Parenting is often described as a journey—one filled with milestones, challenges, and constant
learning. But when you are raising a child with behavioral health issues, that journey can feel less like a linear path and more like a lifelong expedition. The landscape shifts, the stakes are high, and the emotional terrain is often unpredictable. For many families, including mine, the parenting role doesn’t neatly transition when a child becomes an adult. Instead, it evolves into something more complex, more enduring, and at times, more demanding than we ever anticipated.

A Personal Path Toward Advocacy
My path toward advocacy wasn’t something I consciously planned. It emerged from lived
experience, frustration, and eventually, a sense of responsibility. Years ago, when I first sought
support for my adult child’s behavioral health challenges, I discovered the Depression and Bipolar Support Alliance (DBSA). The organization offered the kind of community I desperately
needed—except there wasn’t a chapter anywhere near me.

In that moment, I remember thinking, Someone should really be doing this. I tucked that thought
away as life temporarily settled. But behavioral health journeys come in cycles, and when the waters inevitably turned rough again, the thought resurfaced—this time with a question attached: Why isn’t anyone doing this? And more importantly, why not me?

That question changed the trajectory of my life. It shifted me from being a parent seeking help to a community advocate creating it. I eventually ran a local DBSA chapter for many years, helping
others navigate the same uncertainty, isolation, and fear I had once felt.

From Background Advocate to Public Voice
Before stepping into public advocacy, I spent two decades as what I call a background advocate. I worked at a Protection and Advocacy Agency in a fiscal role, but that never stopped me from inserting myself—sometimes loudly—into conversations about mental health rights, access, and equity. Still, I kept my personal experiences private. The workplace was not an environment where vulnerability felt safe or supported.

It wasn’t until I began running the DBSA chapter that I realized how essential transparency and
authenticity were to meaningful advocacy. Speaking openly about mental health—both my child’s and my own—is what allowed me to connect with others, build trust, and foster community. It gave me the courage to acknowledge that supporting an adult child with a behavioral health condition isn’t something that ends with age; it simply takes a different form.

Understanding Anosognosia: When the Brain Cannot See Itself

One of the most challenging aspects many families face—mine included—is a condition known as anosognosia, often referred to as lack of insight. It’s more than denial or stubbornness; it’s a
neurological condition that prevents a person from recognizing their own symptoms. When the part of the brain responsible for self-awareness is compromised, the individual truly cannot perceive their cognitive, emotional, or functional deficits.

Most of us rely on our own minds to alert us when something is wrong. But what happens when the very organ we depend on for safety can no longer perform that function? That is the heartbreaking paradox of anosognosia.

People experiencing it can’t understand why treatment is necessary. They may reject services,
medication, or support because, from their perspective, nothing is wrong. This creates profound
challenges for families, caregivers, and professionals who are trying to help. It also fuels stigma,
misunderstanding, and unnecessary conflict.

The Emotional Toll on Families

Supporting an adult child with behavioral health issues—especially one experiencing
anosognosia—can feel like walking through a maze with no map. You grieve the gaps between who your child is and who they might be if the illness were treated. You navigate systems that are difficult at best and impossible at worst. You get used to being your child’s advocate, voice, safety net, and in many ways, their lifeline.

What families need—and deserve—is compassion, resources, and understanding. Too often, they encounter judgment instead.

Why Advocacy Matters

Advocacy isn't just about speaking up—it’s about creating space for hope where it has been
overshadowed by confusion or despair. Through DBSA and other community efforts, I’ve met
countless parents, caregivers, and individuals living with mental health conditions who have
reminded me of the immense strength found in shared journeys.

Every conversation, every educational meeting, every support group session helps dismantle
stigma. It helps families feel less alone. And it reminds us that behavioral health challenges are not personal failures—they are medical realities that require compassion, visibility, and systemic support.

A Journey That Continues

Parenting a child with behavioral health issues—whether they are five or fifty—reshapes your life. It stretches your resilience and tests your boundaries. It also reveals your capacity for love, advocacy, and perseverance in ways you may never have imagined.

My journey as a parent and advocate continues to evolve. The challenges remain, but so does the commitment—to my child, to my community, and to the belief that every person living with a behavioral health condition deserves dignity, understanding, and access to care.

And for anyone walking a similar path, know this: you are not alone. Your voice matters. Your story matters. And the work you do—quietly, daily, and often unseen—makes a difference. Share your thoughts and stories with me. I need that support right now.

If you need support from a coach https://pscflcoach.com/tnc, or if you are ready to become an
advocate yourself https://www.peersupportfl.org/services/professional-certifications/.

I suffered in silence for many years after my critical incident and I am ashamed for the ways I poorly coped. I still feel shame for the ways I coped and treated people. I find it hard to believe that nobody realized or even had a gut feeling that I was not doing well. I could not have been that good at hiding my poor coping strategies, or was I? I have always wondered if people were slowly watching me self-destruct because they did not know what to say to me, how to help me, or they did not want to get involved.

It has taken me many years to get back on track. There are many different coping strategies people may use after experiencing trauma. They may be good and healthy, or they may be bad and unhealthy. My coping strategies were bad, harmful, self-destructive, and dangerous. I used alcohol, marijuana, casual sex, and self-harm as some of my poor coping strategies for years after my critical incident.

My poor coping strategies easily put my relationships, job, and health at risk, but I did not care. I wanted to escape from what I was feeling. I wanted to numb my emotions, my thoughts, my body, and any memory of taking someone’s life. I wanted to feel better even if only momentarily. I was selfish and reckless, and I did not care how my self-destructive and dangerous behavior may have affected my family, friends, children, co-workers, and the public.

There were many times after my critical incident that I did not want to go to work. This was not because I had other plans or that I was hungover from consuming too much alcohol, another one of my poor coping strategies, but because I just wanted to stay at home and isolate myself from the world. I wanted to lock all the doors of my home, close all the curtains, and shut everyone out of my life–which I did many times for many years. Sure, I called in sick from time to time, but on one occasion, I intentionally injured myself so that I didn’t have to work. I used an old 12-inch adjustable steel wrench to cause superficial injuries to my left knee. I struck my knee a dozen or more times, enough to cause redness, abrasions, and bruising, and limped into the local emergency room. I explained to the doctor and nurses that I had tripped and fallen walking out of the back door of my house and struck my knee on the steel covering of an underground septic tank. My story was believable enough. I received X-rays of my knee, a prescription for pain medication, and crutches. I was discharged from the emergency room with a doctor’s letter releasing me from work for about one week. This occurred during a busy holiday work week. Although I was not able to truly celebrate the holiday, this deception got me out of work and I was able to enjoy the time alone at home.

Another way I was able to get out of working was to intentionally make myself sick. I remember while taking a shower before my shift I was thinking about the many ways I could get out of work. While I was putting on my ballistic vest, uniform, boots, and duty belt, I thought to myself, I’m going to get out of working by binge eating and making myself vomit. I constructed a plan to visit the local Burger King drive-thru while traveling to work. I ordered a bunch of breakfast food and made sure I washed it down with a large soda and a large orange juice. I needed to make sure I added beverages to my breakfast buffet to ensure it would all come back up more easily.

I continued to travel to work and passed the local McDonald’s and thought, two is better than one. I quickly binged what I purchased from McDonalds and proceeded to work.

I arrived at work and upon exiting my vehicle I masterfully played the role of the “sick employee.” I walked into the police department and made myself vomit in the bathroom. I made sure the bathroom door remained open so that anyone walking by could see or hear me. I made sure that not all my vomit made it into the toilet and landed on the floor for added effect. I was immediately sent home.

Another of the many poor coping strategies I used was abusing alcohol. Before the incident, I collected wine and enjoyed a glass now and then. However, after, I began abusing liquor, mainly whiskey and the cheapest vodka I could get my hands on. I would consume whiskey and vodka straight from their bottles, on the rocks, or I would create my cocktails by combining over-the-counter liquid sleeping or liquid allergy medicines. There were times I would mix in whatever leftover prescription medicines I had in the medicine cabinet, and it didn’t matter if they were prescribed to me or someone else.

For example, I remember one instance when my oldest daughter had leftover prescribed liquid cough medicine containing codeine. I combined whatever was remaining in the bottle with a glass of wine. I was on a prescribed anti-depressant called Venlafaxine while I was abusing alcohol. The label on this medication specifically stated, “DO NOT DRINK ALCOHOLIC BEVERAGES WHILE TAKING THIS MEDICATION.” A warning label did not deter me from abusing alcohol. I very well could have blacked out and never woken up from consuming these dangerous cocktails, but at the time I did not care. Abusing alcohol may have been a quick fix, but it caused me even more stress, anxiety, and depression.

In September 2018, I drafted a written contract with myself to not consume alcohol. I don’t remember writing the contract, but there was something inside of me that recognized how self-destructive alcohol was. This contract quickly became null and void because it took me another three years to reduce my alcohol consumption.

Another way I dangerously coped was by drinking and driving. Before attending any type of social event, even as simple as going to the grocery store, I would consume alcohol. I would travel to a nearby gas station and purchase many small bottles of liquor containing about 1.5 ounces of whiskey, vodka, or whatever I could afford at the time. I would immediately consume the alcohol in my vehicle before traveling to my destination. I tossed the empty bottles in the back of my vehicle or out the window while I was driving. I would rationalize that it would take about 30 minutes for me to feel the effects of the alcohol, and by the time I was impaired I would have arrived at my destination. I was very fortunate that I was not arrested for drinking and driving or even worse, killing someone.

Another example of risky and reckless behavior that I am still ashamed of today involved alcohol, operating while impaired, and my youngest daughter. I was consuming alcohol late morning into the early afternoon and had to pick up my youngest daughter at her mother’s (my ex-wife’s) house and take her to gymnastics. As we drove to gymnastics, I took the wrong turn and drove 21 miles out of the way. I drove for 61 miles impaired by alcohol. For 46 miles, I had my youngest daughter with me.

I used casual sex as a coping strategy and to distract myself from my emotional discomfort and pain. I would meet women and sometimes within 30 minutes, we would have sex. This caused me more stress and anxiety than anything else. Sure, I felt great during sex, but it caused me more harm than good. I was constantly worried about pregnancy and contracting a Sexually Transmitted Disease. Although this type of sexual behavior was risky, self-destructive, and caused me stress and anxiety, it was not enough to convince me to stop. I wanted an instant feel-good escape from my life and casual sex provided that for me.

Another dangerous and unimaginable way I coped was by putting my duty weapon to my head. During my critical incident, it was a Glock 22 Gen 4 – 40 Caliber. I put this weapon to my head at least a dozen times. Sometimes I even placed the barrel in my mouth. I would always remove the magazine, but for those of you who are not familiar with a Glock, if you don’t rack the slide and remove the round from the chamber (barrel) it will still discharge a round. I very easily could have accidentally killed myself. My rationalization was that I simply wanted to hear and feel the metallic click of the trigger being pulled while the barrel of the gun was resting against my right temple. I did this while I was under the influence of alcohol. I still do not truly understand why I did this, and sometimes wonder how many times it happened while I was excessively consuming alcohol. I am very fortunate to be alive.

In December 2021 I experienced a panic attack during an active shooter training which led to a psychological assessment in January 2022. The assessment lasted seven hours and resulted in a nine-page mental health diagnoses. I was thinking about not being honest during the evaluation.  I thought I could beat the evaluation. I chose to be honest with the evaluation and myself; that was the only way I would receive the type of help I needed.

I was diagnosed with Major Depressive Disorder and PTSD with Acute Stress by the police department’s psychologist and deemed Unfit for Duty. This meant I was not able to return to work and needed to undergo intense Psychotherapy, Eye Movement Desensitization and Reprocessing (EMDR), Biofeedback, and Dialectical Behavior Therapy (DBT).

I requested a 90-day leave of absence to work on my mental health in the hope of returning to duty. I attended therapy two and three days a week for 90 days.  I was finally undergoing the right kind of mental health treatment that helped me heal and understand why I adapted to poor coping strategies to self-medicate myself. I only wished I had begun this therapy five years earlier, but it was better late than never.

In April 2022, during my leave of absence, I was placed on a safety plan because of my suicidal ideations. The psychological exam discovered an elevated risk of harm to myself. I agreed to not engage in self-harm, destructive or life-threatening behavior, or any other high-risk behavior to myself or others. I don’t remember ever wanting to die by suicide, but my behaviors were very evident and I was heading in that direction.  There were many nights I would pray to God that he would not let me wake up in the morning.

In May 2022, I met with my police chief and was told my leave of absence was not going to be extended.  I was given the option to resign or I would be terminated.  I chose not to resign and was terminated.

What next? I had been diagnosed with a mental illness, on a safety plan, and terminated from a job I’ve wanted since I was a little boy. I have been employed with the police department for 14 years. What if I had gone home and died by suicide? It was almost as if the police department washed their hands off me. I was ghosted by my co-workers. The same people who not only knew me professionally but personally. They knew my family, and my daughters, helped me move, and even came to me with their own personal and professional mental health challenges. I would have died for them. I felt hopeless, helpless, and abandoned. I was devastated.

I continued weekly therapy that included in-person Psychotherapy and Eye Movement Desensitization and Reprocessing (EMDR). I am also prescribed Lexapro (20mg) and Propranolol (as needed) which are medications that help me with my depression and generalized anxiety.

