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HHS FY2015 Budget in Brief

Substance Abuse and Mental Health Services AdministrationSubstance Abuse and Mental Health Services Administration (SAMHSA)

The Substance Abuse and Mental Health Services Administration reduces the impact of substance abuse and mental illness on America’s communities.

SAMHSA Budget Overview

(Dollars in millions)

Now is the Time Presidential Initiatives

2013

2014

2015

2015
+/
2014

Project AWARE (within Mental Health)

--

55

55

--

Project AWARE State Grants (non-add)

--

40

40

--

Mental Health First Aid (non-add)

--

15

15

--

Healthy Transitions (within Mental Health)

--

20

20

--

Science of Changing Social Norms (within Health Surveillance and Program Support)

--

--

4

+4

Workforce (within Health Surveillance and Program Support)

--

40

51

+11

SAMHSA-HRSA Behavioral Health Expansion (non-add)

--

35

35

--

Peer Professionals (non-add)

--

--

10

+10

Minority Fellowship Program Expansion (non-add)

--

5

5

--

Workforce Data Development (non-add)

--

--

1

+1

Total, Now is the Time Presidential Initiatives

--

115

130

+15


 

Mental Health

2013

2014

2015

2015
+/
2014

Community Mental Health Services Block Grant

437

484

484

--

PHS Evaluation Funds (non-add)

21

21

21

--

Programs of Regional and National Significance

267

378

355

-23

PHS Evaluation Funds (non-add)

--

--

5

+5

Prevention and Public Health Fund (non-add)

--

12

38

+26

Children's Mental Health Services

111

117

117

--

Projects for Assistance in Transition from Homelessness

61

65

65

--

Protection & Advocacy for Individuals with Mental Illness

34

36

36

--

Subtotal, Mental Health 

910

1,080

1,057

-23


 

Substance Abuse Treatment 

2013

2014

2015

2015
+/
2014

Substance Abuse Prevention and Treatment Block Grant

1,710

1,820

1,820

--

PHS Evaluation Funds (non-add)

79

79

79

--

Programs of Regional and National Significance

404

361

297

-64

PHS Evaluation Funds (non-add)

2

2

30

+28

Prevention and Public Health Fund (non-add)

--

50

--

-50

Subtotal, Substance Abuse Treatment

2,114

2,181

2,117

-64


 

Substance Abuse Prevention 

2013

2014

2015

2015
+/
2014

Programs of Regional and National Significance

176

176

186

+10

PHS Evaluation Funds (non-add)

--

--

16

+16

Subtotal, Substance Abuse Prevention

176

176

186

+10


 

Health Surveillance and Program Support 

2013

2014

2015

2015
+/
2014

Program Support

78

73

73

--

Health Surveillance

45

47

49

+2

PHS Evaluation Funds (non-add)

27

30

29

-1

Prevention and Public Health Fund (non-add)

15

--

20

+20

Data Request and Publications User Fees

--

2

2

--

Public Awareness and Support

14

14

16

+2

PHS Evaluation Funds (non-add)

--

--

16

+16

Performance and Quality Information Systems

9

13

13

--

PHS Evaluation Funds (non-add)

--

--

13

+13

Agency-Wide Initiatives

8

46

56

+10

PHS Evaluation Funds (non-add) 

--

--

1

+1

Subtotal, Health Surveillance and Program Support

154

194

208

+14


 


 

SAMHSA Budget Totals, Program Level – Less Funds From Other Sources

2013

2014

2015

2015
+/
2014

Total, Program Level

3,354

3,631

3,568

-63

PHS Evaluation Funds

-130

-133

-211

-78

Prevention and Public Health Fund

-15

-62

-58

+4

User Fees

--

-2

-2

--

Total, Discretionary Budget Authority

3,210

3,435

3,298

-137


 

Full Time Equivalents

2013: 608

2014: 655

2015: 655

2015 +/- 2014: 0

SAMHSA Programs and Services

The FY 2015 Budget requests $3.6 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA), a decrease of $63 million below FY 2014. The Budget continues investments to increase access to mental health services to protect the health of children and communities, and to prevent suicide and substance abuse and promote mental health, especially among American Indian and Alaska Native communities. The Budget also invests new resources to integrate primary care and addiction services and to address prescription drug abuse. As part of SAMHSA’s role in the nation’s mental health and substance abuse prevention and treatment systems, SAMHSA will work to target investments more strategically by:

  • Targeting resources to evidence-based prevention and treatment interventions;

  • More fully integrating Minority AIDS and related programs into the HIV Continuum of Care; and

  • Decreasing negative attitudes toward those with mental health and substance abuse problems and increasing their willingness to seek help.

The Budget includes funding to improve states’ capacity to provide behavioral health services through the block grants and reduces funding for competitive grant activities that will now be brought to scale through other mechanisms such as the block grants or statelevel funding streams.

