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.
Reexamine other than honorable discharges
The Department of Veterans Affairs (VA) should reexamine discharges that were Other than Honorable (OTH) so that more Veterans receive access to critical health benefits.
Though most Veterans leave military service with an honorable discharge, a significant proportion receive OTH discharges and are ineligible for VA benefits. In many instances, Veterans’ mental health or substance use disorders (MH/SUDs) (including those relating to post-traumatic stress, traumatic brain injuries, and military sexual trauma) have contributed to their OTH discharge, which then deprives them of ongoing MH/SUD services through the VA and critical other benefits. OTH discharges should be reexamined to ensure Veterans with MH/SUDs are not inappropriately denied services.
In 2017, the VA estimated that there are more than 500,000 Veterans with OTH discharges.[1] This group is disproportionately people of color and/or LGBTQ+.[2][3] In 2021, VA expanded full benefits to all Veterans who had been given OTH discharges due to sexual orientation, gender identity, and HIV status who had previously been discharged under prior discriminatory military policies.[2] From 2014 through 2022, Black Veterans were 1.5 times more likely than White service members to receive OTH discharges – a clear sign of institutionalized racism.[3] The VA should work swiftly to review OTH discharges (with Congress directing the VA to do so, if necessary, so that Veterans are not inappropriately denied benefits due to simply having an MH/SUD.
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Raise the minimum wage
Congress should raise the federal minimum wage significantly by passing legislation like the Raise the Wage Act.
The federal minimum wage has been stuck at $7.25 an hour since 2009.[1] Since 2009, the federal minimum wage has lost more than a quarter of its value in inflation-adjusted terms. Nearly two-thirds of workers at or just above the federal minimum are women. Tipped workers, for whom the federal minimum is only $2.13 an hour (unchanged since 1991), are also disproportionately women.[2]
In 2019, the U.S. House passed the Raise the Wage Act[3], which would have raised the federal minimum wage to $15 by 2025, resulting in more than 33 million Americans receiving a raise. Roughly one-third of Black and Latina working women would have received a raise, as would a quarter of white working women. More than 15 million children live in a household that would have received a raise.[4]
Research has tied increases to the minimum wage to decreases in mental health and substance use disorders – and to reductions in suicide. One study found that a $1 increase in the hourly minimum wage was associated with between a 3.4 and 5.9 percent decrease in the suicide rate among adults aged 18-64 with a high school education or less.[5] Another study in the United Kingdom found that an increase in the national minimum wage reduced anxiety and depression among low-income people at a level similar to the effect of antidepressants.[6] Yet another study concluded that “the minimum wage could be an important policy tool that improves the mental health among low-wage workers with no college education.”[7] By improving the economic security of millions of low-wage workers, Congress can take an important step forward in improving mental health.
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Improve SNAP in Farm Bill
As part of the next Farm Bill, Congress should take steps to make numerous improvements to the Supplemental Nutrition Assistance Program (SNAP) that have been recommended by the Bipartisan Policy Center (BPC) to reduce food insecurity and hunger, which is critical to improving mental health and well-being.[1]
Key recommendations from the BPC include keeping in place SNAP administration flexibilities that recently expired at the end of the COVID-19 public health emergency; streamlining eligibility and program requirements, administration, and data sharing; expanding SNAP benefits to U.S. Territories, college students, immigrant communities, and people in the military; enhancing SNAP Employment and Training Programs; and allowing SNAP benefits to be used for online shopping transactions.[1]
Robust evidence exists between decreasing hunger, improving nutrition, and mental health. For example, one study found that when states eliminated SNAP asset tests and increased income limits, there was a likely reduction in suicidality and poor mental health among adults.[2] Another 2023 study found that when West Virginia instituted work requirements for SNAP, it resulted in increased health care utilization in Medicaid for anxiety and mood disorders.[3] Additionally, a Texas A&M study found that increased SNAP benefits early in the COVID-19 pandemic likely cushioned children against the psychological stress of the pandemic[4], which is consistent with earlier research that showed the SNAP improved mental well-being among low-income populations.[5] Congress should take steps to reduce barriers to SNAP as part of the 2023 Farm Bill and should eliminate counterproductive work requirements.
