Fact Sheet: Celebrating Mental Health Awareness Month 2023

Our country is facing an unprecedented mental health crisis. The crisis isn’t just affecting adults, its devastating young people, and people from every background are impacted.

President Biden is committed to addressing the nation’s mental health crisis. The Administration has made important progress on expanding access to mental health services,  and invested billions of dollars through American Rescue Plan and the Bipartisan Safer Communities Act, to clearly send the message: Support is Here.

At the Department of Health and Human Services (HHS), we are proud to help lead the whole-of-society response to this crisis.  We launched 988, the Suicide Prevention Lifeline, expanded mental health services in schools, advanced a center for excellence on social media and mental health, and launched the HHS Roadmap for Behavioral Health Integration.  In addition, we have helped states to establish Certified Community Behavioral Health Clinics which provide behavioral health care 24 hours a day, 7 days a week, because mental health crises don’t just happen during business hours. And we are providing hundreds of millions of dollars to programs like Project AWARE, Mental Health Awareness Training, and the National Child Traumatic Stress Initiative, that help reach families and youth where they are, including at schools and in the community.  

This Mental Health Awareness Month, we bring attention to mental health and how essential it is to overall health and wellbeing. The following fact sheet is a snapshot of various efforts made by HHS over the past year:

Mental Health Care in Communities

• Proposes New Standards to Help Ensure Access to Quality Health Care, Including Behavioral Health Care, in Medicaid and CHIP. The Centers for Medicare & Medicaid Services (CMS) released two notices of proposed rulemaking that together would further strengthen access to and quality of care across Medicaid and the Children’s Health Insurance Program (CHIP), the nation’s largest health coverage programs. If adopted as proposed, the rules would establish historic national standards for access to care regardless of whether that care is provided through managed care plans or directly by states through fee-for-service (FFS). 
• Released New Guidance to Encourage States to Apply for New Medicaid Reentry Section 1115 Demonstration Opportunity to Increase Health Care for People Leaving Carceral Facilities. In April 2023 CMS announced a new opportunity in Medicaid for states to increase care for incarcerated people up to 90 days prior to their release to position them to succeed during community re-entry, including services to address various health concerns like SUDs and other chronic health conditions. The Medicaid Reentry Section 1115 demonstration opportunity focuses on covering high-quality services for individuals who are incarcerated, eligible for Medicaid, and returning home to their communities – a group of individuals who have been historically underserved and adversely affected by persistent poverty and inequality.
• Issued a Surgeon General’s Framework for Workplace Mental Health and Wellbeing. In October 2022, Dr. Murthy released a Surgeon General's Framework for Workplace Mental Health & Well-Being that outlines the foundational role that workplaces should play in promoting the health and well-being of workers and our communities.
• Released the First National Strategy to Support Family Caregivers. In partnership with the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregiving and the Supporting Grandparents Raising Grandchildren (SGRG) Advisory Councils, HHS’s Administration for Community Living (ACL) released the first National Strategy to Support Family Caregivers outlining nearly 350 actions the federal government will take to support family caregivers in the coming year and more than 150 actions that can be adopted at other levels of government and across the private sector to build a system to support family caregivers - many of whom have been under great strain during the COVID-19 pandemic.
• Released HHS Roadmap for Behavioral Health Integration. In September 2022, HHS unveiled the HHS Roadmap for Behavioral Health Integration (“HHS Roadmap”) to prioritize bold policy actions that significantly advance access to care. On December 2, they further articulated this vision in a jointly authored Health Affairs Forefront Article. The HHS Roadmap builds on the President’s call to action and outlines HHS’s commitment to providing the full spectrum of integrated, equitable, evidence-based, culturally appropriate, and person-centered behavioral health care to the populations it serves.
• Awarded Almost $30 Million to Improve Quality of Behavioral Health Services Through Rural Communities Opioid Response Program (RCORP). In September 2022, HRSA’s RCORP-Behavioral Health Care Support awarded $29 million to 58 grantee to improve the quality and sustainability of behavioral health care services in their rural communities, including through the provision of evidence-based, trauma-informed treatment for substance use disorder.
• Launched a National Maternal Mental Health Hotline. In May 2022, HRSA launched the National Maternal Mental Health Hotline. The hotline (1-833-943-5746) is available 24/7, 365 days a year, and provides free, confidential emotional support, information, and referrals to any pregnant and postpartum individuals facing mental health challenges and their loved ones. Professional counselors staff the Hotline and provide support in English and Spanish via voice and text, interpreter services are available in 60 additional languages, and a relay service is available for people who are deaf or hard-of-hearing. Since the launch, on May 8th 2022 to March 31, 2023, hotline counselors responded to almost 12,000 calls and texts, with an average response time of under one minute.
• Released Resource on Improving Mental Health in the Workplace. In August 2022, SAMHSA released a new publication "Advisory: Expanding Implementation of Mental Health Awareness Training in the Workplace."  The Mental Health Awareness Training (MHAT) advisory promotes implementation of MHATs by targeting the workplace more broadly, from traditional settings to places in the community people go all the time.