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Responding to National Mental Health Needs

Increasing Access to Mental Health Services to Protect the Health of Children and Communities: While the vast majority of Americans with a mental illness are not violent, violence continues to highlight a crisis in America’s mental health system. The Budget continues key investments to expand access to care for those with mental health problems.

The Budget continues investments proposed by the President in the Now is the Time initiative, and lays out changes toward a healthier and safer country. The Budget includes investments of $130 million in SAMHSA to make sure students and young adults get treatment for mental health issues. These efforts will reach 750,000 young people every year through programs to promote mental health, prevent violence, identify mental illness early and create a clear pathway to treatment for those in need, including through additional outreach and improvements in workforce data collection.

The objectives of this initiative will be accomplished by providing:

  • $55 million for Project AWARE (Advancing Wellness and Resilience in Education) composed of $40 million for state grants to help states and communities implement plans to keep schools safe and get students with behavioral health issues referred to the services they need and $15 million for Mental Health First Aid to encourage adolescents and families to seek treatment when mental illness is detected and equip adults who work with youth with the knowledge to aid in early detection;

  • $40 million for workforce programs initiated in FY 2014, composed of $35 million to continue the partnership with the Health Resources and Services Administration to increase the number of licensed behavioral health professionals available to serve in communities across the nation, and $5 million to continue an expansion of the Minority Fellowship Program grants;

  • $10 million to fund a new workforce program, Peer Professionals, to increase the number of trained peers, recovery coaches, mental health/addiction specialists, prevention specialists, and pre-Master’s level addiction counselors who in some cases have the best chance of effectively reaching out to those who need treatment;

  • $20 million for Healthy Transitions, innovative state-based strategies supporting young people ages 16 to 25 and their families to access and navigate the behavioral health treatment systems; and,

  • $5 million to change the attitudes of Americans about mental and substance use disorders and their willingness to seek help, and to improve data collection and analysis of behavioral health workforce needs.

NEW INITIATIVE -- Now is the Time: Protecting Communities and Helping Young People

The FY 2014 Budget includes $115 million in SAMHSA for the President's Now is the Time initiative to protect the health of children and communities in response to recent tragedies. The FY 2015 Budget sustains these programs and includes an additional $10 million to strengthen the behavioral health workforce by increasing the number of trained peers, recovery coaches, mental health/addiction specialists, prevention specialists, and pre-Master’s level addiction counselors working with an emphasis on youth ages 16 to 25. The Budget also invests an additional $5 million for new outreach initiatives to ensure effective targeting and messaging of mental health communications, and new data initiatives to ensure the nation’s behavioral health workforce needs are well defined and understood.

Improving Children’s Mental Health:The Budget supports coordinated and comprehensive service systems to both promote healthy child development and provide behavioral health services to vulnerable youth.  The Budget includes $35 million for Project LAUNCH, the same level as FY 2014, to coordinate young child-serving systems and integrate behavioral and physical health services.  The Budget also invests $117 million, the same level as FY 2014, for Children’s Mental Health Services for the development of comprehensive community based systems of care for children and adolescents with serious emotional disorders and their families.

Preventing Suicide: The Budget provides $55 million to prevent suicide. This investment includes $5 million to continue support for competitive grants to tribal entities to promote mental health and address substance abuse among American Indian and Alaska Native young people. The Budget also invests additional funding for the National Strategy for Suicide Prevention, the nation’s blueprint for reducing suicide over the next decade. Organized as a publicprivate partnership including experts in suicide prevention, this funding will develop and test nationwide efforts such as suicide awareness, provider credentialing changes, emergency room referral processes, clinical care practice standards, and other activities not currently being addressed in any other national initiative.

SAMHSA’s suicide prevention programs fund states and tribes to develop and implement youth suicide prevention and early intervention strategies in partnership with education and juvenile justice systems, youth support organizations, and other community settings. The Budget sustains the capacity of the National Suicide Prevention Lifeline, a national hotline that routes calls across the country to a network of certified local crisis centers that can connect callers to local emergency, mental health, and social service resources. To ensure access to the latest science and best practices, the Budget also includes continued funding for the Suicide Prevention Resource Center that will provide systemwide enhancements to the nation’s mental health infrastructure related to suicide prevention.

Protecting Individuals with Mental Illness: The Budget includes $36 million to support state protection and advocacy systems to monitor residential treatment facilities which house vulnerable individuals with mental illness and serious emotional disturbances. In 2012, over 13,000 investigations into allegations of abuse, neglect, or rights violations were completed. In over 85 percent of substantiated cases, complaints of neglect handled through these systems resulted in positive changes for clients.

Assisting in the Transition from Homelessness: The Budget dedicates a total of $139 million for services for individuals facing homelessness and suffering from substance abuse or mental illness. Approximately 30 percent of individuals who are chronically homeless have a serious mental illness, and around twothirds have a substance use disorder or chronic health condition that creates significant difficulties in accessing affordable, stable housing.

