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

Approximately one in six U.S. children aged 6-17 experience a mental health disorder each year,[3][4] and the number of youth diagnosed with anxiety and depression has been increasing steadily.[5] The Individuals with Disabilities Education Act (IDEA) provides appropriate public education to eligible children with disabilities, including those with serious mental health conditions, and ensures access to special education and related services.[6] More than 7.5 million infants, toddlers, children, and youth with disabilities are eligible for early intervention, special education, and related services through IDEA.[6]

When passed in 1975, IDEA was to cover 40 percent of the increased costs of special education.[7] Yet, funding never reached that level and currently covers just 14.6 percent of the cost.[7] Funding for programs and resources through the Act has declined for nearly two decades.[8] As the number of children with serious mental health conditions increases, it is increasingly critical that the IDEA is fully funded so they can receive special education services.

For over two decades, the CDC collected three questions relating to unhealthy weight control practices, but these questions were removed in 2015.[2] The most recent data is now over a decade old, even though eating disorders are among the deadliest mental health conditions[3], and emergency department admissions for eating disorders have increased dramatically for youth during the COVID-19 pandemic.[4] YRBSS is unique in its national scope and comprehensive behavior data collection in youth across the nation. It is also more representative of the national population, whereas other sources often overrepresent white and higher-income populations. The lack of current data has stymied research into eating disorders and hindered our public health response to recent increases.

In a disaster or pandemic, people often suffer serious mental or emotional distress, which may exacerbate existing mental health or substance use disorders (MH/SUD).[2] For example, during the COVID-19 pandemic, U.S. adults reported elevated adverse mental health conditions, and some populations – including young adults and racial/ethnic minorities – experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.[3][4]

The Federal Emergency Management Agency (FEMA), the agency responsible for helping people before, during, and after disasters,[4] addresses these behavioral health needs. FEMA’s National Response Framework guides how the nation responds to disasters and emergencies,[5] including the planning and coordination of Federal public health, healthcare delivery, and emergency response systems.[6] The inclusion of screening, supports, and services in pandemic and natural disaster response efforts provides evidence-informed care at the earliest possible point of intervention, either during or immediately after a disaster, which is key to treating every person at risk of or with early signs of MH/SUD.[1] Supports could include SAMHSA’s Disaster Distress Helpline,[7] which provides counseling to those in emotional distress; the Disaster Technical Assistance Center,[8] which prepares communities to deliver an effective MH/SUD-related response; and the Disaster Mobile App,[9] which provides resources to behavioral health first responders to better serve those experiencing distress during disaster events.

An estimated 5.5 million family caregivers provide personal care to U.S. veterans[3] who have sustained or aggravated a serious injury or illness in active armed forces service[4] and cannot perform daily activities.[5] The Department of Veteran Affairs (VA) promotes the health and well-being of these individuals[6] through its Program of Comprehensive Assistance for Family Caregivers, which offers them enhanced clinical support, services, and benefits.[5] These services and benefits may include stipends, health insurance coverage, respite care, and mental health counseling.[4] The VA receives approximately 8,000 PCAFC applications a month.[7] Caregiver supportive services improve outcomes by reducing caregiver burden and mental distress.[8][9] To expand the accessibility and capacity of mental health support and resources available to family caregivers of veterans, Congress should pass legislation to improve the well-being of these caregivers.

Prior to the COVID-19 pandemic, youth mental health in the United States had reached an unprecedented crisis.[2][3] Between 2016 and 2020, the number of youth and adolescents diagnosed with anxiety or depression grew by 30 percent.[2][4] In a given year, up to one in five children experience a mental health disorder,[5] and nearly half of U.S. adolescents (ages 13-18) had a mental disorder at some point in their lifetime.[6]

The Mental Health Services for Students Act would provide $300 million in grant funding for local educational agencies, tribal schools, and community-based organizations to provide onsite, culturally and linguistically appropriate mental health services for students in kindergarten through 12th grade.[1][7][8] The bill would help schools partner with local mental health providers to establish these mental health services and train teachers, administrators, and support personnel to recognize, assist, and refer students who may need mental health support.[1][7][8] Previous versions of the Mental Health Services for Services Act has passed the House in 2021 and 2022 and had broad bipartisan support.

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Evidence-Based Practices Resource Center provides communities, clinicians, policymakers and others in the field with information and tools to incorporate evidence-based practices into their communities or clinical settings to improve prevention, treatment, and recovery support services for mental and substance use disorders.[2]  Since the release of the Zero Suicide Toolkit[3]  in January 2020, the Resource Center has published or shared only three reports specific to suicide prevention evidence-based practices.[4]

The Suicide Prevention Resource Center (SPRC), funded by SAMHSA, advances suicide prevention infrastructure and capacity building and serves as a resource to organizations, communities, and systems that serve populations at risk for suicide.[5] SPRC’s Best Practices Registry[6] aims to increase health equity by sharing programs and interventions that use different types of community and culturally defined evidence to show effectiveness. Only thirteen (13) resources are currently listed on the Best Practices Registry. While thirty-four (34) evidence-based programs are listed in the Best Practice Registry’s Archive from years 2007-2016, the archive will no longer be accessible after January 15, 2024.[7] The widespread implementation of evidence-based practices in suicide prevention depends on access to a broad range of proven and current programs and initiatives.