• Provided Training and Technical Assistance to Help the Human Services Workforce Better Serve People with Mental Health Issues. This includes a new cooperative agreement from the Children’s Bureau (CB) to expand the National Adoption Competency Mental Health Training Initiative, a web-based training for the child welfare workforce and mental health practitioners to increase their capacity to serve children and youth in the child welfare system. Between June 2022 through April 2023, the Office of Family Violence Prevention and Services (OFVPS) provided an array of training and technical assistance (TTA) to improve the response in the mental health field to survivors of intimate partner violence (IPV). Lastly, it also includes a webinar series hosted by the Office of Family Assistance (OFA) in January and March 2023 on engaging families involved in the Temporary Assistance for Needy Families (TANF) program in mental health services.
• Reduced Social Isolation of Older Americans Through Nutrition Programs. ACL’s Innovations in Nutrition grant program awarded a three-year grant to be completed in 2023 to the Georgia State University, University Foundation. The grant has leveraged the skills, interest, and compassion of nutrition services volunteers to reduce social isolation, loneliness, and elevated suicidality among diverse, at-risk, homebound older adults through the novel BE WITH (Belonging and Empathy With Intentional Targeted Helping) innovation.
• Announced the Second Cohort of Grantees for Public Health AmeriCorps (PHA). The funding, through the CDC, will continue to support PHA members placed at local health departments, non-profits, community clinics, and other key public health settings across the United States. PHA meets the local community public health needs by providing public health services and opportunities, including through opioid screening and counseling services; mental health training and mentorship; and by providing pathways to public health careers through hands-on experiences. PHA has recently been featured in Forbes magazine, ForsMarsh media, and the White House’s National Public Health Week Proclamation.
• Launched A Research Effort on Addressing Caregiver Needs and Resilience. In July 2022, the National Institute on Aging (NIA) began support of research solicited via a funding initiative, "Dementia Care and Caregiver Support Intervention Research" (PAR-21-307). This solicitation supports the development and testing of behavioral interventions for caregivers of people living with Alzheimer's Disease and Related Dementias.
• Provided Behavioral Health Training and Support to Nursing Facilities. In September 2022, SAMHSA partnered with CMS to provide behavioral health training and support to nursing facilities nationally through the Center of Excellence for Behavioral Health in Nursing Facilities, focusing on assisting people with Serious Mental Illness (SMI), Substance Use Disorder (SUD), Co-Occurring Disorders (COD) and Serious Emotional Disturbance (SED).
• Launched Center to Improve Support for People Who Have Both Intellectual and Developmental Disabilities and Mental Health Disabilities. In September 2022, ACL launched a new center to improve support for people who have both intellectual and developmental disabilities (I/DD) and mental health needs. The cooperative agreement totaling an estimated $3.25 million over five years will create a resource center and provide national technical assistance to help individuals with both I/DD  and mental health diagnoses live and participate in their communities.
• Released Resource on Expanding Behavioral Health Care For People Experiencing Homelessness. In January 2023, SAMHSA released a guide, Expanding Access to and Use of Behavioral Health Services for People At Risk for or Experiencing Homelessness, highlighting strategies for behavioral health and housing providers to conduct outreach and engage with individuals experiencing homelessness, initiate use of behavioral health treatment as they wait to receive stable housing and retain them in their recovery efforts once housed.
• Published Compendium of Mental Health Programs and Resources on College Campuses. In September 2022, the Rehabilitation Research and Training Center on Community Living and Participation of People with Serious Mental Illness at Temple University funded by ACL’s National Institute for Disability, Independent Living and Rehabilitation Research (NIDILRR)- published a compendium of Mental Health Programs, Initiatives, and Resources on College Campuses.  The compendium is designed to educate and inform college students, faculty, and staff about the variety of interesting and innovative mental health initiatives on college campuses throughout the US.
• Released Online Toolkit on Reducing Social Isolation and Loneliness in Older Adults. NIA supported an online "Social Isolation and Loneliness Outreach Toolkit" to help reduce social isolation and loneliness, which can be harmful to the physical, mental, cognitive, and emotional health of older adults. The toolkit includes animated graphics, social media posts, health information, videos, and links to additional resources. The toolkit has received more than 11,000 visitors since June 2022.
• Surgeon General Released Mindfulness Content Series. In December 2022, Dr. Murthy, with Calm, released a mindfulness content series designed to ease stress and offer mental health support through the holidays and beyond The themes of the free content series are easing holiday stress, combating loneliness, navigating hectic days, and dealing with uncertainty, change, and negativity in the world.
• Held a Webinar Entitled “Dads and Mental Health Matter!” In March 2023, ACF’s Office of Family Assistance (OFA) hosted a webinar, which discussed the mental health needs of fathers and presented practices and resources to help address these needs. Researchers, practitioners, and fathers with lived experiences navigating mental health disorders shared strategies and resources for working with dads.

