Supporting Positive Mental Health Through Food Security and Good Nutrition

April 07, 2023 | Ramya Dronamraju, Claire Rudolph

Good nutrition and adequate food supply are critical—and often overlooked—factors in positive mental health outcomes. Multiple studies show that diets high in refined sugars can worsen symptoms of mood disorders and depression, while fruit and vegetable consumption can increase happiness and well-being. While the understanding of the human gut microbiome continues to evolve, evidence indicates that a healthy diet positively impacts the gastrointestinal tract, which communicates with the brain and impacts mood, sleep, and cognition.

Despite mounting evidence of how healthy diets support positive mental health, consistent and guaranteed access enough healthy food is not guaranteed. Food insecurity is associated with a variety of negative health outcomes and adverse childhood experiences, including behavioral health problems. Food insecurity also makes it more likely that children will consume more high-calorie, nutrient deficient foods and less produce. Recent research shows that dietary interventions such as medically tailored meals and produce prescriptions can reduce food insecurity and support mental health.

As the conversation about the importance of mental health continues to unfold, health agencies have a critical role to play in supporting positive mental health outcomes through nutrition support and food assistance programs.

National Efforts

The White House National Strategy on Hunger, Nutrition, and Health calls on states to act to end hunger and reduce diet-related illness. It also pledges to increase access to nutrition related services through private insurance and federal programs beyond Medicaid Substance Abuse and Mental Health Services Administration and USDA Food and Nutrition Services are supporting the strategy by facilitating the Food and Mood Project, a multisectoral effort promoting emotional wellness and reducing the impact of mental health and substance use issues using strategies and learning opportunities that impact food, food insecurity, and equitable access to culturally appropriate foods.

State and Tribal governments, along with local public and private partners, play an active role in this project. The federal government is also supporting continued efforts related to mental health and nutrition through the Medicaid program. Multiple states have recently received approval from the Centers for Medicare and Medicaid Services to implement food and nutrition services for people with mental health or substance use needs.

Optimizing Medicaid Waiver Options to Offer Food and Nutrition Programs

Medicaid offers flexibility to offer innovative coverage and programmatic options based on needs and capacity through the federal 1115 waiver. Massachusetts received federal funding to provide medically appropriate nutritional support for eligible people, including those who have a mental health or substance use disorder and are or who are at risk of homelessness, and those who are at risk for nutritional deficiency due to food insecurity.

Nutritional supports include counseling, up to three meals per day delivered to a home or private residence for up to six months, medically tailored or nutritionally appropriate food prescriptions, and cooking supplies. This additional meal support is available for all members of the household. Nationwide, approximately 30% of people experiencing homelessness have mental health conditions, while 50% have co-occurring substance use issues. These additional nutritional supports will allow people at risk of (or who are transitioning out of) homelessness to focus on accessing needed healthcare without the distraction of food insecurity.

The Oregon Health Plan, a 1115 Medicaid waiver demonstration approved in October 2022, includes new medically appropriate services for certain Medicaid recipients, including youth with serious mental health concerns who are transitioning to the adult health care system. Children and youth who are involved with the child welfare system and people experiencing homelessness are also eligible. The program provides nutrition counseling and education, meals or pantry stocking for children under 21, up to three medically tailored meals per day for six months, and fruit and vegetable prescriptions for up to six months, all depending on individual need.

Arkansas’ 1115 Medicaid waiver demonstration extension, Arkansas Health Opportunity for Me (ARHOME), was approved in November 2022. It allows the state to cover medically appropriate nutrition counseling and education and healthy meal preparation, as well as case management and linkages to other state and federal programs for people living in rural areas with a serious mental illness or substance use disorder diagnosis. In Arkansas, approximately 41% of people live in rural areas which, as in the rest of the country, experience higher levels of food insecurity than urban areas. Expanding these nutrition services has the potential to lift people out of food insecurity.

Participating in State and Federal Partnerships

Health agencies also offer nutrition support through a variety of existing federal partnership programs including: the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), SNAP-Education, the Child and Adult Care Food Program, the Commodity Supplemental Food Program, the USDA Farm to School Program, and others. Additionally, health agencies should advocate for full participation in all eligible federal food and nutrition support programs, seek to fill in gaps where they exist, connect these programs with mental health programs, and advocate for data and resource sharing.

Recommendations for State and Territorial Health Agencies

• Explore ways to offer food assistance through insurance programs that specifically seek to improve mental health outcomes. Using the 1115 waiver requires meeting Medicaid program objectives without increasing costs to the federal government. Health agencies implementing this waiver should proactively track mental health outcomes data for individuals and families receiving any food or nutrition assistance.
• Evidence shows that trauma-informed peer support programs can reduce food insecurity and depression are associated with trauma. As such, health agencies—distinctly positioned as neutral convenors—should collaborate with other state, island, and local partners to supplement existing financial and social supports for families experiencing food insecurity (e.g., SNAP, WIC, the WIC Farmers’ Market Nutrition Program, and peer support programs).
• Consider equity in all approaches to improving food security and nutrition. Important factors include languages spoken by target communities, availability of diverse and culturally appropriate foods, cultural barriers and supports, and other structural social determinants of health.

Food security and proper nutrition are critical factors for positive mental and physical health. Health agencies are uniquely situated to support population mental health by reducing food insecurity and enhancing nutrition.