Background and Role

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the federal agency primarily responsible for supporting community-based mental health and substance abuse treatment and prevention services. Located within the Department of Health and Human Services (HHS), SAMHSA provides federal funding for these services by administering two large formula-based block grant programs (one for substance abuse prevention and treatment services, the other for mental health services) and other formula and discretionary grants to local communities, states, and private entities.¹

SAMHSA does not directly deliver treatment services. Rather, it supports state and local efforts in providing mental health and substance abuse (collectively known as behavioral health) services, primarily through funding and technical assistance. Behavioral health prevention and treatment activities have historically been the responsibilities of states. The federal government contributes supplementary support by providing funding and some direction for activities.² SAMHSA is the primary agency responsible for supporting state efforts in providing behavioral health treatment services. SAMHSA funds a wide range of activities including education and training for the behavioral health workforce, prevention and early intervention programs, and treatment services. SAMHSA administers its larger grant programs directly to states, and some smaller grants to localities or directly to services providers. SAMHSA also conducts surveillance and data collection, provides statistical and analytic support, maintains performance and quality information systems, and administers other agency-wide initiatives. SAMHSA derives most of its statutory authority from the Public Health Service Act (PHSA). More specifically, Title V and Title XIX of the PHSA contain most authorities for SAMHSA programs and activities.

Strategic Plan

SAMHSA's mission is to reduce the impact of substance misuse and mental illness on America's communities.³ SAMHSA is required to develop a strategic plan every four years.⁴ In its Strategic Plan FY2019-FY2023, SAMHSA articulates its mission, vision, and five core principles which include (1) supporting the adoption of evidence-based practices; (2) increasing access to the full continuum of services for mental and substance use disorders; (3) engaging in outreach to clinicians, grantees, patients, and the American public; (4) collecting, analyzing, and disseminating data to inform policies, programs, and practices; and (5) recognizing that the availability of mental and substance use disorder services is integral to everyone's health.⁵

SAMHSA also outlines five priority areas for FY2019-FY2023:

• 1. Combating the opioid crisis through the expansion of prevention, treatment, and recovery support services.
• 2. Addressing serious mental illness and serious emotional disturbance.
• 3. Advancing prevention, treatment, and recovery support services for substance use.
• 4. Improving data collection, analysis, dissemination, and program and policy evaluation.
• 5. Strengthening health practitioners training and education.

For each area, SAMHSA sets an overarching goal and identifies a series of measurable objectives. Additionally, SAMHSA describes examples of key performance and outcome measures to track progress in each area.

History of SAMHSA

SAMHSA was formed in 1992 following reorganization of the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA). Prior to 1992, ADAMHA supported treatment service delivery and scientific research related to mental health and addiction. The ADAMHA Reorganization Act of 1992 (P.L. 102-321) moved the three existing research institutes within ADAMHA—the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA)—to the National Institutes of Health. ADAMHA was then renamed SAMHSA to reflect its primary focus on funding community-based treatment services.

Behavioral health services in the United States—which include substance abuse treatment and mental health care—have historically been the responsibility of states. The federal role has typically involved supporting state efforts through grant funding. This financial support has often consisted of block grants, with minimal direction to states regarding how to use these funds. Federal support for behavioral health activities was not designed for the federal government to be the primary payer, nor did the federal government intend to be the primary architect of these programs. While the federal government had nearly always played a more robust role in biomedical and health research—through the National Institutes of Health (NIH)—it did not make substantial investments in behavioral health services until the latter half of the 20^th century. During the 1960s, congressional interest in mental health shifted toward a greater emphasis on service development and provision.⁶ At that time, Congress enacted grant programs to establish community-based psychiatric services, improve state hospitals, and develop centers for substance abuse treatment.⁷

The Alcohol, Drug Abuse and Mental Health Administration was created in 1973 to support states in administering substance abuse and mental health treatment services. ADAMHA provided federal funding to bolster state efforts in behavioral health care services. ADAMHA also served as the parent agency for the three research agencies covering substance use and mental health: NIMH, NIDA, and NIAAA.⁸ NIDA and NIAAA were also created in the early 1970s following increased awareness of substance abuse and alcoholism as public health problems. NIMH had been established in 1946, in recognition of the burden that brain and behavioral disorders place on national health resources. Congress, determining that a strong program of research and research training would contribute to improving mental health and to treating mental illness, alcoholism, and drug abuse, established NIMH as one of the original components of the National Institutes of Health (NIH).

In addition to research, the original NIMH's mission included educating and training clinical personnel and providing grants to states to establish clinical treatment centers. This role changed with the creation of SAMHSA. As part of a reorganization of the Public Health Service agencies⁹ in 1992, SAMHSA took on responsibility for education and training of providers, and for administering treatment services—activities it continues today.¹⁰ NIMH, NIDA, and NIAAA—all now within NIH—remain the agencies primarily responsible for advancing mental health and addiction research.

Since its inception in 1992, SAMHSA and many of its programs have undergone multiple reauthorizations through legislation. Two laws—the Children's' Health Act of 2000 (P.L. 106-310) and the Helping Families in Mental Health Crisis Reform Act (Division B of P.L. 114-255, The 21^st Century Cures Act)—provided comprehensive reauthorization of multiple SAMHSA programs. Most of the other reauthorizing laws established or reauthorized specific SAMHSA activities, such as individual grant programs. While many programs have been added or repealed over the years, SAMHSA's primary responsibilities—including administering block grants to the states supporting mental health and substance abuse treatment services—have remained consistent with few significant changes.

Figure 1. Timeline of Major Legislation Authorizing Programs and Activities Administered by SAMHSA

Source: Figure prepared by the Congressional Research Service (CRS) based on analysis of relevant legislation. Acts were included here if they established multiple new authorizations or made amendments to multiple existing SAMHSA authorities. Notes: Most of these laws authorized or reauthorized several select SAMHSA activities rather than the entirety of programs or the agency as a whole. Of note, the Omnibus Budget Reconciliation Act 1981 (P.L. 97-35) provided the initial authorization for the block grant that would eventually become the mental health and substance abuse block grants administered by SAMHSA. ADAMHA stands for the Alcohol, Drug Abuse and Mental Health Administration. SAMHSA stands for the Substance Abuse and Mental Health Services Administration. a. The Children's Health Act amended SAMHSA's existing authorities under Title V, added several new authorities, and authorized appropriations through FY2003. The 2000 reauthorization legislation also incorporated the Drug Addiction Treatment Act (DATA) of 2000 (P.L. 106-310, Title XXXV) which expanded opioid use disorder treatment using buprenorphine.11 b. The No Child Left Behind Act of 2001 (P.L. 107-110, Sec. 4129; enacted January 8, 2002) required SAMHSA to provide consultation to the Secretary of Education in awarding grants to local educational agencies for reducing alcohol abuse in secondary schools. c. The Garrett Lee Smith Memorial Act of 2004 (P.L. 108-355) authorized three suicide prevention programs at SAMHSA—two grant programs and a resource center. d. The 2005 Sober Truth on Preventing Underage Drinking (STOP) Act (P.L. 109-422) authorized SAMHSA to award grants for reducing underage drinking. e. The Patient Protection and Affordable Care Act of 2010 (ACA; P.L. 111-148) contained several provisions relating to mental health and substance abuse services, including new SAMHSA authorities. f. The Comprehensive Addiction and Recovery Act (P.L. 114-198) of 2016 established new—or reauthorized existing—substance abuse treatment-related activities. g. The Helping Families in Mental Health Crisis Reform Act (Division B of the 21st Century Cures Act; P.L. 114-255) made changes to the organization of the agency and amended a number of programs. h. The SUPPORT for Patients and Communities Act (P.L. 115-271) of 2018 primarily established new—or reauthorized existing—substance abuse treatment-related activities.

