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Adopting a public health approach to substance use by implementing harm reduction policies across all levels of government can help communities address the overdose crisis. This post analyzes e

In an effort to help meet demand, some states and territories have joined interjurisdictional licensing compacts that allow a mental health care provider licensed in one state to provide care in another state—without needing to gain licensure in multiple states. These agreements also offer guidance on patient privacy for services rendered remotely or from out-of-state.

The COVID-19 pandemic has negatively impacted youth mental health, particularly as a result of school closures, social isolation, family economic hardship, fear of family loss or illness, and reduced access to healthcare. However, states have many strategies to choose from to improve youth mental health and reduce suicide.

On the 32nd anniversary of the ADA, this blog post explores state legislation around the country that supports people living with disabilities.

State and territorial health agencies continue to be challenged by the opioid epidemic, which has been exacerbated by the COVID-19 pandemic. Addressing the opioid crisis requires a robust public health response, which could be helped by resources from pending and future opioid settlement funds.

Continuing ASTHO’s Legislative Prospectus series—which highlights the top 10 public health policy issues for 2022—we are focusing this week on mental and behavioral health as well as supporting the public health workforce.

In 2020, the COVID-19 pandemic exacerbated barriers to care and treatment for individuals experiencing opioid use disorder. Experts estimate a record-setting 90,000 people died of a drug overdose in 2020. Additionally, as the pandemic continues, it has understandably diverted attention, funds, and personnel usually focused on the opioid crisis. State and local public health departments are experiencing an all-time low in staffing, especially among Maternal and Child Health programs.

This June marked the 40-year anniversary of the first five cases of what later became known as AIDS reported in CDC’s Morbidity and Mortality Weekly Report. Since then, more than 32 million people have died from the disease worldwide and nearly 38 million currently live with the HIV virus (including 1.2 million people in the United States). Over that period, tremendous strides have been made in HIV testing, prevention strategies, and treatment of individuals living with the virus to ensure that they can lead healthier and longer lives. While these advancements have led to significant progress in reducing HIV/AIDS-related deaths and new infection rates, HIV/AIDS continues to be a persistent problem in the United States. The federal government and state legislatures are taking significant steps toward ending the HIV epidemic, including steps to reduce new infections, combating stigma, and advancing access to care and HIV prevention

With data showing the number of the opioid overdose deaths escalated during the COVID-19 pandemic, access to naloxone, a medication that can reverse an opioid overdose, continues to be an important topic for policy makers. The number of laws and policies to increase access to naloxone have grown over the past several years. Policy makers across the country have expanded access to naloxone by allowing third-party prescriptions for friends, family, and other people who may encounter those at risk of an opioid overdose.

The COVID-19 pandemic has impacted both the physical and mental health well-being of youth. Disruptions in both their home and school life have put youth at risk for poor mental health outcomes that include increased anxiety, depression, and risk of suicide. This Mental Health Month we examine state and territorial legislation that addresses youth mental health.

May is Mental Health Awareness Month and the importance of continued mental health promotion and suicide prevention efforts during the COVID-19 pandemic. As we address the physical effects of COVID-19 through social distancing, mask wearing, and vaccination, we still need to prioritize mental health and well-being during and after the pandemic. A recent Morbidity and Mortality Weekly Report found increases in adults reporting symptoms of anxiety or depression (36.4% to 41.5%) and unmet mental health care need (9.2% to 11.7%) between Aug. 2020 to Feb. 2021.

During the early months of the COVID-19 pandemic, the federal government enacted the Coronavirus Aid, Relief, and Economic Security (CARES) Act, temporarily expanding the use of telehealth technologies by removing various requirements and waiving certain restrictions. Many states also expanded telehealth access through changes to state Medicaid laws. These temporary policy changes created an uptick of telehealth use that improved access to care for millions of Americans—but questions remain about which policy changes will stick around beyond the pandemic. Currently, states are making decisions about what temporary policies to permanently implement and which policies to end without disrupting the delivery of care and further exacerbating health disparities.

Three ways policymakers are addressing access to care are through telehealth, safety net and emergency services, and adjusted reimbursement rates to Medicaid-enrolled providers.

State and federal actions to expand the doula workforce and improve maternal health.

