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

The Supplemental Nutrition Assistance Program (SNAP) reached an average of 42 million people annually in the five years leading up to the COVID-19 pandemic in 2020.[2] Eligible low-income individuals and families use SNAP to supplement their grocery budget, reduce their food insecurity,[2][3] and improve their health and economic wellbeing.[4] Numerous studies have found that food insecurity is associated with poor mental health outcomes, including higher rates of depression and anxiety.[5][10] A recent study found that work requirements to receive SNAP benefits worsened depression and anxiety, and at a faster rate for women than men.[1][4][5]

Recently passed legislation[6] mandates new requirements for individuals to receive SNAP benefits and curbs how states can waive work requirements.[7] The expanded work requirements put thousands of adults at risk of losing food assistance.[7][8] Work requirement policies limit the time adults without disabilities or dependents can receive SNAP benefits unless they work or participate in training activities.[5][9] These policies add barriers to populations facing food insecurity[1] and make it more difficult to qualify for benefits, which worsens mental health.[4][5]

Given that work requirements on SNAP benefits do not result in significant employment gains and negatively impact low-income individuals, including those with MH/SUDs, Congress should repeal these requirements.

Sixty-four percent of the more than 100,000 estimated U.S. drug overdose deaths from May 2020 to April 2021 involved synthetic opioids, primarily illicitly manufactured fentanyls (IMFs).[2] From 2019 to 2021, median monthly overdose deaths among adolescents (ages 10-19) increased 109 percent, deaths involving IMFs increased 182 percent, and approximately 41 percent of these adolescents had a history of mental health conditions or treatment.[3]

In April 2023, the White House and the Ad Council announced a campaign to educate youth on the dangers of fentanyl and the benefits of Naloxone.[1] Raising public awareness around the growing fentanyl crisis, especially among youth, is incredibly important. To be effective, however, it is critical that Congress fund and support for the campaign be sustained as the fentanyl crisis continues.

In 2021, more than 48,000 individuals died by suicide, a 5 percent increase from the prior year. The highest rates were among American Indian / Alaska Native people, men, and adults aged 75 and older.[3] Fortunately, suicides can be prevented. One effective way to save lives is to install barriers on bridges and other accessible areas of significant height. Simply delaying or deterring an individual at risk can provide time to get past intense moments of crisis. Research demonstrates the effectiveness of such barriers. One study in Australia showed that barriers on bridges saved lives, resulting in a 240 percent return on investment.[4] In the U.S., the placement of barriers on bridges have similarly cut the number of suicides in those locations.[5]

By helping communities install barriers on bridges, the Barriers to Suicide Act would save lives. Its GAO study would help inform the most effective means of preventing suicides on bridges and other high structures, improving our ability to save lives in the future.

The Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents provides primary care practices with key background information and theory-based, evidence-driven recommendations for themes critical to healthy child development to be used at all preventative care screenings and health supervision visits.[1][3] The Guidelines recommend behavioral, social, and emotional screenings begin at birth[4] to assess infant and early childhood mental health (I-ECMH). I-ECMH encompasses a child’s capacity in three areas – emotions, interpersonal relationships, and familial and cultural environments.[2] Children with adverse childhood experiences, including physical abuse, mental illness, substance use, or other trauma, are at greater risk of developing I-ECMH disorders.[2] Approximately one in six U.S. children aged 2-8 years have a diagnosed mental, behavioral, or developmental disorder.[5][6] For those living below 100 percent of the federal poverty level, more than 20 percent have a mental, behavioral, or developmental disorder.[6] These children are part of the 27 million children under age 18 in the United States covered by Medicaid.[7]

However, neither guidance for I-ECMH screening nor available I-ECMH-trained practitioners is consistently supported within the Medicaid program.[8] Mandating that Medicaid follow the Bright Futures guidelines to screen for and, if indicated, further evaluate a child for I-ECMH disorders would support prevention and treatment for children and their families[2] and ensure that treatment incorporates the unique developmental needs of young children.[9]

U.S. Surgeon General Vivek Murthy’s landmark 2023 report on loneliness and isolation found that older adults’ social isolation increases Medicare spending by an estimated $6.7 billion annually due to increased nursing home and hospital costs.[1] Additionally, social isolation was the greatest risk factor for hypertension among older adults, higher even than diabetes. Social isolation is also related to accelerated cognitive decline and a higher risk of dementia, self-harm, and suicide.[2]

The Elder Justice Reauthorization and Modernization Act of 2023 would appropriate $250 million to address social isolation and loneliness for older adults. Additionally, the act could support community-based interventions and connect at-risk older adults with social and clinical support.[3] By taking steps to address the epidemic of isolation and loneliness among older adults, this legislation would improve older adults’ mental and physical health and overall well-being.

In 2016, the Department of Housing and Urban Development (HUD) issued guidance on the use of criminal records by providers of housing under the federal Fair Housing Act.[1] In 2022, HUD issued an additional memorandum on how criminal background screening policies and practices can violate the Fair Housing Act’s requirements. The memorandum noted that while the U.S. population is about 13 percent Black, Black people account for about 27 percent of all arrests and that Black males have an incarceration rate nearly six times higher than White non-Hispanic males. The incarceration rate of Hispanic/Latino people in state prisons is 1.3 times the rate of White non-Hispanic people. The memorandum expressed concern that background check reports were “often inaccurate, incomplete, or have no relationship to whether someone will be a good tenant.” It also noted that the use of algorithms to screen and reject applicants may contain racial or other prohibited biases.[2] While HUD has explained the requirements of the Fair Housing Act, additional action is needed.

In February 2023, the FTC and CFPB requested stakeholder comments on how the use of criminal and eviction records and algorithms in rental housing impacts individuals, families, and underserved communities.[3] Given that an estimated 44 percent of individuals in jail and 37 percent in prison have a mental health condition and 63 percent and 58 percent, respectively, have a substance use disorder,[4] the widespread and largely unregulated use of criminal and arrest background checks as part of the rental screening process makes it much harder for individuals with these conditions to find housing after they are released. The FTC and CFPB should move forward expeditiously with rulemaking to tackle this long-standing problem.