The Milbank Quarterly | A Multidisciplinary Journal of Population Health and Health Policy

Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do? 

Perspective

  • The Long Arc of Substance Use Policy Innovation in Medicaid: Looking Back, Looking Forward

    The Long Arc of Substance Use Policy Innovation in Medicaid: Looking Back, Looking Forward

    Brendan Saloner, 

    This Perspective examines the role of Medicaid in the innovation of substance use disorder (SUD) treatment. In 2023, an estimated 49 million Americans met criteria for an SUD and more than 100,000 people died of a drug overdose. Compared with the general population, people with SUD experience worse self-rated health, a higher burden of other chronic diseases, and more hospital care.  More

  • State Policy Strategies to Promote the Recruitment and Retention of the Behavioral Health Workforce

    State Policy Strategies to Promote the Recruitment and Retention of the Behavioral Health Workforce

    Briana S. Last,  Jane M. Zhu, 

    See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do? Access…  More

  • Review of Emergent Financing Models for Mental Health Crisis Systems

    Review of Emergent Financing Models for Mental Health Crisis Systems

    Jonathan Purtle,  Amanda I Mauri,  David Frederick, 

    In this article, we provide an overview of emergent models for funding crisis systems in the United States and the policy and service contexts related to these models. Our review assesses the status of crisis system financing recommendations proposed by Hogan and Goldman proposed in 2020 and complements prior reports about financing crisis services.  More

  • Mapping Mental Health Across US States: The Role of Economic and Social Support Policies

    Mapping Mental Health Across US States: The Role of Economic and Social Support Policies

    Rachel Donnelly,  Mateo P. Farina, 

    Mental health (e.g., anxiety, depression) continues to be a major public health concern in the United States that impacts millions of individuals, their families, and communities. Approximately 21% of adults 18 years and older, or 55 million adults, reported symptoms of recent depression in 2022, demonstrating the wide reach of mental health challenges.  More

  • Medicaid’s Role in Addressing the Mental Health and Substance Use Disorder Challenges of Its Members

    Medicaid’s Role in Addressing the Mental Health and Substance Use Disorder Challenges of Its Members

    Kate McEvoy,  Hannah Maniates, 

    Medicaid has both greatly advanced the scope and integration of mental health and substance use disorder services among payers and remains a work in progress with respect to scaling and funding these services across the country.   More

  • Laws Governing Substance Use During Pregnancy: Next Steps for Health Equity Research

    Laws Governing Substance Use During Pregnancy: Next Steps for Health Equity Research

    Hannah L.F. Cooper,  Anna L. Mullany,  Snigdha Peddireddy,  Simone Wien,  Melvin "Doug" Livingston,  Whitney S. Rice,  Anne L. Dunlop,  Michael R. Kramer,  Madison Haiman,  Lasha S. Clarke,  Natalie D. Hernandez-Green,  Angélica Meinhofer, 

    See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers…  More

  • Integrating Mental Health and Substance Use Treatment With Emergency and Primary Care: The Case of Opioid Use Disorder and Suicide

    Integrating Mental Health and Substance Use Treatment With Emergency and Primary Care: The Case of Opioid Use Disorder and Suicide

    Noa Krawczyk,  Hillary Samples, 

    The United States is facing an ongoing mental health and substance use crisis. In 2023, 58.7 million US adults had a past-year mental illness, 46.3 million had a substance use disorder (SUD), and 20.4 million had both.  More

  • Stemming the Tide of the US Overdose Crisis: How Can We Leverage the Power of Data Science and Artificial Intelligence?

    Stemming the Tide of the US Overdose Crisis: How Can We Leverage the Power of Data Science and Artificial Intelligence?

    Magdalena Cerdá,  DANIEL B. NEILL,  ELLICOTT C. MATTHAY,  JOHNATHAN A. JENKINS,  BRANDON D. L. MARSHALL,  Katherine Keyes, 

    People in the United States are dying at record numbers from overdose. Overdose deaths increased from fewer than 17,000 deaths in 1999 to an estimated 100,000 deaths approximately 25 years after, with a peak of almost 108,000 deaths in 2022. Racial/ethnic minoritized groups are now particularly affected: in 2023, the highest rates of overdose were among non-Hispanic Black and American Indian/Alaska Native Americans. Although overdoses increasingly involve both opioids and stimulants, opioids contribute to over three-quarters of all overdose deaths, primarily driven by illegally manufactured synthetic opioids like fentanyl.  More

  • Legal Barriers to Safer Smoking Supplies Cause Harm and Should Be Removed

    Legal Barriers to Safer Smoking Supplies Cause Harm and Should Be Removed

    Corey Davis,  Amy Lieberman,  Czarina Behrends, 

    The United States continues to experience a nearly unprecedented level of drug-related health harms, with over 105,000 Americans dying of overdose in 2023 alone. Although overall overdose deaths declined slightly from 2022 to 2023, rates for Black people continued to rise. Stimulants such as cocaine and methamphetamine are increasingly involved in overdose deaths, and xylazine and other contaminants continue to be prevalent in the illicit drug supply.  More

Original Scholarship

  • Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services

    Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services

    Jane M. Zhu,  Ruth Rowland,  Inga Suneson,  Deborah J. Cohen,  K. John McConnell,  Daniel Polsky, 

    Behavioral health access gaps are well documented in Medicaid, in which managed care now covers most enrollees, and for which there are typically fewer options for going out-of-network for care. Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services, little is known about MCO levers that can improve access to care.  More

  • Facilitators of, Barriers to, and Innovations in the Implementation of the Trauma Recovery Center Model for Underserved Victims of Violent Crime in Los Angeles County

    Facilitators of, Barriers to, and Innovations in the Implementation of the Trauma Recovery Center Model for Underserved Victims of Violent Crime in Los Angeles County

    Annette M. Dekker,  Adrian Yen,  Andrea Larco Canizalez,  Yesenia Perez,  David Salazar,  Bita Ghafoori,  Dorit Saberi,  Breena R. Taira, 

    The Trauma Recovery Center (TRC) model brings comprehensive care to underserved victims of crime, with improvements in PTSD symptoms and quality of life. Funding concerns were the central limitation in model implementation according to TRC staff.  More

  • US State Policies Regarding Social Media: Do Policies Match the Evidence?

    US State Policies Regarding Social Media: Do Policies Match the Evidence?

    Marco Thimm-Kaiser,  Katherine Keyes, 

    The potential adverse effects of social media use for adolescents have received substantial attention. In response, a growing number of state-level social media regulations are emerging in the United States. These policy interventions are being implemented in the context of mixed scientific evidence, forcing policymakers to weigh the need for proactive regulation against the limitations of extant research. We explore policymakers’ publicly stated rationales for social media regulations and contextualize their claims within extant scientific literature.  More