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

Suicide is a leading cause of death in the United States, accounting for more than 48,000 deaths in 2021.[3] Suicide affects all ages, particularly youth ages 10-14 and young adults ages 20-34. Some groups, including veterans, people living in rural areas, and young people who identify as lesbian, gay, bisexual, or transgender (LGBTQ+), have higher rates of suicide.[4]

The Centers for Disease Control and Prevention’s (CDC) Comprehensive Suicide Prevention Program (CSP) funds programs to implement and evaluate a public health approach to suicide prevention. This includes convening and connecting multi-sector partners; using data to understand contributors to and track trends in suicide and suicidal behavior; identifying gaps in existing strategies; and sharing data and outcomes with other partners.[5] However, the CSP currently funds programs in only seventeen states.[1] Expanding the CSP to all fifty states, the District of Columbia and eighteen tribal and territorial jurisdictions will support the CDC’s goal of reducing suicide by 20 percent by 2025.[1]

Every Veteran of the U.S. military, especially those with visible and invisible wounds of war, should have access to high-quality services and supports, including for MH/SUDs. Congress should work to close gaps in services, including for Veterans who live in U.S. Territories (Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa) and U.S.-affiliated Pacific Islands that are freely-associated states (the Marshall Islands, Micronesia, and Palau). Individuals from U.S. territories are U.S. citizens, while individuals from freely-associated states are eligible to come to the U.S. as nonimmigrants to work and live indefinitely.[1] The U.S. is currently investing billions of dollars in military installations on these Pacific Islands as part of the U.S. geostrategic pivot to Asia.[2]

Nearly 3 percent of all U.S. Veterans live in U.S. territories, and Veterans make up nearly 8 percent of Guam’s population and more than 5 percent in American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands. Puerto Rico has more than 80,000 Veterans.[3] Given the high proportion of Veterans, Congress must do more to ensure the availability of services across U.S. territories. Currently, the nearest Veterans Affairs Medical Center to Guam is 4,000 miles away in Hawaii.[2]

While Veterans in freely-associated states are entitled to care, Congress should pass the Care for Compact of Free Association (COFA) Veterans Act to allow the Department of Veterans Affairs (VA) to provide services in the Marshall Islands, Micronesia, and Palau and to compensate Veterans for the cost of travel to receive needed health care services.[4] In June 2023, the U.S. Secretary of State Anthony J. Blinken and Interior Secretary Deb Haaland requested that Congress make these essential changes to help these U.S. Veterans access services.[5]

More broadly, Congress should work with the VA to streamline the process of applying for VA benefits, which is notoriously complex and frequently requires help to navigate.[6] One issue is that the Veterans Health Administration (VHA) has a wide variety of different, complicated authorities that limit which Veterans are eligible to receive different benefits. Congress should work with the VHA to streamline these authorities and simplify eligibility requirements to help reduce the bureaucracy, thereby improving the efficiency of service delivery and increasing Veterans’ access to MH/SUD services and supports.

Neonatal abstinence syndrome (NAS) is a group of conditions that can occur when newborns withdraw from certain substances, including opioids, that they were exposed to before birth.[2][3] Approximately 7 percent of women self-report using prescription opioid pain relievers while pregnant; of those, one in five report misuse of prescription opioids.[4][5] Six newborns are diagnosed with NAS for every 1,000 newborn hospital stays, equivalent to one baby diagnosed with NAS every 24 minutes or more than 59 newborns diagnosed every day.[4][6][7] The number of babies born with NAS increased by 117 percent nationally from 2009 to 2020.[6]

Recent studies found that newborns diagnosed with NAS who stay with their mothers after delivery, (i.e., “room-in,”) have better outcomes than those who go to the neonatal intensive care unit (NICU).[8][9][10] Babies with NAS who room-in with their mothers are far less likely to need pharmacological interventions and leave the hospital days sooner than those who remain in the NICU.[8][9][10] Rooming-in and other non-pharmacologic interventions, such as creating a low-stimulation environment, swaddling, and feeding on demand, should be the evidence-based standard of care for newborns with NAS.[1][8][9][10][11][12]

Hospitals may not have the infrastructure to keep mothers and babies in the same room.[13] Therefore, incentives are needed – including tax credits and grant programs – to fund new and existing efforts within the NICU so mothers and infants with NAS remain together immediately following birth.[1]

In 1998, the National Institute of Justice (NIJ) launched the Arrestee Drug Abuse Monitoring (ADAM) program to expand and restructure[2] its predecessor, the Drug Use Forecasting program, which was in place from 1987-1997.[3] ADAM collected data from adult male arrestees to help monitor drug use trends.[4] ADAM provided an objective biological measure of drug use and self-reported use among those arrested and charged with crimes.[4] The NIJ collected ADAM data between 1998-2003[4] and the Office of National Drug Control Policy reinstated ADAM data collection (as ADAM II) in 2007 with a reduced number of data collection sites.[4] ADAM data has not been collected since 2013, when the program was discontinued.

Data informs decisions in public health by tracking better, faster, and more actionable insights.[5] Centralized data collection repositories like ADAM aid in sharing outcomes, trends, and insights in addressing drug use within this population. ADAM data provided critical information for policymakers at local and federal levels to assess trends of use and impact of public programs.[6]

Fentanyl test strips are small strips of paper that can detect the presence of fentanyl in multiple kinds of drugs.[1] In 2021, overdose deaths due to fentanyl rose 26 percent from the previous year, reaching over 67,000.[2] The rapid rise in fentanyl-related deaths has been driven by the increasing presence of fentanyl in many drugs. The Drug Enforcement Administration (DEA) has reported a rapid rise in fentanyl-laced pills that can appear legitimate that, in fact, contain a potentially lethal amount of fentanyl.[3] In April 2023, the Biden Administration announced a multi-factored approach to disrupt fentanyl supply chains into the United States.[4] However, the problem remains that fentanyl testing strips are illegal in a handful of states.[5] The CDC recommends test strips as a means of saving lives and preventing drug overdoses.[1] Congress should pass the bipartisan STRIP Act to remove fentanyl test strips from the CSA, as well as increase funding to public health agencies to scale up the range of public health approaches, including fentanyl test strips, that are critical to saving lives.[6]