Addressing a Quiet Crisis: Behind a Gift for Childhood Mental Health



Marc Benioff, the CEO of Salesforce, made news last year by forcefully addressing San Francisco’s homeless crisis, through both political advocacy and philanthropic donations.

But he and his wife Lynne also have a long history of support for children’s healthcare. Since 2005, the couple has donated more than $327 million to University of California at San Francisco, including $200 million in support of the Benioff Children’s Hospitals in San Francisco and Oakland, and $50 million to launch the UCSF Benioff Children’s Hospitals Preterm Birth Initiative, in partnership with the Bill and Melinda Gates Foundation. 

Last month, the Benioffs announced a $15 million gift to UCSF Benioff Children’s Hospital Oakland to address the acute shortage of mental health services for children and adolescents in Oakland and the East Bay. The gift is the final investment in their $50 million commitment to UCSF Benioff Children’s Hospital Oakland.

The funds will be put to immediate use to strengthen and enhance the current mental health programs at the Oakland hospital, including by increasing the number of providers on staff, which will allow an additional 5,000 psychiatric visits per year, doubling current capacity. It also will allow for new early intervention approaches, including an access portal to support training of primary care physicians in the community, as well as a patient referral process so that children get the care they need sooner. 

 A Public Health Crisis of Epic Proportions

The Benioffs’ gift comes at a time when the emotional health of children is getting more attention from philanthropy. We’ve reported in the past, for example, about growing funder interest in addressing the fallout from adverse childhood experiences—early trauma that can affect a whole range of life outcomes. "Children are suffering from an extraordinary amount of stress and mental illness, and we must rise to the challenge of meeting this need in what is truly a public health crisis," said Michael Anderson, MD, president of UCSF Benioff Children’s Hospitals, in a press release announcing the grant. According to the American Academy of Child and Adolescent Psychiatry, about one in five children have significant mental health challenges. A recent report by the California Health Care Foundation estimated  that 7.6 percent of children in California—one in 13—has a “serious emotional disturbance,” and the rate climbs to 10 percent among the state’s poorest children. And half of teenagers who are living with mental illness that is severe enough to cause significant impairment in their day-to-day lives are not receiving treatment. 

Child Suicide Rates are Climbing

And then there is the issue of suicide among young people. From 2000 to 2016, the U.S. suicide rate for girls 15-24 rose by 80 percent, while boys in the same age group saw a 20 percent climb. Suicide is now the second leading cause of death for adolescents worldwide, according to the Centers for Disease Control and Prevention. The stigma around mental health can block people from seeking treatment. “The pervasiveness of mental illness has done little to abate the widespread stigma surrounding mental disorders, largely due to a lack of knowledge about their underlying biology and root causes,” according to Bryan King, MD, vice president for child behavioral health services at UCSF Benioff Children’s Hospitals, who was also quoted in the press release. As we’ve discussed in the past, the stigma around mental health has also served to depress philanthropic giving in this area—which tends to be neglected by foundations and major donors alike. Among those private funders who do focus on mental health, few give specific attention to the needs of children—making a gift like the one from the Benioffs especially valuable.

A Shortage of Providers

Nationally, approximately 15 percent of psychiatrists provide only child and adolescent services. In addition, there is a substantial proportion of practicing psychiatrists who are nearing the end of their careers, taking more mental health care providers out of the system. In California this shortage is particularly acute. The state has an average of 13 psychiatrists per 100,000 children, compared to 20 to 30 in the New England states. According to projections from public health authorities, the shortage is expected to worsen sharply in coming years. It has already resulted in a serious dearth of mental health services for young people.

The burden of the mental health specialist shortage affects other critically strained areas of the healthcare system. Most prominently, the primary care sector has been forced to fill the void resulting from the lack of psychiatrists. It has been reported that approximately two-thirds of primary care physicians experience access-related difficulties when referring patients to mental health outpatient services —a figure twice that of other outpatient services.

Bolstering Care for the East Bay

 At UCSF Benioff Children’s Hospital Oakland alone, a team of about 60 mental health clinicians saw a record of nearly 60,000 patient visits in the fiscal year 2017, including approximately 5,000 visits with child psychiatrists, as well as early intervention services, school-based counseling, parent support and other services by psychologists and other therapists. 

Due to the Benioff gift, UCSF Benioff Children’s Hospitals are recruiting six new child psychiatrists, two psychologists and one social worker. The organizations hope that this growth is only the beginning. In addition, the hospital will add two new child psychiatry training positions.

Lastly is the establishment of a new Child Psychiatry Access Portal. The portal program is “designed to train primary care physicians in the community—particularly those in more rural areas—to serve as the front line for early stage mental health care management, with the support of a psychiatric hotline, referral management and continuing medical education.” The goal is to more use primary care settings to manage common mental health conditions and provide needed care early on, and better success managing mental illness.

The Role of Philanthropy

In an era when suicide by young people is on the rise, and the incidence of school shootings committed by children is no longer a rare event, the need for deeper and more effective mental health care for children has never seemed more important. With the health care system so deeply stressed in so many areas, it’s critical that philanthropy step in to help drive systemic improvement for pediatric mental health care. The Benioffs are leading here by example.