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This blog is the second in a three-part series on targeting newly approved federal funds for substance use disorders and mental illness to areas of greatest need. In the first blog, we laid out strategies for state and local advocates to help state officials target the Substance Abuse Prevention and Treatment (SAPT) Block Grant money. This second installment looks at other pools of federal COVID funding that can address mental health and co-occurring substance use disorders needs.
If ever there was a year that brought mental health needs to the fore, this was it. We are not only living through a pandemic, but a “syndemic,” where the intersection and co-occurrence of multiple crises, including COVID-19, unabated systemic racism, transphobia, xenophobia, and our national political divisions, have created an unrelenting state of crisis and trauma.
Congress responded in a big way, providing a boost to mental health funding across the board. This includes $128 billion in grants to elementary and secondary schools in the American Rescue Plan Act (ARPA), which may be used for mental health services and supports. It also includes nearly $8.25 billion in ARPA and the December Covid supplement for state and local mental health and substance use services, school-based mental health programs and workforce training. In addition, the FY 2021 omnibus appropriations package increases SAMHSA general funding by $133 million, including $35 million in the mental health block grant set aside for crisis services.
Is it enough? Probably not, since we cannot remove future triggers that remind us of this year, and that will likely drive ongoing and new mental health and substance use disorders in the years ahead. Nevertheless, this investment will bring some immediate relief to communities, providers and youth, along with an opportunity for advocates to set a stage for better services in the future.
As states allocate these funds, it is time for officials to embrace the insight and perspective of community-based organizations who know best what their communities need. For advocates, it is time to make sure those voices are heard at decision-making tables.
Supporting essential community-based services
About four in 10 adults have reported symptoms of anxiety or depression during the COVID-19 pandemic, four times more than pre-pandemic. Consumers are experiencing increasing gaps in availability of mental health services. ARPA and the December Covid supplement together dedicated $3.15 billion to the Community Mental Health Services (CMHS) Block Grant for providing comprehensive community mental health services. About half of that money is to go out directly to community mental health centers, where it will pay for essential services. The CMHS Block Grant targets start-up efforts, but it can also fund services over the long term, as long as they are not covered by other means. Block grant funds may not be used to "supplant" or replace prior state funding for existing services. Advocacy strategies are the same as for SAPT block grants, since states can develop combined spending plans.
In addition, ARPA authorized more than $6 billion for community health centers, which provide a safety net for up to 30 million people. These funds are primarily to support and expand COVID-19 vaccination, testing and treatment for vulnerable populations. However, some money could be used to expand and sustain the accessibility and availability of comprehensive primary care services, including mental health and substance use disorders services, to meet the ongoing and evolving needs of patients.
Advocates can work to influence community health center spending of these funds by seeking seats on the health centers' governing boards, which must include at least 51% patient representatives. Alternatively, they can influence board members and center officials by highlighting community needs.
Supporting crisis services
For the first time, Congress established a five percent set-aside in the mental health block grant for crisis care. ARPA also creates a Medicaid coverage option with an enhanced federal match rate of 85 percent for the development of community-based mobile mental health and substance use disorders crisis intervention services and appropriates $15 million for planning grants to assist states with developing a Medicaid state plan amendment or waiver request to implement these services.
Advocates can urge states to prioritize establishing or expanding 24/7 non-law-enforcement mobile crisis teams as alternatives to policing and punishments, which disproportionally affect Black and brown communities.
Supporting the behavioral health workforce
Among other provisions for the behavioral health workforce, ARPA appropriates $100 million to SAMHSA to support recruitment and training, including that of peer support specialists. Advocates can push for use of these funds to recruit demographically diverse providers and to train the existing workforce to be more culturally effective. This can help in building trust between providers and patients.
Expanding services in schools
We have no history to tell us what may be the long-term consequences for adolescents of their past year living under the restrictions COVID-19 necessitated. However, we do know during this pandemic, youth mental health is worsening significantly; more youth in the U.S. have severe major depression than in the prior year. This increase was highest among Black, Indigenous, Latinx, and Pacific Islander youth. As most schools reopen their classrooms, youth will need more support to cope with this unprecedented time in their lives.
Besides appropriating additional funding to SAMHSA, the federal government dedicated about $128 billion in grants for elementary and secondary schools to respond to COVID-19. These funds can be used for mental health services and supports; however, this is not a requirement. More than 50 organizations, including Community Catalyst, signed a letter to urge the Department of Education to issue reopening guidance directing schools to use a portion of this money on mental health supports and social-emotional learning. On the local level, it is time for advocates to engage in conversation with school districts to make sure, with or without federal guidance, they are using a portion of available funds to address mental health and co-occurring challenges. Let us meet young people where they are, and where they, with vaccination, will be in the future.
This new funding can help us overcome the crisis of the moment. Let’s also use it to think long-term and set the stage for future system and community resilience – for the next crisis.