Alignment for Progress: A National Strategy for Mental Health and Substance Use Disorders
It’s time for a meaningful national conversation about mental health and substance use care. We must remove the barriers to equitable and available coverage for these conditions so people can get the help they need.
Welcome To The National Strategy
Want to understand more about the importance of building a National Strategy for Mental Health & Substance Use Disorders?
How Content Is Organized and How Best to Search/Sort the Recommendations
The National Strategy recommendations are organized by category, with impacted populations and topical areas providing additional nuance and the ability to narrow a search. We have also included the option to search recommendations by the relevant House and Senate committees of jurisdiction.
Recommendation Selection Methodologies and Criteria
After conducting a thorough review of the federal policy landscape, The Kennedy Forum team created this first-of-its-kind compilation of policy recommendations needed to transform our mental health and substance use systems. The recommendations have been sourced and vetted from numerous organizations, advocates, and experts across the country in order to capture a robust set of recommendations for lawmakers and federal agencies to act on.
All National Strategy Recommendations
These featured recommendations are highlighted based on their importance in beginning the national movement towards better care for everyone.
Require reimbursement of recovery support services
Congress should pass legislation to require reimbursement of recovery support services (RSS) and require the Department of Health and Human Services (HHS) to implement guidelines and reimbursement policies for RSS, which include peer-to-peer programs, jobs and life skills training, supportive housing, and recovery housing.[1]
Recovery support services (RSS) are non-clinical services utilized by individuals recovering from a mental health or substance use disorder (MH/SUD).[1][2] These services provide system-level support to reduce barriers to education, employment, and housing and connect individuals and their families with additional support in the community.[2] There are several challenges in providing RSS to individuals with MH/SUD, including cost and lack of collaboration between support programs.[3] The Recovery-Oriented Systems of Care (ROSC) framework highlights the importance of RSS and describes how these services should be implemented before, during, and after MH/SUD treatment.[4] The Department of Health and Human Services (HHS) should implement guidelines for RSS using this framework as a model.[1]
Additionally, Congress should act to improve reimbursement of RSS.[1] For example, the Maximizing Opioid Recovery Emergency (MORE) Savings Act, as introduced in the 118th Congress, would require the Center for Medicare and Medicaid Innovation (CMMI) to test a model providing RSS under Medicare without cost-sharing, allow Medicaid to cover RSS as part of medication-assisted treatment (MAT), and require private health insurance coverage of MAT-associated RSS at no cost.[5][6]
Topics
Ensure collaboration on student SUD assessment programs
The U.S. Department of Education (DOE) should collaborate with states on student assessment programs such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). SBIRT should be deployed for adolescents in middle school, high school, and college levels.[1]
SBIRT delivers early intervention and treatment services through universal screenings that are comprehensive and integrated into primary care for persons at risk for or with substance use disorders.[2] While initially used in clinical settings, SBIRT services are increasingly offered in high schools and universities.[1] For example, trained middle school and high school staff in Massachusetts reinforce prevention, screen for substance use, provide counseling, and make referrals to students beginning in seventh grade, with the intent to motivate students to seek treatment if they are engaged in substance use.[1] Successful college programming focuses on student substance use assessment, prevention, treatment, and recovery, including SBIRT and Collegiate Recovery Programs.[3] Informed by these models, the DOE should collaborate with states to implement screening, prevention, and treatment programs for middle school, high school, and college students.[1]
Topics
Restore the expanded Child Tax Credit
Congress should pass the American Family Act to restore the expanded Child Tax Credit (CTC), which was increased by the American Rescue Plan Act (ARPA) in 2021, but expired at the end of that year.[1] In 2021, it drove child poverty to all-time lows.
