Congress must fund preventive approaches to mental health care  

By Jace Peterkin and Isha Weerasinghe

Expanding and strengthening access to supportive services for young people is critical to their wellbeing. Time and again, young people from underserved communities—namely people with Black, brown, disabled, and/or LGBTQ+ identities—stress the importance of focusing on wellness, rather than on mental health and diagnoses.  Relatedly, they prefer community-based programs and peer networks over formal mental health services delivered in clinical settings.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the federal agency that provides and oversees public funding to states and tribal entities for mental and behavioral health care. Despite a strong evidence base indicating how primary preventive services can improve livelihood and wellbeing, SAMHSA does not mandate state mental health programs to focus on primary prevention (as opposed to secondary prevention, which focuses on early diagnosis and intervention).

The Case for Primary Prevention

Congress now has an opportunity to change course by providing a set-aside in the Community Mental Health Services Block Grant (MHBG) for primary preventive services. SAMHSA’s Substance Abuse Prevention and Treatment Block Grant mandates that states allocate at least 20 percent of their block grant dollars to primary prevention strategies. Efforts to create a similar set-aside in the MHBG failed with the exception of suicide prevention, because many states do not want to fund services for people without a diagnosis. Limiting mental health services only to people with a diagnosis perpetuates a system that focuses on screening and treatment, which is problematic for underserved populations who often experience increased mental health stigma and distrust of the medical system—resulting in delayed/no care. Moreover, many mental conditions can be prevented before the rise to the level of even requiring a diagnosis. Preventive mental health interventions are often much cheaper than treatment, include defined parameters in the literature, and have a longstanding evidence base dating back to the 1980s. Changing attitudes on this will require a narrative shift around the concepts of wellness and wellbeing for both individuals and communities.

What does youth mental health prevention mean? 

Primary prevention interventions for youth aim to provide protective mechanisms that support emotional and behavioral responses to stressful events in life. These interventions, which must be tailored to the community and environment, are not a one-size-fits-all approach. For example, while funding for housing or food may help young people in one community, a more targeted approach to provide peer support counseling and group therapy may be more beneficial for young people in another place.

Why does this matter and what can be done about it?

We are currently in a youth mental health crisis, which both preceded the pandemic and was accelerated by it. In February 2023, the Centers for Disease Control and Prevention (CDC) found 3 out of 5 young adolescent women felt hopeless or sad and 1 in 4 seriously considered attempting suicide. Among LGBQ+ youth, nearly 3 in 4 felt sad or hopeless. The danger of not positively supporting youth early and consistently has dire consequences.

With the exception of programs focused on suicide prevention, the MHBG only nods to the importance of prevention. For instance, MHBG does not mandate states or tribal entities to build out mental health services without a diagnosis. Policymakers can look to the recent shift in focus toward prevention in Healthy Transitions, another SAMHSA grant program, as an example of what’s possible when administrators issue guidance that values the full scope of interventions in mental health.

Healthy Transitions program 

The Healthy Transitions grant provides an example of how prevention interventions can benefit youth.

The original goal of Healthy Transitions—launched in 2014 by the Obama Administration—was to enhance access to support services and treatment for young adults and youth aged 16-25 years old who had, or were at risk of being diagnosed with, a serious emotional disturbance or serious mental illness. The grant initially focused on supporting young people during this transitional, and often difficult, time in their lives as they move from adolescence to adulthood. Many young individuals require mental health resources but are unable to receive them due to factors such as cost, stigma, or lack of accessibility. The grant aimed to fund various organizations that help support young adults and youth struggling with mental health conditions. The program’s original goal was to address the gap in mental health care and ensure that young people receive necessary resources and services.

Under the Trump Administration in 2018, however, Healthy Transitions underwent reauthorization to restrict eligibility to only those youth and young adults aged 16-25 who had a serious mental health condition, with a focus on medicalized treatment. The shift in funding parameters caused frustrations among our state partners who work with young people. They had to seek alternative funding or cut programs to support the young people they served who weren’t facing serious conditions requiring medical treatment. Under the Biden Administration and due to the urging of advocates including CLASP, SAMHSA changed eligibility rules in March 2023 back to include the full range of youth in the 16-24 category to help them thrive and make their transition to adulthood smoother.

To emulate the Healthy Transitions program, legislators and the Biden Administration must fund preventive mental health strategies that do not rely on a diagnosis. Creating a set-aside in the MHBG program would be a significant and important next step to show that the government acknowledges our mental health crisis and is determined to address people’s needs before they become lifelong and serious.