Authority and Organization

SAMHSA and most of its programs and activities are authorized under Title V of the Public Health Service Act (PHSA). The substance abuse block grant (SABG) and community mental health block grant (MHBG) are separately authorized under PHSA Title XIX Part B. PHSA Title V provides the authorities for an Assistant Secretary of Mental Health and Substance Use (Assistant Secretary)¹² and four centers: the Center for Substance Abuse Treatment, the Center for Substance Abuse Prevention, the Center for Mental Health Services, and the Center for Behavioral Health Statistics and Quality. SAMHSA's four centers and main offices are depicted in Figure 2. Each of the four centers has a director who reports to the Assistant Secretary.

In addition to administering SAMHSA's major block grant programs, each center has general authority to fund states and communities to address priority substance abuse and mental health needs. This authority, called Programs of Regional and National Significance (PRNS), authorizes SAMHSA to fund projects that (1) translate promising new research findings to community-based prevention and treatment services; (2) provide training and technical assistance; and (3) target resources to increase service capacity where it is most needed.¹³ SAMHSA conducts several programs under PRNS authorities, some of which are explicitly authorized in statute while others exist at the discretion of SAMHSA, the Secretary of HHS, or elsewhere within HHS or the Administration. SAMHSA determines its funding priorities in consultation with states and other stakeholders.

The PHSA also directs SAMHSA to conduct data collection and analysis activities related to mental health and substance abuse. These activities are centrally coordinated in the Center for Behavioral Health Statistics and Quality.

For a list of specific program authorities within each of SAMHSA's centers, see Table 1 describing the "Substance Abuse Treatment PRNS" Table 2 describing "Substance Abuse Prevention PRNS", and Table 3 describing "Mental Health PRNS" later in this report.

Figure 2. SAMHSA Organizational Chart Major Offices and Centers at the Substance Abuse and Mental Health Services Administration

Source: CRS figure based on U.S. Department of Health and Human Services, SAMHSA, Justification of Estimates for Appropriations Committees for FY2020 and SAMHSA, About Us; Who We Are; SAMHSA Headquarters Offices and Centers, available at https://www.samhsa.gov/about-us/who-we-are/offices-centers/.

Centers

SAMHSA carries out most of its programs and activities through four statutorily established centers focusing on substance abuse treatment, substance abuse prevention, mental health services, and health surveillance and program support.

Center for Substance Abuse Treatment (CSAT)

The Center for Substance Abuse Treatment (CSAT) has primary responsibility for promoting community-based treatment and recovery services for individuals with substance use disorders.¹⁴ CSAT does not directly deliver treatment services. Rather, the center supports state efforts through funding and technical assistance. CSAT is responsible for leading efforts to increase access to effective treatment; closing the gap between demand and capacity for treatment; promoting evidence-based practices; and strengthening treatment systems (among other responsibilities). CSAT primarily does this by administering the Substance Abuse Prevention and Treatment Block Grant (in coordination with the Center for Substance Abuse Prevention). CSAT is also authorized to develop, evaluate, and implement effective treatment programs; and enable improvement of service quality and access. For an example of the center's activities, see "Substance Abuse Treatment PRNS" later in this report.

PHSA Title V, Part B, Subpart 1 establishes CSAT, lists the Director's duties, and authorizes various programs.¹⁵ The CSAT Director's duties include administering the Substance Abuse Prevention and Treatment Block Grant (SABG).¹⁶ Except for the SABG, all of CSAT's programs and activities fall under the category of substance abuse treatment PRNS (for more details, see Table 1 in the "Substance Abuse Treatment PRNS" section later in this report).¹⁷

Center for Substance Abuse Prevention (CSAP)

The Center for Substance Abuse Prevention (CSAP) has primary responsibility for preventing misuse (and underage use) of alcohol, tobacco, prescription drugs, and illegal drugs.¹⁸ CSAP is responsible for leading the development of effective prevention policies, programs, and services, and enabling states, local communities, and organizations to adopt such policies, programs, and services (among other responsibilities). CSAP is authorized to prevent substance abuse through public education, training, technical assistance, and dissemination of research findings. The center primarily executes this through workforce training programs and technical assistance to grantees. The center also provides states with grants to support their strategic planning activities and for demonstration programs. For an example of the center's activities, see "Substance Abuse Prevention PRNS" later in this report.

PHSA Title V, Part B, Subpart 2 establishes CSAP, lists the Director's duties, and authorizes various programs.¹⁹ Currently all of CSAP's programs and activities fall under the category of substance abuse prevention PRNS (for more details, see Table 2 later in this report). CSAP works with CSAT to administer the Substance Abuse Prevention and Treatment Block Grant. The block grant includes a 20% set-aside for prevention.²⁰

Center for Mental Health Services (CMHS)

The Center for Mental Health Services (CMHS) leads federal efforts supporting the prevention and treatment of mental disorders.²¹ The goals of CMHS include preventing mental illness and promoting mental health.²² CMHS is responsible for leading efforts to increase access to mental health services and improve their quality. CMHS is authorized to help prevent mental illness and promote mental health by providing funds to evaluate, improve and implement effective treatment practices; provide technical assistance to state and local mental health agencies; and collect data. CMHS supports mental health services provided by states and local governments through its mental health block grant and discretionary grant programs. For an example of the center's activities, see "Mental Health PRNS" later in this report.

PHSA Title V, Part B, Subpart 3 establishes CMHS, lists the Director's duties, and authorizes various programs.²³ The CMHS Director's duties include administering the Community Mental Health Services Block Grant (MHBG)²⁴ and other funding programs that target specific populations or activities such as the Projects for Assistance in Transition from Homelessness (PATH) program²⁵ and the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program.²⁶ PHSA Section 561 requires the HHS Secretary, acting through the CMHS Director, to award grants under the Children's Mental Health Services program.²⁷ CMHS is also responsible for administering the Certified Community Behavioral Health Clinics grant program.²⁸ All other CMHS programs fall under the category of mental health PRNS (for more details, see Table 3 later in this report).

