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

Rates of eating disorders among military members are increasing, and their families also have higher rates of eating disorders than the civilian population.[2] Congress passed the Fiscal Year 2022 National Defense Authorization Act with language from the SERVE Act, which requires expansion of treatment under TRICARE and provide additional coverage for Veterans and their families.[1][4] This coverage expansion was supposed to take effect on October 1, 2022, but the Department of Defense (DoD) has yet to implement these changes.[3] To ensure military personnel, retired military, and their families have access to eating disorder treatment, the DoD should fully implement the SERVE Act without delay.[1][2[][3]

Since its passage, the ACA has dramatically expanded access to affordable health insurance and healthcare services.[2] The ACA also mandated coverage for various preventive services, such as routine screenings for diseases or conditions.[3] These screening services must be provided by most private health plans without copay or coinsurance, regardless of whether a person’s annual deductible has been met.[3] The U.S. Preventive Services Task Force (USPSTF) regularly provides updated guidance on mandated preventive services and currently recommends screening for depression in the adult and adolescent population, particularly for those who are pregnant or elderly. The USPSTF also recommends screening and counseling for adults and adolescent populations for unhealthy alcohol use.[4] In an ongoing court case, Braidwood Management v. Becerra, a group of plaintiffs are challenging the ACA requirement to cover preventive services designated by the USPSTF - arguing the mandate is unconstitutional.[5] Access to preventive services must be preserved, including critical screenings for mental health and substance use disorders. The Department of Justice should vigorously defend this latest attack on the ACA and, should protections afforded by the ACA be undone by the courts, Congress should act quickly to restore these protections.

Eating disorders affect an estimated 9 percent of the population and often co-occur with other mental health conditions [3] and have among the highest mortality rates of all mental health and substance use disorders.[4] Eating disorders affect all age groups, including older adults enrolled in Medicare. Medical nutrition therapy is a nutrition-based treatment that also includes counseling services, and has been shown to have positive outcomes for individuals with an eating disorder.[5][6] Unfortunately, about 70 percent of individuals with an eating disorder are unable to receive treatment due to limited insurance coverage.[7] Currently, Medicare Part B only covers medical nutrition therapy for individuals who have been diagnosed with diabetes or kidney disease.[8] The passage of the Nutrition CARE Act would increase access to medical nutrition therapy for Medicare beneficiaries with an eating disorder. [1][2]

Continuity of Operations Plans (COOPs) clearly outlines how an organization will continue to perform its essential functions during a disaster or emergency.[2][3] While critical to ensure workers can get back to work quickly and safely, these plans often fail to address employees’ mental health needs.[3] Essential workers are at an increased risk for job-related trauma and for developing mental health conditions and substance use disorders.[4] As recommended by the National Action Alliance for Suicide Prevention’s “Action Plan for Strengthening Mental Health and the Prevention of Suicide in the Aftermath of COVID-19,” including plans to address employee needs related to mental health, emotional stress, and trauma support in COOPs can help improve the overall health of essential workers during a crisis.[1]

Individuals involved in agricultural work or farming often encounter many challenges that may impact their mental health. Challenges related to volatile agricultural commodities markets, weather and even climate change can contribute to the stressors on farmers and agricultural workers. At the same time, there is often a shortage of healthcare providers to address the needs of agricultural communities. The American Psychological Association notes that rural areas experience shortages of mental health care providers and stigma around mental health.[2]

The FRSAN program connects farmers, ranchers, and other agriculture workers to stress assistance programs and resources. Through FRSAN, state departments of agriculture, state extension services, and non-profits receive funding to establish helplines, provide suicide prevention training for farm advocates, and create support groups for farmers and farm workers. Under the Farmers First Act, departments of agriculture across many states and non-profit organizations are provided the necessary funding to establish helplines, suicide prevention training for farm advocates, and support groups.[3] Congress should prioritize reauthorizing this important program serving the mental health needs of farming communities.

FQHCs frequently serve socially and economically marginalized communities. FQHCs must report on quality measures associated with mental health and substance use disorders (MH/SUDs), including depression screenings, brief alcohol interventions, and depression remissions.[1][2] However, they are not required to use the Center for Medicare and Medicaid Services’ (CMS) core quality measures for publicly funded health plans.[3][4] Clinical experts have raised concerns about the efficacy of existing FQHC reporting requirements, particularly in addressing disparate health outcomes in marginalized communities.[1] HHS should mandate that FQHCs align with CMS’ core measures to address health disparities. Implementation of these reporting requirements should be appropriately funded. [1]