Centering the Community’s Voice in State-Led Health Equity Initiatives health equity, public health departments, health outcomes, michigan public health institute, health disparities, underserved populations, marginalized communities, people of color, indigenous people, premature deaths, minority health, cultural competency, public health, life expectancy, improving health, american indians, health service, african american, native american, social determinants of health, sexual orientation, mortality rate, socioeconomic status, covid-19 pandemic, higher rates, alaska natives, group of people, racial groups, social economic, population health, department of health, astho, association of state and territorial health officials Lana McKinney, Jessica Fepelstein Establishing the community voice in health policy discussions. Over the past two years, ASTHO has worked directly with state public health departments and their communities to build capacity for improving health outcomes. These public health departments are building a culture of health equity through policies, practices, and quality improvement measures. This includes the Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative—a 10-state learning community hosted by ASTHO, the CDC Foundation, and the Michigan Public Health Institute. STRETCH supports states in operationalizing health equity and preventing the constant pressures caused by negative health outcomes on their communities. For example, poverty can create constant pressures just as water pushes against a dam, which can build to the point of breaking and push people into poverty. Additionally, ASTHO supports state and territorial recipients of CDC’s COVID-19 Health Disparities grant to improve the health of high-risk and underserved populations disproportionately impacted by the COVID-19 pandemic. Health disparities impact the quality-of-life and financial well-being of communities, with the economic burden of health disparities increasing from $320 billion in 2014 to $451 billion in 2018. This includes associated costs of excess premature deaths, lost labor market productivity, and excess medical care for Americans of color as compared to their white counterparts. Events in recent years, such as the COVID-19 pandemic, revealed the pressures that Black, Indigenous, People of Color (BIPOC) and other marginalized communities experience because of health disparities. Aligned with the technical assistance received by public health departments, several states have taken concrete steps to achieve optimal health for all by supporting training of public health staff and increasing engagement of under-represented and underserved communities in the policy process. Promoting Staff Health Equity Training Ensuring that public health staff and other leaders are equipped with the knowledge, skills, and attitudes necessary to provide culturally competent and equitable care to all patients, regardless of their social background or identity can improve health outcomes. In recent years, states have worked to expand access to cultural competency and humility training for health system workers. Nevada enacted legislation (AB 267) requiring the state Board of Health to establish the frequency for medical facilities and dependent care facilities to conduct cultural competency training for employees who have direct patient contact. It also (1) requires the Office of Minority Health and Equity and Department of Health and Human Services to establish and maintain a public-facing list of approved courses for cultural competency training, and (2) require nurses, psychologists, marriage and family therapists, counselors, social workers, and behavioral analysts to complete a minimum of three hours of cultural competency training to successfully renew their license. At least four other states—Illinois (SB 2427), Massachusetts (S 1413), Virginia (SB 1440), and Vermont (H 512)—considered bills expanding access to cultural competency training for health care professionals. Vermont’s bill would implement the recommendations of the Health Equity Advisory Commission to provide training and continuing education for health care providers to improve cultural competency, cultural humility, and antiracism in Vermont’s health care system. Public health agencies can also promote health equity training by allocating funding and providing training. For example, the Arizona Department of Health Services leveraged funding from CDC’s COVID-19 Health Disparities grant to establish the Advancing Health Equity, Addressing Disparities (AHEAD AZ) program with the University of Arizona Center for Rural Health, which supports the health care and public health workforce, including support for Arizona’s 17 Critical Access Hospitals health equity strategic plans, and implementing a COVID-19 testing program that provided testing to communities most in need regardless of socioeconomic or immigration status, including those living in correctional facilities and unhoused people. Health Equity Commissions Health equity commissions play a critical role in advancing optimal health for all by bringing together experts, stakeholders, and policymakers to draw on evidence-based approaches that address the root causes of health disparities and to develop strategies to prevent them. At least two states proposed legislation related to health equity commissions in 2023. Colorado passed a law (SB 23-151) extending its Health Equity Commission through 2029. New Jersey is considering S 3136, which would establish and require a Commission on Health Equity to, among other things, recommend implicit bias training requirements for health care providers. Empowering Community Members to Engage in the Policy Process Hearing directly from community members, particularly those with lived experience, provides health agencies with unique insights into the community’s needs and daily life, and helps gain support from those most affected by the policy. There can be several barriers to holistic community engagement, particularly for community members who have fewer resources. Policymakers can take steps to lower these barriers by providing access to childcare, supporting transportation costs to a meeting, and/or compensating community members for their time and effort supporting the policy development process. In 2022, Washington enacted SB 5793 to compensate community members with lived experience for their time and expertise when serving on boards, commissions, councils, committees and other similar policymaking groups. The law directed the state’s Office of Equity to develop equity-driven compensation guidelines for all state agencies, which Washington’s Department of Health used to create and implement its Community Compensation Guidelines. These compensation guidelines outline how and when community members can be paid for their time and expenses when engaging in the policy process. Such methods are particularly valuable because the communities facing the most inequity are also the ones most systemically marginalized. Similarly, in 2023 Oregon’s legislature considered SB 694 to create a Task Force and Work Group Stipend Fund. The fund would provide for providing members who do not otherwise receive compensation for their participation to be compensated for their time and travel for task force or workgroup related work. ASTHO will continue to monitor policy developments supporting health equity programs and initiatives, providing relevant updates. Special thanks to Maggie Davis, JD, ASTHO’s director of state health policy, for her contributions to this blog. Additional Resources to Help Public Health Leaders Increase Community Engagement ASTHO’s Programmatic Health Initiatives and Strategies Georgia Health Policy Center’s Guide to Funding Navigation to help communities design and sustain equity-advancing investment. <!-- Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative framework. --> website yes