I have faced many personal and professional mental health challenges after my critical incident and it has taken me many years to get back on track. I am currently a police captain in Wisconsin. I am where I am today because I finally put myself first and moved past my poor coping strategies.  I would not have been successful in healing my mental health without the unwavering support of my Family, Friends, Colleagues, Counselors, and even complete Strangers. I am very grateful and will never be able to put into words how much their support means to me.

I also want to thank my Police Chief Shawn McGee for strongly supporting my mental health and the mental health of his officers. Chief McGee is helping to stop the stigma of mental health in the law enforcement profession. Chief McGee doesn't just talk the talk - he puts his words into action.

Please reach out to someone if you believe they are struggling with their mental health. I know it may feel awkward or uncomfortable, but most people will not admit they are struggling, and most people will not reach out for help. You could be a light during a very dark time in their life. Remember, it’s okay to talk about your mental health. You are not alone. Please don’t suffer in silence.

Ashley Orie, Certified Recovery Peer Specialist (CRPS)

October 17th marks Global Peer Support Celebration Day (GPSCD) an honorable and exciting day for peer supporters (also known as peer workers or peer specialists) from across the globe to celebrate the vital role they play in helping peers who are recovering from mental health, substance use, and or trauma-related challenges move along the continuum of recovery and inclusion into communities of their choosing. On this day, the Peer Support Coalition of Florida, Inc. (PSCFL)  recognized Peer Specialists from across the state during our 3rd Annual Facebook Live Hour event.

PSCFL received over 12 nominations from peers, mental health advocates, and community members to give a Peer Specialist who has impacted their local community a chance to win a grand prize! 

PSCFL announces that our 2024 “Peer Hero of The Year” grand prize winner is none other than Peer Specialist Ashley Orie, Certified Recovery Peer Specialist (CRPS).

She was born and raised in California and moved to North East Florida in 2016. She is the proud mama of two little boys, and they have helped her grow into the person she is today. She identifies as a person in long-term recovery from substance use. She started her recovery journey in 2020 at a women’s sober living house as the house mom. Her passion for helping others flourished from there and she decided she wanted to continue to use her experience to support others.

In January 2022 Ashley became employed with Starting Point Behavioral Healthcare and currently remains with this organization. Since then, she has become state-certified as a CRPS and CRSS. She is also a certified Recovery Coach. Her current role is the peer lead for their Medically Assisted Recovery program. This program is close to Ashley's heart because it was part of her journey and taught the important life skills she still uses today.

As an advocate for harm reduction, Ashley works to create safer, more supportive environments for individuals in need of guidance and encouragement. She believes in meeting people where they are, offering non-judgmental support, and helping them find pathways to improve their well-being. We are in awe of Ashley's remarkable journey and her unwavering commitment to uplifting and empowering others. Her inspiring work as a Peer Specialist has not gone unnoticed 

See below what makes this Certified Recovery Peer Specialist so special: 

"Ashley is such a fantastic advocate for the individuals she serves. She has gained the trust of her participants and holds them accountable for their own recovery. Ashley has done so much during her time as a peer and her team is so proud of all of her hard work. Ashley attended the Multiple Pathways of Recovery Conference this year and has brought back to her team what she learned. Ashley is a deserving nominee for Peer Hero of the Year this year!"

"I would like like to nominate Ashley Orie for recognition as an outstanding mentor at Starting Point Behavioral Health Care. As a Level 3 Mentor Peer in our Medication Assisted Recovery (MAR) program, Ashley has consistently demonstrated her exceptional resilience and commitment to helping others in their recovery journeys. Ashley is not only a person in recovery herself, but she has also made the inspiring choice to work closely with individuals struggling with substance abuse. Her lived experience gives her a unique perspective and deep understanding of the challenges faced by our clients, enabling her to connect with them on a personal level. She embodies empathy and compassion, creating a safe space for those in recovery to share their stories and seek support. Her strong interpersonal skills, Ashley is a true team player. She collaborates effectively with her colleagues, fostering a supportive environment that encourages open communication and shared goals. Her positive attitude and willingness to lend a helping hand uplift everyone around her, making her an invaluable asset to our team. Furthermore, Ashley’s commitment to professional development and continuous learning enhances her effectiveness as a mentor. She actively seeks out opportunities to expand her knowledge and skills, which she generously shares with her peers and clients alike. Her dedication to empowerment and advocacy not only inspires those she mentors but also contributes to a more supportive and informed community. In recognition of her outstanding contributions and unwavering dedication to the field of substance abuse recovery as well as mental health."

"It is my pleasure to nominate Ashley for her outstanding contributions as a Peer Specialist within the Medication Assisted Recovery Program. Ashley’s dedication, passion, and lived experience have made her an invaluable asset to both the program and the broader community. Years ago, Ashley reclaimed her life through the very same program she now champions. Her journey of overcoming addiction and embracing long-term recovery through medication-assisted treatment is not just a personal triumph but a powerful tool she uses to inspire and support others. Ashley’s ability to connect with individuals, both in the community and among her fellow peers, helps break the stigma surrounding addiction and promotes understanding of how medication can play a critical role in achieving sustained recovery. Beyond her work within the program, Ashley is a committed volunteer across Nassau County. She actively collaborates with sober living homes and works closely with community partners to ensure participants have access to essential resources that support their recovery journey. Her dedication to improving the lives of others, both within the program and throughout the wider community, exemplifies her selflessness and commitment to service. Ashley’s story and her ongoing efforts continue to make a lasting impact on countless lives, and it is with great admiration that I nominate her for this well-deserved recognition. Her contributions to the Medication Assisted Recovery Program, her advocacy for long-term recovery, and her tireless work as a community volunteer truly set her apart as a leader and role model in the field of addiction recovery."

To learn more about Peer Specialist and how to get involved, you can click on this link: https://www.peersupportfl.org/services/professional-certifications/peer-specialists/.

It’s that time of year again! As schools prepare for the 2024-25 academic year, the MHTTC School Mental Health (SMH) Initiative has released three new resource collections that focus on various priorities facing schools across the country. 

• Recruitment and Retention of School Mental Health Providers of Color: Studies have shown that student outcomes improve for all students by ensuring that students are exposed to, and learn from, school mental health providers and educators with diverse backgrounds. This resource collection highlights several MHTTC-developed resources to help schools and school districts recruit, retain, and increase the diversity of their school mental health providers.
• School Violence: School violence describes violent acts that disrupt learning and have a negative effect on students, schools, and the broader community. School is the location where the violence occurs, not a type of violence. Examples of school violence include bullying and cyberbullying, fighting (e.g., punching, slapping, kicking), weapon use, gang violence, and sexual violence (CDC, 2021). This resource collection highlights several MHTTC-developed resources related to school violence and student mental health.
• Case Identification and Community Case Detection: Case identification and community case detection within a school setting encompasses a comprehensive approach that combines responsible and trauma-informed screening and assessment in educational environments, with the active involvement of key informants from students' homes and communities. This resource collection highlights several MHTTC-developed resources designed to help with case identification and community case detection – tools for creating safe and healthy schools. 

As we continue to address these topics and other priorities, you can register for school mental health training and events in our Training and Events Calendar, find additional school mental health resources in our Products and Resources Catalog, and reach out to the MHTTC in your region for additional support. We wish you the best as you continue your preparation for the upcoming school year! 

The day I saw the job posting for a firsthand guide (Peer Recovery Specialist) and the values
 they desired, I knew I had found something special. The principles I had learned in Narcotics Anonymous- gratitude, acceptance, service work, faith, and patience, could all be found in peer support. I believe that my heart was made to assist and contribute
 to the welfare of others who struggle with serious mental illness (SMI) and substance use disorder (SUD) as I had. It seemed like a perfect match!

Fast forward, to May 6th, 2024- I had earned 2 years clean from all mind-altering substances
 and was able to find the right tools to keep my SMI dormant. This did not come easily. It took persistence, grit, and struggling through many hard days. During this time, I moved from Tennessee to Ohio and was able to transfer with my job at firsthand. 

Both my firsthand team in Knoxville, TN and my Youngstown, OH team never allowed me to falter. They offered me compassion, empathy, love, and room to grow and learn. It was messy at times. But the teams saw something in me that I didn't see
 myself. I realized then that the peer support model we practice at firsthand is also utilized within our own teams. We bring so much to each other's worlds. Every day that I walk into the office, I know my team has the same goals and mission as I
 do. I can rely on them, and they can rely on me.


As the month of May continued, many personal matters came up. I stayed focused. I remained
 biased toward action (a firsthand value) in both my work life and home life. I had to accept that life might not be what I wished for it to be that I may not have what I want, but I have what I need. And what was in front of me wasn't actually bad
 at all. It was the BIGGEST BLESSING.  

I found gratitude in my work. I was able to stumble but never fell. I had a safe space to practice professionalism and life with grace. I recognized that the people who surrounded me had similar stories.
 My colleagues were just a call or text away when I needed support. 

My daily mission was to remain teachable and to keep pushing to be of value not just to others, but to my daughter and myself. Outside of work, I always looked to my north
 star-my daughter Penelope. After almost 2 years, on May 18th, I celebrated our first reunification. I was able to kiss her, hug her and most importantly- remind her of the love that myself and so many others have for her.


The Dialectical Behavior Therapy (DBT) non-clinical Skills Group Training Program at the Peer Support Coalition of Florida, Inc. (PSCFL) was developed in collaboration with the UF Health- University of Florida. Our trainers have been taught and mentored by Dr. Allison Ventura, PhD with the UF Department of Psychiatry. Dr. Ventura is one of only a dozen trained DBT clinicians in Florida and has been working with counseling, facilitating, and leading skills groups since 2005. Research data will be collected along the way from both Group Facilitators and the participants served as well to demonstrate efficacy of the model.

This training is the first of its kind to deliver DBT concepts and skills with the lens of recovery-oriented peer to peer delivery. 

The training program is comprised of evidenced-based DBT skills, including four modules with five sessions per module. In addition, this program separates the clinical therapy portion from the practical skills learning and practice. The goals of this training include:

In the context of dialectical thinking, which involves merging opposing ideas rather than adhering to an either/or mindset, individuals in this program are encouraged to adopt a both/and perspective. The primary objective is to achieve equilibrium by acknowledging and accepting oneself, including challenges, while also recognizing the advantages of change. This program guides freeing the mind from fixed perspectives, decreasing emotional intensity resulting from imbalanced thoughts and disputes, and accepting our present circumstances while striving for personal development. 

Mindfulness is another component of the training that consists of intentionally living with awareness of the present moment, waking up your mind from automatic or rote behaviors. It is the conscious awareness of the present moment whereas meditation is the practice of focusing your attention on one thing for an extended time. Practicing mindfulness involves noticing consequences without judgment, being present, and avoiding attachment to the past or future. It includes opening the mind by observing and focusing the mind through meditation. Mindfulness can be cultivated through various activities like meditation, yoga, or hiking. Instead of suppressing negative thoughts, participants of the Training Program learn how to observe them without avoidance to regulate emotions effectively.

After the training program is complete, you or your organization can offer a transformative Peer Specialist delivered group facilitation of DBT Skills that until now has not been accessible in this format.

Training Prerequisites: Minimum of 2 years delivering individual and group support services. 

If you’re interested in this course, you can request to join our waitlist. Training sessions begin during the Fall of 2024.

Click here to be added to our waitlist. 

QUESTIONS?  EMAIL events@peersupportfl.org.

by The Alliance for Rights and Recovery

CMS, the nation’s agency that oversees rules regarding Medicaid reimbursement across the nation has released a clarification (“in response to concerns from various stakeholders”) strongly urges states to consider asking for approval for Medicaid funded peer supporters to be supervised by “other peers with more experience and training in the provision of peer support services, even if the supervising peer support provider does not have formal behavioral health training or licensure.”
It further states that “the level and frequency of supervision as defined by the state may vary depending on state practice acts, the demonstrated competency and experience of the peer support provider, as well as the service mix, and may range from direct oversight to periodic care consultation.”
This clarification can be found at https://www.medicaid.gov/federal-policy-guidance/downloads/faq06052024.pdf.

This clarification to the states seeks to clear up a ‘misinterpretation” that, in 2007 guidance, CMCS was setting a strict rule that only certain mental health clinicians or licensed providers may provide supervision of individuals providing peer support services.

It goes on to say that “CMCS is publishing the following questions and answers to clarify the federal requirements regarding supervision of peer support providers as well as to remind states and other stakeholders of other federal requirements regarding Medicaid coverage of peer support services.”

Time to approach your state to apply for approval to expand the criteria for supervisors of peer supporters in your state!
=====

Here’re more details from the formal clarification, entitled
Frequently Asked Questions on Medicaid and CHIP Coverage of Peer Support Services   June 5, 2024”

This document provides clarifications regarding previously established policy on Medicaid and CHIP coverage of peer support services outlined in the State Medicaid Director (SMD) letter on this topic (SMD letter #07-011) issued on August 15, 2007. The SMD letter #07-011 established that states “have the option to offer [p]eer [s]upport services as a component of a comprehensive mental health and substance use service delivery system.”

The Center for Medicaid and CHIP Services (CMCS) strongly encourages states to expand availability and utilization of peer support services to serve adults, youth, and families who experience mental health conditions and/or substance use disorders, including by allowing coverage of peer support services in emergency room and inpatient settings. Furthermore, CMS encourages states to ensure that payment rates for peer support services are sufficient to support a living wage for peer support providers who are critical members of the care team for individuals with mental health conditions and/or substance use disorders.