Children and Youth Mental Health

• Awarded Nearly $185 Million to Support Youth Mental Health and Help the Health Care Workforce Meet Families’ Mental Health Needs. In December 2022, because of the Bipartisan Safer Communities Act, SAMHSA awarded the following mental health grant programs for up to four years each:
  • $73.6 million for Project Advancing Wellness and Resiliency in Education (Project AWARE) to help develop and support school-based mental health programs and services;
  • $57.7 million in Mental Health Awareness Training grants to prepare and train school personnel, emergency first responders, law enforcement and others to recognize the signs and symptoms of mental health challenges to enable early intervention;
  • $14.9 million for School Based Trauma-Informed Support Services and Mental Health Care for Children and Youth to increase student access to evidence-based and culturally relevant trauma support services and mental health care;
  • $19.5 million for the National Child Traumatic Stress Initiative, to improve treatment and services for children, adolescents, and families who have experienced traumatic events; and,
  • $20 million in Resiliency in Communities after Stress and Trauma grants to promote resilience and equity and prevent violence in communities that have recently faced civil unrest, community violence, and/or collective trauma.
• Increased Prevention Services for Children at Risk of Entering Foster Care. In accordance with the Family First Prevention Services Act (FFPSA) of 2018, the Children’s Bureau has approved 42 Title IV-E Prevention Plans, which allow states, territories, and eligible tribes to provide and fund evidence-based mental health, substance use, in-home parenting, and kinship navigator programs and services and supports to children at risk of entry into foster care and their parents and kinship caregivers.
• Release Proposed Rule to Promote Consistent Use Behavioral Health Core Set. In August 2022 CMS released a notice of proposed rulemaking to promote consistent use of these nationally standardized quality measures in Medicaid and CHIP through mandatory annual state reporting on the Core Set of Adult Health Care Quality Measures for Medicaid. Reporting on the Core Set measures is voluntary for states until 2024, when reporting will become mandatory for the Child Core Set and behavioral health measures on the Adult Core Set. Many states already report on these measures and the most recent publicly available data can be found in the Behavioral Health Chart Pack which is posted along with more information on the Medicaid Adult Core Set and Behavioral Health Core Set here.
• Hosted a Virtual Training for Parents and Caregivers on Children’s Mental Health. In March 2023, ACF and SAMHSA hosted a virtual training for parents and caregivers to provide education about children’s mental health. The training featured parent and youth advocates and ACF and SAMHSA leadership. It provided practical information and emphasized messages about reducing stigma and the importance of self-care. Nearly 3,000 parents and caregivers participated in the live event, and many more were reached by sharing the recording and resources. The recording and resources can be accessed at: https://www.samhsa.gov/families/parent-caregiver-resources
• Held a Virtual Convening on Supporting Latino Youth Mental Health. In March 2023, ACF and CDC, in partnership with UnidosUS, held a virtual community conversation about Latino youth mental health and well-being. The event provided an opportunity for federal leaders and community leaders serving Latino youth and families to exchange information and ideas about strengthening support for Latino youth mental health.
• Expand Access to Mental Health Services in Early Childhood Settings. As of May 2023, 22 states and DC are using ARP funds allocated by the Office of Child Care to engage in supporting mental health initiatives including providing paid mental health consultants, professional development, and other supports for child-care providers.
• Awarded $3 Million to Promote Black Youth Mental Health. In September 2022, the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) announced more than $3 million in grants to eight organizations for a new initiative to demonstrate policy effectiveness to promote Black youth mental health (BYMH). This three-year initiative will help identify health and wellness policies that are successful in improving BYMH, including suicide prevention. Awardees will test the impact of these policies in varied settings, such as schools, faith-based organizations, community centers, and others.
• Launched HHS Children and Youth Resilience Prize Challenge. The HHS Children and Youth Resilience Prize Challenge is intended to fund innovative community-led solutions to promote resilience in children and adolescents affected by the COVID-19 pandemic and other disasters. The Challenge is recognized as part of the President’s Unity Agenda and Mental Health Strategy. The Challenge launched on May 4 and will close for proposals in July. HHS will host its first of three technical assistance webinars on May 18, 2023.
• Issued a Dear Colleague Letter with the Department of Education on Social-Emotional Health of Young Children. In June 2022, the letter went to state, territorial, tribal, and local policymakers and administrators of systems, agencies, and programs responsible for young children’s health and well-being, social-emotional development, and early learning.
• Launched a Behavioral Health Focused Webpage. In the spring of 2023, ACF launched a webpage with mental health resources for families and youth, grantees, tribes, and state and local human services programs. This was developed with feedback from young adults and parents.  As part of this effort, The Office of Early Childhood Development (ECD) created a targeted section on early childhood behavioral health, which includes comprehensive resources for parents and caregivers. early childhood programs, state and territory leaders, and tribes.
• Released Landmark Report on Affirming LGBTQI+ Youth. In March 2023, SAMHSA released Moving Beyond Change Efforts: Evidence and Action to Support and Affirm LGBTQI+ Youth. The report provides a comprehensive overview of the scientific research and consensus that LGBTQI+ youth are resilient and can thrive when they are supported and affirmed, but that pervasive discrimination, rejection, and bullying of LGBTQI+ youth has led to a nationwide mental health crisis. The report finds that this crisis is most acute for transgender youth, whose mental health and well-being is put at risk by policies that seek to restrict their access to appropriate health care and inclusion at school.