Center for Behavioral Health Statistics and Quality (CBHSQ)

The Center for Behavioral Health Statistics and Quality (CBHSQ) has primary responsibility for collecting and analyzing behavioral health statistics. As the federal government's lead agency for behavioral health statistics, CBHSQ designs and implements data collection and analysis projects, advises the HHS Secretary and SAMHSA Assistant Secretary on behavioral health epidemiology, and partners with other agencies to develop federal health statistics policy (among other responsibilities).²⁹ CBHSQ was explicitly established in statute in 2016, though the center conducted many of its activities under other authorizations prior to its formal codification.³⁰

CBHSQ's data collection programs include the National Survey on Drug Use and Health (NSDUH) and the Behavioral Health Services Information System (BHSIS), which includes the National Mental Health Services Survey (N-MHSS), the Treatment Episode Data Set (TEDS), and the National Survey of Substance Abuse Treatment Services (N-SSATS), among others.³¹ One element of the BHSIS is the Inventory of Behavioral Health Services, which provides a listing of all known mental health and substance use treatment facilities used to inform SAMHSA's Behavioral Health Treatment Services Locator webpage.³² CBHSQ also maintains the Evidence-Based Practices Resource Center.³³

CBHSQ maintains a data archive and conducts research on behavioral health access, cost, quality, outcomes, policy, and practices.³⁴ The center disseminates information through articles, short reports, and data spotlights. Through the Substance Abuse and Mental Health Data Archive (SAMHDA), CBHSQ provides public access to much of the data they collect for research analysis.³⁵ CBHSQ is also responsible for agency-wide initiatives such as efforts to develop the behavioral health workforce. Most CBHSQ activities are integrated with the other centers and cross over multiple funding lines.³⁶

PHSA Title V, Section 505 establishes CBHSQ, lists the Director's duties, and authorizes various programs.³⁷ The CBHSQ Director's duties include coordinating SAMHSA's integrated data strategy, which includes collecting data on the incidence and prevalence of mental illness and substance abuse (the NSDUH survey), the number of individuals seeking treatment for mental illness and substance abuse issues, and the number of individuals admitted to emergency rooms as a result of substances (the Drug Abuse Warning Network [DAWN] surveillance system). Duties of the Director also include collecting data on mental health and substance abuse treatment programs (the N-SSATS survey) and making recommendations for performance metrics to evaluate SAMHSA activities. PHSA Section 505 specifies that summaries and analyses of data collected shall be made available to the public.

Headquarters Offices

Key offices within SAMHSA's headquarters are described briefly below.³⁸

The Office of the Assistant Secretary for Mental Health and Substance Use is responsible for managing and directing the agency, leading policy and program development, and working with the Office of the Secretary in HHS (among other responsibilities). Within the Office of the Assistant Secretary is the Office of Intergovernmental and External Affairs and several other offices:

• The Office of Behavioral Health Equity is responsible for coordinating SAMHSA's efforts to ensure equitable access to high-quality behavioral health care and reduce disparities in health outcomes (among other responsibilities).³⁹
• The Office of Tribal Affairs and Policy is responsible for supporting agency efforts to implement the Tribal Law and Order Act of 2010 (Title II of P.L. 111-211) and address behavioral health issues affecting tribal communities in collaboration with tribal governments and tribal organizations (among other responsibilities).⁴⁰
• The Office of the Chief Medical Officer (OCMO) is responsible for ensuring that medically researched and clinically approved practices are incorporated in SAMHSA programs and activities. The Chief Medical Officer also advises the Assistant Secretary on appropriate performance metrics and evaluation designs.⁴¹

The Office of Communications is responsible for guiding the agency's strategic communications plan, managing its online presence, disseminating products through the SAMHSA store (among other responsibilities).

The Office of Financial Resources is responsible for all functions of the Chief Financial Officer, including advising the Assistant Secretary on the agency's budget, assisting with financial management, and reducing waste, fraud, and abuse (among other responsibilities).

The Office of Management, Technology, and Operations is responsible for administrative services, human resources management, and information technology (among other responsibilities).

The National Mental Health and Substance Use Policy Laboratory is responsible for promoting evidence-based practices, evaluating service delivery models of treatment and facilitating adoption of data-driven policies (among other responsibilities).⁴²

Regional Administrators

HHS has 10 regional offices to ensure that "the Department maintains close contact with state, local, and tribal partners and addresses the needs of communities and individuals served through HHS programs and policies."⁴³ SAMHSA's regional administrators represent SAMHSA within these areas; promote behavioral health initiatives; collaborate with other federal agencies; provide support (e.g., technical assistance) to stakeholders; and periodically report on relevant trends, issues, and policies.⁴⁴

Advisory Councils and Committees

To help draw advice from mental health and substance abuse professionals and members of the public, SAMHSA has several advisory councils and committees:⁴⁵

• SAMHSA National Advisory Council,
• CSAT National Advisory Council,
• CSAP National Advisory Council,
• CMHS National Advisory Council,
• Advisory Committee for Women's Services,
• Drug Testing Advisory Board (DTAB),
• Tribal Technical Advisory Committee,
• Interdepartmental Serious Mental Illness Coordinating Committee, and
• Interdepartmental Substance Use Disorders Coordinating Committee.

PHSA Sections 501 and 222 (respectively) require the Assistant Secretary to "establish such peer review groups and program advisory committees as are needed."⁴⁶ Some advisory councils and committees are established under SAMHSA's general authorities, while others are explicitly required in statute. For example, PHSA Section 502 requires the HHS Secretary to appoint an advisory council for SAMHSA and three of its statutorily established centers (CMHS, CSAT, and CSAP).⁴⁷ PHSA Section 501 requires the Assistant Secretary to appoint an Associate Administrator for Women's Services, who must establish an Advisory Committee for Women's Services.⁴⁸ SAMHSA also has a Tribal Technical Advisory Committee consistent HHS's Tribal Consultation Policy.⁴⁹

Interagency Activities

SAMHSA is not the sole federal agency responsible for behavioral health-related activities. SAMHSA participates in interagency efforts to coordinate programs, share knowledge, and advance behavioral health.⁵⁰ While SAMHSA primarily supports direct behavioral health prevention and treatment services, other agencies conduct behavioral health research, provide workforce development resources, and operate other behavioral health-related programs. Other federal agencies may support other behavioral health activities—including direct services in some instances—as well.