As stated in the 2007 SMD letter, “CMS recognizes that the experiences of peer support providers, as consumers of mental health and substance use services, can be an important component in a [s]tate’s delivery of effective treatment.” Research studies indicate that expanding access to peer support services may help improve willingness of individuals to begin and remain engaged in treatment, and there is also evidence that peer support services help reduce use of emergency departments, re-hospitalization, and involvement with the criminal justice system.

I CMCS has worked with state Medicaid agencies to establish Medicaid coverage of peer support services in almost every state.
While there has been a marked increase in the use of peer support services in various settings, research indicates that peer support services for mental health conditions and substance use disorders are not widely accessible, and utilization rates remain low.1F

The Center for Medicaid and CHIP Services (CMCS) strongly encourages states to expand availability and utilization of peer support services to serve adults, youth, and families who experience mental health conditions and/or substance use disorders, including by allowing covrage of peer support services in emergency room and inpatient settings. Furthermore, CMS encourages states to ensure that payment rates for peer support services are sufficient to support a living wage for peer support providers who are critical members of the care team for individuals with mental health conditions and/or substance use disorders.

As stated in the 2007 SMD letter, “CMS recognizes that the experiences of peer support providers, as consumers of mental health and substance use services, can be an important component in a [s]tate’s delivery of effective treatment.” Research studies indicate that expanding access to peer support services may help improve willingness of individuals to begin and remain engaged in treatment, and there is also evidence that peer support services help reduce use of emergency departments, re-hospitalization, and involvement with the criminal justice system.

CMCS has worked with state Medicaid agencies to establish Medicaid coverage of peer support services in almost every state.
While there has been a marked increase in the use of peer support services in various settings, research indicates that peer support services for mental health conditions and substance use disorders are not widely accessible, and utilization rates remain low.

Various stakeholders have raised concerns that the statement in the SMD letter #07-011 that “[s]upervision must be provided by a competent mental health professional (as defined by the [s]tate)” may be mis-interpreted to mean that CMCS was setting a strict rule that only certain mental health clinicians or licensed providers may provide supervision of individuals providing peer support services. CMCS is publishing the following questions and answers to clarify the federal requirements regarding supervision of peer support providers as well as to remind states and other stakeholders of other federal requirements regarding Medicaid coverage of peer support services.

In general, CMCS defers to states in setting qualifications for providers of Medicaid-covered services and benefits under federal law and the states’ Medicaid plans. In keeping with this principle, the SMD letter #07-011 indicated some topics states should consider in setting the qualification requirements for providers of peer support services; for example, the SMD letter recommended that states establish requirements regarding training and supervision. However, more specific details regarding the training required for peer support providers and which types of professionals must supervise those peer support providers are left to the states to determine.

Our federal partner at the Substance Abuse and Mental Health Services Administration (SAMHSA) released several resources that may be useful for states in their determinations, including SAMHSA’s Core Competencies for Peer Workers. In order to promote greater uniformity and reciprocity across the nation, states may consider SAMHSA’s National Model Standards for Peer Support Certification as a guide. Additionally, as referenced in SAMHSA’s

National Model Standards for Peer Support Certification, states should consider incorporating specialization of certification, training, and lived experiences related to serving those who may be military veterans, justice-involved individuals, are LGBTQIA+, or have co-occurring disabilities.

Furthermore, states are encouraged to review SAMHSA’s report Financing Peer Recovery Support: Opportunities to Enhance the Substance Use Disorder Workforce, which analyzes information on current practices..

SAMHSA also provides technical assistance to expand peer support services adoption through the Peer Recovery Center of Excellence, the SAMHSA Program to Advance Recovery Knowledge, and other resources. SAMHSA’s Peer Recovery Center of Excellence’s State Certification Directory for Peer Recovery Support Specialist Training provides information regarding peer training and certification processes for all 50 U.S. states, 5 U.S. territories, and the District of Columbia.

Frequently Asked Questions and Answers
Q1. What steps must state Medicaid agencies take to establish Medicaid coverage of peer support services in their states?
A1. As stated in the SMD letter #07-011, “[s]tates must identify the Medicaid authority to be used for coverage and payment, describe the service, the provider of the service, and their qualifications in full detail.” States may choose from several different federal Medicaid authorities to add coverage of peer support services to their state plans, including the rehabilitative services option2F
iii that has most often been cited by states for this purpose, as well as the preventive services option.3F
iv As specified in the SMD letter, section 1915(b) and section 1915(c) waiver authorities may also be used by states for coverage of peer support services.
In addition, the SMD letter #07-011 specified that “reimbursement must be based on an identified unit of service and be provided by one peer support provider, based on an approved plan of care.” States must also provide assurances that “there are mechanisms in place to prevent over-billing for services” that could include utilization management methods.
Peer Support services can be an important part of mental health and substance use treatment throughout the full continuum of care—prevention, treatment, harm reduction and recovery; for example, outreach by a peer support specialist may be needed after a traumatic experience or at the onset of an illness, as part of early intervention, and to help individuals stay in long-term recovery, in addition to acute treatment.

Q2. What are some specific requirements that states must meet in establishing Medicaid coverage of peer support services in their state?
A2. The SMD letter #07-011 indicated that states must determine the minimum training and certification criteria for peer support providers, the amount, duration, and scope of supervision that must be provided by a competent mental health professional (as defined by the state), and ensure that peer support services are “coordinated within the context of a comprehensive, individualized plan of care” that reflects the needs and preferences of the participant/consumer with individualized goals and measurable results specified in the plan..

Q3. Are there federal Medicaid requirements regarding training and other qualifications of individuals providing peer support services?
A3. Yes, peer support providers are required to have completed some training and certification, but those training and certification requirements are to be defined by the state. CMCS expects that the required training should provide basic competencies to perform peer support services. In addition, CMCS expects states to require some ongoing continuing education for peer support providers, but the specifics of those continuing educations requirements are to be set by the state.
CMCS encourages states to review the resources provided by SAMHSA noted above when designing their peer support services. Finally, consistent with SMD letter #07-011, peers “should be self-identified consumers who are in recovery from mental illness or substance use disorders,” and “demonstrate the ability to support the recovery of others from mental illness and/or substance use disorders.” Furthermore, there is no federal requirement that peer support providers or recipients of peer support services have any specific mental health or substance use disorder diagnosis.

Q4. What are the federal Medicaid requirements regarding the types of individuals who may supervise peer support providers?
A4. The SMD letter #07-011 specified that, “[s]upervision must be provided by a competent mental health professional (as defined by the [s]tate).” However, in working with states to establish authority for peer support services in their Medicaid state plans, CMCS has clarified that states have discretion in determining the types of individuals that may qualify as “mental health professionals” for purposes of providing supervision of peer support providers. CMCS has advised states that individuals supervising peers may include substance use disorder (SUD) treatment specialists, including licensed SUD counselors, as well as unlicensed mental health and SUD practitioners. In addition, supervisors of peer support providers may include other peers with more experience and training in the provision of peer support services, even if the supervising peer support provider does not have formal behavioral health training or licensure.
CMCS has approved Medicaid state plan amendments that authorize these types of practitioners to supervise peer support providers. The level and frequency of supervision as defined by the state may vary depending on state practice acts, the demonstrated competency and experience of the peer support provider, as well as the service mix, and may range from direct oversight to periodic care consultation.

Q5. What other types of peer support providers may be covered by state Medicaid programs?
A5. In subsequent guidance issued in 2013, CMCS clarified that “the parents/legal guardians of Medicaid-eligible children can receive [p]eer [s]upport services when the service is directed exclusively toward the benefit of a Medicaid-eligible child.” Furthermore, this guidance specified that providers of these peer support services for parents/legal guardians should be selfidentified individuals who are in recovery from a mental health condition and/or substance use disorder, a parent of a child with a similar mental health condition and/or substance use disorder, or an adult with an ongoing and/or personal experience with a family member with similar conditions. This guidance also states that peer support services for parents/legal guardians also must meet the basic requirements established in the SMD letter #07-011. In particular, the 2013 guidance emphasized the importance of training for peer support providers including “training for these peer support providers that is specific to how to assist other parents/legal guardians.”

Q6. Can state Medicaid programs cover peer support services for youth?
A6. Yes, state Medicaid programs may cover youth peer support services. Some states, for example, have incorporated peer support services into schools. States should carefully determine qualifications including age and lived/living experience, training, what types of practitioners are considered competent mental health professionals for supervision of youth peer support providers, and how close and frequent that supervision must be. These requirements should also address how youth peer support providers will be reimbursed.

Q7. What are additional federal requirements for Medicaid coverage of peer support services regarding care coordination?
A7. Peer support services must be coordinated as part of an individualized, goal-oriented plan of care. States should utilize person-centered planning with engagement and empowerment tools to ensure these plans of care reflect the needs and preferences of participants.

Q8. Can separate Children’s Health Insurance Programs cover peer support services?
A8. Yes. Peer support services can be included as part of child health assistance as defined in Section 2110(a) of the Social Security Act and 42 CFR 457.402. Peer support services are not a mandatory service in the Children’s Health Insurance Program (CHIP); however, some states have elected to provide coverage of this service. States also have the option in CHIP to provide peer support services that are similar to the benefit provided to either youth or pregnant individuals in Medicaid. States interested in adding this coverage in CHIP must submit a state plan amendment that describes the amount, duration, and scope of the peer support benefit, including any applicable limitations. We encourage states to reach out to their CHIP Project Officer for additional technical assistance.

Chinman M, George P, Dougherty RH, et al. Peer support services for individuals with serious mental illnesses.
assessing the evidence. Psych Serv. 2014,65(4):429-441;
Bouchery E, Barna M, Babalola E, et al. The effectiveness of a peer-staffed crisis respite program as an alternative to hospitalization. Psych Serv. 2018;69(10): 1069-1074;
Substance Abuse and Mental Health Services Administration: Financing Peer Recovery Support: Opportunities to Enhance the Substance Use Disorder Workforce. Publication No. PEP23-06-07-003. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2024.
ii Substance Abuse and Mental Health Services Administration: Financing Peer Recovery Support: Opportunities to Enhance the Substance Use Disorder Workforce. Publication No. PEP23-06-07-003. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2024
iii The Social Security Act, §1905(a)(13); 42 CFR 440.130(d).
iv The Social Security Act, §1905(a)(13); 42 CFR 440.130(c).

The Center for Medicaid and CHIP Services (CMCS) strongly encourages states to expand availability and utilization of peer support services to serve adults, youth, and families who experience mental health conditions and/or substance use disorders, including by allowing coverage of peer support services in emergency room and inpatient settings. Furthermore, CMS encourages states to ensure that payment rates for peer support services are sufficient to support a living wage for peer support providers who are critical members of the care team for individuals with mental health conditions and/or substance use disorders. 

As stated in the 2007 SMD letter, “CMS recognizes that the experiences of peer support providers, as consumers of mental health and substance use services, can be an important component in a [s]tate’s delivery of effective treatment.” Research studies indicate that expanding access to peer support services may help improve willingness of individuals to begin and remain engaged in treatment, and there is also evidence that peer support services help reduce use of emergency departments, re-hospitalization, and involvement with the criminal justice system.0F i CMCS has worked with state Medicaid agencies to establish Medicaid coverage of peer support services in almost every state. 

While there has been a marked increase in the use of peer support services in various settings, research indicates that peer support services for mental health conditions and substance use disorders are not widely accessible, and utilization rates remain low.1F ii

Various stakeholders have raised concerns that the statement in the SMD letter #07-011 that “[s]upervision must be provided by a competent mental health professional (as defined by the [s]tate)” may be mis-interpreted to mean that CMCS was setting a strict rule that only certain mental health clinicians or licensed providers may provide supervision of individuals providing peer support services. CMCS is publishing the following questions and answers to clarify the federal requirements regarding supervision of peer support providers as well as to remind states and other stakeholders of other federal requirements regarding Medicaid coverage of peer support services. 

In general, CMCS defers to states in setting qualifications for providers of Medicaid-covered services and benefits under federal law and the states’ Medicaid plans. In keeping with this principle, the SMD letter #07-011 indicated some topics states should consider in setting the qualification requirements for providers of peer support services; for example, the SMD letter recommended that states establish requirements regarding training and supervision. However, 2 more specific details regarding the training required for peer support providers and which types of professionals must supervise those peer support providers are left to the states to determine.  

Our federal partner at the Substance Abuse and Mental Health Services Administration (SAMHSA) released several resources that may be useful for states in their determinations, including SAMHSA’s Core Competencies for Peer Workers. In order to promote greater uniformity and reciprocity across the nation, states may consider SAMHSA’s National ModelStandards for Peer Support Certification as a guide. Additionally, as referenced in SAMHSA’s National Model Standards for Peer Support Certification, states should consider incorporating specialization of certification, training, and lived experiences related to serving those who may be military veterans, justice-involved individuals, are LGBTQIA+, or have co-occurring disabilities. Furthermore, states are encouraged to review SAMHSA’s report Financing PeerRecovery Support: Opportunities to Enhance the Substance Use Disorder Workforce, which analyzes information on current practices.. 

SAMHSA also provides technical assistance to expand peer support services adoption through the Peer Recovery Center of Excellence, the SAMHSA Program to Advance RecoveryKnowledge, and other resources. SAMHSA’s Peer Recovery Center of Excellence’s StateCertification Directory for Peer Recovery Support Specialist Training provides information regarding peer training and certification processes for all 50 U.S. states, 5 U.S. territories, and the District of Columbia.

