The Path to Decriminalizing Mental Illness: A Conversation with Melissa Beck

This article was updated on May 21, 2024.

The lack of adequate care and empathy for people suffering from mental illness is a monumental concern in the United States. But due to the complexity of the problem and the systems that have stigmatized, criminalized, and dehumanized people with mental illness throughout the nation’s history, finding sustainable solutions is difficult, yet urgently needed work. Melissa Beck, executive director of the Sozosei Foundation, is one of the people fighting for positive change.     

Melissa Beck spoke with NPQ about her life experiences as well as her professional journey from serving as a criminal defense attorney to leading the Sozosei Foundation, which is working to decriminalize mental illness. 

She shared her unique perspective on the intersections between law, justice, perceptions of mental illness, and mental healthcare. Crucially, Beck also shared her insights on how the philanthropic sector can serve as better drivers of systemic change and champions of equity in mental health and healthcare from a more holistic perspective.

Tonie Marie Gordon: Could you walk me through your personal and professional journey?

Melissa Beck: My late father was the executive director of a nonprofit called the Henry Street Settlement. We were the last family in residence at the settlement house. In addition to my father, many of my other family members run nonprofits, so I grew up immersed in the nonprofit world. And thanks to the settlement house I have this very deep sense of optimism where I view people as whole and recognize that all people deserve respect and compassion. My parents then moved to Roosevelt Island which, at that time, was a great experiment in urban planning and affordable housing policy. My parents were Roosevelt Island pioneers because they very much wanted to live in this type of community. And growing up there and at the settlement house, I carried these core values about how we define community and how we support one another, live together, and thrive together. These values remain important to me today, both personally and professionally. 

I went to Hampshire College, which was the perfect academic institution for me. At Hampshire, you design your own academic program and there’s no grades. Which to me was what education is all about, curiosity and experimentation. Then I decided to go to law school, even though I came from a family of social workers. I wanted to go to law school because I felt that there were opportunities to use the law to advance the vision of justice I always had. In law school, I worked on the DNA Innocence Project. I was in this first cohort of students thinking about what innocence looks like and how we might exonerate people who are languishing in prisons, even though they’re innocent. As a young person in law school witnessing that was incredible; the hope, the combination of science and law and justice, that was a big moment for me. It made me realize the importance of science and technology. It made me think, how do we harness the tools of the fourth Industrial Revolution and scientific advancement to increase access to justice? 

Then I wanted to be a public defender and I couldn’t get a job because the Legal Aid Society had a hiring freeze. So, I became a prosecutor. I went to work at the DA’s office in Brooklyn. And it made me realize…that [many] people really saw the world in ways that I did not. And it was deep, it was rooted in a firm belief in good and bad. If you’re arrested, you’re bad. And if you’ve been victimized, you’re good. And, “we” were the good guys, “we” as assistant district attorneys. 

Then I went to the appeals bureau because there, I felt like my job was to scrutinize the legal process and stand for justice. But it became clear that the scales of justice were completely uneven. After that, I went into sex crimes. I thought, at least in sex crimes, I [could] really help. But how do you help in a system that’s so broken? You’re sort of putting a little patchwork on this flood of oppression under the guise of “justice.” So, I left that job and eventually became a public defender representing folks who were incarcerated, on appeal. But appeals are rarely successful because the law favors the prosecutor. I came out of all those experiences as a practicing attorney feeling like we have criminalized poverty and failed to address the kind of deep toxicity of systems that perpetuate all of this, generation after generation. And I really sort of had it at that point. 

Mental illness has been criminalized because we have no mental healthcare system.

So, I got involved with efforts to reform the criminal legal system. After a while, I was part of an extraordinary team to start The Nathaniel Project, which was and perhaps is the nation’s only alternative to incarceration for adults with mental illness who were convicted of felonies. In this moment in my career and in my life as a human being, perhaps for the first time, I felt like what I was doing [with my career] was correct, because why are we sending people who are sick to jail and prison? It’s inhumane. I really valued what was happening at The Nathaniel Project, but remained curious about other parts of the legal system where these issues were playing out. And at the time, I was serving on the board of a nonprofit called Legal Information for Families Today (LIFT), [and] the executive director decided to leave the organization. I resigned from the board and applied and became the executive director of LIFT. And so, for 10 years, I was essentially raising funds for and running and building an organization that empowers unrepresented litigants to represent themselves in the family court system in New York State, which is how most litigants travel through family courts. In most cases there is no right to counsel. So, you have hundreds and thousands of people going through a legal system that will determine the future of their lives, their families’ lives, their wellbeing, and mental health without any structure outside of a judge. 

