Ima Hogg wanted to change the way Texans talked about and accessed mental health, or mental hygiene as it was known at the time.
The daughter of the first Texas-born governor, James Stephen Hogg, was 8 when he became governor. She traveled around the state with him during his term, 1891-1895. That meant she saw the state schools for children who were deaf or blind and the state hospitals for adults and children with mental illness.
She also knew about mental illness from her own mother, Sallie Stinson Hogg, who died when Ima was 13, after many bouts of depression. Ima studied psychology at the University of Texas and had her own struggles with mental illness following her father’s death in 1906 and after the Spanish flu in 1918.
The Hogg family’s story is one of tragedy. Mother Sallie Stinson Hogg died at age 41 in 1895. The governor was 55 when he died. Ima Hogg’s oldest brother, Will, died in 1930 when he was 55. Brother Mike died in 1941 at age 56. The last brother, Tom, died in 1949 at age 61, after struggling with a drinking problem for years. Ima Hogg outlasted them all and was 93 when she died in 1975.
They were also a family of wealth. In 1902, the Hoggs bought the Varner plantation, on which Black people were once enslaved, in West Columbia. On Jan. 15, 1918, oil was discovered there, the first of many oil strikes that made the family multimillionaires.
Led by Will Hogg, the siblings founded the Hogg Brothers company to manage and distribute the oil money.
The struggles of her mother, brother Tom and herself informed Ima Hogg’s mission to turn the estate’s wealth into a lasting foundation for the public good.
That idea became the Hogg Foundation. Much of the family history and the early years of the foundation are chronicled in Williams S. Bush's book "Circuit Riders for Mental Health: The Hogg Foundation in Twentieth-Century Texas," written for the 75th anniversary of the foundation in 2015.
A need for education
Mental health, Hogg Foundation’s archivist and records manager Elizabeth Stauber says, "was not as huge a topic as it is today. There was such a need for education and learning and building out that workforce."
For 80 years, the foundation overseen by the University of Texas has fueled efforts toward education around mental illness. With a $170 million endowment, the interest pays for about $8 million a year in grants and $2 million in running the foundation’s programs.
The foundation’s primary goal, education, was achieved at first by public talks and distributing pamphlets, then by funding innovative programs, data collection and provider training. This education changed the conversation Texans have around mental health each legislative session and the months in between.
The foundation was not Ima Hogg’s first foray into promoting mental health. She had been introduced to the idea of proactive or positive mental health after years of trying to find answers to her own illness through experts in psychotherapy, which was becoming more popular in the 1920s.
She became focused on bringing mental health causes to Texas just as the National Center for Mental Health was forming state chapters. Hogg also helped begin the Texas Society for Mental Hygiene in 1934 and the Houston Child Guidance Center in 1929.
The opportunity to begin the Hogg Foundation came after Will Hogg died in 1930. He left his estate and the fortune that was within it for siblings Mike and Ima to manage.
Will Hogg directed them in his will to give almost everything in the estate, about $2.5 million, to an endowment fund that could be used as a vocational school on the plantation for troubled kids, a "lecture foundation" overseen by the Board of Regents at the University of Texas, or, as the will stated, "any foundation or benefaction" that Mike and Ima Hogg deemed for the common good for part or all of Texas.
His will created conflicts for both the University of Texas and the family because Ima Hogg wanted it to go to a foundation at the University of Texas that would be for the purpose of working on mental health initiatives. The will was clear that if the money went to the University of Texas it would be for a "lecture foundation" and not for the third scenario of a foundation for the common good.
The new Hogg Foundation, led by executive director Robert Sutherland, then had to figure out how to be a "lecture foundation" as expected by the University of Texas regents with the purpose of educating around mental health, as expected by Ima Hogg.
"The foundation is shaped the way it is because of her input and her tenacity," Stauber says. "She was not a woman to be trifled with."
Its first big event, a three-day conference in February 1941, was advertised as being for "Texans Interested in Public Education and Mental Hygiene."
Education in printed form
In those early years, the foundation offered both educational lectures and consultations on how to set up mental health clinics and services across the state.
One of the ways it did that was through creating and handing out pamphlets. They had titles such as "Children and the War" from 1943; "The Seriously Disturbed Youngster" from 1970; and "Family Violence: The Well-Kept Secret" from 1979.
Hogg Foundation educators also would travel from community to community trying to distribute pamphlets and educate about mental health. Some in those early years equated mental health with the morals of young people. Much like sex education curriculum continues to be debated, mental hygiene caused a stir. These "circuit riders," as Bush describes them, often were not wanted.
Even after those first two decades, some projects never took hold because there was no buy-in from either the community served or the people who needed to implement the programs on the ground.
In the 1970s, the Hogg Foundation tried to bring mental health services to Zavala County in South Texas but found itself caught between wealthy landowners and laborers during the rise of La Raza Unida. The government and health providers trying to do the work were not trusted by the population they were trying to serve.
In the 1990s, when the foundation tried to set up mental health care within schools in Austin, San Antonio, Dallas and Houston through a program called the School of the Future, the foundation learned that school districts have many different pulls and sometimes internal politics don’t create a champion to continue a program after the initial Hogg Foundation funding.
"Looking at those examples," Executive Director Dr. Octavio Martinez says, "has made us continue to be thinking capacity building and sustainability are important. We’re not going to fund (a program) forever."
