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 re-arrested.[4] Formerly incarcerated individuals face many challenges, including difficulty accessing employment, education, housing, and health care.[4][5] For people with mental health conditions, the reentry process is especially difficult and, as a result, they have a higher recidivism rate.[6] These individuals are at an increased risk for experiencing barriers to employment and housing, and often struggle to access mental health services.[6] One-stop shop reentry programs can lower recidivism by improving access to critical support services.[1][2][3]

There are approximately 450,000 Veteran renter households who have extremely low incomes but receive no rental assistance.[1] According to a 2023 U.S. Department of House and Urban Development’s (HUD) Mandatory Affordable House Program report, many Veterans have the “worst case housing needs.”[3] This means they fall below the federal poverty line, spend more than half of their income on substandard housing, and receive no housing assistance.[3] Joint programs such as the U.S. Department of Housing and Urban Development and the U.S. Department of Veterans Affairs Supportive Housing (HUD-VASH) initiative are well positioned to provide assistance to Veterans with both their housing and health needs. Specifically, HUD-VASH is designed to assist homeless and extremely low-income Veterans and their families by providing rental assistance, along with clinical and case management services to improve access to health care, mental health treatment, substance use counseling, and other supportive programs.[2] To provide Veterans with housing security and address this population’s health needs, Congress should approve the $13 billion in funding requested in the President’s Fiscal Year 2024 Budget Proposal to help expand and sustain critical programs such as HUD-VASH.[1]

Mass shootings in the United States are not only a threat to public safety, but also a source of widespread fear and anxiety that affects the mental health of millions of Americans. More than 50 percent of teenagers worry about a shooting occurring in their school, which is associated with heightened anxiety and fear. A large majority of Americans report fears of mass shootings, with one in three avoiding certain events and places.[2]

One of the factors that contributes to this fear is the availability and use of assault weapons and dangerous hardware that facilitate and increase the lethality of mass shootings. Assault weapons are semi-automatic firearms that can fire more rounds in a shorter amount of time and cause more damage than other kinds of guns.[3] High-capacity magazines generally hold more than 10 rounds of ammunition and allow shooters to fire more shots without reloading, increasing the potential for casualties.[4] Researchers found that the federal ban on assault weapons and high-capacity magazines from 1994 to 2004 reduced the likelihood of mass shooting deaths by 70 percent for the ban period and estimated that 314 out of 448 would have been prevented in the 12 years before and after the ban.[5]

Other conversion devices, such as silencers and bump stocks, can also enhance the deadly potential of firearms. Silencers, which are devices that suppress the noise of gunshots, can hinder the ability of law enforcement or bystanders to locate and respond to an active shooter.[6] Bump stocks, which are devices that enable semi-automatic rifles to fire at a nearly automatic rate, were used by the shooter in the 2017 Las Vegas massacre that killed 58 people and wounded hundreds more.[7]

Mass shooters, on average, exhibit four to five observable and concerning behaviors before their attacks[2]. Firearms are used in half of suicide deaths, and a majority of gun deaths are suicides.[3] In states without ERPOs, individuals who notice warning signs have no legal way to intervene to remove firearms. ERPO laws create a legal process to prevent firearm deaths through intervention.[4]

ERPO laws in multiple states have been shown to be a promising tool for preventing firearm homicides and suicides. A case study in California found that ERPOs had been used to remove firearms from 21 individuals who had threatened to commit mass shootings and that none of these shootings had occurred at the time of the study.[5] Another study showed that ERPO laws saved a life for every 10 firearms removed in Indiana and a life for every 10-20 firearms removed in Connecticut.[6]

Currently, the U.S. public health surveillance system for mental health and substance use is severely lacking. The Substance Abuse and Mental Health Services Administration (SAMHSA), for example, runs the National Survey on Drug Use and Health, which provides estimates of substance use and mental health at the national, state, and substate levels.[1] Yet this data is delayed and is not broken down by local geographies that would allow officials to respond to local trends in near real time. Similarly, the CDC’s Provisional Drug Overdose Death Counts for a given month are released five months later and are not broken down by demographic groups or sub-state geographies, making meaningful responses extraordinarily difficult.[2]

In contrast, the U.S. has robust data available across many decades relating to the U.S. population, economy, and workforce. For example, the Department of Commerce houses the U.S. Census Bureau and the Bureau of Economic Analysis[3], while the Department of Labor houses the Bureau of Labor Statistics.[4] The failure to collect such robust data for mental health and substance use leaves our federal, state, and local government agencies, as well as other stakeholders, ill-positioned to properly address population needs and trends. By creating a world-class public health data system for mental health and substance use that collects a wide variety of mental health and substance use disorder data by demographic groups, Congress can ensure systems affecting mental health and substance use have foundational data needed to improve mental health and well-being across the country.

In 2020, 81 percent of 14- to 22-year-olds reported using social media “daily” or “almost constantly.”[1] During the pandemic, the time teenagers spent in front of screens for activities unrelated to school more than doubled, from 3.8 to 7.7 hours per day.[1] There is growing concern about the impact of social media and technology on youth mental health and wellbeing.[1]

In May 2023, the White House described steps it’s taking “to protect youth mental health, safety, and privacy online,” including the creation of a new “Task Force on Kids Online Health and Safety.”[2] Additionally, in September 2022, the Substance Abuse and Mental Health Service Administration (SAMHSA) awarded a $2 million grant to the American Academy of Pediatrics (AAP)[3][4] to establish a National Center of Excellence on Social Media and Youth Mental Health[5] to “serve as a centralized, trusted source for evidence-based education and technical assistance to support the mental health of children and adolescents as they navigate social media.”[5]

Congress has also recognized the need to address the issue, including language in the Consolidated Appropriations Act of 2023 that requires the U.S. Department of Health and Human Services to study the effects of smartphone and social media use on adolescents’ emotional, behavioral, and physical health and to research the health and developmental effects of media and technology more broadly on infants, children, and youth.[6][7] Congress should continue to support similar efforts through increased funding for research and consumer education.[1]