• Launched Resources to Support LGBTQI+ Youth and Young Adults. In June 2022, the Transitions to Adulthood Center for Research, Implementation Science & Advances Research Center at UMass Chan Medical School funded by ACL’s NIDILRR launched Providing Culturally Competent Mental Health Care to LGBTQIA+ Youth and Young Adults, a collection of resources for providers. The collection includes an introduction to the LGBTQIA+ population, statistics on adverse life events experienced by LGBTQIA+ youth, a research overview, and specific tips for providers working with this population. The collection also includes a link to a recent blog post from center staff about their experiences with mental health and employment as LGBTQ+ people who represent different ages, races, genders, sexual identities, and lived experiences.
• Continued Implementation of the CDC’s What Works in Schools Program to Support Youth. This evidence-based approach for education agencies reaches nearly 2 million students and reduces sexual risk behavior, experiences of violence, substance use, and poor mental health among students in schools. Schools served by CDC-funded local education agencies have seen significant declines in the percentage of students engaged in sexual risk behavior, used substances, and experienced violence. Schools in funded districts that implemented policies and practices to support LGBTQ youth saw improved mental health and decreased suicidal ideation in both LGBTQ and heterosexual students.
• Informational Bullets on Strengthening Access to Services for Children. CMS issued two informational bulletins in August 2022 on strengthening access to high-quality, comprehensive health care for children, which included behavioral health components:  “Leveraging Medicaid, CHIP, and Other Federal Programs in the Delivery of Behavioral Health Services for Children and Youth,” which reinforces Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) statutory mandates for children’s health coverage, in particular mental health coverage. The guidance also includes strategies to improve prevention, early identification, and treatment; expand provider capacity; and increase the integration of behavioral health and primary care.
• Released CDC’s Youth Risk Behavior Survey Data Summary & Trends Report. In February 2023, the CDC released this report that provides surveillance data from 2021, as well as 10-year trends from 2011 through 2021, on behaviors and experiences among high school students in the United States related to health and well-being. The data show that many of the same behaviors and experiences that were moving in the wrong direction before the COVID-19 pandemic, like poor mental health, continued to worsen, and highlight the challenges youth continue to face. Data show that school environments, which are influenced by how teachers manage classrooms, programs to support positive youth development, and policies and practices that support LGBTQ+ students, can have a strong and lifelong effect on areas where youth are struggling now, including mental health.
• Released School Health Profiles Report, Which Demonstrates How Schools Promoted Connectedness. School connectedness protects against a wide array of youth health risks, including sexual risk and substance use, violence, and poor mental health. CDC released a new School Health Profiles report, which shows how schools implemented policies and practices that addressed these issues and promoted connectedness during the COVID-19 pandemic. These data show the efforts schools made to keep students connected during this time and how much more is needed to repair and restore school connectedness for youth.
• Updated the Health Education Curriculum Analysis Tool (HECAT) to Strengthen Mental and Emotional Health Education in Schools.  CDC recently updated the HECAT to strengthen research-based guidance for schools in selecting, developing, or revising health education curricula. One of the primary health topic modules found in the tool is Mental and Emotional Health. Based on updated empirical evidence and practice-based guidance, HECAT’s Mental and Emotional health module includes information and skills to help students in grades Pre-kindergarten through 12 recognize and regulate emotions and feelings, analyze how mental and emotional health is related to and affects other health behaviors, value diversity and strengthen interpersonal relationships, and examine how communication technology influences mental and emotional health.
• Collected Data on Pandemic’s Impact on Adolescent Mental Health. CDC collected data to document how the pandemic affected adolescent mental health. Publications include “Adverse childhood experiences among U.S. adolescents over the course of the COVID-19 pandemic” (accepted for publication in Pediatrics, April 2023) and “Associations between adverse childhood experiences and pandemic-related stress and the impact on adolescent mental health during the CoVID-19 pandemic” (published in Journal of Child and Adolescent Trauma, December 2022).
• Hosted a Town Hall on Youth Mental Health. On Feb. 16, 2023, U.S. Secretary of Education Miguel Cardona and U.S. Surgeon General Dr. Vivek Murthy participated in a youth mental health town hall discussion with high schoolers from John R. Lewis High School in the Fairfax County Public Schools district. A panel discussion, moderated by NBC Anchor Savannah Sellers, included the director for CDC's Division of Adolescent and School Health. 
• Released Strategic Framework Addressing Youth Mental Health Disparities. In February 2023, NIH/NIMH released a Strategic Framework for Addressing Youth Mental Health Disparities to help guide NIMH activities, including research funding, stakeholder engagement, and workforce development, aimed at addressing racial and ethnic disparities in mental health outcomes.
