Bipartisan Legislation Seeks to Expand US Approach to Mental Health

Legislation includes a CDC community public health approach to build mental wellness and resilience.

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The American Psychiatric Association (APA) has recently endorsed bipartisan legislation introduced in the fall in the House by Representatives Paul Tonko (D-NY) and Brian Fitzpatrick (R-PA) and in the Senate by Senators Ed Markey (D-MA), Jeff Merkley (D-OR), and Richard Blumenthal (D-CT). The legislation seeks to reduce the current epidemic of mental and behavioral health problems and prevent future ones by using a public health approach to build population-level mental wellness and resilience for all types of toxic stress, including those generated by the climate emergency.

The legislation, H.R. 9201, The Community Mental Wellness and Resilience Act, is an urgently needed new policy that will direct the Centers for Disease Control and Prevention (CDC) to provide small planning grants and larger implementation grants to community coalitions to strengthen the capacity for mental wellness and resilience among all adults and youth.

The need for the new policy is evident. In 2021 alone, more than 1 in 5 American adults experienced a diagnosed mental illness. Residents nationwide are experiencing accelerating toxic stresses due to job, income, and housing insecurity; poverty; and other struggles.

Another cause of the rise in mental distress is that 90% of counties in the United States were impacted by a major natural disaster in 2021.1 Research shows that disasters cause traumatic symptoms in 20% to 40% of those who are directly impacted, as well as those who know someone affected or watch the events from afar.2 The combination of escalating toxic stresses and acute disasters produces community-level and societal traumas as well as those to individuals.3

There are nowhere near enough mental health professionals to assist all the individuals who experience mental and behavioral health problems today. This gap will only grow over time as the climate emergency worsens. In addition, many individuals will not engage in personal treatment due to high costs, fears of being stigmatized, and other reasons. Community-based initiatives that help the entire population strengthen their capacity for mental wellness and resilience will go a long way in addressing these issues.

APA CEO and Medical Director Saul Levin, MD, issued the following statement about this legislation:

“The American Psychiatric Association strongly supports the Community Mental Wellness and Resilience Act and commends Representatives Tonko and Fitzpatrick for their leadership in introducing it. This forward-thinking proposal would authorize grants focused on strategies to enhance the ability of communities to confront the mental health impacts of acute and long-term disruptions from natural disasters, as well as other public health impacts of climate change. APA strongly supports this effort to foster resilience and mental wellness in communities across the nation.”

In addition to the APA, more than 115 national, state, and local organizations have endorsed H.R. 9201. Some of the national endorsers include theAmerican Psychological Association, the National Alliance on Mental Health, the National Association of Social Workers, the American Public Health Association, Mental Health America, the National Association of State Mental Health Program Directors, the Children’s Environmental Health Network, the Anxiety and Depression Association of America, the National Council for Mental Wellbeing, the Alliance of Nurses for Healthy Environments, the American Lung Association, Campaign for Trauma-Informed Policy and Practice, the American Association on Health and Disability, the Kennedy Forum, Health Care Without Harm, and many others.

State organizations ranging from United Way of the Columbia Willamette in Oregon to the New York State Association of County Health Officials (NYSACHO), as well as numerous local organizations including Resilient Communities Utah; the Community Resilience Initiative in Walla Walla, Washington; and the Neighborhood Resilience Project in Pittsburg, Pennsylvania, have also signed on.

Specifically, the Community Mental Wellness and Resilience Act will:

  • Authorize the CDC to establish a grant program to expand existing community-based initiatives and form new ones that use a public health approach to enhance population-level capacity to prevent and heal mental health problems generated by persistent disasters and toxic stresses.
  • Appropriate $30,000,000 for fiscal years 2023 through 2027 to fund small planning grants of up to $15,000 to help community initiatives get organized, and larger program grants of up to $4 million to support and help expand existing community wellness and resilience initiatives. (Note: This total is likely to change when the legislation is reintroduced in 2023.)
  • Target community-based initiatives that will involve a wide and diverse network of grassroots and neighborhood leaders, as well as nonprofit, private, and public organizations.
  • Encourage community initiatives to develop their own age and culturally appropriate strategies to engage all adults and youth in enhancing and sustaining mental wellness and resilience, with high-risk individuals and those with pathological symptoms given special attention as part of the larger community effort.
  • Encourage strategies that use evidence-based, evidence-informed, promising, and/or indigenous practices to engage residents in strengthening existing protective factors and forming new ones, and to help all individuals push back against traumatic stressors, maintain mental wellness, and rapidly recover when impacted by toxic stresses or disasters.
  • Individualized mental health treatment will support the community-based wellness and resilience building activities and assist individuals who still cannot function or are at risk of harming themselves or others.

Representatives Tonko and Fitzpatrick and the House co-sponsors, as well as Senators Markey, Merkley, and Blumenthal, will reintroduce the Community Mental Wellness and Resilience Act in the coming Congress. APA members are encouraged to contact their House and Senate members to urge them to co-sponsor the legislation and push for its rapid enactment.

Mr Doppelt is the coordinator of the International Transformational Resilience Coalition (ITRC). For almost a decade, he directed the Climate Leadership Initiative at the University of Oregon, where he was also an adjunct faculty member in the University of Oregon Department of Planning, Public Policy, and Management. Dr Haase is medical director of psychiatry for Carson Tahoe Regional Center and chairs the climate committees for the APA and the Group for the Advancement of Psychiatry. Dr Pollack is professor emeritus for public policy at Oregon Health and Science University in Portland, Oregon.

References

1. Costley D. Report: 90% of US counties hit with disaster in last decade. AP News. November 16, 2022. Accessed November 10, 2022. https://apnews.com/article/science-united-states-emergency-management-climate-and-environment-4663b776dd05fb4114276b31e503b77c

2. Sawada Y, Bhattacharyay M, Kotera T. Aggregate impacts of natural and man-made disasters: a quantitative comparison. Int J Dev. 2019;9(1):43-73.

3. Ayapong B, Shalaby R, Eboreime E, et al. Cumulative trauma from multiple natural disasters increases mental health burden on residents of Fort McMurrayEur J Psychotraumatol. 2022;13(1):2059999.

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