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

According to a report from the Congressional Black Caucus, the suicide death rate among Black youth is increasing faster than any other racial/ethnic group.[1] From 2000 to 2020, Black youth ages 10-19 also experienced the largest increase in suicide rates, 78 percent. And in a research study among the youngest children — ages 5-12 — Black youth were approximately two times more likely to die by suicide than their White counterparts.[2]

Historically, a small amount of research funding has been committed by the NIH, and specifically the NIMH, to investigate Black youth mental health and suicide increases.[1] In response to the growing concern over Black youth suicide, in June 2020 the NIMH released a notice of special interest to encourage research focused on Black child and adolescent suicide.[3] The notice outlines a number of research areas that could receive funding, including: epidemiology, etiology, and trajectories; intervention and services research; preventive interventions; treatment interventions; and services interventions.[3] This was followed by a Funding Opportunity Announcment (FOA) released in March 2022 with the aim to advance translational research to better understand factors that confer risk and resilience for suicide among Black youth.[4]

Continued investment in this space is needed. Congressional appropriators should provide NIH/NIMH with the resources they need to continue to fund research on Black youth suicide. Research areas of focus should include, but not be limited to:

• Risk and protective factors for suicidal behaviors among Black youth;
• Mental health motivation, utilization, and engagement among Black youth with an emphasis on examining motivation for mental health treatment;
• Risk and protective factors, as well as mental health utilization and engagement, among Black LGBTQ+/SGL (same gender loving) youth;
• Practical, systemic, and cultural barriers to treatment; the effectiveness of depression screenings by professionals across healthcare professions and institutions for helping to identify Black youth at risk for suicide;
• The effect of social media usage on Black youth; and
• Evidence-based interventions relating to mental health and suicide risk; in particular, those that are age-appropriate and culturally and linguistically relevant for Black youth.[1]

An estimated 2.7 million children live with kin caregivers.[3] Individuals who care for a child whose parent(s) cannot, who are related to the child by blood, marriage, or adoption, or who have “an emotionally significant relationship” with the child are considered relative, kin, or fictive kin foster family (“kin caregivers”).[4] Prioritizing placing children entering foster care with kin caregivers instead of non-relative foster families[5], when it can be done safely, is preferred because it is usually best for children to remain with family, which reduces trauma and placement disruptions.[6] The Department of Health and Human Services (HHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Administration on Children Youth and Families (ACYF) should provide additional and more proactive guidance on best practices and technical assistance.[1][2][3]

LGBTQ+ youth report challenges with bullying, feeling sad or hopeless, and experiencing other mental health and substance use disorders (MH/SUD) at a higher rate than their non-LGBTQ+ peers.[3] Many LGBTQ+ youths may have to navigate an environment that might not be inclusive, or accepting of their sexual orientation or gender identity (SOGI) - especially within their families. [4] Family rejection, neglect, and abuse can lead to MH/SUDs.[4] These challenges have resulted in LGBTQ+ youth being overrepresented in the child welfare system and increase the chances of LGBTQ+ youth encountering homelessness.[5] Congress should pass the Pride in Mental Health Act to address the unique mental health needs of this population, especially those deriving from incidences of child abuse and neglect.[1][2]

Approximately one in six U.S. children aged 6-17 experience a mental health disorder each year,[3][4] and the number of youth diagnosed with anxiety and depression has been increasing steadily.[5] The Individuals with Disabilities Education Act (IDEA) provides appropriate public education to eligible children with disabilities, including those with serious mental health conditions, and ensures access to special education and related services.[6] More than 7.5 million infants, toddlers, children, and youth with disabilities are eligible for early intervention, special education, and related services through IDEA.[6]

When passed in 1975, IDEA was to cover 40 percent of the increased costs of special education.[7] Yet, funding never reached that level and currently covers just 14.6 percent of the cost.[7] Funding for programs and resources through the Act has declined for nearly two decades.[8] As the number of children with serious mental health conditions increases, it is increasingly critical that the IDEA is fully funded so they can receive special education services.

For over two decades, the CDC collected three questions relating to unhealthy weight control practices, but these questions were removed in 2015.[2] The most recent data is now over a decade old, even though eating disorders are among the deadliest mental health conditions[3], and emergency department admissions for eating disorders have increased dramatically for youth during the COVID-19 pandemic.[4] YRBSS is unique in its national scope and comprehensive behavior data collection in youth across the nation. It is also more representative of the national population, whereas other sources often overrepresent white and higher-income populations. The lack of current data has stymied research into eating disorders and hindered our public health response to recent increases.

In a disaster or pandemic, people often suffer serious mental or emotional distress, which may exacerbate existing mental health or substance use disorders (MH/SUD).[2] For example, during the COVID-19 pandemic, U.S. adults reported elevated adverse mental health conditions, and some populations – including young adults and racial/ethnic minorities – experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.[3][4]

The Federal Emergency Management Agency (FEMA), the agency responsible for helping people before, during, and after disasters,[4] addresses these behavioral health needs. FEMA’s National Response Framework guides how the nation responds to disasters and emergencies,[5] including the planning and coordination of Federal public health, healthcare delivery, and emergency response systems.[6] The inclusion of screening, supports, and services in pandemic and natural disaster response efforts provides evidence-informed care at the earliest possible point of intervention, either during or immediately after a disaster, which is key to treating every person at risk of or with early signs of MH/SUD.[1] Supports could include SAMHSA’s Disaster Distress Helpline,[7] which provides counseling to those in emotional distress; the Disaster Technical Assistance Center,[8] which prepares communities to deliver an effective MH/SUD-related response; and the Disaster Mobile App,[9] which provides resources to behavioral health first responders to better serve those experiencing distress during disaster events.