Congress must invest in mental health and substance use care infrastructure

The nation’s infrastructure is about more than roads and bridges, broadband and renewable energy. At the most fundamental level, infrastructure literally begins with — and depends on — people. And when it comes to mental health and substance use disorders, our human infrastructure was vulnerable and struggling before COVID-19, and it has taken a battering during the pandemic.

For years now, almost one in four adults in the United States has been living with a mental illness, substance use disorder or both. Suicide is the tenth leading cause of death in the United States, and the second leading cause of death for people ages 10 to 34. More than 92,000 people died from a drug overdose in 2020 according to provisional data just released by the CDC, an increase of nearly 30 percent from the previous year and a grim new record of deaths during a 12-month period. Tragically, COVID-19 has significantly exacerbated a problem that had festered for decades — lack of investment in critical mental health and substance use disorder services.

Our human infrastructure is in crisis.

We cannot recover from the devastating impacts of COVID-19 without also addressing the overdose and suicide crisis that existed before the pandemic. We simply cannot go back to the “normal” that existed before the pandemic. 

Now is the time to create something better, an approach that addresses the structural weaknesses in our national mental health and substance use disorder system of care and invests in a long-term strategy of health and wellness.

As Congress and the Administration continue to negotiate the scope of an infrastructure bill, the Coalition for Whole Health, a national coalition of organizations working to improve coverage for and access to mental health and substance use disorder care, urges swift and decisive action in four key areas that will help people, families, communities and our nation to become healthier and stronger in the wake of the pandemic.

1. Strengthen and expand the nation’s mental health/substance use disorder workforce by investing in educational and training opportunities for mental health/substance use disorder workforce professionals, career development and loan forgiveness within both fields while intentionally building a diverse and culturally and linguistically effective workforce.

2. Invest in the digital mental health/substance use disorder infrastructure to support the continuation and expansion of tele-behavioral health services and electronic health information exchange as well as equitable access to the technology infrastructure for underserved individuals and communities.

3. Build capacity to expand access to comprehensive care by significantly expanding federal investment in the community-based system of mental health and substance use disorder care while prioritizing health and recovery over punishment and incarceration.

4. Expand affordable stable housing opportunities and enforce anti-discrimination protections, which together are some of the most important factors in successful reentry from incarceration and sustained health for people with mental health and substance use disorder histories.

We have a once in a generation opportunity to truly make a difference in the lives of millions of people in this country.

Strong, sustained action by Congress and the White House could change the trajectory of the nation — from one whose policies have fostered perpetual punishment and inequity to one that promotes health, justice, equity, and opportunity.

Congress should not let this moment slip away. Now is the time for a bold and strategic investment in the nation’s mental health and substance use disorder infrastructure. Only by investing in the mental health and wellness of all our people can we truly thrive as a nation.  Now that is true recovery.

Paul N. Samuels is director and president of the Legal Action Center.

Ron Manderscheid is president and CEO of the National Association of County Behavioral Health and Developmental Disability Directors.

They are co-chairs of the Coalition for Whole Health.