Frequently Asked Questions and Answers

Q1. What steps must state Medicaid agencies take to establish Medicaid coverage of peer support services in their states? 

A1. As stated in the SMD letter #07-011, “[s]tates must identify the Medicaid authority to be used for coverage and payment, describe the service, the provider of the service, and their qualifications in full detail.” States may choose from several different federal Medicaid authorities to add coverage of peer support services to their state plans, including the rehabilitative services option2F iii that has most often been cited by states for this purpose, as well as the preventive services option.3F iv As specified in the SMD letter, section 1915(b) and section 1915(c) waiver authorities may also be used by states for coverage of peer support services.  

In addition, the SMD letter #07-011 specified that “reimbursement must be based on an identified unit of service and be provided by one peer support provider, based on an approved plan of care.” States must also provide assurances that “there are mechanisms in place to prevent over-billing for services” that could include utilization management methods. 

Peer Support services can be an important part of mental health and substance use treatment throughout the full continuum of care—prevention, treatment, harm reduction and recovery; for example, outreach by a peer support specialist may be needed after a traumatic experience or at the onset of an illness, as part of early intervention, and to help individuals stay in long-term recovery, in addition to acute treatment. 

Q2. What are some specific requirements that states must meet in establishing Medicaid coverage of peer support services in their state?

A2. The SMD letter #07-011 indicated that states must determine the minimum training and certification criteria for peer support providers, the amount, duration, and scope of supervision that must be provided by a competent mental health professional (as defined by the state), and ensure that peer support services are “coordinated within the context of a comprehensive, individualized plan of care” that reflects the needs and preferences of the participant/consumer with individualized goals and measurable results specified in the plan.. 

Q3. Are there federal Medicaid requirements regarding training and other qualifications of individuals providing peer support services?

A3. Yes, peer support providers are required to have completed some training and certification, but those training and certification requirements are to be defined by the state. CMCS expects that the required training should provide basic competencies to perform peer support services. In addition, CMCS expects states to require some ongoing continuing education for peer support providers, but the specifics of those continuing educations requirements are to be set by the state. CMCS encourages states to review the resources provided by SAMHSA noted above when designing their peer support services. Finally, consistent with SMD letter #07-011, peers “should be self-identified consumers who are in recovery from mental illness or substance use disorders,” and “demonstrate the ability to support the recovery of others from mental illness and/or substance use disorders.” Furthermore, there is no federal requirement that peer support providers or recipients of peer support services have any specific mental health or substance use disorder diagnosis.

Q4. What are the federal Medicaid requirements regarding the types of individuals who may supervise peer support providers?

A4. The SMD letter #07-011 specified that, “[s]upervision must be provided by a competent mental health professional (as defined by the [s]tate).” However, in working with states to establish authority for peer support services in their Medicaid state plans, CMCS has clarified that states have discretion in determining the types of individuals that may qualify as “mental health professionals” for purposes of providing supervision of peer support providers. CMCS has advised states that individuals supervising peers may include substance use disorder (SUD) treatment specialists, including licensed SUD counselors, as well as unlicensed mental health and SUD practitioners. In addition, supervisors of peer support providers may include other peers with more experience and training in the provision of peer support services, even if the supervising peer support provider does not have formal behavioral health training or licensure. CMCS has approved Medicaid state plan amendments that authorize these types of practitioners to supervise peer support providers. The level and frequency of supervision as defined by the state may vary depending on state practice acts, the demonstrated competency and experience of the peer support provider, as well as the service mix, and may range from direct oversight to periodic care consultation. 

Q5. What other types of peer support providers may be covered by state Medicaid programs? 

A5. In subsequent guidance issued in 2013, CMCS clarified that “the parents/legal guardians of Medicaid-eligible children can receive [p]eer [s]upport services when the service is directed exclusively toward the benefit of a Medicaid-eligible child.” Furthermore, this guidance specified that providers of these peer support services for parents/legal guardians should be self identified individuals who are in recovery from a mental health condition and/or substance use disorder, a parent of a child with a similar mental health condition and/or substance use disorder, or an adult with an ongoing and/or personal experience with a family member with similar conditions. This guidance also states that peer support services for parents/legal guardians also must meet the basic requirements established in the SMD letter #07-011. In particular, the 2013 guidance emphasized the importance of training for peer support providers including “training for these peer support providers that is specific to how to assist other parents/legal guardians.”

Q6. Can state Medicaid programs cover peer support services for youth?

A6. Yes, state Medicaid programs may cover youth peer support services. Some states, for example, have incorporated peer support services into schools. States should carefully determine qualifications including age and lived/living experience, training, what types of practitioners are considered competent mental health professionals for supervision of youth peer support providers, and how close and frequent that supervision must be. These requirements should also address how youth peer support providers will be reimbursed. 

Q7. What are additional federal requirements for Medicaid coverage of peer support services regarding care coordination?

A7. Peer support services must be coordinated as part of an individualized, goal-oriented plan of care. States should utilize person-centered planning with engagement and empowerment tools to ensure these plans of care reflect the needs and preferences of participants. 

Q8. Can separate Children’s Health Insurance Programs cover peer support services?

A8. Yes. Peer support services can be included as part of child health assistance as defined in Section 2110(a) of the Social Security Act and 42 CFR 457.402. Peer support services are not a mandatory service in the Children’s Health Insurance Program (CHIP); however, some states have elected to provide coverage of this service. States also have the option in CHIP to provide peer support services that are similar to the benefit provided to either youth or pregnant individuals in Medicaid. States interested in adding this coverage in CHIP must submit a state plan amendment that describes the amount, duration, and scope of the peer support benefit, including any applicable limitations. We encourage states to reach out to their CHIP Project Officer for additional technical assistance.

i Chinman M, George P, Dougherty RH, et al. Peer support services for individuals with serious mental illnesses. assessing the evidence. Psych Serv. 2014,65(4):429-441; Bouchery E, Barna M, Babalola E, et al. The effectiveness of a peer-staffed crisis respite program as an alternative to hospitalization. Psych Serv. 2018;69(10): 1069-1074; Substance Abuse and Mental Health Services Administration: Financing Peer Recovery Support: Opportunities to 5 Enhance the Substance Use Disorder Workforce. Publication No. PEP23-06-07-003. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2024. ii Substance Abuse and Mental Health Services Administration: Financing Peer Recovery Support: Opportunities to Enhance the Substance Use Disorder Workforce. Publication No. PEP23-06-07-003. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2024 iii The Social Security Act, §1905(a)(13); 42 CFR 440.130(d). iv The Social Security Act, §1905(a)(13); 42 CFR 440.130(c)

May 1, 2024, marked World Maternal Mental Health Day, and on May 12, 2024, we will celebrate Mother’s Day. While maternal health is a recognized public health crisis in the United States, mental health, substance misuse, and substance use disorder (SUD) are often overlooked as part of the crisis. Mental health conditions, substance misuse, and SUD that occur during the perinatal period (before, during, and up to one year after pregnancy) are the leading cause of maternal mortality. Unfortunately, barriers to care result in poor health outcomes for parents and their children, and, while growing, limited clinical research on effective interventions in this area results in fewer opportunities for prevention.

The Biden-Harris Administration has demonstrated that addressing the maternal mental health and substance use crisis is a national priority, with government agencies like SAMHSA and the Centers for Disease Control and Prevention (CDC) recognizing the importance of this issue. Professional organization, members of Congress, and advocates also have helped to advance this area as a public health priority. In 2023, the Department of Health and Human Services launched the Maternal Mental Health Task Force, a group of federal and non-federal experts seeking to identify ways to reduce barriers to care for pregnant and parenting individuals with mental health conditions and co-occurring SUD. Current barriers to improving the state of maternal mental health, substance misuse, and SUD in the United States, such as a lack of available data (PDF | 1.6 MB, can be overcome, but facilitating a response to this crisis of maternal health requires that stakeholders, government agencies, and experts convene and share resources, knowledge, and experience.

Maternal Mental Health, Substance Misuse, and SUD in the United States
CDC research indicates that the most frequent underlying cause of pregnancy-related deaths is a mental health condition, which is defined by the CDC to include SUD, overdoses, and suicide. The CDC also found that over 80 percent of pregnancy-related deaths were preventable. In some instances, these conditions appear to be increasing: analysis of the 2000-2015 National Inpatient Sample revealed a 7-fold increase in recorded diagnoses of depressive disorders nationwide, from 4.1 per 1,000 delivery hospitalizations in 2000 to 28.7 per 1,000 delivery hospitalizations in 2015.

While not everyone who uses a substance will develop or has a substance use disorder, professional organizations such as the American College of Obstetrics and Gynecologyrecommend avoidance of any substance use, including nicotine, during pregnancy. Data suggests this message may not be consistently reaching its intended audience. A study conducted using the 2016, 2017, and 2018 National Survey of Drug Use and Health found that 22.3 percent of pregnant women reported using at least one substance in the previous month. Perinatal SUD has been estimated to appear in 5.5 percent of deliveries, according to a study analyzing deliveries in Massachusetts from 2003-2007. Between 1999 and 2014, the number of pregnant women with opioid use disorder, alone or in combination with other substance use disorders, increased from an estimated 1.5 to 6.5 cases per 1,000 hospital births. Experts have associated this change with a steep increase in the number of infants born with neonatal abstinence syndrome from 1.2 to 8.0 per 1,000 hospital births, with some areas reaching 20.0 per 1,000 hospital births.

Maternal mental health, substance misuse, and SUD are affected by various structural and social factors, such as race and racism. A study of Black women associated gendered racial stress with increased depressive symptoms in early pregnancy. Similarly, in an Asian and Pacific Islander cohort of pregnant women, experiencing racial discrimination was associated with a higher risk of postpartum depression. Other research showed a greater association with perinatal substance use, depression, and anxiety with women who identified as indigenous.

Other factors, such as trauma experienced before or during the perinatal period, have been shown to have an impact. Research has associated distress during labor and delivery as the most important risk factor for postpartum post-traumatic stress disorder, followed by other factors such as low support during labor and delivery, previous traumatic experiences, and obstetrical emergencies. Other research identified a greater instance of postpartum depression following cesarean deliveries.

The Impact of Maternal Mental Health Conditions, Substance Misuse, and SUD on Parents and Infants
Mental health conditions, substance misuse, and SUD can complicate pregnancy and have deleterious effects on pregnant and postpartum individuals and their infants, particularly when left undetected, untreated, or undertreated. Research has found an association between perinatal depression and preterm birth. In addition, suicidal behavior by the pregnant individual has been linked with a greater risk for antepartum hemorrhage, placental abruption, postpartum hemorrhage, premature delivery, and poor fetal outcomes. A cohort study of 7,542 women with eating disorders showed an increased risk of preterm birth and microcephaly among infants born to women with any diagnosed eating disorder compared with those without this condition.

Reports of any substance use during pregnancy correspond with reports of delayed or inadequate prenatal care and low rates of postpartum follow-up visits, which increased risk of obstetric complications. The stigma associated with substance use and fear of legal repercussions may prevent patients with SUD from seeking care early in pregnancy. In addition, having SUD during pregnancy, particularly opioid use disorder, correlates with a higher risk of dying by overdose and suicide. In utero exposure to alcohol has been frequently studied and is associated with a range of long-term developmental and physical disabilities characterized as fetal alcohol spectrum disorder.

SUD and mental health conditions often co-occur and further exacerbate negative health outcomes for parents and babies. Pregnant and postpartum individuals with SUD disproportionately experience co-occurring psychosocial issues that can negatively affect maternal and infant outcomes, including comorbid mental health conditions. These findings are also associated with other structural issues, including limited availability and quality of care.

Barriers to Treatment Services and Prevention
Treatment and prevention initiatives for addressing the maternal mental health, substance misuse, and SUD crisis are limited. There are numerous barriers, including stigma, lack of training, siloed healthcare and social services systems, and a dearth of relevant research. Each of these factors, and the many others at play, intersect and interact. As a result, these health conditions and their consequences are not treated, nor are they prevented.

Pregnant individuals are frequently untreated or undertreated for their conditions, even when there is a recognized standard of care for treatment: one study has found that women are less likely to receive treatment for a mental health condition if they are pregnant. Likewise, pregnant individuals are often not treated for their SUD. Only about one-third of pregnant persons with opioid use disorder receive treatment in the form of methadone and buprenorphine, despite these medications being the standard of care for treatment of opioid use disorder, including during pregnancy. Even when individuals do initiate treatment, it is more likely to be obtained during the postpartum period than prior to or during pregnancy.

Negative and stigmatizing attitudes create a barrier to mental health and SUD treatment. Perceptions of gender and parenthood for individuals who are pregnant and may need services further exacerbate stigma. Stigma against people with these health conditions can also lead to healthcare providers’ refusal to undergo the training needed to treat pregnant and parenting people with mental health conditions, SUD, and co-occurring disorders. Health practitioners’ lack of knowledge, training (PDF | 748 KB, or comfort in how to treat perinatal persons safely and effectively are significant barriers to perinatal mental health and SUD identification and management. This often leads to inadequate care, such as practitioners wrongly advising their patients to discontinue needed medications.