SAMHSA is statutorily required to collaborate with other agencies—such as the Department of Veterans Affairs, the Department of Justice, and other HHS agencies like NIH and the Agency for Health Care Research and Quality (AHRQ)—to coordinate behavioral health activities and translate research findings into services.⁵¹ For example, SAMHSA cooperated, along with the Health Resources and Services Administration (HRSA), the SAMHSA-HRSA Center for Integrated Solutions. This body promoted the integration of primary care and behavioral health services through training and technical assistance for treatment organizations.⁵² The Behavioral Health Coordinating Council and the Interagency Coordinating Committee on the Prevention of Underage Drinking are other examples of formal collaborations with other agencies.

The 21^st Century Cures Act of 2016 (Cures; P.L. 114-255) established the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC). The committee is tasked with making recommendations to improve the coordination and administration of services for adults with serious mental illness and children with serious emotional disturbance. The committee provided recommendations in the first of two statutorily required reports to Congress submitted in December 2017.⁵³ According to statute, the ISMICC will sunset in 2023.⁵⁴

Budget and Funding

The total amount of funding available to SAMHSA (i.e., total program level) traditionally includes discretionary budget authority provided in annual appropriations acts, Public Health Service (PHS) Program Evaluation Set-Aside funds,⁵⁵ Prevention and Public Health Fund (PPHF) transfers,⁵⁶ and data request and publications user fees.⁵⁷ The main source of funding for SAMHSA is the discretionary budget authority it receives through the annual appropriations process.⁵⁸ SAMHSA is funded through the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor-HHS-ED) appropriations act.⁵⁹

SAMHSA's budget and appropriations fall under four categories: (1) mental health, (2) substance abuse treatment, (3) substance abuse prevention, and (4) health surveillance and program support. These categories roughly correspond with SAMHSA's four centers. CBHSQ activities, however, are integrated throughout the other centers and cross over multiple funding lines. CBHSQ receives much of its funding from the health surveillance and program support category in addition to a set-aside in the SABG.⁶⁰

In FY2020, SAMHSA had a program level budget of $5.89 billion ($5.74 billion in discretionary budget authority).⁶¹ SAMHSA supported 494 full-time employee equivalents in FY2019.⁶² More detailed descriptions and funding levels for SAMHSA's programs and activities are available in SAMHSA's annual budget request.⁶³ For a list of SAMHSA authorizations and their funding levels, see Table 1, Table 2, and Table 3.

Figure 3. SAMHSA Budget at a Glance Percent of Budget by Category, FY2020

Source: CRS analysis based on SAMHSA, Operating Plan for FY2020.

Major Programs and Activities

SAMHSA's major programs and activities include two block grant programs, numerous activities known as Programs of Regional and National Significance (PRNS), several other grant programs, technical assistance to grantees, data collection and other related activities.

The majority of SAMHSA's programming consists of grants to support mental health and substance abuse treatment and prevention activities, including direct treatment services. The largest grants are awarded to states via a designated Single State Agency. The state may then distribute funds—often in the form of subgrants and contracts—to localities for redistribution or directly to treatment providers. Similarly, SAMHSA may award some grants directly to mental health and substance abuse service providers. For other grants, SAMHSA distributes the funds to local government entities, organizations, Indian tribes, or local educational agencies, for instance, who in turn support entities providing direct treatment or prevention activities (see Figure 4).

Some of SAMHSA's programs are directed through statute. Most of SAMHSA's activities are carried out under general authorities, though they may target specific substances of abuse, particular mental health issues, specified populations, or certain prevention or treatment activities. SAMHSA's general PRNS authority gives the agency, in consultation with states, flexibility to determine the specific problem the funds will be used to address, such as unique or emerging substance abuse issues in a particular state. This practice may also make it easier to provide coordinated care for those in need of multiple substance abuse treatment services. The dynamic nature of SAMHSA's PRNS authorities and the flexible uses of block grant funding, however, can make tracking activities and determining spending on specific issues challenging.⁶⁴

Figure 4. Distribution of SAMHSA Grants Course of grant funding from SAMHSA to prevention and treatment providers

Source: Figure prepared by the Congressional Research Service.

Block Grants

SAMHSA's two biggest programs are block grant programs. One block grant supports substance abuse prevention and treatment services (the SABG) and the other supports mental health services (the MHBG). SAMHSA has estimated that the Substance Abuse Prevention and Treatment Block Grant (SABG) accounts for nearly a third of the expenses of state agencies responsible for substance abuse.⁶⁵ By comparison, SAMHSA's Community Mental Health Services Block Grant (MHBG) funds an average of 1% of the expenses for state mental health agencies.⁶⁶ The difference reflects the historical role federal and state governments have played in funding services in these two areas.⁶⁷ As behavioral health services have primarily been the responsibilities of states, the block grant programs administered by SAMHSA were designed to supplement these activities, not provide the primary source of financial support.

History

A predecessor to the current block grant programs, the Alcohol, Drug, and Mental Health Services (ADMS) block grant was one of seven block grants established by the Omnibus Budget Reconciliation Act of 1981 (OBRA).⁶⁸ This block grant consolidated several existing categorical grants for substance abuse and community mental health services in order to provide state and local governments more flexibility and control over funding. Shifting to a single block grant sought to enhance states' ability to meet localized needs, end duplication of effort in delivering services, and enable better coordination. The flexibility provided by the block grants replaced previous federal categorical grant authorizations that specified uses, including authorizations for establishing community mental health centers.⁶⁹ OBRA authorized ADMS block grant funds for FY1982 through FY1984 in proportion to the historical funding patterns of the original categorical grants. Due to the resulting inequities among states in per capita funding for substance abuse and mental health services, OBRA directed HHS to conduct a study that would produce a formula, considering population and state fiscal capacity, to more equitably distribute funds among states.

The 1984 ADAMHA Amendments renewed the block grants for three years with a new formula, while striving to maintain minimum existing levels for states. ⁷⁰ The amendments included a "minor equity adjustment" that would hold harmless states that would have otherwise received decreased funding under the new calculation. Funds above the FY1984 hold-harmless level were to be allocated using a formula based equally on state population and relative per capita income.⁷¹ The Amendments also required a nongovernmental entity to provide recommendations on the formula proposed by HHS. The resulting recommendations, from the Institute for Health and Aging (IHA), included phasing out the hold-harmless provisions, allocating funds based on populations at risk, and incorporating a state fiscal capacity measure.⁷²

The Anti-Drug Abuse Act of 1988 revised the formula, based on the IHA recommendations, to phase out the hold-harmless provision, use total taxable resources as the measure of state fiscal capacity, and incorporate weighted age cohorts as a measure of population at risk.⁷³ The high-risk age cohorts, determined using an IHA study, were 25-64 years for alcohol abuse, 18-24 years for other drug abuse, and 25-44 for selected mental disorders. Later studies indicated that inequities in block grant distribution to states (regarding need for financial support for behavioral health services) persisted even after the recommendations were implemented.⁷⁴

The 1992 ADAMHA Reorganization Act split the ADMS block grant into two separate block grants, one for mental health services (now the MHBG) and another for substance abuse services (the SABG).⁷⁵ The formulas for the two block grants were adjusted, in Sections 1918 and 1933 of the PHSA, to reflect the differences in the population in need of mental health and substance abuse services.⁷⁶ Hold-harmless provisions, state minimums, and maintenance of effort requirements were reestablished.⁷⁷ The current block grant formulas have undergone minimal amendment since their formulation in 1992.