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Build supportive housing and shelters
Congress should use the Religious Land Use and Institutionalized Persons Act of 2000 (RLUIPA)[1] model to prohibit the use of zoning, landmarking, and other land use laws to prevent the construction of permanent supportive housing and homeless shelters, which are critical to addressing our nation’s homelessness crisis.
Permanent supportive housing combines affordable housing assistance with voluntary support services, including mental health and substance use disorder (MH/SUD) treatment.[2] Stable housing is frequently essential to addressing chronic health needs, including MH/SUDs. The evidence for permanent supportive housing is robust. According to a National Academies of Sciences’ review of available evidence, permanent supportive housing’s “housing first” approach has been shown superior to approaches that prioritize “treatment first,” which historically required receiving MH/SUD treatment before receiving housing assistance.[3]
Unfortunately, the National Academies of Sciences’ review also found that permanent supportive housing (and other affordable housing) units are often blocked through local exclusionary zoning policies, as well as restrictive covenants and special permitting requirements. While more funding for permanent supportive housing is urgently needed, local restrictions block projects and unnecessarily drive up costs, wasting critical resources.[3] Inevitably, these local barriers increase homelessness and the number of unsheltered individuals living on the streets, including a disproportionate number of individuals with MH/SUDs, leading to worsening health outcomes and criminal legal system involvement.
RLIUPA is a powerful model that could be used to increase permanent supportive housing units and homeless shelters. Enacted in 2000, RLIUPA prevents discrimination against religious assemblies or institutions. Local governments have often used zoning, landmarking, or other land use laws to prevent places of worship, religious schools and camps, and religious social service facilities (such as group homes and homeless shelters) from locating within their boundaries. RLUIPA’s requirements are enforced by the U.S. Department of Justice and, importantly, through private rights of action. After RLUIPA’s passage, it became much more difficult for local governments to block such facilities. While RLUIPA protects religious-affiliated social service facilities, including homeless shelters, the protections do not extend to permanent supportive housing and homeless shelters more broadly.
Congress should utilize the RLUIPA model to prevent local communities from blocking critically needed permanent supportive housing, which is essential to preventing homelessness, including for individuals with MH/SUDs.
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Set quantifiable goals for National Strategy for Suicide Prevention
The new National Strategy for Suicide Prevention should include quantitative outcomes goals against which progress can be measured and which can inspire public-private coordination to prevent suicide and hold systems accountable for demonstrable progress.
In 2012, the National Action Alliance for Suicide Prevention, the nation’s public-private partnership for suicide prevention, released with the U.S. Surgeon General the National Strategy for Suicide Prevention, which served as a call to action intended to guide the nation’s suicide prevention efforts.[1] As the Action Alliance works with public and private sector stakeholders to update the strategy in 2024, it should set quantitative outcomes goals to drive suicide prevention efforts nationwide, which are critical to saving lives.
Government agencies should adopt such quantitative goals and commit to changing the policies and practices necessary to reduce suicide, particularly given recent alarming trends that have been moving in the wrong direction. Ambitious, quantitative goals have been critical to making progress in other areas. For example, in 2019, agencies across the Department of Health and Human Services developed an operational plan to pursue the bold goal of Ending the HIV Epidemic in the U.S. by 2030.[2] Similarly, in 2021, the Administration set goals of achieving a 50-52 percent reduction in greenhouse gas pollution in 2030 below 2005 levels and having 100 percent carbon pollution-free electricity by 2035.[3] Setting such goals for suicide prevention will be essential to changing practices across public and private stakeholders that are necessary to reduce suicide.
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Pass the Stop Mental Health Stigma in Our Communities Act
Congress should pass the Stop Mental Health Stigma in Our Communities Act, which would require the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop and implement an outreach and education strategy in the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) community to promote mental health and reduce stigma associated with mental health and substance use disorders (MH/SUD).[1][2]
In 2021, only 25 percent of AANHPI individuals with a mental health condition received any treatment, according to SAMHSA. To increase well-being and access to services in underserved populations, culturally and linguistically-competent approaches are needed that recognize each community’s unique history and culture.[3][4][5][6] Policymakers must work to address systemic barriers that prevent underserved communities from accessing mental health services and supports, including stigma, limited culturally and linguistically appropriate care, and insufficient population-specific research.[1][2]
By passing the Stop Mental Health Stigma in Our Communities Act,[1][2] Congress can advance a broad-based national outreach and education strategy that is still tailored to meet the needs of underserved AANHPI communities.