Pregnant and postpartum people with opioid use disorder may experience discrimination and even criminalization. Healthcare providers have reported ethical concerns about screening, reporting, or treating opioid use disorder during pregnancy because some states require reporting to child welfare or protection agencies. This reporting can—and has—led to wrongful removal of the child, separating families and further traumatizing both parent and child, despite evidence that family-focused interventions for parents with SUD result in better outcomes. Other barriers may be financial in nature; further, patients may lack access to health care or to coordinated care between obstetricians, primary care providers, and mental health and SUD treatment providers.

Despite the negative impacts and the many barriers to treatment, the causes behind most perinatal mental health conditions, as well as SUD, are not well-studied (PDF | 1.6 MB, so there is limited opportunity for prevention. People who are pregnant have been called “therapeutic orphans” due to the infrequency of clinical research conducted with pregnant individuals and the resulting lack of clinical understanding of pregnant bodies. Although existing literature has aimed to identify the relationships between various risk factors, there is a dearth (PDF | 1.6 MB) of evidence reporting strong associations between these factors and health-related outcomes. Bias in medical research and the pathologizing of the female body has led to a paucity of research on women’s health and the health of people capable of becoming pregnant, so much so that a recent Executive Order by President Biden mandated a greater focus on women and the female body in clinical health research. This bias, in concert with a similar bias against people with mental health conditions and SUD, is likely a cause of the lack of adequate evidence that could be applied into actionable policy change.

Existing Efforts to Address this Crisis
There are numerous federal initiatives to coordinate across the government and support individuals with maternal mental health conditions, substance misuse, and SUD and the providers who help care for them. SAMHSA’s residential and outpatient Pregnant and Postpartum Women programs use a family-first model to provide comprehensive services for perinatal individuals with SUD. The Health Resources and Services Administration’s National Maternal Mental Health Hotline offers free and confidential mental health support 24/7 for individuals and their families before, during, and after pregnancy.

In 2023, the U.S. Department of Health and Human Services formed the Task Force on Maternal Mental Health as a subcommittee of SAMHSA’s Advisory Committee for Women’s Health. The purpose of the Task Force is to identify, evaluate, and make recommendations to the Advisory Committee for Women’s Health to coordinate and improve federal activities related to addressing maternal mental health conditions, substance misuse, and SUD. This Task Force, comprised of federal and non-federal members, including individuals with lived experience, is also developing a national strategy that will recommend to the Advisory Committee for Women’s Health ways to improve the prevention, identification, timely referral, intervention, and access to care and other supports for maternal mental health conditions, substance misuse, and SUD.

Conclusion
Within the maternal mortality crisis is a crisis of maternal mental health and SUD. Attention to this issue by the Biden-Harris Administration has enabled groups like the Maternal Mental Health Task Force to convene, share knowledge, and identify solutions to this pressing public health issue. However, there is more to be done. This issue requires greater amounts of relevant qualitative and quantitative data that can be used to develop policy and implement actionable change. Improved efforts by healthcare providers and the public at large to understand mental health and SUD can reduce stigma and empower individuals to seek treatment. Critically, continued national attention to this issue will enable lasting change for pregnant and parenting people with mental health conditions and SUD.

Veterans’ organizations in the public sector and government agencies like the US Department of Veterans Affairs (VA) are working to improve veterans’ access to healthcare and mental health services. Despite those efforts, more work is needed to make good on our nation’s commitments to honor veterans.

When it comes to the physical health and wellbeing of the veteran population, the statistics are disparaging. The suicide rate, which has been climbing in the United States in general, is even more devastating for the veteran population. According to the VA’s 2023 National Veteran Suicide Prevention Annual Report, the suicide rate for veterans is significantly higher than for nonveterans.

More work is needed to make good on our nation’s commitments to honor veterans.

Veterans who are unhoused, who have a mental health or substance use disorder diagnosis, or who reside in rural areas were among those most likely to die by suicide. Some racial groups had significantly higher rates of suicide than others; in 2021, American Indian and Alaska Native veterans (46.3 per 100,000), White veterans (36.3 per 100,000) and Asian, Native Hawaiian and Pacific Islander veterans (31.6 per 100,000) had the highest rates. The overall unadjusted suicide rate for veterans in 2021 was 33.9 per 100,000; for nonveteran US adults it was 16.7 per 100,000. Therefore, in 2021, veterans experienced a suicide rate more than double the rate for the country overall. In the same year, LGBTQ+ veterans, and younger people who left the military in more recent years were among the subpopulations at a heightened risk of suicide.

Veterans face unique health challenges. Due to their service, they are at a higher risk for musculoskeletal injuries, chronic pain, mental health issues and PTSD, traumatic brain injury, and chemical and noise exposure. Veterans also suffer from several chronic illnesses at higher levels when compared to the average US population, including coronary heart disease, stroke, skin cancer and other cancers, chronic obstructive pulmonary disease, emphysema, chronic bronchitis, arthritis, rheumatoid arthritis, gout, lupus, fibromyalgia, depressive disorders, and diabetes.

When considering the health needs and challenges of the veteran population, it is crucially important to understand that veterans are not a monolith and differences in military service have implications for health and wellbeing. For example, enlisted veterans tend to have poorer health, social, and vocational wellbeing than former military officers. Veterans who have been deployed to a war zone have more physical and mental health concerns than those who were not deployed.

Though the challenges facing veterans are significant, they are not insurmountable.

The health consequences of deployment are a mounting concern for veterans. As an article in Healthcare points out, “The physical demands on U.S. service members have increased significantly over the past several decades as the number of military operations requiring overseas deployment have expanded in frequency, duration, and intensity.”

Advocates for veterans’ health, many of them veterans themselves, have created nonprofits and other solutions that could help improve veterans’ health and wellbeing. They have also made important recommendations regarding the improvements needed to address veterans’ access to healthcare and the quality of care received.

Policies Veterans Need to Protect Their Physical and Mental Health

Though the challenges facing veterans are significant, they are not insurmountable. Nonprofit leaders and government officials have recommended policy changes, interventions, as well as program and process enhancements that could radically transform the state of healthcare for veterans, including those whose lack of social support and other circumstances make them more vulnerable to poor health outcomes. The recommendations include:

• Auto-Enroll Veterans into Healthcare Programs

With the number of health issues veterans experience, it is no surprise that healthcare is veterans’ top concern after they are discharged from the military. But many veterans don’t have access to care, and not all of those who have access enroll in a health plan. Though there were 18 million veterans in 2023, only about half were eligible for care through the VA, and only 6 million were using it. Veterans are not automatically enrolled in healthcare upon completing military service. For many, enrolling in healthcare services can be a confusing and arduous task. In a STAT article, Jenn Kerfoot, who’s also a veteran, argues that veterans who are honorably discharged should be auto-enrolled in health plans because “it shouldn’t be easier to enlist in the military than it is to get good health care.” By automatically enrolling veterans in healthcare programs upon discharge, we ensure that veterans can access the services they need to ensure their physical and mental health and wellbeing during what can be a very difficult transition.

Behind barbed wire in maximum-security prison sit dozens of inmates suffering from severe behavioral problems. They are doing time for crimes that might have been prevented with access to the right treatment and medication.

Having mentally ill people in a jail is almost a human rights issue. They don’t belong in jail.

"Having mentally ill people in a jail is almost a human rights issue. They don’t belong in jail," said Martin County Sheriff William Synder.

Snyder said they don’t belong on the street, either. About a third of the inmates in his 700-bed jail have mental health issues and nurses give them medication multiple times a day, he said.

While his constitutional duty is to keep the county safe, his moral responsibility drives him to search for better ways to serve these men and prevent them from ending up back behind bars, Snyder said.

"We have hired somebody, at taxpayer expense, to monitor them as they leave," Snyder told CBS12 News. "To make sure that if they are entitled to Medicare or Medicaid, that they are back on it... that if they are on medication, that they have follow up care and then we follow up with them."

He's breaking the cycle by making sure they get medication and counseling and that in turn means his deputies aren’t arresting the same people over and over. However, Snyder has proposed a better solution –- a mental health wing. It would be a place where these inmates can serve their sentence in a setting better suited to meet their needs.

"What I have to do is keep my mentally ill inmates away from the rest of the population for several reasons," he explained. "They can be violent and hurt my other inmates, or the other inmates can perceive them as weak and take advantage of them."

They can be violent and hurt my other inmates, or the other inmates can perceive them as weak and take advantage of them.

The Martin County jail is a microcosm of Florida's struggle with treating behavioral health. With limited bed space in both private and public clinics, too many times, people suffering without treatment end up behind bars or dead.

Roman Phelps, a former student, crashed his van through the front gate of Dreyfoos School of the Arts in West Palm Beach and was killed in a confrontation with police. Family and friends had tried to get him checked into a behavioral health unit, but their attempts failed.

Just a couple of weeks ago, a mentally ill man with multiple arrests tried to get on campus at Suncoast High School in Riviera Beach, and he was attacked a police officer before being shot twice in the school driveway just as kids were arriving for class.

"There are estimates that one in four people have some form of mental illness in their lives," Dr. Ryan Wagoner, the Chair of the Psychiatry and Behavioral Neurosciences Department at the University of South Florida, told CBS12 News.

There are estimates that one in four people have some form of mental illness in their lives.

Wagoner said not all of those illnesses are severe or even permanent, but those that are can require in-patient, long-term care and there’s not enough to go around.

"Anytime we start a new service, or bring in a new provider, that person can get filled up very quickly because there is so much demand for mental health services," he explained.

Mental health problems cover a broad spectrum, some are simple stress from work, school, relationships, social media, even watching the news. Other times, it comes from abusing drugs or alcohol, often in an attempt to cope with stress or trauma.

However, over time, without treatment, all of these can become much more serious.

You also have to take into account all those people who are born with mental and behavioral problems.

The state is at a tipping point in addressing the mental health needs of our population, now and into the future and lawmakers are taking note.

"By conservative estimates Florida has probably 500 to 700 thousand of our constituents, friends, neighbors who suffer from some form of mental illness," said Florida Senator Jim Boyd.

Senator Boyd was the driving force behind the Behavioral Health Teaching Hospitals Bill signed into law by Governor Ron DeSantis in March of 2024. As soon as July, $300 million dollars will be invested in training the next generation of behavioral health workers.

It will be a partnership between Tampa General Hospital in affiliation with the University of South Florida, UF Health Shands Hospital in affiliation with the University of Florida, UF Health Jacksonville in affiliation with the University of Florida and Jackson Memorial Hospital in affiliation with the University of Miami.

But there’s another important component of this law.

“Do we have enough social workers? Do we have enough mental health counselors? All of those things, we just don’t know," Dr. Julie Serovich, the Dean of the College of Behavioral and Community Sciences at the University of South Florida, told CBS12 News.

Serovich says it’s now their job to track the number of Behavioral Healthcare workers and the number of available beds at treatment centers statewide. They will also be tasked with reporting those numbers to Tallahassee.

In order to meet the need, you have to have an accurate read of what the needs are, and to her that’s going to be the easy part.

The most challenging task, Serovich explains, is keeping those currently in the field on the job while they train the next generation. She tells CBS12 News it’s difficult work and burnout is the number one reason people leave.

"We are tasked also with being a little creative about this... yes we need a Masters prepared, licensed therapist. We need PhD level prepared, we need MDs, we need all of that," she said. "But we can also find ways to utilize those with undergraduate degrees.”

If you feel like you might want to talk to someone or know someone who could use some support, below you will find are several agencies to contact:

• 988 Suicide & Crisis Lifeline: 988 is confidential, free crisis service that is available to everyone 24 hours a day, seven days a week.
• 741741 Crisis Text Line: Text “HELLO” to 741741. The Crisis Text hotline is available 24 hours a day, seven days a week throughout the U.S.
• 1-800-273-8266 Veteran Crisis Line: Call 1-800-273-8255 and press 1 or text to 838255. The Veterans Crisis Line is a free, confidential resource that connects veterans 24 hours a day, seven days a week with a trained responder, even if they are not registered with the VA or enrolled in VA healthcare.
• 1-800-985-5990 National Disaster Distress Helpline: The disaster distress helpline provides immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. The helpline is free, multilingual, confidential, and available 24 hours a day, seven days a week
• 1-800-799-7233 National Domestic Violence Hotline: you can alsoText " LOVEIS" to 22522
  
• 1-800-422-4453 National Child Abuse Hotline: you can also Text 1-800-422-4453
  
• 1-800-656-4673 National Sexual Assault Hotline
  
• 1-800-677-1116 Elder Care Locator
  

For more helpful mental health links, click here.

Experts also recommend reaching out to your Human Resources Department at work, since most employers offer free confidential counseling services.

Peers have a unique ability to drive sustained patient engagement, industry insiders said at Behavioral Health Business’ VALUE conference. This makes the peer support model cost-effective for providers looking to shift away from fee-for-service models and toward value-based care.

“Pretty much every person who is getting treatment for a mental health or substance use condition will benefit from peer support,” Shrenik Jain, founder and CEO of Marigold Health, said at BHB’s VALUE conference.

Boston-based Marigold employs peer specialists and recovery coaches and embeds them with partner providers, including outpatient MAT programs, residential treatment and primary care groups. It also operates a technology platform where members can communicate with each other in anonymous forums moderated by peer specialists.

Peer support specialists are people with lived experience of behavioral health conditions who are now in recovery and can offer support to people currently grappling with similar conditions. They are not clinically trained and do not offer diagnoses or treatments.

“That scope of practice is really important,” Dr. Kim Newell Green, co-founder and chief medical officer of Flourish Labs, said. “Peer supporters say, I have been there in your shoes, and I know that you can recover, I know that you have everything you need inside of you. So let’s figure out what your strengths are, set some goals, and I’m going to be alongside you as you walk this path towards recovery.”