The Cures Act reauthorized the block grants in 2016. The law amended the stated purposes of the programs and application and expenditure requirements, though the formulas remained unchanged. Among the adjustments was a provision permitting states to combine their applications for the MHBG and SABG.⁷⁸ This change acknowledged that behavioral health treatment often includes both types of care, particularly for individuals with co-occurring mental health and substance use disorders.

Community Mental Health Services Block Grant (MHBG)

The Community Mental Health Services Block Grant (MHBG) supports community mental health services for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED).⁷⁹ SAMHSA distributes MHBG funds to states (including the District of Columbia and specified territories)⁸⁰ according to a formula specified in statute.

Each state may distribute MHBG funds to local government entities and nongovernmental organizations to provide community mental health services for adults with SMI and children with SED in accordance with the state's plan. States have flexibility in the use of MHBG funds within the framework of the state plan and federal requirements. The state must designate a Single State Agency responsible for administering the grant and submit the state plan to the HHS Secretary every two years.

Each MHBG grantee must support a mental health planning council, which provides input on the state's plan for providing comprehensive community mental health services. A majority of members of the mental health planning council must be mental health service consumers or family members (of children with SED); other members represent relevant state agencies (e.g., mental health, education, and social services). States may opt to have behavioral health planning councils, which are responsible for both mental health and substance abuse services.⁸¹

While use of funds is generally determined by the states, each state must expend at least 10% of its block grant funds each fiscal year (or at least 20% by the end of the succeeding fiscal year) to support evidence-based programs to address early serious mental illness (see above textbox). No more than 5% of the grant funding can be used for administrative expenses. For each of the 50 states and the District of Columbia, the MHBG allotment formula is based on the population at risk (weighted), cost of services, and available resources.⁸² The MHBG allotment for each territory is proportional to the civilian population of the territory.⁸³ All states (including the District of Columbia) and territories have minimum allotments. While states do not technically need to provide matching funds, they are statutorily required to maintain spending on community mental health services.⁸⁴

Public Health Service Act Title XIX, Part B, Subpart I authorizes the MHBG program. Provisions in PHSA Title XIX, Part B, Subpart III also apply to the MHBG. PHSA Section 1920 explicitly authorizes to be appropriated $533 million (rounded) annually for each of FY2018–FY2022 for the MHBG.⁸⁵

Substance Abuse Prevention and Treatment Block Grant (SABG)

The Substance Abuse Prevention and Treatment Block Grant (SABG) supports services to prevent and treat substance use disorders. SAMHSA distributes SABG funds to states (including the District of Columbia and specified territories⁸⁶) and one tribal entity according to a formula specified in statute.

Each state may distribute SABG funds to local government entities, administrative service organizations, and prevention and treatment service providers (among others) in accordance with the state's plan for expending SABG funds.⁸⁷ States have flexibility in the use of SABG funds within the framework of the state plan and federal requirements. The state must designate a Single State Agency responsible for administering the grant and submit an application containing the state plan to the HHS Secretary by the first of October preceding the fiscal year.⁸⁸

While the use of funds is generally determined by states, each SABG grantee must expend at least 20% of its SABG allotment on primary prevention strategies.⁹⁰ In addition, each SABG grantee must enact laws that prohibit the sale or distribution of tobacco products to minors; enforce such laws; inspect tobacco outlets; and report annually to the HHS Secretary on past-year enforcement activities (and the extent of success achieved), as well as enforcement strategies for the coming grant year.⁹¹

For each of the 50 states and the District of Columbia, the SABG allotment formula is based on the MHBG formula and takes into account the population at risk (unweighted), cost of services, and available resources.⁹² The SABG allotment for each territory is proportional to the civilian population of the territory.⁹³ All states (including the District of Columbia) and territories have minimum allotments. For Indian tribes and tribal organizations that request SABG funds directly (and that the HHS Secretary determines would be better served by means of direct grants), the grant amount is reserved from the state's SABG allotment based on the ratio of the state's allotment expended for the tribal entity in FY1991.⁹⁴ While states do not technically need to provide matching funds, they are statutorily required to maintain spending on substance use disorder services.⁹⁵

PHSA Title XIX, Part B, Subpart II authorizes the SABG. Provisions in PHSA Title XIX, Part B, Subpart III also apply to the SABG. PHSA Section 1935 explicitly authorizes to be appropriated $1.86 billion (rounded) annually for each of FY2018–FY2022 for the SABG.

Issues Regarding Block Grant Formulas and Distribution

Determinations of block grant distribution—in the form of the funding formula—have been critiqued since the program's inception. The block grants represent the majority of funding SAMHSA provides to states. Despite their prominent role in SAMHSA operations, the formula determining funding levels has undergone little change since 1992. A number of issues have been raised regarding the current formulas. Economists and health policy experts have raised concerns about the appropriateness of this formula for ensuring equitable distribution of block grant funds between the states. The variables in the formula may not aptly represent state need for funding or for support for behavioral health activities for instance. Other critiques have questioned the formulas' adequacy in responding to public health needs surrounding substance abuse and mental illness. While demands on the behavioral health infrastructure may shift with drug epidemics for example, block grant levels remain relatively constant.

After the reauthorization of the block grants in 1992, the RAND Corporation evaluated the equity of the formula used in the SABG and MHBG.⁹⁶ The formula considers three factors: (1) the size of the population needing services, (2) the cost of services in the state, and (3) the fiscal capacity of the state. RAND concluded that the measures for two of the three components in the formula could be improved. Specifically, the population in need and the costs of services would be better indicated by different metrics. For example, RAND explained that the number of young adults in urban areas—which is double counted in the SABG formula—is not as indicative of substance abuse treatment need in a state as other empirically supported variables, such as high school graduation rate and residence in rural areas.⁹⁷ Cost estimates—the second variable in the formula—could also be improved by changing the current equation which is based on wages, rents, and average fees of practicing physicians. These variables are not sensitive to the specific labor needs of substance abuse services (since physicians do not provide most substance use treatment services) or to cost differences in rural and urban settings. RAND recommended changes in the block grant formula that would make allocations more equitable and also result in "big shifts in funding" compared to the current approach.

