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

Approximately 600,000 people are released from prison each year. Within five years, three-quarters will have been rearrested.[1] Housing is essential to reducing recidivism and helping individuals with mental health and substance use disorders (MH/SUDs) sustain their recovery. Securing stable post-release housing is particularly critical for the estimated 44 percent of individuals in jail and 37 percent in prison with a mental health condition and 63 percent and 58 percent, respectively, with an SUD.[2] By passing legislation such as the Returning Home Act, which would provide $100 million for community organizations to establish housing demonstration projects for individuals returning from incarceration and authorize funds for rental assistance and other housing stabilization services, Congress could make progress towards decriminalizing mental illness in America.[3]

Evidence-based home visiting programs provide new parents with health, social, and child-development services that have proven effective in the detection and intervention of prenatal complications, postpartum depression, Adverse Childhood Events (ACEs), and developmental concerns for pregnant parents and young children under five.[1][2] In partnership with the Administration for Children and Families (ACF), the Health Resources and Services Administration’s (HRSA) Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program provides funding to state programs to deliver these services through local agencies; however not all state Medicaid programs cover these visits, and-out-of-pocket costs can range from one to five thousand dollars annually.[3][4] Home visiting programs can improve health equity and provide a head start for all families.[5] However, to do so, they must be offered as a covered benefit for all health plans.[1]

School shootings instill a deep sense of fear in communities, and education systems are under intense pressure to implement policies to address and mitigate the risk of school shootings. Over 95 percent of K–12 schools in the United States participate in active shooter drills. [1]

Active shooter drills range in content but typically require students and school staff to lock down and practice safety measures. They can often include more involved tactics like fighting back and evacuating and can be planned or unaccounted simulations. At least 40 states require active shooter drills.[2] School active shooter drills are associated with increased anxiety, stress, and depression (39-42%).[3] In a report on active shooter incidents, the Everytown for Gun Safety Support Fund, the American Federation of Teachers, and the National Education Association concluded there is almost no research affirming the value of active shooter drills for preventing school shootings or protecting the school community when shootings do occur. [2]

Congress should pass legislation such as the PREP for All Students Act to establish the Council on Emergency Response Protocols to provide evidence-based guidelines for use by states, early child and education settings, local educational agencies, and institutions of higher education in developing and implementing emergency response protocols including gun violence response, natural disaster protocols, and fire drills, that provide for students’ safety, do not do further harm, and are inclusive and accessible. [4]

Gun violence is a major public health challenge in the U.S. According to the Centers for Disease Control and Prevention (CDC), there were over 45,000 firearm-related deaths in the U.S. in 2020. Suicides accounted for a majority of all firearm-related deaths, while homicides accounted for over 40 percent. Gun violence also disproportionately impacts Black, American Indian, and Latino populations.[1]

Community-based violence intervention programs attempt to prevent gun violence by targeting those at high risk of being involved. Some of the main program models include GVI programs, HVIPs, and street outreach. GVI programs have individuals at risk for violence meet with community members, social service organizations, and law enforcement to educate them about the consequences of gun violence while also offering social services. HVIPs intervene with patients while they are still in the hospital to minimize the possibility of retribution while also offering individuals social services similar to those in GVI programs. Street outreach programs utilize outreach workers within the community to proactively prevent gun violence through conflict mediation.[2]

The RISE from Trauma Act would support these programs by providing $600 million in funding through a Department of Health and Human Services (HHS) grant program for community-based organizations involved with trauma intervention. The Act would also create another HHS grant program to fund hospital-based trauma interventions such as HVIPs.[3]

There are at least three parking spaces for each of the estimated 260 million cars in the United States.[3] Municipalities often have minimum parking mandates that require parking spaces for every building.[4] Parking minimum mandates have vast unintended consequences, worsening housing affordability, congestion, and climate change.[3] Related outcomes of minimum parking mandates include increased housing costs and pollution emissions and reduced building development and public transit use.[2]

Housing insecurity, which includes lack of affordable housing, overcrowded conditions, and homelessness, exposes individuals and families to increased stress, negatively impacting mental and physical health.[5] For individuals with mental health and substance use disorders (MH/SUDs), housing insecurity exacerbates a cycle of MH/SUDs symptoms and discrimination that contribute to the overrepresentation of those experiencing homelessness also having MH/SUDs.[6] Congress should pass the People Over Parking Act to mitigate the negative impacts of parking minimum mandates, especially on those suffering from MH/SUDs.

Nearly one in three adults have a mental health or substance use disorder (MH/SUD), yet many do not receive any treatment.[2] Screenings and assessments are critical to identifying MH/SUDs and increasing early treatment.[3] The Centers for Disease Control and Prevention (CDC) has developed a program, “Learn the Signs. Act Early.” that provides support materials for parents on childrens’ developmental stages so they can better identify developmental delays.[4] In addition, the program provides a tracker for parents to monitor developmental milestones, and resources are available in case there is a concern for developmental delays.[5] A similar program should be developed so family members and caregivers can be aware of the signs of an MH/SUD that may be developing so that they can seek care for their loved ones.[1]