Supporting Mental Health: Addressing a New Public Health Crisis

December 10, 2023

Introduction

More than one in five adults in the United States experience mental illness. In addition, nearly eight million young people have at least one mental health disorder, with almost half of those children going without treatment. And while suicide rates have generally risen for the population overall, for teens and young adults, suicide rates rose more than 60% from 2007-2021. Increasing access to behavioral health services is important, and state and territorial legislatures have recently considered or adopted policies to support both youth and adults living with mental health conditions and individuals in mental health crisis and their families.

Legislative Trends

Suicide Prevention and Crisis Supports

Suicide continues to be one of the leading causes of death in the United States, with overall rates rising in recent years. There are a number of ways to prevent suicide, such as supporting crisis response, creating protective environments for people at risk for suicide, and reducing access to lethal means.

More than half of suicide deaths (55%) involve a firearm. Safe storage practices, which include both the use of safety devices and laws limiting the ability of certain populations (e.g., children) to access firearms, are part of a comprehensive strategy to prevent suicide. During the 2023 legislative session, more than 20 states considered bills related to the safe storage of firearms. Maryland’s new law (MD SB 0858) requires the deputy secretary of public health to develop and disseminate a youth suicide prevention and firearm safe storage guide. The law also modifies the state’s firearm access law and prohibits access to a loaded firearm by people under 18, absent adult supervision or other relevant exceptions. In addition, Nevada enacted SB 294, which requires licensed firearms dealers to provide a locking device with each firearm transfer or sale and authorizes the state suicide prevention program to provide information about safe storage requirements and offer further education and support for safe storage options like locking devices. In Vermont, the state legislature acknowledged that the vast majority of firearm deaths in the state are suicides and enacted H 230, which establishes penalties for individuals who negligently store firearms where children or other prohibited persons might have access to them.

Jurisdictions are also exploring interventions to support individuals experiencing a mental health emergency. This includes enacting laws supporting the 988 suicide and crisis helpline, which offers phone, chat, or text options for individuals in crisis and their loved ones. State legislatures have also advanced laws related to other types of crisis response. Utah (UT HB 0066) expanded the roles and responsibilities of its Behavioral Health Crisis Response Commission, Virginia (VA HB 2216) will require insurance coverage for mobile crisis response services, and Hawaii (HI HB 948) established a child and adolescent mobile crisis pilot program.

Eating Disorders and Youth Mental Health

During the 2023 legislative sessions, states pursued policies that support the millions of young people experiencing mental illness and their families. Several states have considered legislation aimed at suicide prevention resources at schools, including Vermont (VT H 481), which will develop a model suicide prevention protocol for schools, and Utah (UT HB 481), which will notify families about suicide prevention if they have a child who was involved in a bullying or hazing incident or has threatened suicide. States are also exploring improved access to mental health supports in schools, with Delaware (DE HB 3) requiring referrals to a school-based specialist after a certain number of behavioral health-related absences. In addition, Illinois (IL SB 1709) has enacted a bill requiring the state’s department of human resources and board of education to work together to support available and accessible mental health resources in schools.

Eating disorders are a group of illnesses defined by unhealthy behaviors and emotions related to food and include conditions such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. More than 28 million people will have an eating disorder in their lifetime. Individuals with an eating disorder often experience additional mental health conditions such as anxiety or depression. Anorexia nervosa, in particular, has a high mortality rate compared to other mental disorders due to the risks of both the physical complications from severe calorie restriction as well as suicide.

In 2023, several states considered bills related to eating disorder screening, treatment, and prevention. For example, a Pennsylvania bill (PA SB 623) would require schools to provide information on eating disorders to families and direct the Pennsylvania Departments of Health and Education to develop guidelines for educating parents about eating disorders. Similarly, a bill in Connecticut (CT HB 6326) would have required local and regional boards of education to include goals related to reducing disordered eating in school wellness policies.

In Colorado, two bills related to eating disorder prevention and treatment (CO SB 176 and CO SB 14) are now law. As a result, the state will create a disordered eating prevention program within the state health agency that will work with the state’s office of suicide prevention to increase awareness and align initiatives. The state will also prohibit Medicaid and other health insurance plans from imposing specific utilization management requirements for certain disordered eating treatments.

Therapeutic Substance Use for Mental Health Disorders

Some research indicates that psychedelic substances like psilocybin may be effective therapies for mental health disorders, including PTSD, depression, and eating disorders. Following issue referendum votes, the Oregon Health Authority established a therapeutic psilocybin program in 2023, and the Colorado Department of Regulatory Agencies is anticipated to establish a similar program by 2024. During the 2023 legislative sessions, at least 24 states considered legislation to either decriminalize certain psychedelics or support their therapeutic use to treat mental health disorders like PTSD. Both Oregon and Colorado enacted legislation in 2023 clarifying aspects of their psilocybin programs established by voter referenda. Additionally, at least three states—Minnesota (MN SF 2995), Nevada (NV SB 242), and Washington (WA SB 5263)—enacted laws creating working groups or taskforces to explore legalizing therapeutic psychedelics like psilocybin, LSD, or MDMA.

Looking Ahead

ASTHO expects state and territorial legislatures to continue supporting mental health care needs in 2024. These actions may include:

• Continuing to support and operate the national 988 suicide and crisis helpline and related crisis support services.
• Considering legislation that applies a public health approach to firearm injury prevention.
• Continuing to explore the potential therapeutic use of psychedelic substances like psilocybin to treat mental health conditions.