The CTC expansion resulted in an unprecedented decline in child poverty, which reached a record low of 5.2 percent in 2021. More than 2 million children were lifted above the poverty line due to the increase in the credit and disparities in child poverty rates decreased for children of all races and ethnicities.[2] Several ARPA changes were particularly important, including increasing the amount of the credit (to $3,600 per child under age 6 and to $3,000 per child aged 6-17, with 17 years olds being included for the first time), making the credit fully refundable so that low-income families could fully benefit, and allowing the Treasury Department to issue 50 percent of the criteria to families as advance monthly payments. Making the credit fully refundable was particularly critical for Black and Latino children, as well as children in rural areas, because previously large percentages of these families had not earned enough to take full advantage of the credit. With the changes, 27 million additional children from the poorest families received the full CTC.[3]
With a significant body of research demonstrating the link between financial stability and mental health[4][5], not surprisingly the CTC expansion improved mental health. One study found that the expanded CTC was associated with reduced anxiety symptoms for parents receiving the CTC, with Black and Latino families particularly benefitting. The study concluded that “[t]he expanded CTC has the potential to improve the environments in which vulnerable low-income children grow up.” Congress significantly harmed youth mental health by allowing the expanded CTC to expire. It should restore it without delay.
Topics
Expand eligibility for SSI and SSDI
Congress should expand eligibility for Supplemental Security Income (SSI) and Supplemental Security Disability Income (SSDI) to include people with substance use disorders (SUDs).[1]
SSDI and SSI previously allowed benefit claims solely on the basis of a substance use disorder (SUD).[2] However, in 1996 Congress passed the legislation that eliminated the ability to claim benefits for SUD.[3] Currently, a SUD does not automatically result in a denial of benefits. However, if SUD is considered “material” or a significant reason for an individual’s disability, then benefits are denied.[4] Disabilities caused by SUDs should be treated no differently than diseases caused by a physical health condition when it comes to claiming SSDI and SSI benefits.[1]
Topics
Repeal the Faircloth Amendment
Congress should repeal the Faircloth Amendment, an antiquated restriction that limits the number of units any public housing authority could own and operate, creating an artificial barrier that prevents policymakers from addressing the growing housing insecurity crisis.[1][2][3][4]
Approximately 1.1 million public housing units, operated by more than 3,000 local public housing agencies, serve 2.2 million residents.[5] Inadequate funding results in losing 10,000 public housing units annually to disrepair, and a large backlog of unmet renovation needs places the health and safety of residents at risk.[6] Limiting the number of public housing units through the Faircloth Amendment creates greater housing insecurity, exposing individuals and families to increased stress and negatively impacting mental and physical health.[5][7][8] Additionally, the lack of adequate affordable housing disproportionately impacts individuals with mental health and substance use disorders, whose conditions put them at higher risk of becoming homeless.
Housing insecurity, which includes lack of affordable housing, overcrowding living conditions, and homelessness,[5] is a critical social determinant of health.[9] Social Determinants of Health (SDOH) are nonmedical factors in the environments where people are born, grow, work, live, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.[10][11][12] While federal, state, and local public housing programs provide critical housing supports for people with mental health and substance use disorders, they are often underfunded and serve only a fraction of those in need.[9]
Congress should pass legislation to repeal the Faircloth Amendment[1] to remove barriers to creating new and maintaining existing public housing.[5]
Topics
Pass the Autism Family Caregivers Act
Congress should pass the Autism Family Caregivers Act, which would authorize grants to nonprofits, community health centers, and hospital systems that provide caregiver skills training to family caregivers of children with autism or other developmental disabilities or delays. [1][2][3]
About one in 36 children have autism spectrum disorder, while an estimated 1-3% of children in the United States have an intellectual disability.[4] Children with autism are more likely to have mental health challenges such as attention deficit hyperactivity disorder (ADHD) and anxiety, which can affect their overall health.[5][6] Providing evidence-based skills training to family caregivers is a successful approach to expanding access to health services and social engagement for children with autism and intellectual and developmental disabilities (IDD), especially if they cannot readily access these services in their community.[7] With this training, caregivers are better equipped to provide activities and support at home that will help improve the physical and mental health of their children.[7] Congress should pass the Autism Family Caregivers Act to improve resources available to family caregivers.[1][2][3]