Many of the issues the foundation first addressed continue today. Throughout its pamphlets, organizational reports and now its mental health guide, published every two years just before the next legislative session, some of the issues remain: what to do with the state hospital system; the needs of students in schools; access to care, especially in rural populations; post-traumatic stress as it is now known in soldiers returning from home; alcohol and substance abuse.
Access to mental health care is something the Hogg Foundation "was really pushing at a policy level and service delivery level long ago," Martinez says. "It always had seen it as having a potential to reach our historically marginalized communities and rural communities in more cost-effective ways."
Part of the conversation
While the Hogg Foundation does not lobby or advocate for specific legislative changes, it does inform the conversation. "We do put out legislative issues that we think need to be addressed," Martinez says.
Its mental health guide becomes the place that legislators and local governments go for information to inform proposed legislation.
"What’s really pleasing is a lot of great policy work" that has come from its guides, Martinez says.
For this legislative session, the foundation is putting together data around the need for telemedicine to expand, even after the COVID-19 pandemic, and not have regulations rolled back; the need for expanding the availability of continuity of care through all levels of mental health care from inpatient hospital care to outpatient telemedicine and everything in between; and whole patient care. They will look at opportunities to have that care, even if it is hospital-level care, close by instead of sending patients across the state.
It’s also looking at environmental factors, such as access to housing, food scarcity and employment. Racial disparity and barriers to care likely will be included, as well as the effect of the justice system on mental health, who the best people are to answer mental health crisis calls, and what can be done to educate and train police.
What separates it from other mental health organizations is that the foundation has the ability to be local rather than national. "It’s always been very community-oriented," Stauber says.
It’s also been part of the national conversation as groups in Washington, D.C., and other states look at the work being done.
Adding to the workforce
In addition to informing state policy, the Hogg Foundation also has worked on building the workforce dedicated to mental health and informed in mental health practices. Martinez says that today, Texas doesn’t have enough providers to serve the number of mental health hospital beds it has. The foundation continues to work on closing this gap.
The Hogg Foundation learned about a decade ago that about 1,000 psychology graduates did not get matched with a residency. In 2010, staff created the Hogg Foundation Policy Fellows Grants and later Peer Policy Fellow, which match new graduates with an organization and a mentor for two years. The program started as five fellows and then added five additional fellows who have some lived experience in mental health or substance abuse. They regularly meet as a group, both the fellows and the mentors, for continued education and conversations through the Mental Health Policy Academy, facilitated by Texas Cares for Children.
"It’s giving someone an opportunity to get their foot in the door to work on mental health policy," says Josette Saxton, Texas Care for Children’s director of mental health policy. "Every two years ... we have 10 more people working on policy."
Saxton says not only is it expanding the workforce, it’s expanding the conversation between organizations because the mentors also participate.
"To do this work, you need to build a network to rely on each other for support. That’s the magic sauce," she says. "It has given me the opportunity to interact with organizations and expose me to other organizations I wouldn’t have worked with."
Graduates of the program then go on to other organizations or state agencies to continue to spread knowledge about mental health policy.
These fellows are just some of the on-the-ground training the Hogg Foundation has provided in recent years. Martinez estimates thousands of professionals have benefited from Hogg Foundation training programs.
Care for rural communities
One of its newer programs is the Well-being in Rural Communities initiative, which is focusing on how organizations within a county can build up mental health care in community-driven ways. The first five counties awarded grants are Bastrop in Central Texas, Brooks in South Texas, Morris in Northeast Texas, Nacogdoches in East Texas and Victoria in Southeast Texas.
"We’ve done some amazing things," says Krystal Grimes, the director of inclusion and resilience at Bastrop County Cares. She oversees the Hogg Foundation grant, which has allowed Bastrop County Cares to work with communities of people who typically have been underserved, such as veterans, people of color and people living in more rural parts of the county. Bastrop is also working on the effect of trauma from fire, floods, racial disparities and now COVID-19.
"How can we leverage all the resources throughout the county?" Grimes says. "It’s not just Bastrop County Cares."
The grant has allowed different groups in the county to come together and have conversations around access and go through training. Grimes estimates in Bastrop County 1,000 people have received training in mental health care through this grant.
The initial three-year Hogg grant has encouraged others like St. David’s Foundation to also fund the work.
"The work we’ve been doing as a county has been so successful, we have other entities willing to support the work," she says.
This initiative is in the third year of a three-year grant cycle. Hogg Foundation is looking for the next initiative.
They know that COVID-19 has made the lack of health inequity more apparent. Martinez predicts in a year, two years, three years, there will be a wave of mental health issues coming out of the pandemic, just as they have seen mental health waves in communities following school shootings or hurricanes.
The foundation has been working in the space of calamity care for a while, as well as looking at holistic care.
It’s given a $500,000 grant to Dell Medical School at the University of Texas to work on integrated health care.
It’s also been working in the space of recovery and continuity of care. "The illness should not define you," Martinez says.
Ima Hogg and the foundation’s legacy is in the people it’s trained, the state legislation it’s informed and the nonprofit organizations it has helped create or grow.
"As we’ve been operating from the early years, we’ve covered and achieved so much." Martinez says.
Eighty years ago, Ima Hogg might not have envisioned work around diversity, including the mental health effects of bathroom bills or a pandemic or mass shooting, but she would see mental health as a human right, which is the way the Hogg Foundation leaders believe it should be.
"What’s very unique to this organization," Martinez says, "it’s really the spirit of Ima Hogg. It’s amazing how tangible it is in what we do. We can be at a staff meeting and different voices at different times will say, ‘Is this in line with what Ima would have wanted?’ ... She’s an ongoing entity at the table with us."