• Released Funding Opportunities Aimed at Preventing Black Youth Suicide. In September 2022, NIMH issued two funding opportunities aimed as supporting research to better characterize risk and protective factors for suicide among Black youth (RFA-MH-22-140; RFA-MH-22-141). Suicide is the second leading cause of death in youth ages 10-14 and people ages 25-34 and the third leading cause for youth ages 15-24. NIMH plans to support translational research to better understand factors that confer risk and resilience for suicide among Black youth. Both Notices encourage research to identify novel targets for future development of prevention and intervention efforts. 
• Released Funding Opportunity on Social Media and Youth Mental Health. In December 2022, NIMH released a funding opportunity to encourage applications that focus on understanding bidirectional relationships between social media use and adolescent mental health, psychiatric symptoms, and risk or resilience for psychopathology (RFA-MH-23-116).In response to concerns that increased social media use contributes to poor mental health outcomes, such as depressive symptoms and suicidal thoughts and behaviors, NIMH supports research focused on understanding this connection and developing effective interventions.
• Established National Center of Excellence on Social Media and Mental Well-Being. In September of 2022, SAMHSA funded $2million per year (up to 5 years) to the American Academy of Pediatrics to establish the National Center of Excellence on Social Media and Mental Well-Being. The Center will work to improve the mental health of children and teens by reducing the risks and leveraging the benefits of social media; build the capacity of individuals who work with youth to mitigate social media’s harmful impacts on mental wellbeing and promote healthy social media use; and synthesize and promote the evidence base and best practices for healthy social media use via communication, guidance, and other resources.
• Released an Early Intervention Screening Tool. In October 2022, SAMHSA released a multidimensional screening tool (Screen4Success) to help parents and caregivers determine if a child may benefit from early intervention or additional support, by asking questions about substance use, mental and physical health, general wellbeing, and family life. Screener results do not provide a clinical diagnosis. Recommended support may range from prevention services (universal, selective, and indicated) to treatment and ongoing recovery support services.
• Study on Telepsychiatry Use Before and During the COVID-19 Pandemic Among Children Enrolled in Medicaid. This study was published in Psychiatric Services. A retrospective analysis was conducted of claims data from the Transformed Medicaid Statistical Information System for children (ages 3–17) with any mental health service use in 2019 (N=5,606,555) and 2020 (N=5,094,446). The number of children using mental health services declined by 9.1% from 2019 to 2020. Mental health services in all care settings (inpatient, outpatient, residential, emergency department, intensive outpatient/partial hospitalization) declined except for telehealth, which increased by 829.6%. In 2020, 44.5% of children using telehealth were non-Hispanic White, 16.1% were non-Hispanic Black, and 19.7% were Hispanic. Attention-deficit hyperactivity disorder, trauma, anxiety, depression, and behavior/conduct disorder were the most prevalent psychiatric diagnoses among children using telehealth services. Although telehealth use increased substantially in 2020, overall mental health service use declined among Medicaid-enrolled children. Telehealth may not fully address unmet mental health service needs.
• Issue Brief on Racial/Ethnic Differences in Children’s Mental Health Services Use Before and During the COVID-19 Pandemic Issue Brief: This ASPE Issue Brief examines racial and ethnic disparities in children's mental health before and during the COVID-19 Pandemic. Using a national Medicaid database, the report shows significant racial/ethnic disparities in mental health service use among children during the COVID-19 pandemic.  Average monthly mental health service use among children covered under Medicaid/Children’s Health Insurance Program declined by 5% during the COVID-19 pandemic. The size of the decline varied by race and ethnicity and was larger for Black (-11%), Hispanic (-5%), and Asian (-3%) children than White children (-1%). The report also shows that while telehealth services for mental health treatment increased during the pandemic, it was not sufficient to make-up for the overall decline in mental health service use, especially among children from minority background.
• Research Article on Psychotropic Medication Utilization Among Children Diagnosed With Fetal Alcohol Spectrum Disorder: This research article was published in Pediatrics. It used the 2017 IBM Watson Health MarketScan Multistate Medicaid and Commercial Claims databases. The sample for the analysis includes children between the ages of 0 and 17 with either an FASD diagnosis or a mental health diagnosis. More than half of the children with an FASD diagnosis were prescribed psychotropic medications (63% Medicaid; 57% private). Utilization rates of psychotropic medication among children with cooccurring FASD and a mental health condition (79% Medicaid; 71% private) were higher compared to children with a mental health diagnosis but no FASD (57% Medicaid; 57% private). Stimulants were the most commonly prescribed. Encephalopathy, attention deficit hyperactivity disorder, and epilepsy were the 3 most common cooccurring diagnosis among children with FASD using psychotropic medication under Medicaid compared to encephalopathy, attention deficit hyperactivity disorder, and anxiety with private insurance. These results exemplify the complexity of the neurobehavioral profile of children with FASD and the challenge of treatment. Future studies may determine how supportive services for these children will affect psychotropic medication use.