Dr. Kim Newell Green, co-founder and chief medical officer of Flourish Labs, speaks at BHB’s VALUE conference.

Flourish Labs uses technology to help scale professional peer support. It trains young adults to become certified peer support specialists and then pairs them with teens in need of help.

Peers role in value-based care

Peers play a critical role in value-based behavioral health care as part of a full continuum of care, according to Dana Foglesong national senior director of recovery and resiliency services at Magellan Healthcare.

Magellan Healthcare is the managed care subsidiary of Magellan Health, a health plan focused on special populations. Magellan Healthcare covers 19.5 million lives and has more than 1,000 employer contracts.

Peers are a valuable resource for providers to drive value, not just because of the evidence supporting their effectiveness.

“In my mind, there’s a massive opportunity in this space to begin to use peers,” Green said. “In many ways, they are a faster workforce to train, maybe a little bit less expensive than some of the more licensed providers and can provide incredibly high-quality work.”

Despite the potential benefits of value-based arrangements, peer support is most commonly reimbursed through a fee-for-service model.

“If you think about the sophistication that has to go into a values-based arrangement, it’s mostly because the field in general collectively has not gotten to that level of sophistication,” Foglesong said. “But we at Magellan definitely do case rates and bundled payments.”

Marigold most commonly operates on a case rate model. Peers’ roles mainly involve getting patients engaged in care, Jain said, but traditional fee-for-service models do not account for the research and effort that peers put in before connecting with patients.

“Whereas on the day rate, that continuous work to keep someone sticky in a personalized way [is reimbursable],” Jain said. “We’ve found that conceptually for a lot of the plans we talk to, paying for more peer support is actually not a controversial thing. It’s a no-brainer. It’s a very cost-effective service and a very, very small percentage of the people who could benefit currently use it.”

Growing adoption of peer-based models

Peer models are gathering momentum nationwide, especially over the last five years, Jain said, citing his company’s quick expansion. Two years ago Marigold operated in a single state. The company now operates in half a dozen.

Also signaling increased traction for peer support models, certification processes now exist in every state and are Medicaid reimbursable in 35. The Substance Abuse and Mental Health Services Administration (SAMHSA) considers peer support to be a best practice. 

Multiple factors have spurred increased discussion and adoption of peers at the national level, Foglesong said.

“One of those is the opioid crisis,” Foglesong said. “As a result, millions of dollars have flowed through states, localities and different federal agencies that have focused on the substance use peer support workforce. Since in many spaces, those certification trainings are combined, that’s just naturally grown the capacity around building a workforce.”

The White House has also driven an increased spotlight on peers.

In 2022, The Biden-Harris administration released a national mental health strategy that included a commitment to build a national certification program for peer specialists to “accelerate universal adoption, recognition and integration of the peer mental health workforce.”

In January, The Centers for Medicare & Medicaid Services (CMS) furthered the legitimization of peers by releasing a code specific for principal illness navigation-peer support that defines the role of peers in Medicare.

Despite the progress with the CMS code, Foglesong noted that it would likely take at least a decade before Medicare fully utilizes peers.

There is more of an opportunity for peers in Medicaid, Jain said.

“In Medicaid, the money’s there, the rates have gone up, plans want to see the service delivered more,” he said. “And there’s a shortage of actually scalable care delivery models.”

A barrier to fully leveraging peers in the behavioral health industry, Jain said, is providers’ lack of experience in effectively operationalizing a peer workforce.

“Especially if you see a large Medicaid population … look at the waiver for your state and actually look at what the benefit says, because the benefit is oftentimes saying that it’s a service that a broad range of folks can actually receive,” Jain said. “But we as providers don’t always have the model to operationalize that efficiently.”

Despite growing acceptance, progress is still being made in the large-scale adoption and regulation of peers.

It would be “much easier” for companies offering peer support if there was a single national certification standard, rather than each state having its own process, Green said.

Unmasking Myself

Despite seeing signs of autism in my son and his father, the idea that I could be autistic myself never occurred to me. My initial ignorance regarding my own condition was likely due to preconceived notions of how autism should 'look.' My lack of self-recognition is a testament to the power of stereotypes and stigmas associated with autism. It wasn't until my son was three and struggling with emotional regulation that I saw the parallels between us. His difficult behavior mirrored my own struggles. It dawned on me: "My son is just like me!

This realization motivated me to confront my own situation. I wanted to learn how to manage my challenges, not just for my own well-being, but to guide my son towards a better, easier life with less struggles than I had growing up without that early intervention. I got my official diagnosis after many tests and therapy sessions-Autism Level 2, ADHD, OCD, PTSD, and Anxiety Disorder. 

Over the years, I had been misdiagnosed multiple times with mental health issues including Bipolar Disorder, Borderline Personality Disorder, and Depression. While I could relate to each of these disorders to various extents, none of them fully encapsulated my lived experience. With an accurate diagnosis, I was able to better understand my true condition, affirm my experiences, and navigate my life with greater clarity moving forward.

Understanding the Connection with Substance Abuse

The journey of self-discovery also helped me understand the struggles of my family members. My mother exhibited signs of severe mental illness. She was very abusive and emotionally and financially unstable. Unfortunately, she never received proper treatment and was left undiagnosed. Growing up, my brother was kicked out of school and eventually landed in the foster care system. As he got older, he was stuck in the agonizing loop of substance abuse tied to ADHD, autism, and bipolar disorder, which were not diagnosed until adulthood. Across the board, individuals with mental health disorders often resort to methods of self-medication when they lack proper support and resources. This desperate need to escape discomfort or achieve temporary relief points to a clear connection between substance usage and disorders such as autism 1. I myself used marijuana and alcohol for many years, without realizing there could be an underlying reason.

Unmasking Autism

After my and my son’s diagnosis, it became a passionate pursuit for me to better understand autism and mental health as a whole. My search included both personal introspection and extensive therapy sessions. The journey was overwhelming at times, but helped me face "masking" ‒ a behavior common among individuals with mental health disorders. We hide our struggles to fit into societal norms, eventually convincing ourselves and others that we're okay when we may not be 2. We push through things. We try to survive. It takes so much effort to be what is considered “high functioning.” 

firsthand Experiences

Now, as a firsthand Guide (peer support specialist) at firsthand, I use my lived experience and insights to help and inspire others who are currently navigating their own mental health struggles. I continue to experience growth, both professionally and on an individual level, as I learn more about myself each day. I've also learned the importance of vulnerability and authenticity – to strive to be secure in expressing feelings or speaking my truth.

Through the process, I've learned to appreciate the importance of being your authentic self, and what that truly means, in spite of mental or neurological differences. We can all learn from each other's experiences and empathize with their struggles and triumphs.

It's essential to approach any person from a place of openness and humility. Remember, your perception may not capture the whole picture - the similarities between Bipolar Disorder and Autism illustrate this well 3.

By sharing my personal journey living with autism, I hope to continue raising awareness, enhancing understanding, and humanizing the narratives around autism and other forms of neurodiversity. By doing so, I believe we can collectively break down existing stigmas and misconceptions, fostering a more empathetic world for everyone that struggles with mental illness and disorders. 

Sources:

1. Autism and Addiction Close Connection

2. Reflections on Unmasking

3. Bipolar Disorder and Autism Differences

“We are facing a crisis with increasing shortages of behavioral health care professionals such as mental health counselors and social workers. With the establishment of the center, we will be able to address this urgent need and continue our important work in this area. I appreciate that the state has entrusted us with increasing access to behavioral health care for those who need it.” – Julie Serovich, dean of the College of Behavioral and Community Sciences

USF was recently awarded $5 million in recurring funds to create the center to enhance recruitment and retention efforts and expand pathways to behavioral health professions. Based in the College of Behavioral and Community Sciences, the Florida Center for Behavioral Health Workforce joins the Louis de la Parte Florida Mental Health Institute at USF – which serves as the conduit between academic researchers, community organizations and government agencies – in strengthening mental health services in Florida through research, training and education.

According to the U.S. Department of Health and Human Services, nearly 1 in 4 U.S. adults lives with a mental illness. Nationally, more than half the population lives in an area with a shortage of mental health professionals; the situation is worse in Florida. The agency attributes the shortage to a number of factors, such as lack of uniformity across mental health-related professions, reimbursement challenges and provider burnout.

The creation of the Florida Center for Behavioral Health Workforce and the $5 million in recurring state funds provided to operate it, were components of Senate Bill 330, sponsored by Sen. Jim Boyd and Rep. Sam Garrison, which was one of the bills included in the Live Healthy legislation package signed by Gov. Ron DeSantis in March. Senate Bill 330 also creates a new category of teaching hospitals dedicated to advancing behavioral health care. In partnership with USF, Tampa General Hospital was selected to be one of four hospitals throughout the state to receive the “behavioral health teaching hospital” designation.

Sen. Jim Boyd

“Nationally, we’re facing a growing mental health crisis. Florida is taking a proactive approach to strengthen our behavioral health care system and grow our health care workforce to support the needs of Floridians,” Boyd said. “Senate Bill 330 is an integral part of the solution. It creates the Center for Behavioral Health Workforce within the University of South Florida Louis de la Parte Florida Mental Health Institute to promote education, foster innovation and advance research initiatives in Florida. I am grateful for the support of USF, Gov. Ron DeSantis, Senate President Kathleen Passidomo and my colleagues in the Florida Legislature for supporting this meaningful legislation that is now Florida statute."

Rep. Sam Garrison

“The demand for mental and behavioral health services is greater than ever before,” Garrison said. “The passing of Senate Bill 330 shows that the state of Florida is at the forefront of addressing this critical demand by expanding access to behavioral health services and working to create and support a highly skilled mental health workforce pipeline at the newly established Florida Center for Behavioral Health Workforce at the USF Louis de la Parte Florida Mental Health Institute.”

The College of Behavioral and Community Sciences is uniquely positioned to serve as home of the Florida Center for Behavioral Health Workforce because of its interdisciplinary and collaborative focus that includes the behavioral sciences in one college and its portfolio of research conducted in FMHI over the past 50 years.

“Through our recent research to understand the need for mental health services and the availability of behavioral health care providers, we project a significant gap," said Carrie Zeisse, president and CEO of Tampa Bay Thrives, a local organization that champions mental health advocacy through legislation, community partnerships and public education. "We are thrilled that the Florida Center for Behavioral Health Workforce will be in place to ensure that there are adequate pathways and strategies for growing this important sector."

Throughout the last year, 55 behavioral health care students gained hands-on experience working with one of 40 local organizations that partner with USF, such as Tampa Bay Thrives, as part of their field placement. In addition to undergraduate degrees, students can also earn master’s degrees in rehabilitation and mental health counseling, marriage and family therapy, applied behavior analysis and social work. USF also offers doctoral degrees in applied behavior analysis, behavioral and community sciences and social work.

USF has a strong track record of keeping a pulse on workforce demands and rising to the challenge through the creation of new curriculum and programs. The USF College of Nursing is home to the Florida Center for Nursing and is in the process of expanding undergraduate nursing education. More than 750 undergraduates are expected to graduate with a degree in nursing by 2028 – a 200% increase – helping address the critical nursing shortage. 

First responders face extremely stressful situations.
DANA NUMKENA, BEC PHOTOGRAPHY

Out of the thousands of calls Mary Jensen answered throughout her 20-year career as a 911 dispatcher in South Florida, the memory of a singular gunshot still rings out with haunting clarity.

“An elderly gentleman had called one afternoon,” Jensen said. “He asked for the police to respond. When I tried to question what he needed, he just said to send somebody right away and hung up.”

Jensen called back and asked the woman who picked up to quickly locate him.

“As she walked into his bedroom, that’s when the gunshot went off. He had taken his own life,” Jensen said. “I can still hear that sound. I can still hear her scream.”

National Public Safety Telecommunicators Week, which is being celebrated April 14-20, is not only the ideal time to recognize current and former 911 dispatchers like Jensen but also to ensure they have the proper tools to process the traumas they face every day.

Emergency dispatchers become part of traumatic events unfolding in real time. That constant weight takes an emotional toll that can lead to damaging and sometimes life-threatening behaviors.

Jensen said she’s seen the negative impacts of the job manifest differently among her friends.

“Some turn to alcohol and some turn to suicide,” she said.

Statistically, first responders and dispatchers have higher rates of relationship issues, alcohol or drug abuse, and suicide attempts and completions. In fact, more than 1,250 first responders in the U.S. have taken their own lives since 2018, according to Blue H.E.L.P. Eighty-one of those were in Florida.

However, Jensen said that seeking help — especially from a peer — can make a significant positive difference in dispatchers’ mental health.

Jensen recalls that she reached her breaking point on the day of that suicide, but that a colleague, who happened to be part of their organization’s critical incident stress management team, recognized she was upset and took her on a walk. That simple outreach from a peer proved remarkably effective in helping Jensen process the trauma and feel supported.

No longer an emergency dispatcher, Jensen has come full circle as one of dozens of peer specialists on the other line when a first responder needs help. Jensen co-founded and serves as chief operations officer for Zero Life Center, one of several providers that administer a First Responder Peer Support program, developed and managed by LSF Health Systems.

The program employs specially trained peer specialists, who are current or former first responders or military members, to provide confidential and free support to first responders and their family members across 20 counties in Northeast and Northern Central Florida, including St. Johns County. This includes dispatchers, police officers, firefighters, EMTs and corrections officers.