Learn how states can leverage policy to reduce ACEs and improve children's well-being in this Health Policy Update.

Legislative Snapshot: Suicide Prevention Infrastructure and AI Chatbots Legislative Snapshot: Suicide Prevention Infrastructure and AI Chatbots JoAnne Deehr Suicides continue to be a critical public health issue — learn how states are leveraging policy to improve suicide prevention. Suicide remains a persistent public health challenge, affecting people of all ages, racial and ethnic groups, geographic regions, and income levels in the United States. Despite ongoing prevention efforts, more than 49,300 Americans died by suicide in 2023. National suicide rates steadily rose from 2003 until 2018 and have remained high since then, reflecting an enduring and widespread impact. While all communities are affected by suicide, certain demographics face higher risks. Disproportionately higher rates of suicide are seen among elderly Americans, Veterans, individuals with lower income, less education, and those living in rural areas. People in certain industries, such as mining, construction, and public safety, are also at elevated risk. At the same time, emerging technologies like chatbots powered by artificial intelligence (AI) have raised new considerations related to safety, oversight, and appropriate use in mental health settings, underscoring the need for thoughtful state approaches to suicide prevention. Policymakers are responding to these challenges in multiple ways, including establishing state suicide prevention infrastructure and regulating AI chatbot use in mental health. Suicide Prevention Infrastructure Legislation Suicide prevention efforts are most effective when states and territories have dedicated infrastructure — such as suicide prevention offices, coordinators, commissions, and fatality review processes — to support coordination, surveillance, and implementation of evidence-based strategies. These structures enable state and territorial health agencies to identify populations and communities at increased risk, align partners across public health, health care, and public safety, and pursue sustainable funding for suicide prevention and crisis system improvements. ASTHO’s Suicide Prevention Offices and Committees Legal Map highlights the varied policy approaches states have taken to establish this infrastructure and identifies which states had statutory suicide prevention structures in place as of January 1, 2025. During the 2025 legislative session, states considered at least 30 bills related to establishing suicide prevention offices, coordinators, advisory bodies, and suicide fatality reviews. Five of these bills were enacted, including Delaware’s HB 54 which establishes the state’s Office of Suicide Prevention. Delaware also enacted HB 87, expanding membership in the state’s Suicide Prevention Coalition to include someone who has experienced suicidal ideation or survived a suicide attempt and someone who has lost a loved one to suicide. Conversely, Oklahoma enacted SB 676, repealing the section of the state’s Suicide Prevention Act that established the Oklahoma Suicide Prevention Council, which was slated to sunset in 2020. The council was originally tasked with identifying issues and promoting strategies to prevent suicide, and providing technical assistance on best practices for identifying people at risk of suicide. The Department of Mental Health and Substance Abuse Services still serves as the leading agency for implementing the remainder of tasks outlined in the Act. Illinois and Texas enacted legislation establishing advisory bodies focused on suicide prevention among first responders. In Texas, HB 1593 creates a committee to study suicide prevention and peer support programs within fire departments and requires a report with recommendations by September 2026. In Illinois, HB 2551 reconstitutes the First Responders Suicide Prevention Task Force, and increases membership in the task force to include a member from an organization that provides mental health training and support to first responders and two members who represent organizations that advocate on behalf of public safety telecommunicators, such as 911 operators and dispatchers. The bill also charges the task force with developing a final report by December 2026. Both bodies are scheduled to sunset in January 2027. Currently, Wisconsin has several types of fatality review teams operating through voluntary efforts with no law formally establishing or governing these teams. Wisconsin is considering SB 192, which would formally establish processes for reviewing fatalities, including deaths by suicide. It would also