering right away.

2) People give when the recipients of the gift are appealing. That's why programs that help young children or animals are often very successful in raising funds.

In contrast, many severe mental disorders such as schizophrenia (which some have speculated afflicted Jared Loughner) don't arise until a person is in their late teens or 20's. And the condition may make their behavior appear odd or scary--the very opposite of appealing.

3) People give when they are personally affected by the issue. Programs to support cancer care and research have been very effective in attracting donations in part because so many of us have been touched by cancer. When greater than 1 in 3 Americans will be diagnosed with cancer in their lifetime, virtually all of us will be affected by cancer in some way.

Mental illness, ranging from mild to severe, may impact Americans to as great a degree, but again, it's much more invisible. And it's much more stigmatized--you are much less likely to know that your neighbor or co-worker (or one of their relatives) has a mental illness than that she or he has cancer. Out of sight means that many people don't feel a personal connection to the issue, and are less likely to donate to it.

4) People give when there's a strong possibility for, and/or track record of success. This is crucial to my role as a fundraiser: I have to always make the case to potential donors why our programs are, or will be, successful. People want their money to go where they feel like it's making a difference.

Treatment for mental illness doesn't easily make the case for "success." Many mental illnesses affect those with them for their entire lives, and often the best one can hope for is to manage the disease, not to be cured. In contrast, many cancer survivors go on to live cancer-free for decades.

As a result, the treatment of mental illness requires public funds

These factors are why mental illness has usually been treated via public funds, such as Medicaid and state hospitals. Even private nonprofit providers of mental health services are primarily funded with government dollars, because people don't give to address mental illness the same way they do for many other causes. Perhaps the shootings in Arizona will raise enough awareness about the needs of people with severe mental illnesses that charitable dollars will follow. But there's no guarantee of that. In the meantime, should we just let people suffer?

Next post: charity and health care reform

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