By calling 211, a first responder can talk privately with someone who has been in their shoes. Dr. Christine Cauffield, CEO of LSF Health Systems, said with the split-second decisions dispatchers make each day, it is only natural that they carry a lot of emotional weight on their shoulders.

“With this program, they have a free, confidential way to release some of that burden,” Cauffield said. “They are there for us ‘first,’ so our program is designed to be there for them ‘now.’”

For more information on First Responder Peer Support, first responders can go to StayFitforDuty.org or call 211.

Approximately 49 million people in the U.S. population aged 12 or older had a substance use disorder in 2021—and most went without treatment.

That amounted to 17.3% of the population living with these disorders, according to 2022 Substance Abuse and Mental Health Services Administration data released in November 2023. These sometimes deadly disorders are on the rise: The share of Americans with substance use disorders jumped by nearly a percentage point from 2021 to 2022, per SAMHSA data. Reported drug overdose deaths are also rising compared to historical levels, reaching nearly 106,000 in the 12 months ending in September 2023, compared to just under 69,000 during the same period in 2019.

In Florida, there were about 60,358 people in substance use treatment in 2021, or 271 for every 100,000 residents. It ranks #45 among states for the share of its population seeking treatment, and has 681 substance use treatment facilities. Other SAMSHA data suggests that about 14.7% of the state's population has a substance use disorder, ranking #49 among U.S. states and D.C. The 2021 SAMHSA survey used official diagnostic criteria to determine estimates of the prevalence of substance use disorder, basing questions on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

The survey showed that most who didn't receive treatment believed they didn't need it. But there are many other reasons people don't seek treatment, including a lack of facilities, long waiting lists, and high expenses. There are exceedingly low vacancies at residential substance use rehab facilities, so help isn't always available for those who seek it.

Treatment for substance use disorders can save lives—but treatment options aren't universally accessible. Ophelia identified the number of people in each state being treated at substance use treatment facilities—and further analyzed treatment within Florida—as of the 2022 National Substance Use and Mental Health Services Survey, the most recent and comprehensive data available. For this analysis, statistics are mapped as the number of patients per capita within each state.

REGIONAL DIFFERENCES IN SUBSTANCE USE TREATMENT

There is a relatively weak correlation between substance use disorder prevalence and the share of residents in treatment. However, there are some standouts within the data.

For instance, in Washington D.C., SAMHSA estimates that about 23%, or nearly 1 in 4 residents, have substance use disorders—the highest in the nation. However, the district has one of the lowest concentrations of residents in treatment. On the other hand, West Virginia, Maine, and Arizona have high concentrations of people in treatment but relatively average prevalence of the disorders.

Some states reinforce the correlation: Vermont, for example, has the third-highest rate of substance use disorders but also the third-highest rate of people in treatment for those disorders. Texas and Hawaii both have low rates of substance use disorder and low concentrations of people in treatment. SAMHSA provides state profiles to dive deeper into the volume and types of services each state offers.

Since substance use disorder has been more widely viewed as a treatable disease, and in the 13 years since opioid use specifically was declared an epidemic, treatment options and humane care have grown. Still, research has found that there are still high volumes of unmet need nationwide.

The federal government is continually rolling out resources to address this need. In early February 2024, SAMHSA announced two grant opportunities to expand treatment within adult and family treatment drug courts and among pregnant and postpartum people. Last year, the agency awarded tens of millions in grants toward prevention programs, connecting people to treatment and recovery services, and expanding access to medications for opioid use disorder. Some of these have focused on funding state solutions, allowing states to develop services specific to their populations' needs.

This story features data reporting and writing by Paxtyn Merten and is part of a series utilizing data automation across 51 states.

This story originally appeared on Ophelia and was produced and distributed in partnership with Stacker Studio.

© Stacker Media, LLC.

DeSantis also signed two bills that, along with the expansion of the Coordinated Opioid Recovery (CORE) Network, would bolster the state's fight against the overdose crisis, he said Monday at a lectern in Seminole County, behind a sign that read "Fighting Fentanyl."

The CORE recovery program is modeled on a program in Palm Beach County, which, among other efforts, created a hospital unit, especially for patients who have overdosed. Unlike other ERs, patients are hooked up with needed services such as housing and are urged to go into treatment. The Addiction Stabilization Unit at JFK North Hospital in West Palm Beach also helps patients with medication-assisted treatment — drugs like Suboxone — that help sustain recovery.

One of the bills DeSantis signed Monday deals with first responders being exposed to fentanyl. He said the bill (SB 718) would "make sure that the people that wear the uniform are protected." State Surgeon General Joseph Ladapo and Department of Children and Families Secretary Shevaun Harris joined DeSantis at the press conference.

"If an officer says 'Do you have drugs in your possession,' and you lie, and then the officer ends up getting exposed and harmed, we're gonna throw the book at you, and we're gonna hold you accountable," DeSantis said.

According to national medical experts, however, first responders being exposed to fentanyl isn't a problem that needs legislation. Instead, they say, this law would create an “unnecessary concern."

“National bodies of experts have thoroughly assessed the risk of exposure to fentanyl during emergency response and have determined it to be extremely low,” wrote Dr. José G. Cabañas, president of the National Association of EMS Physicians, in an email to USA TODAY Network-Florida in January.

“It is essential to recognize that such a policy could also potentially discourage bystanders or family members from reaching out for emergency assistance during an overdose,” he added.

DeSantis also signed another bill (SB 66), also known as "Victoria's Law," which establishes June 6 as a day for the Florida Department of Health "to raise awareness of the dangers of opioid overdose and the availability and safe use of opioid antagonists as an effective way to rapidly reverse the effects of opioid overdose."

Victoria Siegel, the daughter of reality TV star Jackie Siegel, who also starred in 2012's "The Queen of Versailles," died at 18 from an overdose in 2015.

The CORE Network is an effort between the state's Department of Health, Department of Children and Families and the Agency for Health Care Administration. Its aim is to curb the number of deaths caused by the polluted drug supply and will be expanded to 29 counties.

The program, which started in 12 counties in 2022, connects people with medication treatment, recovery programs and peer support.

Counties that will now have CORE clinics are: St. Lucie, Broward, Miami-Dade, Indian River, Brevard, Clay, Escambia, Gulf, Marion, Pasco, Volusia, Citrus, Duval, Flagler, Manatee, Pinellas, Bay, Collier, Hernando, Hillsborough, Lake, Lee, Leon, Monroe, Okaloosa, Orange, Polk, Sarasota and Seminole counties.

At a late August meeting in a windowless room at Minneapolis College, a handful of students barely a week into classes sat back on couches, took a breath, and marveled that they were there at all.

“Gifting myself with an education is a part of my recovery,” said Nomi Badboy, age 43, one of three students attending this week’s meeting of the school’s collegiate recovery program. But she admitted to feeling overwhelmed: Her four kids were trying her nerves, her ailing father was requiring more of her time, and a bad-news ex had left her with a destructive puppy and a lingering disbelief that she can pull it all off. 

Ray Lombardi, 50, listened thoughtfully. “What I’m hearing is that we have three things in common: It’s hard to be a parent. It’s hard to stay sober. And it’s hard to go back to school as an adult,” he said, adding, “It would be a great tragedy to get sober, get my life in order, and then come here and have college be the cause of going back into using.” 

WHY WE WROTE THIS
Community colleges are increasingly embracing students who are recovering from substance use disorder, creating programs and tackling challenges like funding and staffing. Their involvement offers a path to access – and second chances.

Collegiate recovery programs began appearing at four-year institutions in the late 1970s, offering services like sober-living dorms, life skills classes, and recovery coaches. Today, more than 170 programs exist across the United States and Canada. But it’s only in the last dozen or so years that programs began popping up at community colleges; Minneapolis College’s program, opened in 2017, was the first in Minnesota and the fifth in the nation.

Today, there are at least 23 recovery programs at community colleges. Their expansion reflects a growing awareness that many survivors of opioid addiction and those who struggled with substance use during the pandemic are now enrolling in pursuit of a fresh start. But despite the need, the programs face significant obstacles, and many are scrambling for dollars and staffing to stay afloat.

Substance use disorder affects about 18% of American adults, according to national statistics. Among 18- to 25-year-olds, the share is nearly 28%. Meanwhile, of the 29 million adults nationwide who said they’ve ever had a problem with substance use, about 72% considered themselves to be in recovery or recovered.

Unlike treatment, a necessary but often short-term process, recovery is the long-term work of rebuilding a healthier and typically sober life. Education is an example of what’s called “recovery capital,” something earned that makes long-term recovery more likely.

Community colleges are a natural first step for people in recovery, says Jessica Miller, who oversees four collegiate recovery programs, including two at community colleges, for the Ten16 Recovery Network, a substance use disorder treatment provider in Central Michigan. At two-year institutions, admission is accessible, tuition is affordable, and flexible coursework fits into schedules complicated not only by jobs and families, but counseling, support groups, and doctor visits.

“I don’t know why we weren’t trying to do this years ago,” she says.

A broader approach to recruitment
In November, the Association of Recovery in Higher Education, which serves as a hub for the programs, launched a working group tasked in part with editing the guidelines for starting recovery programs to make them more applicable to community colleges. A new networking group for community college program coordinators held its first call in February. 

Advocates say the growing number of recovery programs makes sense not just for individuals but for community colleges looking to recoup lost students. Since 2010, enrollment at two-year institutions has declined by nearly 40%, as more people have opted to remain in the workforce or head directly to four-year colleges, among other factors.

Minneapolis College's collegiate recovery program opened in 2017, the first in the state to be housed at a two-year school.

Minneapolis College's collegiate recovery program opened in 2017, the first in the state to be housed at a two-year school.

The downturn has pushed community colleges to broaden their approach to recruitment, resulting in an increase in the number of students requiring more support and services, says Taylor Odle, an assistant professor of education policy studies at the University of Wisconsin-Madison. The schools are pursuing their goals of serving more students, but the additional supports bring higher costs. “The price tag is not the same,” he says.

Schools investing in recovery programs do so without an abundance of research connecting the programs to improved student outcomes. But the data that exists is encouraging, says Noel Vest, an assistant professor of community health sciences at Boston University. A 2014 paper reviewing the impact of recovery programs, mostly at four-year colleges, found lower incidences of relapse for involved students and slightly higher GPAs and graduation rates compared to their peers overall.

Dr. Vest plans to complete a study this summer of five recovery programs, including Minneapolis College’s. He expects the findings to illuminate best practices for the programs and provide an evidence-based foundation for starting more of them. “Right now,” he says, “the data that says we must be doing this just isn’t out there.” 

In the interim, advocates for the programs are using creative approaches to keep them alive and growing. At Tompkins Cortland Community College near Ithaca, New York, program leaders have forged connections with student groups on campus whose struggles with substance use might fly under the radar, such as student athletes. 

In Central Michigan, the Ten16 Recovery Network is helping its clients enroll in colleges with recovery supports by providing pre-enrollment services at its out-patient treatment facilities. A client might meet with the collegiate recovery program coordinator, for example, to receive counseling about which career paths might be a good fit, and which ones might present obstacles due to the client’s history with addiction and the legal system. 

At Skagit Valley College, a two-year institution north of Seattle, Aaron Kirk runs the recovery program for formerly incarcerated students jointly with the school’s Breaking Free Club. (About 60% of people who are incarcerated struggle with substance use disorder, according to the Substance Abuse and Mental Health Services Administration.) In his role, Mr. Kirk has built a relationship with the local drug court, which offers alternative sentences to eligible individuals who commit to treatment for substance use. Typically, the sentences include a work or education component, making Skagit Valley a natural fit.

“Hope for the future”

Genevieve Ward, 42, enrolled at Skagit Valley in the summer of 2021 after spending time in prison on a drug conviction. While taking coursework in human services, she used money earmarked for students in the recovery program to earn certification as a peer recovery coach. She uses the skills daily as a leader in the recovery housing where she lives near campus.

The collegiate recovery program at Minneapolis College has faced funding and staffing challenges.

“In school, the number one struggle is that most of us don’t feel like we’re smart enough. That’s what I see the most, and what I feel the most,” she says. She credits the Breaking Free Club with creating the community she and her peers need to beat back their insecurities and succeed in the classroom.

In the years leading up to her incarceration, Ms. Ward says she was living each day simply to survive. “But this college, this club, has given me hope for the future — I know that there is one.” After graduating this spring, she plans to transfer to nearby Western Washington University, where talks are underway to expand recovery supports thanks in part to advocacy from students in the Breaking Free Club. Ultimately, she hopes to land in a career that helps people with struggles like the ones she’s faced.

For many students like Ms. Ward, community colleges’ flexible academic offerings make college possible. But the same flexibility creates obstacles to the success of on-campus groups. Options like part-time course loads, online classes, and short certificate programs can stymie consistent attendance and participation. Even for full-time students, the two-year window creates frequent turnover. “A lot of our work is student-led,” says Mr. Kirk at Skagit Valley. “It’s challenging to have these awesome leaders who graduate so quickly.” 

It’s also hard to engage students in recovery programs when they don’t have the time to linger on campus. “These students are flying home from work, making dinner, getting their kids settled, then racing to get over here on time for class,” says Cheryl Kramer, recovery program advisor at Cape Cod Community College, in Massachusetts. 

