Behavioral Health and COVID-19: High-Risk Populations and Related Federal Relief Funding


What GAO found

The effects of the COVID-19 pandemic and related economic crisis, such as increased social isolation, stress and unemployment, have heightened concerns about the number of people in the United States affected by behavioral health issues : mental health and substance abuse disorders. Based on 32 interviews With federal, state, and other stakeholders, and a review of selected research, GAO found that some populations may be at higher risk for new or exacerbated behavioral symptoms or conditions related to the pandemic. Six populations were cited by the greatest number of actors as being at greater risk for such behavioral health effects for a variety of reasons. Children and adolescents, for example, had increasing rates of behavioral health problems before the pandemic and then faced disruptions in behavioral health services in schools, stakeholders said. They also said that people could be in several populations at higher risk, although not all people at risk would develop symptoms or conditions. Stakeholders have warned that with the ongoing COVID-19 pandemic, it will take time to determine how different populations may be affected in the long term.

Populations cited by most stakeholders as being at higher risk of behavioral health effects

As of November 2021, the federal government had provided more than $ 8 billion in COVID-19 relief funds for behavioral health. Over 97% of this funding was provided to states and other recipients through six programs: one program from the Federal Emergency Management Agency and five programs from the Addiction and Health Services Administration. mental (SAMHSA). For example, SAMHSA has awarded approximately $ 5.3 billion to 50 states, Washington, DC, eight US territories and other jurisdictions, and one tribe through supplements to existing block grants for addiction and mental health using standard statutory formulas. The Federal Emergency Management Agency has also provided approximately $ 467 million to 46 states, Washington, DC and four U.S. territories through the Crisis Counseling Assistance and Training Program.

GAO’s review of program documentation shows that COVID-19 behavioral health relief funds, as allocated through the six programs, could generally serve the six high-risk populations identified by stakeholders. . Selected funding recipients in four states and Washington, DC, reported various ways they were using or planning to use relief funds to reach high-risk populations. For example, state officials said they plan to use block mental health grant funds to help children and adolescents in the child welfare service system. SAMHSA officials said it would take time to determine who was actually served by programs funded by COVID-19 relief, but said it was important to examine beneficiary data to determine whether populations targets were met and identified gaps, and the agency planned to do so then.

Why GAO did this study

The COVID-19 pandemic has taken its toll on the behavioral health of the nation. During the pandemic, American adults reported higher rates of symptoms of anxiety and depression and of substance use. To address related concerns, the CARES Act; the 2021 consolidated finance law; and the American Rescue Plan Act of 2021 earmarked relief funds specifically for behavioral health.

The CARES Act includes a provision for GAO to report on its ongoing surveillance and surveillance efforts related to the COVID-19 pandemic. This report describes (1) populations that may be at higher risk for behavioral health effects; (2) the amount and type of funding the federal government has provided as part of COVID-19 assistance to meet behavioral health needs; and (3) whether the COVID-19 behavioral health relief funds could serve high-risk populations, and how the selected funding recipients plan to use these funds. GAO will continue to monitor behavioral health issues as part of ongoing surveillance related to COVID-19.

To conduct this work, GAO reviewed selected research on COVID-19 and behavioral health, as well as relevant documents on federal funding opportunities and awards. GAO also interviewed stakeholders, such as federal officials, researchers, and beneficiaries. Recipients included state officials and providers in four states and Washington, DC, selected based on state behavioral health measures and CARES-funded grants received, among other factors.

The GAO incorporated technical comments from the departments of Health and Human Services and Homeland Security, where applicable.

For more information, contact Alyssa M. Hundrup at (202) 512-7114 or [email protected]


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