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Connecting Mental Health and Wealth in North Carolina

Views from the Field
Posted January 29, 2024
vff_jan24_baker-charaba-thompson
Morgan-Hynd

Christi Baker, Director of Strategic Initiatives, Asset Funders Network
Dawn Charaba, MBA, Executive Director, Reidsville Area Foundation
Sarah Thompson, Vice President, Community Investment, Economic Opportunity, Dogwood Health Trust

Mental health and wealth are inextricably linked, influencing each other bidirectionally. While many factors contribute to mental health, we know from the social determinants of health (SDoH) that the most foundational are socioeconomic, including income, wealth, and safe neighborhoods. Asset Funders Network (AFN) defines wealth in an assets-to-debt ratio.

Research shows that low wealth affects our mental health, increasing the likelihood of distress and depression (Ettman et al. 2020). Yet, wealth, as evidenced by our persistent racial wealth gaps, is not distributed evenly due to longstanding structural racism and disparities (Aladangady et al. 2023). This divide degrades both the mental health and wealth of communities of color and presents a range of opportunities for philanthropy to invest in integrated mental health-wealth interventions and reimagine systems, policies, and care that promote wealth and mental health for all. 

In North Carolina, two AFN members, who are also health conversion foundations, are embedding equity into their work, connecting health-wealth interventions, and building new structures to ensure that well-being and economic security are evenly distributed in their communities. Both foundations organize their grantmaking around the SDoH via different strategies from leading comprehensive community assessments to supporting workforce development programs.

Reidsville Area Foundation

Like many rural communities, Rockingham County, NC, is experiencing behavioral health challenges exacerbated by the strain of the pandemic coupled with provider shortages and historic underfunding. To tackle these challenges, the Rockingham County Department of Health and Human Services (RCDHHS) and Reidsville Area Foundation spearheaded the formation of a 26-agency Behavioral Health Community Assessment workgroup in the fall of 2022. The workgroup acknowledges the importance of people’s well-being as a driving force in achieving economic prosperity and thus centers the social determinants of health in their work. The multisector, collaborative approach aims to create a more comprehensive and effective health system, of which the scale and complexity are much bigger than any one organization.

Eight community agencies jointly commissioned the Rockingham County Behavioral Health Community Needs Assessment and Gaps Analysis. The awarded partner, Crescendo Consulting Group, utilized both quantitative and qualitative research approaches, including a community survey and access audit, stakeholder interviews, and focus group discussions with a diverse range of community members to evaluate the gaps in behavioral health services and identify the root causes of local challenges. The Crescendo “Equity Champions” approach has a decades-long history of embracing marginalized, overlooked, and misunderstood communities and embedding input from all communities aligned with their equity-centered philosophy.  Over 500 individuals were engaged in the process, cultivating a shared language, collective analysis, and community accountability.

The workgroup utilized a modified Delphi Method to prioritize eight categories from a list of 29 needs for the region. The list was analyzed for feasibility, urgency, available resources, and high community importance ranking. Categories include:

  1. Advocacy and policy change;
  2. Awareness and stigma reduction;
  3. Prevention, early intervention, and harm reduction;
  4. Behavioral health services for individuals in the criminal justice system;
  5. Behavioral health workforce shortage, retention, and recruitment;
  6. Continuum of care and service gaps for adults and older adults;
  7. Continuum of care and service gaps for youth and children; and
  8. Social determinants of health.

Potential strategies identified to improve the social determinants of health and address both mental health and wealth in Rockingham County include driving large-scale community solutions to meet affordable housing, education, and workforce development needs. Findings were presented to the County Commissioners and in a community presentation meant to raise awareness and accountability and share valuable insights and solutions-based recommendations. A larger workgroup will launch in January 2024 to investigate potential strategies for implementation and drive strategic plans in Rockingham County. The executive summary and full report are available on the RCDHHS website here.

Dogwood Health Trust

Dogwood Health Trust (Dogwood) exists to dramatically improve the health and well-being of all people and communities in the 18 counties and Qualla Boundary of Western North Carolina. To do this, they focus a large portion of their community investments on creating equitable outcomes within their four key strategic priorities of housing, education, economic opportunity, and health & wellness, which intertwine to significantly influence overall well-being.

In Western North Carolina, where household incomes consistently fall below national and state averages, Dogwood has targeted economic opportunity as one of their strategic priorities, recognizing that achieving health and well-being for all residents means creating a strong economic ecosystem where everyone has access to economic mobility. Dogwood’s economic opportunity strategy places heavy emphasis on workforce development, aiming to support pathways to quality jobs that pay family-sustaining wages through training and credentialing programs.

Viewing workforce development as a continuum, they seek to support organizations and initiatives that create career awareness and skill building, starting with students as early as middle school and continuing into adulthood. Dogwood’s Community Investment Vice Presidents and their teams are intentionally weaving elements of Dogwood’s strategic priorities in housing, education, and health & wellness, together with their economic opportunity focus, to support workforce development across sectors. Recognizing that the region’s shortage in the construction trades workforce is negatively impacting its housing market, they have made grants into programs that train these skills. To meet the growing and evolving needs of the health care system, they have supported the training and retention of the health care workforce. Recognizing the need to start career exploration early, they have supported Career and Technical Education programs in the region’s public school systems.

There are emerging and increasing barriers related to work readiness and credential attainment, as many residents face obstacles in completing their training. Dogwood has supported non-academic advising programs at community colleges, often referred to as “success coaches,” which aim to remove barriers to credential attainment. These advisors and coaches support students in navigating transportation, child care, housing, physical health, mental health, and other needs to ensure students can pursue their course of study and career opportunities with successful outcomes. The wraparound services and resources can represent the crucial intervention needed for a person to complete the training program that leads to a job and career that allows them the financial security to live a healthy life.

Different grantmaking strategies exist to improve mental health and wealth simultaneously and effectively. Philanthropy has the opportunity to learn from other foundations funding mental health-wealth interventions and to invest in social determinants of health and behavioral health policy advocacy and programs.


References

Aladangady, Aditya, Chang, Andrew C, and Krimmel, Jacob. “Greater Wealth, Greater Uncertainty: Changes in Racial Inequality in the Survey of Consumer Finances.” FEDS Notes, Board of Governors of the Federal Reserve System, October 18, 2023.

Ettman, Catherine K, Cohen, Gregory H, and Galeo, Sandra. “Is wealth associated with depressive symptoms in the United States?” Annals of Epidemiology. Vol. 43 (2020).

Focus Area(s): Access and Quality, Health Equity and Social Justice

Related Topic(s): Behavioral Health, Social Determinants of Health
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