Pursuant to a provision in the Cures Act of 2016, SAMHSA and the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) again partnered with RAND to study the appropriateness of the current SAMHSA block grant formulas.⁹⁸ In their 2019 report, RAND again concluded that the formulas for the block grants could be revised to improve their accuracy.⁹⁹ More specifically, they noted that the population need and the cost of service indicators could both be updated to incorporate the best data available, such as state-level prevalence of adults with serious mental illness. They also recommended removing the current minimum allotment rules. No changes have been made since the release of this congressionally mandated report.

Other critiques have made similar recommendations regarding the block grant formulas. Some experts have recommended using data from major national epidemiological surveillance datasets that measure levels of mental illness and substance abuse in a state (rather than general population age distribution) to determine the population in need of services.¹⁰⁰ These may include data from the National Comorbidity Survey-Replication¹⁰¹ for mental health needs, for example, or the National Survey on Drug Use and Health (NSDUH)¹⁰² for mental health and substance abuse needs. Research also indicates that the cost-of-services measure currently used does not adequately represent interstate wage variations in occupations related to substance abuse and mental health.¹⁰³ The formula also does not consider variations in numbers of uninsured individuals across the states, and other federal funding (e.g., Medicare and Medicaid) that a state may also receive for mental health and substance abuse services.¹⁰⁴

There are also questions as to whether a formula is the ideal approach to distributing substance abuse and mental health treatment funds. In their 2001 report Choosing the Right Formula, the National Academies of Science, Engineering, and Medicine (NASEM) described a tradeoff between providing stability in funding from one year to the next and flexibility to redirect funds to different jurisdictions as true needs change. Substance abuse needs may have significant regional differences and epidemics may shift over time, sometimes rapidly. Static funding may not adequately respond to fluctuating public health needs. At the same time, states may rely on federal funding to support essential behavioral health infrastructure. Consistent and reliable funding streams may be necessary to maintain needed substance use and mental health services. Predictable funding may also be essential in establishing prospective public health strategies and achieving long-term behavioral health goals.

There have also been questions about whether the block grants supplement or supplant state funding for substance abuse and mental health initiatives.¹⁰⁵ While the block grants have historically represented a small percentage of state spending on behavioral health activities, there are no state matching requirements for these programs. Some have questioned whether increased federal funding results in a subsequent decrease in state spending on behavioral health initiatives. Research has demonstrated that state substance abuse spending is positively associated with substance abuse block grant allocation, however. One study found that for every $1.00 increase in state SABG funding, for example, state administered spending on alcohol treatment also increased by $0.80.¹⁰⁶ Other reports have found similar results; state investments in mental health and substance use treatment services increase in tandem with federal grant funding.¹⁰⁷ This suggests that federal block grant funding appears to have a positive correlation with state substance abuse treatment and prevention efforts and block grants may largely be used to supplement, not supplant, state funding.¹⁰⁸

Other issues concern block grant funding not keeping up with health care inflation. The National Association of State Alcohol and Drug Abuse Directors (NASADAD) estimated that the inflation-adjusted value—the actual purchasing power—of the SABG block grant funding decreased 24% between 2009 and 2019.¹⁰⁹

Finally, a 2015 investigation by the Government Accountability Office (GAO) found variations in how SAMHSA oversees grants and documents grant-related activities.¹¹⁵ While states are required to discuss the manner in which they use block grant funds in their application or plan, it is unclear how SAMHSA surveys this information and whether they audit states for accuracy. SAMSHA does not publish this information publicly. An HHS OIG publication in 2017 noted that SAMHSA's reporting has improved since that GAO study.¹¹⁶ While some concerns regarding SAMHSA's supervision of block grant activities remain, investigations into block grant spending largely demonstrate that states use the block grant funding as intended, despite historically little oversight.¹¹⁷

Programs of Regional and National Significance (PRNS)

In addition to the block grant programs, SAMHSA administers other programs supporting mental health and substance use treatment and prevention activities. PHSA Title V Part B requires the HHS Secretary to "address priority ... needs of regional and national significance" in mental health, substance abuse treatment, and substance abuse prevention. The statute instructs the HHS Secretary to do so "directly or through grants or cooperative agreements with States, political subdivisions of States, Indian tribes and tribal organizations, other public or private nonprofit entities."¹¹⁸ SAMHSA administers grants and activities under these authorities commonly known as Programs of Regional and National Significance (PRNS).

SAMHSA's Programs of Regional and National Significance encompass numerous grants and activities within each of three areas: (1) substance abuse treatment, (2) substance abuse prevention, and (3) mental health. PRNS activities may include competitive grants, contracts, and cooperative agreements. PRNS programs are either determined by HHS and SAMHSA (sometimes at direction of the presidential administration) or by Congress through statutory authorizations/requirements or appropriations language. Some of the PRNS grants and activities have explicit authorizations in statute; at some point Congress enacted a law explicitly authorizing the PRNS program. Other PRNS initiatives have never had explicit authorizations and operate under SAMHSA's general PRNS authorities for mental health, substance abuse treatment, or substance abuse prevention. Commonly, Congress will codify existing programs without explicit authorizations through legislation. PRNS programs themselves may vary from year to year as existing programs are terminated or new programs are created, either at SAMHSA's discretion or at the direction of Congress.

PRNS grants and activities within each area fall into two categories, called "Capacity" and "Science and Service." Most PRNS programs are in the Capacity category. Capacity grants emphasize expanding service system activities. Those in the Science and Service category tend to focus on training and technical assistance. For example, within mental health PRNS, primary and behavioral health care integration activities appear under both categories: grants to community mental health centers for treatment services appear under Capacity, and a competitive cooperative agreement for a training and technical assistance center appears under Science and Service.

Substance Abuse Treatment PRNS

The substance abuse treatment PRNS support states and communities in carrying out activities related to substance use treatment services. PHSA Section 509 authorizes the substance abuse treatment PRNS generally. Subsequent PHSA sections authorize specific substance abuse treatment PRNS programs. PHSA Section 509(f) authorizes to be appropriated $334 million (rounded) annually for each of FY2018–FY2022 to carry out the substance abuse treatment PRNS. Table 1 lists FY2020 grant programs and activities categorized as substance abuse treatment PRNS; additional details (e.g., program descriptions and funding levels) are available in SAMHSA's FY2021 budget request.¹¹⁹

Example: Building Communities of Recovery

In 2016, the Comprehensive Addiction and Recovery Act (CARA; P.L. 114-198) authorized funding for recovery community organizations through a new Section 547 of the PHSA (within the authorizations for the Substance Abuse Treatment PRNS). This Building Communities of Recovery (BCOR) program provides funding for the development, enhancement, expansion, and delivery of peer recovery support services for substance abuse disorders. Grant support also enables links between recovery networks and other community organizations such as health care providers, the criminal justice system, and housing and employment services. The BCOR program supplanted previous SAMHSA peer professional workforce development programs.

