State and territorial legislatures are advancing a range of behavioral health policies as the nation addresses rising mental illness and substance use challenges. In 2024, an estimated 23.4% of U.S. adults—about 61.5 million people or more than one in five—experienced a mental illness. While overdose deaths declined nearly 24% in 2024 to approximately 87,000 over a 12-month period, overdose remains a leading cause of death nationwide.
Mobile crisis response continues to be a legislative priority. During the 2025 legislative session, at least 13 states considered and six enacted measures related to mobile crisis services. Rhode Island enacted HB 6118, which will require insurance coverage for mobile response and stabilization services for children and adolescents under 18. Washington passed HB 1813, directing additional planning and coordination among service providers to promote access to crisis stabilization services for Medicaid enrollees. On September 5, 2025, SAMHSA and CMS issued joint guidance to state health officials on supporting the crisis services continuum through Medicaid and the Children’s Health Insurance Program.
With naloxone now approved for over-the-counter sale by the FDA as of 2023, states are advancing policies to make the overdose-reversing medication available in public settings. Colorado enacted SB 25-164 to advance youth overdose prevention, clarifying access to naloxone in school communal areas and giving the state board of health authority over naloxone distribution. Montana enacted SB 503, extending liability protections for those administering expired opioid antagonists, including in schools.
Several states are exploring therapeutic use of psilocybin and ibogaine for mental health conditions. In 2025, more than two dozen states considered psilocybin measures, and seven states passed laws allowing psilocybin prescribing pending FDA approval, though approval has not occurred. At least 10 states considered legislation to study ibogaine or fund clinical trials for treatment of PTSD, depression, and opioid use disorder. Texas enacted SB 2308 to establish a consortium focused on ibogaine research to support FDA approval.
States are also regulating kratom, an unregulated substance with addiction risk. At least 34 states considered kratom legislation in 2025, with 11 states passing measures. Six states—Colorado, Mississippi, Nebraska, Rhode Island, South Carolina, and South Dakota—restricted kratom sales to those 21 and older and established product labeling standards.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.astho.org/advocacy/state-health-policy/legislative-prospectus-series/behavioral-health/