Alignment for Progress: A National Strategy for Mental Health and Substance Use Disorders
It’s time for a meaningful national conversation about mental health and substance use care. We must remove the barriers to equitable and available coverage for these conditions so people can get the help they need.
Welcome To The National Strategy
Want to understand more about the importance of building a National Strategy for Mental Health & Substance Use Disorders?
How Content Is Organized and How Best to Search/Sort the Recommendations
The National Strategy recommendations are organized by category, with impacted populations and topical areas providing additional nuance and the ability to narrow a search. We have also included the option to search recommendations by the relevant House and Senate committees of jurisdiction.
Recommendation Selection Methodologies and Criteria
After conducting a thorough review of the federal policy landscape, The Kennedy Forum team created this first-of-its-kind compilation of policy recommendations needed to transform our mental health and substance use systems. The recommendations have been sourced and vetted from numerous organizations, advocates, and experts across the country in order to capture a robust set of recommendations for lawmakers and federal agencies to act on.
All National Strategy Recommendations
These featured recommendations are highlighted based on their importance in beginning the national movement towards better care for everyone.
Expand eligibility for SSI and SSDI
Congress should expand eligibility for Supplemental Security Income (SSI) and Supplemental Security Disability Income (SSDI) to include people with substance use disorders (SUDs).[1]
SSDI and SSI previously allowed benefit claims solely on the basis of a substance use disorder (SUD).[2] However, in 1996 Congress passed the legislation that eliminated the ability to claim benefits for SUD.[3] Currently, a SUD does not automatically result in a denial of benefits. However, if SUD is considered “material” or a significant reason for an individual’s disability, then benefits are denied.[4] Disabilities caused by SUDs should be treated no differently than diseases caused by a physical health condition when it comes to claiming SSDI and SSI benefits.[1]
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Repeal the Faircloth Amendment
Congress should repeal the Faircloth Amendment, an antiquated restriction that limits the number of units any public housing authority could own and operate, creating an artificial barrier that prevents policymakers from addressing the growing housing insecurity crisis.[1][2][3][4]
Approximately 1.1 million public housing units, operated by more than 3,000 local public housing agencies, serve 2.2 million residents.[5] Inadequate funding results in losing 10,000 public housing units annually to disrepair, and a large backlog of unmet renovation needs places the health and safety of residents at risk.[6] Limiting the number of public housing units through the Faircloth Amendment creates greater housing insecurity, exposing individuals and families to increased stress and negatively impacting mental and physical health.[5][7][8] Additionally, the lack of adequate affordable housing disproportionately impacts individuals with mental health and substance use disorders, whose conditions put them at higher risk of becoming homeless.
Housing insecurity, which includes lack of affordable housing, overcrowding living conditions, and homelessness,[5] is a critical social determinant of health.[9] Social Determinants of Health (SDOH) are nonmedical factors in the environments where people are born, grow, work, live, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.[10][11][12] While federal, state, and local public housing programs provide critical housing supports for people with mental health and substance use disorders, they are often underfunded and serve only a fraction of those in need.[9]
Congress should pass legislation to repeal the Faircloth Amendment[1] to remove barriers to creating new and maintaining existing public housing.[5]
Topics
Pass the Autism Family Caregivers Act
Congress should pass the Autism Family Caregivers Act, which would authorize grants to nonprofits, community health centers, and hospital systems that provide caregiver skills training to family caregivers of children with autism or other developmental disabilities or delays. [1][2][3]
About one in 36 children have autism spectrum disorder, while an estimated 1-3% of children in the United States have an intellectual disability.[4] Children with autism are more likely to have mental health challenges such as attention deficit hyperactivity disorder (ADHD) and anxiety, which can affect their overall health.[5][6] Providing evidence-based skills training to family caregivers is a successful approach to expanding access to health services and social engagement for children with autism and intellectual and developmental disabilities (IDD), especially if they cannot readily access these services in their community.[7] With this training, caregivers are better equipped to provide activities and support at home that will help improve the physical and mental health of their children.[7] Congress should pass the Autism Family Caregivers Act to improve resources available to family caregivers.[1][2][3]
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Reexamine other than honorable discharges
The Department of Veterans Affairs (VA) should reexamine discharges that were Other than Honorable (OTH) so that more Veterans receive access to critical health benefits.