• Issue Brief on Child and Adolescent Mental Health During COVID-19: Considerations for Schools and Early Childhood Providers: This ASPE Issue Brief evaluates concerns regarding child and adolescent mental health during the COVID-19 Pandemic, as well as potential interventions for schools and early childhood providers. The analysis finds high likelihood of mental health conditions which suggests underlying population occurrence, potentially exacerbated by social isolation, quarantine, and overall stress and adversity related to the pandemic rather than the COVID-19 diagnosis itself. The brief reviews the rates of individual mental health conditions (anxiety, depression, trauma and stressor related disorders, ADHD, behavior/conduct disorders) by age and the practical application for school mental health and early childhood providers in identifying and referring children appropriately for services. Schools and early childhood providers may need additional supports and resources to address the needs of children with adverse childhood experiences and those with disabilities, as both populations have increased likelihood for mental health conditions compared to the rest of the children in this study. The American Rescue Plan Act allocates substantial funding to children’s mental health services, including funding for evidence-based interventions in school and early childhood education settings.
• Article on Mental Health Conditions Among Children and Adolescents With a COVID-19 Diagnosis: For this article, IQVIA's U.S. Open Source Claims database was utilized to evaluate the rate of new onset of mental health conditions among children and adolescents who had received a COVID-19 diagnosis but had no recent history of mental health problems. ASPE analysts extracted December 2018–April 2021 data from IQVIA’s U.S. Open Source Claims, a multipayer, preadjudicated health insurance claims database covering all 50 U.S. states and Washington, D.C. The sample included 2,036,333 children diagnosed as having COVID-19 and 1,329,662 children who had tested negative for COVID-19; all children had no mental health conditions or mental health–related service utilization in the 12 months before the COVID-19 diagnosis or test. Children were organized into three age cohorts: 0–5, 6–11, and 12–17 years. A higher proportion of children with a COVID-19 diagnosis (N=145,159, 7.1%) experienced new onset of a mental health condition compared with children with a negative COVID-19 test (N=45,627, 3.4%). The median length of time to a psychiatric diagnosis was 33 days after a COVID-19 diagnosis and 160 days after a negative COVID-19 test . The most common mental health conditions after a COVID-19 diagnosis were anxiety (43%), attention-deficit hyperactivity disorder (36%), and trauma or stressor disorders (22%). The adjusted risk ratio (ARR) for new onset of any mental health condition was almost three times higher among those with a COVID-19 diagnosis than among those with a negative COVID-19 test (ARR=2.84).

Crisis Supports

• Launched the 988 Lifeline. In July 2022, SAMHSA transitioned the National Suicide Prevention Lifeline to the 988 Suicide & Crisis Lifeline, connecting more people to care, and connecting them faster, than ever before. The 988 Suicide & Crisis Lifeline has received more than 2.1 million contacts (calls, texts and chats) from July to December 2022.  Compared to the same six-month timeframe in 2021, the 988 Lifeline answered about 892,000 more contacts and significantly improved how quickly contacts were answered. Calls answered increased by 43%, chats increased by 224%, and texts increased by 1145%. The average speed to answer across all contacts decreased from 2 minutes and 46 seconds to 49 seconds.
• Established a 988 Tribal-Response Program. The Bipartisan Safer Communities Act provided $150 million in funding to expand the capacity of the Lifeline in December 2022. This funding has been used to strengthen the network infrastructure, enhance local response by states and territories, establish a new 988 Tribal response program to support Tribal nations in building out crisis response, provide technical assistance to grantees and partners on crisis system development and continue awareness building and foundational communications work to better understand needs and preferences of populations at higher risk of suicide.
• Launched Specialized Crisis Supports for LGBTQI+ Youth. In September 2022, SAMHSA launched a specialized call, text, and chat supports for LGBTQI+ youth and youth adults pilot program in September 2022. The pilot program aims to connect people under the age of 25 who reach out to the 988 Lifeline with an option of connecting with a counselor specifically focused on meeting the needs of LGBTQI+ youth and young adults.
• Launched Specialized Crisis Supports for Spanish Speakers. The 988 Lifeline increased the number of call centers dedicated to taking Spanish calls in October/November 2022. The Spanish subnetwork has seen both an increase in calls along with improvement in response rates (45% answered volume increase over previous year). The Spanish call line improved response rates across states and territories from 63% in July to around 81% in January 2023.  SAMHSA has funded the 988 Lifeline to add Spanish chat and text services by the end of FY2023 and is focused on supporting the Spanish crisis center workforce with trainings and webinars in Spanish.
• Provided $40 Million for Community Mental Health Block Grant for Crisis Services. In October 2022, SAMHSA provided over $40 million in Community Mental Health Block Grant Crisis Services Set-aside funds to support crisis support services – including 988 Call Centers, Mobile Crisis Response, and Crisis Stabilization units in every state and territory across the nation. In addition in October 2022, SAMHSA awarded over $59 million in supplemental Community Mental health Block Grant funds as the first installment of BSCA funds.
