Alignment for Progress: 
A National Strategy for Mental Health and Substance Use Disorders

Workforce challenges are persistent across hospitals and other health-based service providers, including the Department of Veterans Affairs; these challenges require creative and sustained solutions to recruit and retain healthcare professionals to serve one of the largest and most vulnerable populations: veterans. The VA Clinician Appreciation, Recruitment, Education, Expansion, and Retention Support (CAREERS) Act would help alleviate these workforce challenges by improving reimbursement eligibility for continuing education, providing support for licensure exam costs, and revising the pay system for physicians. The CAREERS Act would help address vacancies in the VA hospital system with transparency and timeliness. We cannot let veterans continue to be underserved in the VA hospital system. Congress should pass the CAREERS Act to provide needed resources to VA health providers.

Information technology (IT) has become increasingly important in healthcare settings, especially for care integration and provider-patient communications. Mental health and substance use disorder care has previously been left out of funding opportunities to advance IT in health care. The Behavioral Health Information (BHIT) Coordination Act would provide grant funding to finance the expansion of behavioral health IT, have SAMHSA develop behavioral health IT standards, and direct SAMHSA, CMS, and ONC to release joint guidance to states on how they can promote adoption of EHR technology to behavioral health providers. Mental health and substance use disorder care must be integrated into all health care IT for truly integrated care across providers. Physical health care providers should be able to see the behavioral health history of their patients and vice-versa. Congress should pass the BHIT Coordination Act so that mental health and substance use care is included in all health care IT moving forward.

A host of research indicates that the majority of people living with Autism Spectrum Disorder (ASD) have at least one concurring mental health condition. Mental illnesses also become more apparent as people with ASD age but are often found early in children and teens with the proper screening. Traditionally, autism research has had gaps that are not inclusive of concurrent mental illnesses and suicidal or self-harmful behaviors.[2] To better understand and treat concurrent mental illnesses in people with ASD, critical funding and resources are needed for research. The primary source of grant funding for research, services, and training for autism is through the Autism CARES Act of 2019. In 2024, the important law was enhanced in the form of a new bill with important updates and renewal of funding before the original 2019 funding expired. Some important changes include support for the study of autism and aging and research on expanding the number of pediatricians trained to treat children with autism. Importantly, it directs the Director of NIH to take a more inclusive approach to research about autism.[1] 

The Autism CARES Act of 2019 has been transformational, and before its existence, there were virtually no public policy efforts specifically to help people with autism.[3] The Autism CARES Act established the hugely important Interagency Autism Coordinating Committee (IACC) within the Department of Health and Human Services, a federal advisory committee that studies and advises the Secretary of HHS on Autism Spectrum Disorder. The IACC has taken a groundbreaking approach to autism research, that includes the intersection of gender and race in outcomes for people with autism. Congress should pass the Autism CARES Act of 2024 so that the important and timely research and funding for autism continues in the federal government.

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In a time where rising costs and availability of health care can mean the difference between lifesaving treatment for those who most need it, the need to expand the workforce and reduce prescription drug costs is needed now more than ever. Workforce shortages, in addition to inaccurate provider directories, make getting care difficult in an already difficult-to-navigate system. For those enrolled in Medicaid who seek treatment for mental health and addiction care, physicians and mental health practitioners should be readily available. Unfortunately, there are fewer than five active providers for every 1,000 Medicaid enrollees. One in 4 Medicare enrollees live with mental illness, with very few providers able to treat them [1]. In some less than urban areas there is no single active provider under Medicaid or Medicare [1] This bill would provide incentives and bonuses to providers to fill the large gaps in provider coverage.

The ongoing addiction crisis highlights the need for health professionals to receive training on substance use disorders (SUDs).[2] According to the Substance Abuse and Mental Health Services Administration, “[i]ncorporating training on SUD into routine healthcare will enable practitioners to screen more widely for SUDs, treat pain appropriately, prevent substance misuse, and engage people in life-saving interventions.”[2][3] In conjunction with its repeal of the harmful requirement that prescribers have a separate waiver (the X-waiver) to prescribe lifesaving buprenorphine, the 2023 Medication Access and Training Expansion (MATE) Act requires Drug Enforcement Administration (DEA) registered practitioners to complete eight hours of training on opioid and SUD prevention, treatment, and care.[2][3][4] All federally funded medical training programs (e.g., federal graduate medical education (GME) programs) should include similar training requirements.

Racial and ethnic minorities are disproportionately impacted by mental health and substance use disorders (MH/SUDs).[4] However, MH/SUD professional training programs often do not reflect the diverse needs of these communities.[5] The Minority Fellowship Program (MFP)[6][7] is designed to increase provider education on issues related to prevention, treatment, and recovery support for MH/SUDs among racial and ethnic minority populations.[3][4] The program improves the quality of MH/SUD services and treatments and increases the number of culturally competent educators, researchers, and service providers.[8] The President’s FY 2024 Budget included $36.7 million for the MFP.[1][2] Congress should fully fund this request and maintain funding levels to meet future needs.