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

Social media usage can be harmful for children depending on the time spent on platforms and the type of content children consume or are exposed. A cohort study of adolescents aged 12-15 found adolescents who spent 3 or more hours on social media daily were twice as likely to experience poor mental health outcomes such as anxiety or depression.[1] Social media can also perpetuate negative self-image issues and disordered eating, particularly among teen girls[2], while the majority of teens using social media are often exposed to hate content through social media.[3]

In May 2023, U.S. Surgeon General Vivek Murthy released an Advisory on Social Media and Youth Mental Health, noting the vulnerability of young people to social media harms and calling for action on the need to better research and understand the full impact of social media use on young people, the importance of maximizing benefits and minimizing harm of social media, and the need to create healthy, online environments for children.[4] Congress should act to protect children and youth on social media platforms by passing federal legislation that has the following privacy components:

Age verification:

• Requirement that social media platforms institute stricter age verification controls
• Ban children under 13 from engaging with content/users
• Mandate secure digital identification credentials

Increased safeguards for minors:

• Set default settings at the privacy settings
• Social media platforms should provide minors with tools to limit communication with other users, prevent public access of personal data, limit features that encourage prolonged use of platform, control personalized recommendation systems, and restrict geolocation sharing for minors

Transparency measures:

• Social media platforms should regularly release reports on how data can harm minors

Content controls:

• Ban content that encourages eating disorders, is linked to purchasing of controlled substances or firearms, gives information about how to harm oneself or others, commit suicide, or other harms
• Ban advertising of illegal products, moving beyond the previous standard that social media platforms use a “shall not facilitate” standard
• Social media platforms should provide information to users that allows them to control the content they see

Reporting mechanisms:

• Platforms should make clear reporting mechanisms

Data collection:

• Prohibit collection of personal information of teens 13-16 without consent

Additionally, the Assistant Secretary of Commerce for Communications and Information should create a program for researchers to access data from platforms for research on harms, the Director of the National Institute of Standards and Technology should conduct a study on methods to verify age of platform users, and the Federal Trade Commission (FTC) should establish a Youth Privacy and Marketing Division within FTC to address privacy of and marketing directed toward children and teens and provide guidance on market research/data.

Congress should address many of these issues by passing the Children’s Online Privacy and Protection Act (COPPA)[5], the Kids Online Safety Act (KOSA)[6], and Protecting Kids on Social Media Act.[7]

The postpartum period is a critical time for maternal mental and physical health. Extending Medicaid coverage can ensure that mothers have access to health care services during this period. The postpartum period is a time when women are at increased risk of developing health complications such as postpartum depression, psychosis, hypertension, infections, and cardiomyopathy.

Medicaid covers more than 40 percent of all births. Federal law requires states to provide pregnancy-related Medicaid coverage for up to 60 days after delivery for pregnant people with incomes up to 138 percent of the federal poverty level. Research demonstrates that expanding postpartum coverage beyond 60 days has many benefits for the mother and her baby. One study found that women who gave birth used twice as many postpartum services and three times the number of mental health and substance use services when they had coverage in the postpartum period.[1] The Department of Health and Human Services estimates that about 720,000 people annually would receive Medicaid postpartum coverage if states were to expand postpartum coverage to one year.[2]

The American Rescue Plan Act gave states the option to extend Medicaid postpartum coverage to 12 months using temporary state plan amendments, sunsetting after five years.[3] The Consolidated Appropriations Act made the state option to extend the postpartum coverage period for 12 months permanent.[4] As of July 2023, 46 states had either expanded Medicaid coverage for up to 12 months postpartum or were in the process of doing so.[5]

In addition to encouraging states to expand postpartum coverage, Congress should require states to extend the postpartum coverage period for 12 months, rather than making it optional as it is under current law.