“The need is everywhere”

But the toughest scrambles are often for staff and funding. Jonathan Lofgren, a professor of addiction counseling at Minneapolis College, launched the college’s program in 2017 after a sabbatical year studying recovery on college campuses. School leaders provided a dedicated space for the program and allowed Dr. Lofgren a half day per week to manage it, but they stopped short of hiring a dedicated coordinator. 

During the pandemic, the program moved online and participation dropped. Welcome news arrived in 2021, though, when the school won a state grant in collaboration with a nearby four-year university, providing funding for two paid interns, a peer recovery coach, and a coordinator, Lisa Schmid.

But amid a nationwide shortage of staff in the treatment and recovery field, the peer coach and one intern position remain vacant. In November, Ms. Schmid took extended personal leave, which left her role unfilled as well. While she was out, two student workers ensured the recovery program room stayed open, emails went out, and weekly meetings happened. But broader goals, like increasing awareness of recovery support services on campus, lost steam.

When Ms. Schmid returned from leave in February, she prioritized spreading word of the program to likely partners, such as the college’s veteran services program and its admissions team. In March, Minneapolis College leaders reached an agreement with the campus health clinic to continue funding her position once the state grant runs out. 

“The need is everywhere,” Ms. Schmid says. Recovery “has always been such a hush-hush thing. How do we normalize it?”

The recovery room at Minneapolis College, staffed by student workers like Connie Hsu, is open daily for drop-in support or as a place to relax and work.

Advocates hope that a percentage of the hundreds of millions of dollars in state opioid settlement funding can be earmarked for collegiate recovery, and that Congress might one day approve additional funding. President Biden’s stalled 2024 budget includes $10.8 billion for the Substance Abuse and Mental Health Services Administration, of which 10% would be set aside for recovery support services. 

In a handful of states, legislation has made for a rosier funding picture. Washington lawmakers passed a bill in 2019 that led to the creation of a state grant fund to support recovery. From that work grew the Washington State Collegiate Recovery Support Initiative, which has provided funding for eight colleges, including four community colleges, to open recovery programs or provide recovery services in pre-existing programs, like Skagit Valley’s Breaking Free Club.

Patricia Maarhuis of Washington State University says that, ultimately, collegiate recovery supports are about propelling academic success. “People might say this is just another student group, but no. This is not the frosting; this is the cake. If you want your students to stay in school and do well, you need recovery supports.” 

Back in Minneapolis, Ms. Badboy has found a new home for the destructive puppy and her kids are settled in good schools and daycares. She’s thriving in her classes and expects to graduate in 2025. The balancing act of family, school and recovery, for now, is stable.

Recovery is painstakingly hard, she says. But her journey – more than 12 years sober after nine bouts of treatment – has created a firm structure in her life that supports college success as much as it supports her well-being. Her peers in the program understand that in a way few others can, she says, and she feels accountable to them. 

“It’s made it so that I really want to do this – almost that I must do this, I have to do this,” she says. “Because other people like me, who’ve felt the same way about themselves, need to see that this is possible.”

This story about collegiate recovery programs was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. The piece is also appearing in the MinnPost, in Minneapolis. 

mikkelwilliam/Getty Images

With rates of suicide and opioid deaths rising in the past decade and children's mental health declared a national emergency, the United States faces an unprecedented mental health crisis. But access to mental health care for a significant portion of Americans — including some of the most vulnerable populations — is extremely limited, according to a new government report released Wednesday.

The report, from the Department of Health and Human Services' Office of Inspector General, finds that Medicare and Medicaid have a dire shortage of mental health care providers.

The report looked at 20 counties with people on Medicaid, traditional Medicare and Medicare Advantage plans, which together serve more than 130 million enrollees — more than 40% of the U.S. population, says Meridith Seife, the deputy regional inspector general and the lead author of the report.

Medicaid serves people on low incomes, and Medicare is mainly for people 65 years or older and those who are younger with chronic disabilities.

The report found fewer than five active mental health care providers for every 1,000 enrollees. On average, Medicare Advantage has 4.7 providers per 1,000 enrollees, whereas traditional Medicare has 2.9 providers and Medicaid has 3.1 providers for the same number of enrollees. Some counties fare even worse, with not even a single provider for every 1,000 enrollees.

"When you have so few providers available to see this many enrollees, patients start running into significant problems finding care," says Seife.

The findings are especially troubling given the level of need for mental health care in this population, she says.

"On Medicare, you have 1 in 4 Medicare enrollees who are living with a mental illness," she says. "Yet less than half of those people are receiving treatment."

Among people on Medicaid, 1 in 3 have a mental illness, and 1 in 5 have a substance use disorder. "So the need is tremendous."

The results are "scary" but "not very surprising," says Deborah Steinberg, senior health policy attorney at the nonprofit Legal Action Center. "We know that people in Medicare and Medicaid are often underserved populations, and this is especially true for mental health and substance use disorder care."

Among those individuals able to find and connect with a provider, many see their provider several times a year, according to the report. And many have to drive a long way for their appointments.

"We have roughly 1 in 4 patients that had to travel more than an hour to their appointments, and 1 in 10 had to travel more than an hour and a half each way," notes Seife. Some patients traveled two hours each way for mental health care, she says.

Mental illnesses and substance use disorders are chronic conditions that people need ongoing care for, says Steinberg. "And when they have to travel an hour, more than an hour, for an appointment throughout the year, that becomes unreasonable. It becomes untenable."

"We know that behavioral health workforce shortages are widespread," says Heather Saunders, a senior research manager on the Medicaid team at KFF, the health policy research organization. "This is across all payers, all populations, with about half of the U.S. population living in a workforce shortage."

But as the report found, that's not the whole story for Medicare and Medicaid. Only about a third of mental health care providers in the counties studied see Medicare and Medicaid patients. That means a majority of the workforce doesn't participate in these programs.

This has been well documented in Medicaid, notes Saunders. "Only a fraction" of providers in provider directories see Medicaid patients, she says. "And when they do see Medicaid patients, they often only see a few."

Lower reimbursement rates and a high administrative burden prevent more providers from participating in Medicaid and Medicare, the report notes.

"In the Medicare program, they set a physician fee rate," explains Steinberg. "Then for certain providers, which includes clinical social workers, mental health counselors and marriage and family therapists, they get reimbursed at 75% of that rate."

Medicaid reimbursements for psychiatric services are even lower when compared with Medicare, says Ellen Weber, senior vice president for health initiatives at the Legal Action Center.

"They're baking in those discriminatory standards when they are setting those rates," says Steinberg.

The new report recommends that the Centers for Medicare & Medicaid Services (CMS) take steps to increase payments to providers and lower administrative requirements. In a statement, CMS said it has responded to those recommendations within the report.

According to research by Saunders and her colleagues at KFF, many states have already started to take action on these fronts to improve participation in Medicaid.

Several have upped their payments to mental health providers. "But the scale of those increases ranged widely across states," says Saunders, "with some states limiting the increase to one provider type or one type of service, but other states having rate increases that were more across the board."

Some states have also tried to simplify and streamline paperwork, she adds. "Making it less complex, making it easier to understand," says Saunders.

But it's too soon to know whether those efforts have made a significant impact on improving access to providers.

CMS has also taken steps to address provider shortages, says Steinberg.

"CMS has tried to increase some of the reimbursement rates without actually fixing that structural problem," says Steinberg. "Trying to add a little bit here and there, but it's not enough, especially when they're only adding a percent to the total rate. It's a really small increase."

The agency has also started covering treatments and providers it didn't use to cover before.

"In 2020, Medicare started covering opioid treatment programs, which is where a lot of folks can go to get medications for their substance use disorder," says Steinberg.

And starting this year, Medicare also covers "mental health counselors, which includes addiction counselors, as well as marriage and family therapists," she adds.

While noteworthy and important, a lot more needs to be done, says Steinberg. "For example, in the substance use disorder space, a lot of addiction counselors do not have a master's degree. And that's one of their requirements to be a counselor in the Medicare program right now."

Removing those stringent requirements and adding other kinds of providers, like peer support specialists, is key to improving access. And the cost of not accessing care is high, she adds.

"Over the past two decades, [in] the older adult population, the number of overdose deaths has increased fourfold — quadrupled," says Steinberg. "So this is affecting people. It is causing deaths. It is causing people to go to the hospital. It increases [health care] costs."

Gov. Ron DeSantis has signed a measure that makes privacy protections in Florida’s problem solving courts more uniform.

DeSantis on March 22 signed HB 715 by Republican Rep. Patt Maney, a retired Northwest Florida judge. Sen. Darryl Rouson, a St. Petersburg attorney, sponsored the companion, SB 910.

The legislation creates a public records exemption for participants in veterans and mental health courts, extending the same privacy protections that apply to other problem-solving courts.

With exceptions for the patient’s attorneys and health care providers, the bill would shield from public view such things as intake records, drug screenings, and mental health and behavioral evaluations. The legislation took effect when DeSantis signed the bill.

Because it is a public records exemption, the Legislature must reauthorize it in 2029, or it will sunset.

The Fiscal Year (FY) 2025 President’s Budget includes $8.1 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA), $612 million more than the agency’s FY 2023 enacted budget. The FY 2025 budget proposal continues to support the President’s Unity Agenda to address the nation’s ongoing mental health crisis and overdose epidemic.

“SAMHSA’s Fiscal Year 2025 budget includes vital investments to addressing our country’s ongoing mental health crisis and overdose epidemic by funding programs that promote mental health, prevent substance misuse, provide treatment and recovery supports, while ensuring equitable access and better outcomes for Americans,” said Miriam E. Delphin-Rittmon, Ph.D., the Health and Human Services’ Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA.

SAMHSA’s FY 2025 budget proposal includes resources needed to increase access to suicide prevention and mental health services by serving anyone, any time, from anywhere across the nation through continued expansion of the 988 and Behavioral Health Crisis Services Programs. Given the approximately 8% increase in older adult suicide in 2022, the budget proposes a new grant program in conjunction with the Administration for Community Living (ACL) to reduce suicide among this growing population.

The budget also proposes to change ‘abuse’ to ‘use’ in the agency’s and its centers’ names, to reduce the historic stigma, and to specifically authorize the agency’s Office of Recovery. It expands resources for harm reduction activities, women’s behavioral health services, and treatment for substance use disorder.

Investments to enhance access to suicide prevention and mental health services include:

Investments focused on preventing substance use and overdose include:

The budget also seeks $3.5 million for a Women’s Behavioral Health Technical Assistance Center, which would serve as a national system of clinical consultation and technical assistance for health providers of various disciplines spanning topics across the lifespan within the field of women’s mental health and substance use.

View the SAMHSA budget proposal.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol issues, visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.gov or call 800-662-HELP (4357).

Reporters with questions should send inquiries to media@samhsa.hhs.gov.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (HHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes.

After announcing plans last year, Miami-Dade County officially passed legislation this month to create a Behavioral Health Advisory Board, a significant step towards addressing critical needs of residents’ emotional and mental well-being.

On. Feb. 6, the county commission approved the final reading of an ordinance establishing the Behavioral Health Advisory Board, comprised of 21 voting members selected to assist public and private entities in matters impacting Miamians affected by behavioral health disorders.

The goal is to create a coordinated system of care with adequate capacity to ensure that citizens in crisis have access to quality behavioral health and substance use disorder services, increase access to care and provide direct linkages to community-based services.

The board’s 21 voting members including the director of the Miami-Dade Police Department or the county sheriff, the director of the Miami-Dade Corrections and Rehabilitation Department, the executive director of the Homeless Trust, the state attorney and the public defender for the 11th Judicial Circuit Court, the director of the Miami-Dade Community Action and Human Services Department, the director of the Miami-Dade Juvenile Services Department, the superintendent of schools, the CEO of the South Florida Behavioral Health Network and the CEO of the Public Health Trust.

These 10 persons can serve on the board or appoint a designee. The remaining 11 must be:

■A current member of the county commission.

■A representative from the judicial system in Florida.

■A representative from the State of Florida Department of Children and Families.

■A person involved with veteran services.

■Representatives from two behavioral health service providers licensed in Florida and representing psychiatry, behavioral health, or medical health.

■Two people diagnosed with or suffering from a behavioral health disorder.

■Two family members of people diagnosed with or suffering from a behavioral health disorder.

■An expert in behavioral health sciences.

Member must be permanent residents and qualified electors of the county unless county commissioners, by a two-thirds vote, waives that requirement.

Behavioral Health Advisory Board members will serve unpaid four-year terms. The 11 public members are not subject to the term limit.

Powers and duties of the Behavioral Health Advisory Board include advising county commissioners on behavioral health issues, recommending ordinances, policies, activities or programming, and improving access to treatment.

The board is to develop a needs assessment for behavioral health services and monitor the operations of all behavioral health centers in the county, including the about-to-open Miami Center for Mental Health and Recovery.

Located at 2200 NW Seventh Ave., the new 150,000-square-foot, seven-story building includes a receiving center, integrated crisis stabilization unit, residential treatment, courthouse, outpatient behavioral health and primary care, and dental and optometric services.

Once open, the facility is to have 208 beds, 16 acute care and crisis stabilization beds, 48 short-term residential beds and another 144 for longer-term residential treatment. A team of doctors, nurses, therapists and social workers is to coordinate services.

The campus is to offer day treatment and day activity programs, including a barber shop and basketball court, classrooms and educational spaces, a courtroom, legal and social service agencies, transitional housing, employment services, and vocational rehabilitation.