Though most Veterans leave military service with an honorable discharge, a significant proportion receive OTH discharges and are ineligible for VA benefits. In many instances, Veterans’ mental health or substance use disorders (MH/SUDs) (including those relating to post-traumatic stress, traumatic brain injuries, and military sexual trauma) have contributed to their OTH discharge, which then deprives them of ongoing MH/SUD services through the VA and critical other benefits. OTH discharges should be reexamined to ensure Veterans with MH/SUDs are not inappropriately denied services.
In 2017, the VA estimated that there are more than 500,000 Veterans with OTH discharges.[1] This group is disproportionately people of color and/or LGBTQ+.[2][3] In 2021, VA expanded full benefits to all Veterans who had been given OTH discharges due to sexual orientation, gender identity, and HIV status who had previously been discharged under prior discriminatory military policies.[2] From 2014 through 2022, Black Veterans were 1.5 times more likely than White service members to receive OTH discharges – a clear sign of institutionalized racism.[3] The VA should work swiftly to review OTH discharges (with Congress directing the VA to do so, if necessary, so that Veterans are not inappropriately denied benefits due to simply having an MH/SUD.
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Raise the minimum wage
Congress should raise the federal minimum wage significantly by passing legislation like the Raise the Wage Act.
The federal minimum wage has been stuck at $7.25 an hour since 2009.[1] Since 2009, the federal minimum wage has lost more than a quarter of its value in inflation-adjusted terms. Nearly two-thirds of workers at or just above the federal minimum are women. Tipped workers, for whom the federal minimum is only $2.13 an hour (unchanged since 1991), are also disproportionately women.[2]
In 2019, the U.S. House passed the Raise the Wage Act[3], which would have raised the federal minimum wage to $15 by 2025, resulting in more than 33 million Americans receiving a raise. Roughly one-third of Black and Latina working women would have received a raise, as would a quarter of white working women. More than 15 million children live in a household that would have received a raise.[4]
Research has tied increases to the minimum wage to decreases in mental health and substance use disorders – and to reductions in suicide. One study found that a $1 increase in the hourly minimum wage was associated with between a 3.4 and 5.9 percent decrease in the suicide rate among adults aged 18-64 with a high school education or less.[5] Another study in the United Kingdom found that an increase in the national minimum wage reduced anxiety and depression among low-income people at a level similar to the effect of antidepressants.[6] Yet another study concluded that “the minimum wage could be an important policy tool that improves the mental health among low-wage workers with no college education.”[7] By improving the economic security of millions of low-wage workers, Congress can take an important step forward in improving mental health.
Topics
Improve SNAP in Farm Bill
As part of the next Farm Bill, Congress should take steps to make numerous improvements to the Supplemental Nutrition Assistance Program (SNAP) that have been recommended by the Bipartisan Policy Center (BPC) to reduce food insecurity and hunger, which is critical to improving mental health and well-being.[1]
Key recommendations from the BPC include keeping in place SNAP administration flexibilities that recently expired at the end of the COVID-19 public health emergency; streamlining eligibility and program requirements, administration, and data sharing; expanding SNAP benefits to U.S. Territories, college students, immigrant communities, and people in the military; enhancing SNAP Employment and Training Programs; and allowing SNAP benefits to be used for online shopping transactions.[1]
Robust evidence exists between decreasing hunger, improving nutrition, and mental health. For example, one study found that when states eliminated SNAP asset tests and increased income limits, there was a likely reduction in suicidality and poor mental health among adults.[2] Another 2023 study found that when West Virginia instituted work requirements for SNAP, it resulted in increased health care utilization in Medicaid for anxiety and mood disorders.[3] Additionally, a Texas A&M study found that increased SNAP benefits early in the COVID-19 pandemic likely cushioned children against the psychological stress of the pandemic[4], which is consistent with earlier research that showed the SNAP improved mental well-being among low-income populations.[5] Congress should take steps to reduce barriers to SNAP as part of the 2023 Farm Bill and should eliminate counterproductive work requirements.