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Ensuring Substance Abuse Treatment and Prevention and Mental Health Services

PROGRAM HIGHLIGHT -- Primary Care and Addiction Services Integration

The Budget invests $20 million in new funding for Primary Care and Addiction Services Integration to enable addiction care providers to offer a full array of both physical health and substance abuse services to clients. This effort will improve the physical health status of adults with substance use disorders who have or are at risk for co-occurring primary care conditions and chronic diseases, including HIV/AIDS, which are a significant component of the overall higher cost of care for individuals with substance use disorders today.

The Budget includes $1.8 billion for the Substance Abuse Prevention and Treatment Block Grant, the same level as in FY 2014, and $484 million for the Community Mental Health Services Block Grant, the same level as in FY 2014, to implement evidencebased treatment and prevention strategies nationwide and maintain the nation’s public behavioral health infrastructure. These flexible sources of funding represent 32 percent of total substance abuse agency funding, and approximately 1 percent of all state and federal spending on mental health care in the United States, respectively.

The Budget’s block grant funding is anticipated to contribute to services to over 10 million individuals. As access to health coverage expands through the implementation of the Affordable Care Act, SAMHSA will work with states to leverage these resources to provide services necessary for care but not covered by insurance.

Integrating Primary Care and Addiction Services: The Budget provides $20 million in new funding to bring primary care services to community substance abuse treatment provider sites. By colocating primary and specialty care medical services, this program will improve the rate at which substance abuse treatment patients are successfully referred to primary care services. This effort draws on lessons from the successful and ongoing Primary and Behavioral Health Care Integration program, and will fund implementation, technical assistance, and evaluation efforts, including dissemination of successful approaches. The Budget also increases funding for existing grants to ensure states have the capacity to meaningfully use electronic health records to improve the integration of primary care and addiction services.

Responding to the Epidemic of Prescription Drug Abuse: The Budget proposes a total of $26 million in the Centers for Disease Control and Prevention and SAMHSA to address prescription drug misuse, abuse, and overdose. Within SAMHSA, this collaborative effort will invest $10 million in grants to states to enhance, implement, and evaluate strategies to prevent prescription drug misuse and abuse, and to improve collaboration on the risks of overprescribing and the use of monitoring systems between states’ public health and education authorities, and pharmaceutical and medical communities. For example, epidemiological analyses using prescription drug monitoring program data can identify highrisk populations within a state to better target future state and federal efforts.

PERFORMANCE HIGHLIGHT -- National Suicide Prevention Lifeline

The National Suicide Prevention Lifeline, 1-800-273-TALK, provides suicide prevention and crisis intervention services to individuals seeking help at any time, day or night.

The Lifeline averaged 94,183 calls per month in 2013, including a peak of 104,754 calls in December, 24 percent above 2012. The program continues to implement new research and evaluation results, such as following up with individuals with suicidal thoughts and attempts upon discharge from health care facilities and to conduct additional research to evaluate communication beyond the telephone, such as through chat-based services.

Building a Foundation on Solid Evidence: The Budget includes a setaside of five percent of the Mental Health Block Grant for evidencebased early intervention programs to address the needs of individuals with serious mental illness. This effort will improve the dissemination of evidencebased practices and will encourage states and the federal government to track and implement these practices. In addition, SAMHSA’s National Registry of EvidenceBased Programs and Practices now includes more than 320 interventions, up from 280 last year, which help to inform the public and the medical community about the effectiveness and readiness for dissemination of interventions.

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Testing and Delivering Targeted Interventions

SAMHSA’s Programs of Regional and National Significance have long fostered innovative solutions to emerging issues in substance abuse and mental health services. A key part of SAMHSA’s role in the health care system is to evaluate promising approaches to the nation’s most challenging behavioral health concerns. The Budget includes $838 million, $78 million below FY 2014, for Programs of Regional and National Significance and other competitive and targeted grant activities. Programs in these areas are proposed at the same level as last year or are eliminated because the programs have been designed to be tested and moved into mainstream funding sources if successful.

For example, the Budget includes savings of $50 million from the elimination of the Access to Recovery program. SAMHSA will work closely in FY 2014 with states and grantees to ensure that mainstream funding sources expand the traditional provider network to those who typically do not bill insurance, such as faithbased organizations, and to fund recovery support services typically not covered by insurance such as transportation, housing, and employment support.

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Ensuring Informed and Responsible Management

Health Surveillance and Program Support: Other than increases described above associated with the President’s Now is the Time initiative, the Budget continues support at the same level as FY 2014 for national survey efforts, the administration and monitoring of SAMHSA programs and grantees, and public awareness activities. The Budget also includes a focus on program integrity to ensure that scarce resources are appropriately and responsibly monitored. SAMHSA’s national surveys and the analyses conducted through them are used by federal, state, and local authorities, as well as by health care providers, to inform policy about substance use and mental disorders, the impact and treatment of these disorders, and the recovery process.

Data and Publication User Fees: The Budget continues SAMHSA user fees to fulfill extraordinary requests for data analyses and bulk publications. While the vast majority of data and publications will remain free, the costs of the most expensive requests will continue to be borne by the requestor.

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