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The demand for mental health services is increasing across the country, yet millions of individuals in the U.S. still lack access to necessary support. Recent statistics indicate that just approximately half of those with a mental health issue — and under one in four individuals dealing with a substance use disorder — receive treatment.

Lawmakers have reacted by attempting to broaden access to care, including the nationwide 988 crisis hotline, as well as enhancing involuntary measures such as compulsory medications and hospitalization. A new study from the School of Public Health at Washington University in St. Louis investigates public perceptions regarding the expansion of behavioral health-care policies, discovering a strong preference for voluntary treatment rather than involuntary hospitalization or medicating individuals against their will. This research, titled “Public Attitudes Toward Mental Health Treatment Policy,” was published on Sept. 17 in JAMA Network Open.

Programs based in the community — including 24/7 crisis hotlines, walk-in facilities, and peer-led initiatives — strive to keep individuals within their localities and avoid hospitalization.

“Community-centered services, including those facilitated by peers, have demonstrated improvements in public health and a decrease in reliance on expensive institutional care,” stated Morgan C. Shields, an assistant professor at the School of Public Health and the primary author of the study. “Our results indicate strong bipartisan consensus that these services should be prioritized — a noteworthy point of agreement in today’s divided political environment.”

However, despite Americans favoring community-based, voluntary care, recent federal initiatives are taking a divergent direction. In July, the federal government enacted the executive order “Ending Crime and Disorder on America’s Streets.” This directive urged federal entities to undermine judicial safeguards and broaden the utilization of civil commitment — a legal procedure allowing treatment for mental illness without the individual’s consent.

This directive specifically targets individuals experiencing homelessness and significant mental health issues. This policy alteration intensifies discussions regarding how to balance public safety, personal rights, and effective, evidence-driven care.

Researchers surveyed 1,442 adults in the U.S. between Jan. 17 and Feb. 12 utilizing a nationally representative online panel executed through Qualtrics. Quota sampling was implemented for gender, age, race, ethnicity, income, education, and region to align with U.S. census population estimates. Participants expressed their support for various mental health-care policies on a nine-point scale.

The survey focused on several crucial areas: community-based services; peer-led support provided by individuals with lived experience of mental health challenges; treatment and recovery; coerced medications; involuntary short-term inpatient psychiatric admissions; mandated long-term inpatient psychiatric stays; and compulsory treatment for substance use challenges. Researchers also gathered data on political party affiliations to explore differences among groups.

Almost three-quarters of respondents (73%) advocated for expanding access to community-based services, with consistent support across party lines: 78% among Democrats, 72% among Republicans, and 71% among Independents. Similarly, a significant majority across political affiliations backed the expansion of peer-led services.

In contrast, support waned for policies permitting treatment to be imposed on individuals unwillingly. A mere 40% favored mandated psychiatric medication, 45% approved of short-term involuntary hospitalization, and 42% endorsed long-term hospitalization. Required substance-use treatment received slightly more backing, at 53%.

Democrats showed slightly less support for policies involving forced treatment compared to Republicans, while Independents consistently expressed lower support for all policies.

“At the national level, policies have oscillated between institutional, involuntary approaches and community-based solutions,” Shields mentioned. “This research suggests a pathway forward: investing in community services that are both empirically sound and politically sustainable.”

She added that the research team aspires for these findings to guide policymakers and community leaders towards solutions that enhance care access while safeguarding individual rights. The paper was co-authored by Nev Jones, at the University of Pittsburgh, Shyamal Sharma, at Brandeis University, and Susan H. Busch, at Yale University.

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