Postpartum psychosis is perhaps the least understood of perinatal psychiatric disorders. It affects 1-2 per 1,000 women and constitutes a true psychiatric emergency that requires hospitalization and intensive treatment.[1] Postpartum psychosis is underdiagnosed and underreported by primary care providers, obstetricians, and psychiatrists, because, like many perinatal psychiatric conditions, there is no standard screening procedure in place during the prenatal and postnatal periods. The Edinburgh postnatal depression scale and the Mood Disorder Questionnaire have been found to be effective screening tools to identify signs of depression and mania in populations at risk.[2] However, insufficient research on postpartum depression and the lack of treatment guidelines mean far too many women cannot access needed care.[3] To address these barriers, the National Institute of Mental Health should prioritize and fund research relating to postpartum psychosis, and SAMHSA should convene the relevant clinical specialty association to urge them to create treatment guidelines.

Existing law allows employers to pay individuals with disabilities, including mental health and substance use disorders (MH/SUDs), below minimum wage.[3] This practice is commonly referred to as “subminimum wage”. The majority of subminimum wage workers have intellectual, developmental, mental health, or other disabilities and are paid less than $3.50 an hour.[3] Supported employment programs, which address MH/SUD and employment needs concurrently, help individuals with MH/SUDs find competitive employment, work more hours, and earn higher wages.[4] Research shows that 70 percent of adults with MH/SUDs would like to work and the majority would be successful with supported employment programs. However, only 2 percent receive any form of supported employment.[4]

The TCIEA would limit the ability to offer subminimum wages to individuals with disabilities.[1] The legislation would also direct the Department of Labor to award grants to assist states in transforming business and program models that support individuals with disabilities and provide technical assistance to employers in offering competitive employment and wages for disabled individuals.[1]

Individuals with MH/SUDs deserve opportunities for competitive wages and sustained employment through supported employment programs. Congress should help meet these needs by prohibiting subminimum wage for individuals with MH/SUDs and funding evidence-based supported employment programs.[2]

Suicide rates for Black youth are increasing faster than any other racial/ethnic group.[1][3][5][6][7][8] Additionally, Black adolescents are significantly less likely to receive care for depression—a major risk factor for suicide—because pervasive structural inequities around the social determinants of health and stigma and mistrust of healthcare providers create barriers to treatment.[1][5][9][10][11][12]

Little research exists around recommendations for universal screening for suicide risk in adolescents,[1][3][4] and much less specific to Black youth.[1][2][3][4][6][8][11] Yet, limited funding is dedicated to investigate evidence-based interventions relating to mental health and suicide risk or study risk factors, protective factors, mental health utilization and engagement, as they pertain to Black youth.[1] Demonstration projects would provide opportunities to test, assess, and advance best or promising practices in youth suicide interventions, guided by expert researchers and clinicians,[1] and can occur in schools, through government/public-private partnerships, and in collaboration with faith-based organizations.[3][6][10][12] Congress should fund research, including demonstration projects, to address suicide risk and intervention for Black youth and other under-researched populations.[1][6][9]

The power sector is the largest stationary source of greenhouse gases (GHGs), emitting 25 percent of U.S. emissions that are mostly from fossil fuel combustion.[1] Standardizing GHGs emissions and limiting the use of fossil fuels in power plants is a step in protecting public health and reducing harmful pollutants.[1] The EPA estimates that its proposals would avoid approximately 1,300 premature deaths; 800 hospital and emergency room visits; 2,000 cases of asthma onset; 300,000 cases of asthma symptoms; 38,000 school absence days; and 66,000 lost work days.[1] The EPA’s proposed standards would provide an estimated $85 billion in climate and public health benefits over the next two decades,[1] an annual net benefit of approximately $6 billion.[2]

For more than a decade, the EPA has acknowledged that GHG emissions negatively impact public health and welfare.[3] Evidence shows that climate stressors, like GHG emissions, affect mental health, resulting in what is referred to as “climate anxiety.”[4] Factors like geography, pre-existing conditions, socioeconomic and demographic inequalities may increase the likelihood of climate change impacting mental health.[5] Extreme weather, including increases in wildfires and wildfire smoke, heat waves, hurricanes, flooding, and other climate-related disasters, negatively affects mental health. Nearly 70 percent of U.S. adults have reported anxiety about climate change, and increased temperatures have been shown to increase mental health emergency departments visits and even suicide attempts. Air pollution has also been directly tied to increased risk of mental health disorders.[6] By addressing the fossil fuel-fired power plants’ impact on the environment, the EPA’s proposed standards will directly benefit those more likely to experience mental health conditions.