Early Action for Youth Mental Health and Substance Use: Prevention, Identification, and Support

Promoting youths’ mental health and preventing substance use, along with early identification and intervention, are critical to improving the well-being of young people across the United States. Adolescents and young adults face growing challenges related to mental health and substance use issues. Anxiety and depression rates continue to rise, and although overall youth substance use has declined, it remains unacceptably high, with overdose fatalities exceeding prepandemic levels.^{[i],[ii],[iii]}  Addressing these issues at their root will reduce the long-term personal, social, and economic costs associated with untreated conditions.^[iv] Taking early action prevents crises, eases the burden on health care systems, and helps build a healthier, more resilient generation. Current efforts, however, are failing to meet these urgent needs.

To effectively identify mental health and substance use challenges among youths and to take preventive action, policymakers must recognize these challenges’ connection to upstream factors such as education, economic stability, and community environment. Schools, child welfare agencies, and the military play a crucial role in engaging youth and their families, while primary care settings are expanding access by integrating care. Federal programs also reach those with limited access to traditional health care. A coordinated, whole-of-government strategy strengthens these efforts and ensures broader support for them.

Despite growing awareness of the various challenges, federal funding for youth mental health promotion, substance use prevention, and early intervention remains relatively low. In recent years, resources have stagnated and failed to keep pace with rising demand and the increasing complexity of youths’ needs. Although fiscal responsibility and government efficiency remain priorities, Congress must make critical investments to sustain vital programs such as the Children’s Mental Health Initiative, which help protect the mental well-being of millions of young people. The federal government remains well-positioned to strengthen youth mental health promotion and substance use prevention efforts, even as the Department of Health and Human Services (HHS) implements its recent reorganization plan.^[v]

The Bipartisan Policy Center’s Youth Mental Health and Substance Use Task Force advocates for a national, comprehensive governmental approach to prevention and early intervention. By optimizing investments in prevention and working across nonhealth sectors, the task force aims to strengthen federal support for state and local entities, address funding gaps, and elevate youth mental health promotion and substance use prevention as national priorities. A comprehensive, bipartisan approach is essential to meeting the evolving needs of youths and their families, ensuring they receive the support necessary to thrive.

The task force recommends the following:

1. Congress should direct the Government Accountability Office (GAO) to map and track federal funding for youth mental health promotion and substance use prevention. Congress should also require the Children’s Interagency Coordinating Council to improve coordination across federal agencies to ensure that programs and investments align and are implemented effectively.
2. The Department of Health and Human Services (HHS) should provide guidance and leverage existing funds to develop and strengthen state-coordinated planning structures, such as children’s cabinets. To maximize resources, HHS should also develop a federal guide to highlight best practices for coordinating bodies.
3. HHS should work with states to identify the proportion of funds from the State Opioid Response and Children’s Mental Health Initiative program that are dedicated to youth-focused mental illness and substance use prevention services. HHS should also require states to report on their progress in implementing the latest Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) guidance.
4. The HHS secretary should direct the Centers for Medicare & Medicaid Services (CMS) and the Administration for Children & Families (ACF) to issue joint guidance to improve collaboration between state Medicaid agencies and child welfare agencies. This guidance should seek to strengthen youth mental health promotion, substance use prevention, and early intervention efforts.
5. HHS should work with federal agencies to issue guidance to and provide technical assistance for state and local educational agencies on the use of evidence-based practices in schools and higher education institutions that support prevention and early intervention.
6. The Defense Department should enhance early intervention protocols to identify mental health and substance use concerns among young adult reservists, guardsmen, and children of military families during key stages, including at home, predeployment, and during deployment.
7. The DOD should expand its behavioral health workforce to increase access to services for children of military families and young adult reservists.
8. Congress should allow at least 5% of the Substance Abuse and Mental Health Services Administration’s Community Mental Health Services Block Grant to support early intervention services for young people at risk of serious emotional disturbance (SED) or serious mental illness (SMI).
9. CMS should clarify that for states adopting the Multi-Tiered Systems of Support (MTSS), Tier 1 services can be covered as allowable prevention and early intervention services under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

The Bipartisan Policy Center has long led efforts to strengthen the nation’s behavioral health system by advancing bipartisan solutions that improve behavioral health and primary care integration, expand access to services, and enhance efficient federal spending. Building on this foundation, BPC has prioritized mental health promotion and substance use prevention, and seeks to ensure that early intervention remains central to a comprehensive approach to care.

Through our Youth Mental Health and Substance Use Task Force, we leverage deep expertise to engage policymakers, experts, and community leaders in identifying critical gaps in funding, implementation, and cross-agency coordination. This final publication expands on the task force’s previous recommendations and BPC’s broader mental health and substance use policy work by outlining concrete, actionable steps to enhance prevention and early intervention.

The following sections examine key challenges, the role of federal programs, and the policy solutions needed to ensure that all young people receive the support necessary to thrive.

Endnotes

[i] Nirmita Panchal, “Recent Trends in Mental Health and Substance Use Concerns Among Adolescents,” KFF, February 6, 2024. Available at: https://www.kff.org/mental-health/issue-brief/recent-trends-in-mental-health-and-substance-use-concerns-among-adolescents.

[ii] National Institute on Drug Abuse, “Monitoring the Future,” 2024. Available at: https://nida.nih.gov/research-topics/trends-statistics/monitoring-future.

[iii] Nirmita Panchal and Sasha Zitter, “Teens, Drugs, and Overdose: Contrasting Pre-Pandemic and Current Trends,” KFF, October 15, 2024. Available at: https://www.kff.org/mental-health/issue-brief/teens-drugs-and-overdose-contrasting-pre-pandemic-and-current-trends/.

[iv] National Research Council and Institute of Medicine, Preventing Mental, Emotional, and Behavioral Disorders Among Young People (Washington, DC: National Academies Press, 2009). Available at: https://nap.nationalacademies.org/catalog/12480/preventing-mental-emotional-and-behavioral-disorders-among-young-people-progress.

[v] U.S. Department of Health and Human Services, “Fact Sheet: HHS’ Transformation to Make America Health Again,” HHS Press Room, March 27, 2025. Available at: https://www.hhs.gov/about/news/hhs-restructuring-doge-fact-sheet.html.