• Announced $120 Million Funding Opportunity for Certified Community Behavioral Health Clinic (CCBHC) and $15 Million in State Planning Grants to Support Efforts to Expand CCBHCs. In March 2023, SAMHSA announced two funding opportunities for Certified Community Behavioral Health Clinic (CCBHC) expansion, totaling $123.6 million. The CCBHC Planning, Development, and Implementation (CCBHC-PDI) grant aims to assist clinics to establish and implement new CCBHC programs, and the CCBHC Improvement and Advancement (CCBHC–IA) grant seeks to enhance and support existing CCBHCs that currently meet the CCBHC Certification Criteria. In March 2023, SAMHSA also awarded 15 one-year state planning grants that will prepare states to develop the necessary capacity to compete to join the CCBHC Demonstration in 2024.
• Worked with States to Expand Access to Mobile Crisis Intervention Services. Section 9813 of the American Rescue Plan (ARP) increased federal medical assistance percentage (FMAP) for qualifying community-based mobile crisis intervention services. CMS has worked closely with three states that have obtained CMS approval for state plan amendments for mobile crisis services - Oregon, Arizona and North Carolina.  Additionally, CMS has provided technical assistance to 27 states about their crisis continuum of behavioral health services and mobile crisis services.  This includes 5 states that have submitted draft state plan amendments to CMS for review prior to formally adding mobile crisis services to their programs.
• Released Funding Opportunity for Research on Supporting Crisis Response Services. In January 2023, as part of its effort to support the implementation of 988, the national suicide prevention and mental health crisis hotline, NIH issued a Notice of Special Interest (NOT-MH-23-140) seeking to outline priorities for research in crisis response services. NIH is particularly interested in studies in real-world settings, where factors like age, geographical location, cultural background impact access to and quality of crisis care. Studies are encouraged that address the continuum of crisis service systems, as well as applications that address crisis services for children and under-resourced populations.

Mental Health Workforce

• Awarded $20 Million for the Pediatric Mental Health Care Access Program. In September 2022, HRSA awarded approximately $20 million in Bipartisan Safer Communities Act, to support the Pediatric Mental Health Care Access (PMHCA) Program. The PMHCA program awards grants to develop statewide or regional pediatric mental health care telehealth access programs and to support the improvement of existing statewide or regional pediatric mental health care telehealth access programs.
• Funded Training and Technical Assistance to Support Integration of Behavioral Health in Primary Care. In 2022, HRSA awarded $1.7 million in funding for training and technical assistance (TA) to support the integration of behavioral health (BH) within primary care. This may include providing medications for opioid use disorder (MOUD), pediatric mental health services, pregnancy substance use disorder care, and any other area of BH integration support requested by health centers.
• Awarded Almost $60 Million to Train Primary Care Resident in Mental Health. In January 2023, HRSA awarded $58 million in BSCA funding to support the Primary Care Training and Enhancement - Residency Training in Mental and Behavioral Health.  These funds are used to train primary care residents in the prevention, identification, diagnosis, treatment, and referral of services for mental health conditions for the pediatric, adolescent, young adult, and other vulnerable populations who are at-risk or have experienced abuse, trauma, or mental health and/or substance use disorders.
• Released Funding Opportunity To Expand Screening and Treatment for Maternal Mental Health and Substance Use Disorders. In April 2023, HRSA released a notice of funding opportunity for approximately 14 awards for an investment of $8.75 million through the Screening and Treatment for Maternal Mental Health and Substance Use Disorders Program.  This funding will support states, tribes, and tribal organizations expand health care providers’ capacity to screen, assess, treat, and refer pregnant and postpartum women for maternal depression and related behavioral disorders like anxiety and substance misuse. This screening and treatment program uses telehealth and other strategies to provide real-time psychiatric consultation and care coordination to front-line maternal health care providers.  This opportunity will close June, 2023.
• Issued the National Health Service Corps Loan Repayment Program. In February 2023, HRSA issued the National Health Service Corps Loan Repayment Program (2-year) that recruits and retains licensed primary care clinicians in eligible disciplines in eligible communities of need designated as Health Professional Shortage Areas. Under the National Health Service Corps Loan Repayment Program, the Secretary of Health and Human Services will repay up to $50,000 of the graduate and/or undergraduate educational loans of applicants selected to be participants in the program. For Fiscal Year 2023, the National Health Service Corps expects to make approximately 1,700 new awards to health professionals committed to serving in underserved communities and rural areas. In FY 2022, the National Health Service Corps Loan Repayment Program (2-year) awarded 3,782 clinicians.
• Issued the National Health Service Corps Rural Community Loan Repayment Program.In February 2023, HRSA issued the National Health Service Corps Rural Community Loan Repayment Program that recruits and retains licensed primary care and substance use disorder treatment clinicians in eligible disciplines to provide evidence-based substance use disorder treatment in rural Health Professional Shortage Areas. In FY 2023, the National Health Service Corps expects to make approximately 230 new awards to health professionals committed to serving in underserved communities and rural areas. In FY 2022, the National Health Service Corps awarded 808 clinicians.
• Implement Suicide Prevention Gatekeeper Training in Indian Health Service. In June 2023, the Indian Health Service will implement system wide suicide prevention gatekeeper training to all IHS Staff to increase recognition and response to suicide within American Indian and Alaska native populations. The training, Question Persuade and Refer, is culturally customized to focus on suicide among American Indians and Alaska Natives and address unique factors related to suicide within tribal communities.
