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

Gun violence is a major public health challenge in the U.S. According to the Centers for Disease Control and Prevention (CDC), there were over 45,000 firearm-related deaths in the U.S. in 2020. Suicides accounted for a majority of all firearm-related deaths, while homicides accounted for over 40 percent. Gun violence also disproportionately impacts Black, American Indian, and Latino populations.[1]

Community-based violence intervention programs attempt to prevent gun violence by targeting those at high risk of being involved. Some of the main program models include GVI programs, HVIPs, and street outreach. GVI programs have individuals at risk for violence meet with community members, social service organizations, and law enforcement to educate them about the consequences of gun violence while also offering social services. HVIPs intervene with patients while they are still in the hospital to minimize the possibility of retribution while also offering individuals social services similar to those in GVI programs. Street outreach programs utilize outreach workers within the community to proactively prevent gun violence through conflict mediation.[2]

The RISE from Trauma Act would support these programs by providing $600 million in funding through a Department of Health and Human Services (HHS) grant program for community-based organizations involved with trauma intervention. The Act would also create another HHS grant program to fund hospital-based trauma interventions such as HVIPs.[3]

There are at least three parking spaces for each of the estimated 260 million cars in the United States.[3] Municipalities often have minimum parking mandates that require parking spaces for every building.[4] Parking minimum mandates have vast unintended consequences, worsening housing affordability, congestion, and climate change.[3] Related outcomes of minimum parking mandates include increased housing costs and pollution emissions and reduced building development and public transit use.[2]

Housing insecurity, which includes lack of affordable housing, overcrowded conditions, and homelessness, exposes individuals and families to increased stress, negatively impacting mental and physical health.[5] For individuals with mental health and substance use disorders (MH/SUDs), housing insecurity exacerbates a cycle of MH/SUDs symptoms and discrimination that contribute to the overrepresentation of those experiencing homelessness also having MH/SUDs.[6] Congress should pass the People Over Parking Act to mitigate the negative impacts of parking minimum mandates, especially on those suffering from MH/SUDs.

Nearly one in three adults have a mental health or substance use disorder (MH/SUD), yet many do not receive any treatment.[2] Screenings and assessments are critical to identifying MH/SUDs and increasing early treatment.[3] The Centers for Disease Control and Prevention (CDC) has developed a program, “Learn the Signs. Act Early.” that provides support materials for parents on childrens’ developmental stages so they can better identify developmental delays.[4] In addition, the program provides a tracker for parents to monitor developmental milestones, and resources are available in case there is a concern for developmental delays.[5] A similar program should be developed so family members and caregivers can be aware of the signs of an MH/SUD that may be developing so that they can seek care for their loved ones.[1]

Tragically, 90 percent of suicide attempts with guns are fatal, whereas 4 percent of suicide attempts not made with firearms end in death. Many individuals who die by gun suicide act impulsively and could have been saved by a waiting period for gun purchases.[1][2] A waiting period requires gun buyers to wait a certain amount of time before taking possession of a firearm they have purchased. The waiting period allows time for a background check, a cooling-off period, and an intervention or counseling for individuals who may be in distress.[2]

Waiting periods have proven to reduce firearm suicides by creating a buffer of time that can save lives. They are also supported by most Americans, including gun owners. However, only 10 states and the District of Columbia have waiting periods for all or some types of firearms.[3] The federal government does not require a waiting period for gun purchases, except for cases where a background check is delayed for up to 3 days.[2] Requiring gun buyers to wait 7 to 10 days before accessing a gun they have purchased would provide sufficient time for background checks and cooling-off periods.

Young adults aged 18 to 25 have the highest rates of substance use disorders (SUDs), including alcohol use disorder, compared to other age groups.[2] Collegiate Recovery Programs (CRP) provide supportive environments within campus culture for college and university students in recovery from SUDs.[3] There are more than 150 CRPs on college and university campuses nationally.[3] However, the diversity of models and practices has not been well documented.[4] Identifying best practices, which include dedicated space, trained staff, programs supporting recovery, and peer support,[3] and providing support and technical assistance, should be a priority for the ONDCP, SAMHSA, and DOE to increase the number and capacity of CRPs.[1]

Each year, Head Start programs serve more than 1 million children ages birth to five and pregnant people through federally-funded grantee organizations.[2] The Office of Head Start provides guidance to grantees on using quality improvement funds to support Head Start teachers in addressing behavioral challenges and potential mental health conditions.[3] Previously proposed legislation sought funding and requirements for the Health and Human Services Secretary to identify, review, and implement effective, evidence-based interventions that improve children’s mental health in Head Start programs.[4][5][6] Congress should amend the Head Start Act to prioritize support for evidence-based, trauma-informed programs, age-appropriate interventions, and mental health screenings.[1]