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

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.

The Americans with Disabilities Act protects people with disabilities from discrimination in areas such as employment, state and local government activities, public transportation, commercial facilities, and telecommunication services.[3] Both employers (Title I) and state and local governments (Title II) are required to make reasonable accommodations to give people with disabilities an opportunity to take advantage of all available job opportunities, resources, and services.[3] It is critical for these protections to be interpreted and enforced to protect people with MH/SUD and maximize their access to employment opportunities.[2] Currently, an employee or applicant actively engaging in illegal drug use is not protected.[4] This increases stigma and discrimination against people with SUDs.[5] In addition, certain mental health conditions, such as anxiety and depression, can make it difficult for people with MH/SUDs to access disability or life insurance.[6] While the ADA includes essential protections for people with disabilities, steps must be taken to ensure individuals with MH/SUD are afforded the same protections as those with other medical conditions.[1][7]

The Equality Act is essential to combatting widespread discrimination against LGBTQ+ people, who lack consistent and comprehensive federal protections.[1][2] Approximately two-thirds of LGBTQ+ people have reported experiencing discrimination in their lives, and such discrimination can negatively impact their mental health, increasing their risk of depression, anxiety, and even suicidal thoughts and self-harm.[2]

Passing the Equality Act would help reduce discrimination, decreasing a significant risk factor for poor mental health. Research has shown that LGBTQ+ people who lived in states that allowed same-sex marriage (prior to it being legal nationwide) had lower rates of mood, anxiety, and substance use disorders than those who lived in states that did not allow same-sex marriage. The very existence of marriage equality – even if the sexual minority men were not partnered – reduced health care utilization and costs for mental and physical health.[3] Other research has found that marriage equality laws “shrank the mental health gap between sexual minorities and heterosexuals.”[4][5] Another study showed that lesbian, gay, and bisexual individuals living in states with comprehensive legal protections have higher self-rated health than those living in states without these protections.[6]

Currently, mortality data for both suicide and drug overdoses lack standardization and are significantly delayed, which limits our ability to respond to these public health crises. As recommended by the 2017 Commission on Combating Drug Addiction and the Opioid Crisis, the CDC should work with states to “develop and implement standardized rigorous drug testing procedures, forensic methods, and appropriate toxicology instrumentation in investigating drug-related deaths.”[1] The CDC should do the same for investigating possible suicides, particularly given the difficulty of distinguishing unintentional and intentional drug overdoses.[2]

To assist with standardization across jurisdictions, Congress should significantly increase funding for local medical examiners and tie federal funding to standardized processes and reporting to ensure the availability of near-real-time data reporting. Funding should also be tied to standardized policies that allow access to linkable mortality data for purposes in the public interest, such as surveillance, research, and clinical quality improvement. Federal funding is particularly urgent given the chronic underfunding of many state and local medical examiners’ offices.[3]