• Funded Efforts to Increase Diversity of Behavioral Health Workforce. In October 2022, SAMHSA’s Minority Fellowship Program (MFP) awarded grants which supported the training of 884 graduate level behavioral health clinicians to serve individuals in high need in underserved communities. On March 10, 2023, SAMHSA released a new MFP NOFO with eight anticipated awards. MFP helps foster specialized training of behavioral health professionals in the following disciplines: marriage and family therapy; nursing; professional counseling; psychiatry; psychology; social work; and addictions treatment.
• Expanded Access to Essential Specialty Care for Millions of Medicaid and CHIP Beneficiaries. In January 2023, CMS issued guidance that creates an easier path to specialty care for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. For the first time, state Medicaid and CHIP programs are able to pay specialists directly when a beneficiary’s primary health care provider asks for advice. For example, if a pediatrician consults with a specialty behavioral health provider about a specific patient’s needs, both providers may be reimbursed for their care – even if the patient is not present. This move “links” routine care with specialty care, allowing more people to benefit from practitioners with specialized knowledge.
• Improve Access to Behavioral Health Services in Fee-For-Service Medicare. In the CY 2023 Medicare Physician Fee Schedule final rule, CMS finalized several policies to expand access to behavioral health to reduce existing barriers and make greater use of the services of behavioral health professionals, including by expanding access to behavioral health providers, and expanding access to Behavioral Health Integration (BHI) services
• Behavioral Health in Medicare Advantage. In April 2023, CMS issued the Medicare Advantage (MA or Part C) and Part D final rule (CMS-4201-F). Through this final rule, CMS finalized policies that strengthen network adequacy requirements and reaffirm MA organizations’ responsibilities to provide behavioral health services. CMS finalized changes including: (1) adding Clinical Psychologists and Licensed Clinical Social Workers as specialty types for which CMS sets network adequacy standards, and making these types eligible for the 10-percentage point telehealth credit for MA plans; (2) amending general access to services standards to include explicitly behavioral health services; (3) codifying standards for appointment wait times for primary care and behavioral health services, and more.
• Funded Research on Innovative Approaches to Expand Access to Behavioral Care. In January 2023, the National Institute of Mental Health (NIMH) solidified its commitment to an ongoing research initiative by reissuing a funding opportunity (PAR-23-096) on digital health interventions (including telemedicine and health information technology) that offer the potential to bridge the treatment gap and provide evidence-based interventions to the many individuals who currently are unable to access treatment in traditional health care settings. NIMH’s program on Laboratories to Optimize Digital Health supports several research projects to test strategies to increase the reach, efficiency, and quality of digital mental health interventions which may impact mental health outcomes, including suicide behaviors and serious mental illness.
• Screening and Treatment for Maternal Mental Health and Substance use Disorders (MMHSUD) Program. In December 2022, HRSA’s Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD) Program was reauthorized, and Tribes and Tribal organizations were added to the pool of eligible applicants. The MMHSUD program is designed to provide real-time psychiatric consultation, care coordination support services, and culturally and linguistically appropriate training to maternity care providers to support them to screen, assess, treat, and refer diverse pregnant and postpartum women for maternal mental health and substance use disorders. The current and first-ever cohort of seven states will complete their fifth and final year of the program in September 2023. In FY 2021, providers received expert consultation for 18,066 pregnant or postpartum women, of whom 77 percent lived in rural/underserved areas. New awards will be supported in FY 2023.
• Licensure Portability Grant Program. In Summer 2023, HRSA’s Licensure Portability Grant Program will expand access to telebehavioral health services and triple resources dedicated to promoting interstate license portability for delivery of behavioral health services across state lines. HRSA’s Licensure Portability Grant Program provides support for state professional licensing boards to work together to reduce the burden on clinicians who provide telehealth services, including for behavioral health services, in multiple states. This program supports two awardees who created the Interstate Medical Licensure Compact and the Psychology Interjurisdictional Compact. This increased investment will help us to grow membership within these compacts, which already boast 38 member states, Washington, DC, and Guam for the Interstate Medical Licensure Compact, and 34 states, Washington DC, and the Commonwealth of the Northern Mariana Islands for the Psychology Inter-jurisdictional Compact.
• Launched A Wellness Campaign for IHS Staff. In April 2023, the Indian Health Service initiated a health and wellness campaign for IHS staff and patients. The health and wellness campaign were designed for American Indians and Alaska Natives to increase access to crisis care services such as the Suicide & Crisis Hotline as well as the Crisis Text Line. IHS has developed posters and fact sheets which can be viewed at https://www.ihs.gov/dbh/resources/posters-and-fact-sheets/.
• Released National Model for Peer Specialist Certification. In April 2023, as part of the President's Unity Agenda, SAMHSA collaborated with partners to release for public comment Model National Standards for Peer Specialist Certification.  These standards are designed to improve the consistency and quality of peer specialist providers across the nation.