direct the Department of Health Services to establish a fatality review program comprised of established local teams and authorize the department to establish state fatality review teams. AI Chatbots While states continue to strengthen suicide prevention infrastructure, policymakers are beginning to turn their attention to emerging mental health considerations related to AI. Since emerging in the 1950s, AI has evolved from rule-based systems to today's machine learning and natural language processing applications, powering everything from data analysis to interactive chatbots. Recent AI advances enable chatbots to simulate human conversation so convincingly that users may forget they are interacting with a machine. However, these systems lack genuine empathy and cannot substitute for professional mental health treatment. Their tendency to be excessively agreeable creates particular dangers for people experiencing suicidal ideation, leading some states to explore regulations governing AI chatbot use in mental health and suicide prevention contexts. At least 19 states considered legislation regulating the use of AI for mental health related reasons to promote user safety. At least five bills were enacted, including California SB 243, which requires chatbot platform operators to disclose that users are interacting with AI if confusion could occur, develop protocols to prevent and respond to suicidal ideation or self-harm, and report annually on safety measures to the state Office of Suicide Prevention. The California legislature also passed AB 1064, which the Governor subsequently vetoed due to concerns that its broad restrictions on AI companion chatbots for minors could limit access to potentially beneficial tools. Illinois and Nevada passed legislation that largely prohibits AI from providing behavioral health services. Illinois HB 1806 restricts the use of AI for therapy or psychotherapy unless delivered by a licensed professional who is required to inform the patient, or their legal representative, in writing and receive consent. The law also prohibits licensed professionals from allowing AI to make independent therapeutic decisions or interact directly with clients and allows the use of AI only for administrative or supplemental tasks under professional oversight. Nevada AB 406 similarly prohibits AI systems from providing or representing themselves as offering professional mental or behavioral health care, prohibits AI from performing the functions of a school counselor, psychologist, or social worker in public schools, and allows licensed professionals to use AI only for administrative or supportive purposes, with oversight to ensure accuracy and safety. New York and Utah passed laws requiring mental health chatbots to clearly disclose that they are not human. As part of their annual budget, New York S 3008 mandates that AI companion systems capable of simulating human-like interactions detect suicidal ideation or self-harm, provide crisis referrals, and regularly disclose that users are interacting with AI rather than a person. Utah HB 452 requires AI-driven mental health chatbots to provide clear disclosures and limits advertising and data practices. At the federal level, on December 11, 2025, the White House issued an executive order seeking to establish a national policy framework for artificial intelligence and create a “minimally burdensome” federal approach. The order also directs the Department of Justice to form an AI Litigation Task Force to identify and challenge state AI laws deemed in conflict with this federal policy, and the Department of Commerce to limit eligibility for certain federal funds for states that take a non-preferred approach. The scope and criteria of these federal actions, including their impact on state laws aimed at suicide prevention, have not been clearly defined. Advancing suicide prevention will require states and territories to take comprehensive approaches that address both systemic gaps within state infrastructure and emerging technologies. ASTHO will continue to monitor these policy developments and provide relevant updates. Reviewed by - Baker-White, Maffey article yes

This toolkit is designed to support public health leaders in leveraging the policy development process to achieve health equity in their jurisdiction.

This brief examines the ways states can support certification for community health workers.

PrEP is a powerful tool to reduce new HIV infections; expanding access to PrEP is a priority within the federal Ending the HIV Epidemic in the U.S. initiative. One way to increase access to PrEP is by allowing pharmacists to prescribe and dispense it.