Substance Abuse Prevention PRNS

The substance abuse prevention PRNS support states and communities in carrying out activities related to the prevention of substance use. PHSA Section 516 authorizes the substance abuse prevention PRNS generally. Subsequent PHSA sections authorize specific substance abuse prevention PRNS programs. PHSA Section 516(f) authorizes to be appropriated $211 million (rounded) annually for each of FY2018–FY2022 to carry out substance abuse prevention PRNS. Table 2 lists FY2020 grants and activities categorized as substance abuse prevention PRNS; additional details (e.g., program descriptions and funding levels) are available in SAMHSA's FY2021 budget request.¹²⁰

Example: Drug-Free Workplace and National Laboratory Certification

SAMHSA provides oversight of the Federal Drug-Free Workplace Program and the related National Laboratory Certification Program. The Federal Drug-Free Workplace Program aims to eliminate illegal drug use (and prescription drug misuse) in executive branch agencies and federally regulated industries by ensuring that employees are tested.¹²¹ The National Laboratory Certification Program inspects and certifies the laboratories that conduct drug tests for executive branch agencies and federally regulated industries. Federally regulated industries include organizations receiving federal grants and organizations with federal contracts of $100,000 or more.¹²² SAMHSA's Drug Testing Advisory Board (DTAB) advises the agency on its drug testing activities.¹²³

Mental Health PRNS

The substance abuse treatment PRNS support states and communities in carrying out activities related to mental health prevention and treatment services. PHSA Section 520A authorizes the mental health PRNS. PHSA Section 520A(f) authorizes to be appropriated $395 million (rounded) annually for each of FY2018–FY2022 to carry out mental health PRNS. Table 3 lists FY2020 grants and activities categorized as mental health PRNS; additional details (e.g., program descriptions and funding) are available in SAMHSA's FY2021 budget request.¹²⁴

Example: Project LAUNCH

SAMHSA's Project Linking Actions for Unmet Needs in Children's Health (LAUNCH) is a national initiative aimed at promoting the wellness of children from birth to eight years old. Project LAUNCH works "to ensure that the systems that serve them (including early childcare and education, home visiting, and primary care) are equipped to promote and monitor healthy social and emotional development" of young children.¹²⁵ It does this through behavioral health screenings for children, home visiting programs for families, and trainings for community providers. A multi-site evaluation completed in 2018 showed improved social and academic functioning among children, decreases in child problem behaviors, and enhanced community child and family-serving systems for participants in this program. Project LAUNCH operates under SAMHSA's general PRNS authorities—it does not have an explicit authorization in statute.

Other SAMHSA Grant Programs

In addition to the block grant programs and Programs of Regional and National Significance, SAMHSA also carries out several other statutorily required grant programs. These function similarly to statutorily required PRNS in that they target specific populations or substances of abuse. They are authorized in separate provisions from the PRNS in Title V of the PHSA, though SAMHSA will sometimes organize these programs with the PRNS when communicating about non-block-grant programs.

Children's Mental Health Services

The Children's Mental Health Services program supports services for children with serious emotional disturbance. The program also supports efforts to identify and serve children at risk. In recent years, SAMHSA has awarded competitive grants to help states, local governments, tribes, and territories develop and implement systems of care; cooperative agreements to sustain and expand systems of care; and contracts to provide technical assistance and conduct evaluations. The systems of care approach focuses on delivering evidence-based interventions in the least restrictive setting.

PHSA Title V, Part E (Sections 561–565) authorizes the Children's Mental Health Services program.¹²⁶ PHSA Title V, Part E, requires the HHS Secretary to award grants to support "comprehensive community mental health services for children with a serious emotional disturbance." It specifies reporting requirements, technical assistance requirements, and the ages of children to be served, among other factors. PHSA Section 565 explicitly authorizes to be appropriated $119 million annually for each of FY2018-FY2022 to carry out the program.¹²⁷

Projects for Assistance in Transition from Homelessness (PATH)

The Projects for Assistance in Transition from Homelessness (PATH) program supports services for people with serious mental illness (including those with co-occurring substance use disorders) who are homeless or at imminent risk of becoming homeless. The PATH program distributes funds to states (including the District of Columbia and specified territories) according to a formula. The states, in turn, make grants to local governments and private nonprofit organizations to support mental health and substance abuse treatment, case management, and other services. Up to 20% of the federal payments may be used for housing-related assistance. All services provided using PATH funding must be consistent with (and included in) the state's comprehensive mental health services plan (as required for participation in the mental health block grant).¹²⁸

Each state's allotment is based on its population living in urbanized areas (as a percentage of the total U.S. population living in urbanized areas). A minimum allotment for each state is prescribed in statute (with exceptions for specified territories). States must provide matching funds of at least $1 for every $3 of federal funds. The 21^st Century Cures Act required the Assistant Secretary to conduct a study of the PATH grant allotment formula and to submit a corresponding report to Congress by January 2018.¹²⁹

PHSA Title V, Part C (Sections 521-535) authorizes the Projects for Assistance in Transition from Homelessness program.¹³⁰ PHSA Section 535 explicitly authorizes to be appropriated $65 million (rounded) annually for each of FY2018-FY2022.¹³¹

Treatment Systems for Homeless

The Treatment Systems for Homeless awards grants, contracts, and cooperative agreements to states, local governments, and communities to provide mental health and substance abuse services to individuals experiencing homelessness. Grants support activities such as the development and expansion of local systems that provide permanent housing or supportive services for adults, youth, families, and veterans. Some of the Treatment Systems for Homeless are joint initiatives managed by CMHS and CSAT.

PHSA Section 506 authorizes the Treatment Systems for the Homeless.¹³⁷ PHSA Section 506 explicitly authorizes to be appropriated $41 million (rounded) annually for each of FY2018-FY2022.¹³⁸

Protection and Advocacy for Individuals with Mental Illness (PAIMI)

The Protection and Advocacy for Individuals with Mental Illness (PAIMI) program supports state-designated protection and advocacy (P&A) systems mandated to protect individuals with mental illness residing in care or treatment facilities from abuse, neglect, and violations of their civil rights. The PAIMI program distributes funds to P&A systems in the states (including the District of Columbia and specified territories) and the American Indian Consortium according to a formula.¹³⁹

Unlike many of SAMHSA's other formula grants, for which formulas are prescribed in statute, PAIMI's formula is prescribed by the HHS Secretary, subject to statutory requirements. Specifically, it must be based equally on (1) each state's population and (2) each state's population weighted by per capita income relative to the United States. A minimum allotment for each state is prescribed in statute. Exceptions to components of the formula and minimum allotment calculation are made for specified territories and the American Indian Consortium.¹⁴⁰

