The Federal and State Role in Mental Health

The federal government works in partnership with the states to address mental health. The federal role in mental health includes regulating systems and providers, protecting the rights of consumers, providing funding for services, and supporting research and innovation. As a major funding source for mental health services, the federal government establishes and enforces minimum standards that states can then expand upon.

• Federal Legislation and Regulations. Federal laws create changes and provide oversight across the states. Legislation at this level may take a longer time but can have a massive impact once passed. Regulations are rules issues by federal agencies to help implement the laws. In terms of mental health, regulations cover a variety of topics and apply to a number of groups including schools, insurance companies, treatment providers, and employers. These rules clarify just how major pieces of legislation like the Americans with Disabilities Act (ADA), the Rehabilitation Act, the Mental Health Parity and Addiction Equity Act (MPHAEA), and the Affordable Care Act (ACA) should be implemented. The agencies also issue additional guidance when questions about compliance arise. The federal government invites individuals and groups to submit comments on regulations. You might see this or hear this referred to as a notice for proposed rulemaking. For more information about how you can be heard, check out www.regulations.gov.
• Federal Protections. The federal government works to protect the rights of individuals with mental health disorders in a variety of settings, including the workplace, schools, and in treatment. It sets privacy standards, prohibits abuse, and fights discrimination to promote civil liberties and inclusion. It works to provide reasonable accommodations and supports to those who need them. Mental Health America's history is deeply rooted in protecting the rights of those with mental health disorders, and this focus continues to guide our work. To learn more from MHA about rights and protections, check out Rights of Persons with Mental Health and Substance Use Conditions, Community Inclusion after Olmstead, and Privacy Rights.
• Federal Role in Funding Services. The federal government is a major funding stream for mental health services. In addition to funding mental health services that fall under Medicare and the Department of Veterans Affairs (VA), it matches state Medicaid and CHIP (Children's Health Insurance Program) spending from between 50 to 70 percent, depending on the state. While these programs do not focus exclusively on mental health, Medicaid is the single largest funder of mental health services in the country, which makes this support especially valuable. The federal government also provides Mental Health Block Grants (MHBG) that support states in building out their community mental health services. MHA supports the continued role of the federal government in funding services and advocates for expanded and sustained funding for mental health services.
• Federal Role in Research. Federal funding of mental health research creates opportunities to study causes of, treatments for, and recovery from mental health disorders that might not otherwise be available. Government agencies, like the National Institute of Mental Health (NIMH) or the Substance Abuse and Mental Health Services Administration (SAMHSA), lead research, administer grants, and educate the public about findings. This information contributes to our overall understanding of mental health disorders and services and can improve treatment and future research.

The States' Role in Mental Health

States have significant power in making decisions about their mental health systems so mental health regulations and available services can look very different from state to state and even from county to county. State mental health systems must meet certain standards set by the federal government, but they are free to expand beyond what exists at the federal level and improve services, access, and protections for consumers. This freedom to experiment with new or innovative services and delivery models allows states to create improvements that can ultimately be translated across the country.

• State Legislation and Regulations. State laws create changes and provide oversight within the state. Regulations are rules issued by state agencies to help carry out laws. In terms of mental health, state regulations can address a variety of issues including treatment facilities, medical records, and standards for involuntary treatment. These rules help states to implement their mental health plans and provide guidance as to what is and is not allowed under law.
• State Protections. States follow the protections established by the federal government with many states increasing protections even further. From the workplace to schools to treatment facilities, states have the power to increase standards for protecting privacy, fighting abuse, and eliminating barriers and discrimination to promote civil liberties and inclusion. This ranges from discretion over civil commitment standards to determining duty-to-warn laws to supporting access to the least restrictive services that keep people in the community. Mental Health America's history is deeply rooted in protecting the rights of those with mental health disorders, and this focus continues to guide our work. To learn more from MHA about rights and protections, check out Rights of Persons with Mental Health and Substance Use Conditions, Community Inclusion after Olmstead, and Privacy Rights.
• States' Roles in Funding Services. A state's role in funding mental health services varies greatly across the U.S. While all states receive federal support via Mental Health Block Grants and partial funding of services provided through Medicaid and CHIP (Children's Health Insurance Program), each has freedom in designing and funding its mental health system. In addition to funding state hospitals, state funding is typically funneled to county and local levels where services are offered. Depending on the state's political and economic climate, states will play a more or less substantial role in funding comprehensive mental health services.
• States' Roles in Research. Because they vary in their services and delivery of services, state reporting of outcomes provides important insight into what may or may not work and can translate into improvements both within a state and across other states. States often use models or areas that have been successful and filter programs upwards, expanding them in size or to other regions. This flexibility can create examples of new or improved programs that can then be implemented around the country. State-funded academic institutions also play an important role in fostering research.