When you run a nonprofit, you are pretty much the fundraiser. And I really liked fundraising, but it also caused me to wonder about philanthropy and how funders make decisions. The power dynamic built into philanthropy made me curious and made me feel that I might be able to transform part of the field which needs transformation. And so my first philanthropy job was running a family foundation called The Educational Foundation of America (EFA), which doesn’t fund education, the family’s fortune had been made in textbook publications. I took the reins there and created a path forward. We designed grantmaking programs in central Appalachia and in the Black Belt region of Alabama and in Florida around things like access to reproductive healthcare, democracy, and climate. After about eight and a half years [of] running this family foundation, I found out about Sozosei Foundation, which focuses on decriminalizing mental illness. I was so excited and honored to become the inaugural executive director in June of 2020. We’re still young as an organization, but our trajectory thus far has been extraordinary and exhilarating. I feel like we’ve really been able to move the needle. 

TMG: What do you see as some of the major problems that we’re facing in terms of mental healthcare and how should philanthropy address mental health? 

You have to imagine abundance. You have to imagine equitable structures. You have to say, we are going to move forward….And, so we try to function as abundant future thinkers.

MB: One of the things that’s always been interesting to me about philanthropy is the really strong desire for…a quick fix, something that will have a more immediate impact. But when you’re dealing with human beings, there is no quick fix. Human beings are complex, systems are complex. I think that philanthropy requires a level of patience, fortitude, and deep listening. One of the things we’ve tried to do at Sozosei Foundation is not wait. When I took the job in June, we had our first strategic plan by August, because my feeling was that accessing mental healthcare is very hard in this country. 

It’s easy to get out there and start working to help ensure access. But it’s also very complex because the barriers to access have very, very deep roots. And until we address the root problems, philanthropy can’t do its job. So, for us as a foundation, we work across communications, grantmaking, and convenings because we believe we need to execute on all three of those fronts to get at deep, historic, systemic toxicity, and begin addressing it through large policy shifts that question the very structure of systems. Why is Medicaid like it is? Why do we have a federal block grant for healthcare? Why is our access to healthcare determined by what state we live in? These are our taxpayer dollars. 

And we want to have a conversation about abundance. If you [always] sit in a place of scarcity, it’s exhausting. You have to imagine abundance. You have to imagine equitable structures. You have to say, we are going to move forward. We can overcome these challenges and barriers. And so we try to function as abundant future thinkers. How can we be architects, or how can we help folks to draw blueprints for a future that we really want to build together? So, we moved very quickly to establish our first strategy, and I think came quickly to the realization that mental illness has been criminalized because we have no mental healthcare system. 

We’ve become very comfortable as a nation with letting jails and prisons fill in for that care. And we’re comfortable because of the deep discrimination and perceptions that we have of people with mental illnesses as people we should fear. For us [at Sozosei Foundation], we’ve taken upstream approaches through our grantmaking like enforcing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). We also fund large-scale grassroots and community-driven responses to problems. For instance, if I was having a heart attack, your first response would not be let’s get a cop out here because we really need to get Melissa into jail to find out what’s happening. But if there’s a mental health emergency, the knee-jerk reaction is, this is scary and I’m at risk, and we really need to send the police when it’s a healthcare emergency and you need a healthcare provider response. One of our grantees is 1 Million Madly Motivated Moms (1M4). A huge project that they just completed is called the Right Response Directory, which is a national searchable database of non-law-enforcement responses for mental health emergencies. 

