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

Permanent supportive housing combines affordable housing assistance with voluntary support services, including mental health and substance use disorder (MH/SUD) treatment.[2] Stable housing is frequently essential to addressing chronic health needs, including MH/SUDs. The evidence for permanent supportive housing is robust. According to a National Academies of Sciences’ review of available evidence, permanent supportive housing’s “housing first” approach has been shown superior to approaches that prioritize “treatment first,” which historically required receiving MH/SUD treatment before receiving housing assistance.[3]

Unfortunately, the National Academies of Sciences’ review also found that permanent supportive housing (and other affordable housing) units are often blocked through local exclusionary zoning policies, as well as restrictive covenants and special permitting requirements. While more funding for permanent supportive housing is urgently needed, local restrictions block projects and unnecessarily drive up costs, wasting critical resources.[3] Inevitably, these local barriers increase homelessness and the number of unsheltered individuals living on the streets, including a disproportionate number of individuals with MH/SUDs, leading to worsening health outcomes and criminal legal system involvement.

RLIUPA is a powerful model that could be used to increase permanent supportive housing units and homeless shelters. Enacted in 2000, RLIUPA prevents discrimination against religious assemblies or institutions. Local governments have often used zoning, landmarking, or other land use laws to prevent places of worship, religious schools and camps, and religious social service facilities (such as group homes and homeless shelters) from locating within their boundaries. RLUIPA’s requirements are enforced by the U.S. Department of Justice and, importantly, through private rights of action. After RLUIPA’s passage, it became much more difficult for local governments to block such facilities. While RLUIPA protects religious-affiliated social service facilities, including homeless shelters, the protections do not extend to permanent supportive housing and homeless shelters more broadly.

Congress should utilize the RLUIPA model to prevent local communities from blocking critically needed permanent supportive housing, which is essential to preventing homelessness, including for individuals with MH/SUDs.

In 2012, the National Action Alliance for Suicide Prevention, the nation’s public-private partnership for suicide prevention, released with the U.S. Surgeon General the National Strategy for Suicide Prevention, which served as a call to action intended to guide the nation’s suicide prevention efforts.[1] As the Action Alliance works with public and private sector stakeholders to update the strategy in 2024, it should set quantitative outcomes goals to drive suicide prevention efforts nationwide, which are critical to saving lives.

Government agencies should adopt such quantitative goals and commit to changing the policies and practices necessary to reduce suicide, particularly given recent alarming trends that have been moving in the wrong direction. Ambitious, quantitative goals have been critical to making progress in other areas. For example, in 2019, agencies across the Department of Health and Human Services developed an operational plan to pursue the bold goal of Ending the HIV Epidemic in the U.S. by 2030.[2] Similarly, in 2021, the Administration set goals of achieving a 50-52 percent reduction in greenhouse gas pollution in 2030 below 2005 levels and having 100 percent carbon pollution-free electricity by 2035.[3] Setting such goals for suicide prevention will be essential to changing practices across public and private stakeholders that are necessary to reduce suicide.

In 2021, only 25 percent of AANHPI individuals with a mental health condition received any treatment, according to SAMHSA. To increase well-being and access to services in underserved populations, culturally and linguistically-competent approaches are needed that recognize each community’s unique history and culture.[3][4][5][6] Policymakers must work to address systemic barriers that prevent underserved communities from accessing mental health services and supports, including stigma, limited culturally and linguistically appropriate care, and insufficient population-specific research.[1][2]

By passing the Stop Mental Health Stigma in Our Communities Act,[1][2] Congress can advance a broad-based national outreach and education strategy that is still tailored to meet the needs of underserved AANHPI communities.

The Supplemental Nutrition Assistance Program (SNAP) reached an average of 42 million people annually in the five years leading up to the COVID-19 pandemic in 2020.[2] Eligible low-income individuals and families use SNAP to supplement their grocery budget, reduce their food insecurity,[2][3] and improve their health and economic wellbeing.[4] Numerous studies have found that food insecurity is associated with poor mental health outcomes, including higher rates of depression and anxiety.[5][10] A recent study found that work requirements to receive SNAP benefits worsened depression and anxiety, and at a faster rate for women than men.[1][4][5]

Recently passed legislation[6] mandates new requirements for individuals to receive SNAP benefits and curbs how states can waive work requirements.[7] The expanded work requirements put thousands of adults at risk of losing food assistance.[7][8] Work requirement policies limit the time adults without disabilities or dependents can receive SNAP benefits unless they work or participate in training activities.[5][9] These policies add barriers to populations facing food insecurity[1] and make it more difficult to qualify for benefits, which worsens mental health.[4][5]

Given that work requirements on SNAP benefits do not result in significant employment gains and negatively impact low-income individuals, including those with MH/SUDs, Congress should repeal these requirements.

Sixty-four percent of the more than 100,000 estimated U.S. drug overdose deaths from May 2020 to April 2021 involved synthetic opioids, primarily illicitly manufactured fentanyls (IMFs).[2] From 2019 to 2021, median monthly overdose deaths among adolescents (ages 10-19) increased 109 percent, deaths involving IMFs increased 182 percent, and approximately 41 percent of these adolescents had a history of mental health conditions or treatment.[3]

In April 2023, the White House and the Ad Council announced a campaign to educate youth on the dangers of fentanyl and the benefits of Naloxone.[1] Raising public awareness around the growing fentanyl crisis, especially among youth, is incredibly important. To be effective, however, it is critical that Congress fund and support for the campaign be sustained as the fentanyl crisis continues.

In 2021, more than 48,000 individuals died by suicide, a 5 percent increase from the prior year. The highest rates were among American Indian / Alaska Native people, men, and adults aged 75 and older.[3] Fortunately, suicides can be prevented. One effective way to save lives is to install barriers on bridges and other accessible areas of significant height. Simply delaying or deterring an individual at risk can provide time to get past intense moments of crisis. Research demonstrates the effectiveness of such barriers. One study in Australia showed that barriers on bridges saved lives, resulting in a 240 percent return on investment.[4] In the U.S., the placement of barriers on bridges have similarly cut the number of suicides in those locations.[5]

By helping communities install barriers on bridges, the Barriers to Suicide Act would save lives. Its GAO study would help inform the most effective means of preventing suicides on bridges and other high structures, improving our ability to save lives in the future.