Economic Infrastructure Commentary Series
Originally drafted 2021 by Sarah Huffman. Updated by the Drake Institute Editorial Team, August 2025.
Commentary
In 2021, the Drake Institute examined barriers facing women with co-occurring mental health and substance use disorders. These overlapping conditions place women at significantly higher risk of homelessness, incarceration, unemployment, and victimization. At the time, the Institute noted how treatment was often fragmented: one program for mental health, another for substance use, and few integrated models that addressed both simultaneously. Cost, misdiagnosis, and lack of gender-responsive programs—including the absence of childcare at treatment sites or women-only groups—further compounded barriers.
Over the past two decades, federal law has laid groundwork for improved access. The Mental Health Parity Act of 1996 established initial parity protections, expanded by the Mental Health Parity and Addiction Equity Act of 2008, which required large-group insurance plans to cover mental health and substance use treatment on equal terms with physical health . The Affordable Care Act (2010) extended these protections to small-group and individual plans, and mandated behavioral health as an Essential Health Benefit, broadening access through Medicaid expansion . Yet gaps persisted: as recently as 2020, nearly half of U.S. adults who reported needing mental health treatment cited cost or lack of coverage as a primary barrier .
States have stepped in with innovative responses. California’s Assembly Bill 2265 expanded Mental Health Services Act funding to cover individuals with co-occurring disorders, easing restrictions on how counties use dollars for integrated treatment . In Massachusetts, bills H.1043 and S.605 sought to require insurance coverage for co-occurring treatment needs . New York legislation required mental health practitioners and counselors to be trained in trauma-informed and gender-sensitive approaches, recognizing that women often bring distinct needs shaped by trauma and perinatal experiences .
Hawaii advanced postpartum coverage expansions for immigrant women not otherwise eligible for Medicaid, extending access to both substance use and mental health treatment for up to a year following childbirth . New Jersey created a $100 million bond program to fund integrated facilities, while also strengthening oversight of sober living homes to ensure women with co-occurring disorders had access to licensed mental health professionals .
At the community level, correctional and reentry initiatives have also emerged. In Illinois, a Dual Diagnosis Program piloted at Logan Correctional Center showed promising results for women in prison, helping them develop skills to manage both mental health and substance use conditions . In New Jersey and Massachusetts, bipartisan commissions were established to study barriers for women—whether during the perinatal period or after incarceration—embedding equity into long-term system design .
From the Drake Institute’s perspective, these developments reinforce that health is economic infrastructure. When women cannot access integrated, affordable, and gender-responsive care, the result is destabilized families, lower workforce participation, and higher costs in emergency care and corrections. By contrast, when states fund trauma-informed, women-centered treatment that integrates mental health and substance use services, they build a healthier and more economically resilient society.
Archival Reference
This commentary draws on Improving Treatment Access for Women with Co-Occurring Mental Health and Substance Use Disorders (Huffman, 2021). The original version is archived by the Drake Institute and can be accessed here: