The Future of Mental Health

How to be more flexible, local, and built for impact

In a recent Atlantic piece, Rogé Karma looked at Walmart’s impact on local economies, revealing a paradox many of us have assumed was the case: low prices may seem beneficial, but they ultimately leave communities poorer by suppressing wages, eliminating local businesses, and concentrating market power.

The mental health system provides a strikingly similar example. For decades, the U.S. has attempted to expand access and control costs through a largely one-size-fits-all model, built around insurance reimbursement, federal grants, and standardized national policies. The result? A system that prioritizes short-term affordability over long-term impact, scale over sustainability, and national efficiency over local effectiveness.

But mental health, like economic well-being, is deeply tied to place—to the stability of communities, the strength of local infrastructure, and the ability of neighborhoods to invest in solutions that meet their unique needs.

What if, instead of chasing centralized, top-down solutions, we built a mental health financing system that was as dynamic, adaptable, and community-driven as the issues it seeks to address?

Before we go any further, you may be wondering why I have spent the last several weeks looking at payment and financing. Well, my friends, these perennial issues, often looked over in service to innovation in care delivery, are, as a friend of mine once said, the “tail that wags the dog.” In other words, no matter how groundbreaking our mental health interventions may be, they are only as effective as the systems and processes that fund and sustain them.

The Case for Localized Mental Health Financing

Mental health challenges don’t look the same everywhere. A struggling urban neighborhood with high unemployment needs different investments than a rural farming town facing high suicide rates. The financing solutions that work in a city like New York may not be the same ones that work in West Virginia. This is where we have the biggest challenge and most promising opportunity (and these are just domestic examples- the same plays out internationally, too).

What about instead of forcing every community into the same rigid funding structures, we pursue financing models that empower local leaders to invest in what works best for them and their community? This means rethinking not just how we pay for the basics like therapy and crisis services—but also how we finance prevention and address the root causes of many mental health issues.

What if we began to shift our attention to what could have the most impact locally? From my vantage point, there are a few important things that appear.

Invest in Social Programs as Mental Health Infrastructure

Mental health isn’t just about therapy—it’s about stability, security, and support. Consider something as simple yet complex as housing. Studies show that stable housing is one of the most powerful interventions for reducing mental health crises—yet mental health funding rarely flows into housing initiatives. Thankfully, this is slowly beginning to change.

Instead of waiting for precious federal funding, we could pursue things like Revenue-Based Financing (RBF) to support initiatives like housing-first programs where private investors provide capital for programs and are repaid based on long-term reductions in things that either save money like hospitalizations, ER visits, and incarceration rates or things that make money like new people entering the workforce. The logic is that the investment in the program unlocks new savings or revenue opportunities and a percent of those goes back to the person or company who made the loan.

Or what about having communities use social impact bonds to fund things like tiny home villages, recovery housing, or co-living models that help those with severe mental illness stabilize before they reach a crisis. This could be a big step towards more of the community facing models Josh discussed recently that have been occurring in Trieste, Italy.

Local Mental Health Trusts for Community-Driven Solutions

Perhaps even more radical - instead of relying on fragile state or federal grants, local governments could create self-sustaining mental health investment funds that reinvest profits into mental health services.

While a simple example, a city could pool tax revenue, local philanthropy, and private investment dollars into a mental health impact fund that supported local mental health initiatives. Communities could also use things like blockchain-based financing to crowdfund local mental health projects allowing residents to directly invest in solutions that worked for their community.

Dynamic Pricing & Localized Mental Health Markets

What about instead of relying on static insurance reimbursement rates, mental health providers were able to adjust pricing based on local economic conditions. For example, a rural town with a shortage of providers could use dynamic pricing models to incentivize clinicians to move there—offering higher reimbursement rates where demand is high and supply is low. Or, a community mental health center could offer low-cost subscription models for mental health services, where members pay what they can afford, ensuring sustainability without excluding those in need.

Employer-Led Mental Health Investments in Local Communities

Businesses benefit from a mentally healthy workforce—so why don’t they have a direct stake in funding local mental health infrastructure? Large employers could use Corporate Venture Capital (CVC) to invest in workplace mental health programs, community therapy programs, startups, or local crisis centers. In addition, instead of just offering insurance-covered therapy, employers could fund peer support groups, recovery-friendly workplaces, and financial counseling—addressing the economic stressors that drive poor mental health (just as I discussed a few posts ago).

Why This Matters Now

The challenge we face today is not just about increasing funding for mental health but ensuring that funding is allocated in ways that maximize impact at the community level. Recent reports like Scaling Mental Health Access: Case Studies and Practices for Public Sector Integration highlight how public-private partnerships and localized solutions can bridge the gap between policy and real-world mental health outcomes.

Around the world, community-driven models have demonstrated success—whether through embedding mental health in education systems in Bihar, India, integrating social prescribing in the UK, or leveraging cross-sectoral collaboration in Kenya to make mental health a core part of public health initiatives​.

Perhaps I am too in the weeds on this, but the lessons from case studies like these seems to indicate that mental health financing needs to be more adaptive and responsive to local needs, rather than relying on that centralized, one-size-fits-all approach I talked about earlier.

With all the uncertainty in the air right now about the future federal funding, what about instead of waiting for these dollars to dictate the direction of care, we begin to more aggressively pursue flexible financing models those that blend social impact investment, revenue-based financing, employer-led initiatives, and public-private partnerships to create sustainable, scalable mental health ecosystems.

After all, the future of mental health isn’t just about spending more, it’s about investing smarter, closer to home, and with long-term impact in mind. I know this is a heavy lift, but it feels like one we have to work to figure out, together.