State P&A systems were established under the Developmental Disabilities Assistance Act of 1975 (P.L. 94-103, as amended).¹⁴¹ The PAIMI Act of 1986 (P.L. 99-319, as amended) authorized the formula grant to support P&A systems in serving the mentally ill.¹⁴² Section 10827 of the PAIMI Act explicitly authorized appropriations for the PAIMI program through FY2003. Since that time, the program has continued to operate under its general authorities and has continued to receive funding through the annual appropriations process. The Cures Act required GAO to submit a report on programs funded by PAIMI grants to specified congressional committees by July 2018.¹⁴³

Minority Fellowship Program

The SAMHSA-administered Minority Fellowship Program provides grants to professional associations (e.g., the American Psychiatric Association and the American Nurses Association) to offer stipends to minority doctoral students who are studying for degrees in a mental or behavioral health profession.¹⁴⁴ PHSA Section 597 requires the HHS Secretary to maintain a "Minority Fellowship Program" to award fellowships, which may include stipends, for post-baccalaureate training for mental health professionals in the fields of psychiatry, nursing, social work, marriage and family therapy, mental health counseling, and substance use disorder and addiction counseling. It authorizes to be appropriated $13 million (rounded) annually for each of FY2018-FY2022.¹⁴⁵

Additional Opioid Grant Programs

State Targeted Response (STR) for the Opioid Crisis Grants

The State Targeted Response to the Opioid Crisis (Opioid STR) grant program provided nearly $1 billion to the states and territories over FY2017 and FY2018 to support activities related to the opioid epidemic. While the funds were appropriated to HHS generally, the responsibility for administering these grants was delegated to SAMHSA.¹⁴⁶ SAMHSA awarded grants to all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, the Northern Mariana Islands, Micronesia, Palau, and American Samoa.¹⁴⁷ The funds provided to each grantee were allocated based on a formula that considered two factors: (1) unmet need for opioid use disorder treatment and (2) drug poisoning deaths.

Section 7181 of the SUPPORT for Patients and Communities Act (SUPPORT Act; P.L. 115-271) reauthorized the Opioid STR grant for $500 million for each of FY2019 through FY2021. The SUPPORT Act was signed into law in October 2018 after the FY2019 Labor-HHS-Education appropriations bill (P.L. 115-245) was enacted, leaving the authorization for the STR grant expired when funding for FY2019 was appropriated. The grant program was not funded for FY2020.

State Opioid Response (SOR) Grants

Similar to the Opioid STR grants, the State Opioid Response (SOR) grants provided $1 billion in funding for states to address the opioid epidemic in FY2018.¹⁴⁸ The SOR grants sought to increase access to medication-assisted treatment and enhance state prevention, treatment, and recovery systems. The SOR grants followed similar distribution methods as the Opioid STR grants. The funds provided to each grantee were allocated based on a formula determined by the Secretary. The program included a 15% set-aside for the 10 states with the highest drug overdose mortality rates. The program also included a $50 million set-aside for tribes. For FY2019, the amount for the SOR grant program increased by $500 million—the same amount the Opioid STR grants were reduced. The grant program received level funding—$1.5 billion—for FY2020.

Data Collection and Related Activities

In addition to the activities described above, SAMHSA collects data and conducts related activities. Many of these activities are conducted—or coordinated—by the CBHSQ. Examples include the following:

• Surveillance and data collection: for example, the National Survey of Drug Use and Health (NSDUH), an annual household survey of drug use and other health information among the U.S. population age 12 or older.¹⁴⁹ Other examples include the National Survey of Substance Abuse Treatment Services (N-SSATS), an annual survey of all known substance abuse treatment facilities in the United States,¹⁵⁰ and the Drug Abuse Warning Network (DAWN), a nationally representative public health surveillance system that monitors drug-related visits to hospital emergency departments.¹⁵¹
• Statistical and analytic support: for example, the Substance Abuse and Mental Health Data Archive (SAMHDA), a repository for public access data files that provides public access and analysis.¹⁵²
• Performance and quality information systems activities: for example, the Evidence-Based Practices Resource Center (EBP Resource Center), a searchable online database of mental health and substance abuse information supported by scientific research.¹⁵³ The EBP Resource Center aims to "provide communities, clinicians, policy-makers, and others" with "the information and tools they need to incorporate evidence-based practices into their communities or clinical settings."¹⁵⁴ Launched in April 2018, the EBP Resource Center replaced the National Registry of Evidence-based Programs and Practices—in existence since 1997—after the Cures Act codified and amended the responsibilities of SAMHSA to publicly provide information on evidence-based program and practices.¹⁵⁵
• Agency-wide initiatives: for example, SAMHSA's collaboration with the Health Resources and Services Administration (HRSA) to develop consistent methods of identifying and tracking behavioral health workforce needs.

PHSA Section 505 requires the HHS Secretary, acting through the SAMHSA Administrator, to collect data on various topics. Specific requirements include conducting annual surveys and making summaries and analyses available to the public.¹⁵⁶ PHSA Title V includes numerous other references to collecting and disseminating data, embedded within larger programs. Under PHSA Title XIX, both block grant programs also require some data collection and evaluation activities.

National Mental Health Policy Laboratory

Through its National Mental Health Policy Laboratory, SAMHSA evaluates and disseminates information on best practices in the field. Title VII (Section 7001) of the Cures Act established within SAMHSA a National Mental Health Policy Laboratory.¹⁵⁷ The statute requires the laboratory to facilitate the implementation of policy changes likely to improve the prevention and treatment of mental illness and substance use disorders, disseminate information on evidence-based practices, and periodically review SAMHSA programs to reduce duplication and make recommendations to improve effectiveness, among other responsibilities. The statute also allows the Assistant Secretary to award grants for (1) evaluating promising service delivery models and (2) expanding the use of evidence-based programs. In January 2018, SAMHSA announced the launch of the Policy Laboratory by naming its first director and officially establishing it as one of SAMHSA's Offices and Centers.¹⁵⁸

Publications

SAMHSA publishes guidance, clinical best practices, and other resources on treatment, prevention, and recovery for mental and substance use disorders. Through the SAMHSA online store, clinicians, patients, and policymakers can access downloadable materials on a variety of topics.¹⁵⁹ SAMHSA offers series of treatment-related resources such as Treatment Improvement Protocols, SAMHSA Advisories, and Evidence-Based Practice Kits, among others. The SAMHSA Store, where many of these materials can be obtained, is managed through the Public Engagement Platform contract through the Office of Communications.¹⁶⁰

Technical Assistance

SAMHSA provides technical assistance to help states, territories, tribes, and other behavioral health providers develop and strengthen behavioral health care services. Technical assistance typically includes instruction on the grant application process, consultation on grant management, and workforce development programs. SAMHSA may provide this technical assistance directly, through contract, or through a grant. SAMHSA operates several National Technical Assistance and Resource Centers to enhance grantee performance and improve quality of service delivery.¹⁶¹ The agency also organizes and disseminates training and learning resources to facilitate the identification of evidence-based programs. Some of these activities are explicitly authorized in statute.

Appendix.