We believe in structural change in systems, but we also believe in grassroots, people-driven, person-centered advocacy efforts that can really shift structures. So, as a grantmaker, we move like an accordion between large policy issues and grassroots efforts. We also aren’t afraid of litigation. We believe in the power of looking at our legal system and saying, where’s the muscle here? What’s the role of the Americans with Disabilities Act (ADA) and decriminalizing mental illness? We’ve been thrilled to see success in Alameda County, CA to say that jails cannot function as mental healthcare providers. We cannot arrest people because they’re mentally ill, because mental illness is considered a disability under the ADA. Those are some of our strategies. 

The core message for philanthropy is to be brave.

Underlying this work is a lot of research. When I was reading, the same names kept popping up as researchers. And I was like, what would happen if we made a grant to the three of them? It’s a big field, but it’s not an enormous field. You could draw a constellation of the academic institutions and researchers working on this. So, we made a grant to those three researchers and asked them, can you organize the field? What do we know? What don’t we know? And what do we need to know to decriminalize mental illness? What works? Our law enforcement response work seems like it works, but has anyone tested that? What happens to people after that? Do they end up receiving mental healthcare or do they end up somewhere else? What’s the role of housing? To answer these questions, we built a national advisory board. And at our summit, they did this amazing presentation on their findings. They had this incredible vision of how to transform the field. This is so important because we can’t do anything without data. Facts are critically important, and they will move this field and we don’t have enough. So, we’re really excited about continuing to support this research work. 

We also support what we call scaling what works, which is looking for promising practices across the nation. It’s very hard to scale promising healthcare practices in this country because of our regional differences. Sozosei means creativity in Japanese. We also spend a lot of time and are very grounded in the arts and communications because we believe in the importance of narrative change. And I want to be clear here that it’s not an antistigmatization campaign that we’re after, but rather we want to disrupt the status quo that makes us so comfortable with locking people up because they’re not well. And as we move forward, that’s the lens. That screen is widening for us because one of the panels that I moderated at the summit—Sex, Drugs, and Mental Health—was about the criminalization of reproductive healthcare, pregnancy, the criminalization of pregnant and parenting people, the criminalization of HIV status, and the criminalization of substance use disorders. And one of the questions that emerged from that panel was, why do we talk about these things separately? Because really, the criminalization of healthcare anywhere is the criminalization of healthcare everywhere, and particularly for members of our [most vulnerable] communities. Whose healthcare is of the lowest priority? Why don’t women have access to abortion? This narrative shift is as important as deploying financial resources to the field and our convening power. 

Our summit to decriminalize mental illness included attendees from all over the US and abroad who are coming into the conversation from all different perspectives. We hosted family members of loved ones with mental illness and people with their own lived experience, psychiatrists, government leaders, elected officials, lawyers, and judges. We curate the experience so that people walk away feeling like they’ve had provocative conversations that make them question their own assumptions. Part of our work as a foundation is to acknowledge and take responsibility for the past while also creating new pathways forward. 

The core message for philanthropy is to be brave. And it’s interesting because you don’t really think about bravery when you think about philanthropy. But it’s a cautious industry. So, I think examining the structure of your philanthropic organization and asking yourself questions like, does my performance review process adequately support failure? Does it give enough room for creative practice? I think that’s a good place to start in terms of philanthropic organizations having an iterative process to be able to refine their work. 

There’s a lot of new mental health funders. And, they’re often thinking, what are we going to do? I let them know how important it is to have a strategy….We’re in a data-poor sector, so it can be difficult to think through the unintended consequences of different efforts. For example, there was a rush to build mental health services within public schools because people didn’t read the research about the school-to-prison pipeline. 

Why are we not looking at pediatric practice? Why aren’t we looking at how pediatricians are trained? Why don’t all pediatricians do some kind of check for mental health vitals after they check height and weight? This is another lesson for philanthropy, to talk less, listen more, and really do your homework. When I think of our [collective] efforts to increase access to healthcare, we need to look beyond simple, surface-level solutions. We must learn from history. 

Philanthropy is not bold enough. It’s not brave enough. It’s not fast enough. Some foundations have billions of dollars, they need to make the right investments. I think there’s a lot of promise. But we need more bravery, courage, and creativity, we need to acknowledge and admit that we’re building on top of systems that are classist, racist, and misogynistic. The systems we’re building on are toxic and the work is hard. I think that that sums it up.