HHS FY2016 Budget in Brief
Substance 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)
|Community Mental Health Services Block Grant||483||483||483||--|
|Programs of Regional and National Significance||377||371||377||+7|
|Children's Mental Health Services||117||117||117||--|
|Projects for Assistance in Transition from Homelessness||65||65||65||--|
|Protection & Advocacy for Individuals with Mental Illness||36||36||36||--|
|Subtotal, Mental Health||1,078||1,071||1,078||+7|
|Substance Abuse Treatment||2014||2015||2016||2016
|Substance Abuse Prevention and Treatment Block Grant||1,815||1,820||1,820||--|
|Programs of Regional and National Significance||361||361||321||-41|
|Subtotal, Substance Abuse Treatment||2,176||2,181||2,141||-41|
|Substance Abuse Prevention||2014||2015||2016||2016
|Programs of Regional and National Significance||175||175||211||+36|
|Subtotal, Substance Abuse Prevention||175||175||211||+36|
|Health Surveillance and Program Support||2014||2015||2016||2016
|Agency-Wide Initiatives (Behavioral Health Workforce)||46||47||78||+31|
|Public Awareness and Support||13||13||16||+2|
|Data Request and Publications User Fees||13||13||13||--|
|Performance and Quality Information Systems||2||2||2||--|
|Data Request and Publications User Fees||193||194||237||+43|
|Subtotal, Health Surveillance and Program Support||72||72||80||+8|
|SAMHSA Budget Totals, Program Level – Less Funds From Other Sources||2014||2015||2016||2016
|Total, Program Level||3,622||3,621||3,666||+45|
|Prevention and Public Health Fund||-62||-12||-58||-46|
|PHS Evaluation Fund Appropriation||-133||-134||-211||-77|
|User Fees for Extraordinary Data Request and Publications||-2||-2||-2||--|
|Total, Discretionary Budget Authority||3,426||3,474||3,396||-78|
Full Time Equivalents
2015 +/- 2014: 0
SAMHSA Programs and Services
The FY 2016 Budget requests $3.7 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA), an increase of $45 million above FY 2015. The Budget continues investments to increase access to mental health services in order to protect the health of children and communities, prevent suicide and substance abuse, and promote mental health. The Budget also invests new resources to expand access to prevention and treatment of opioid prescription drug and abuse, with a special focus on heroin. In addition, the Budget includes new funding to integrate primary care and addiction services; to assist communities, and tribal organizations in particular, with addressing substance abuse, suicide prevention, and trauma; to establish effective crisis response systems; and to further respond to the critical need for additional behavioral health care providers.
The impact of untreated behavioral health conditions on individuals' lives and the costs of health care delivery in the United States are staggering. For example, Medicaid enrollees with common chronic conditions and co-occurring mental and substance use disorders have health care costs two to three times higher than Medicaid enrollees without these conditions. Incorporating mental and emotional health promotion into a public health approach as well as increasing treatment of mental and substance use disorders can reduce health care costs and improve overall health.
Improving Mental Health throughout America
Improving the Availability of Mental Health Services to Protect the Health of Children and Communities: While individuals with mental illness are more likely to be victims of violence than perpetrators, incidents of violence continue to highlight a crisis in America’s mental health system. Today, less than half of children and adults with diagnosable mental health problems receive the treatment they need. The Budget expands key investments to improve access to care for those with mental health problems.
The President’s Now is the Time initiative lays out changes toward a healthier and safer country. The Budget invests $151 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 that promote mental health through identifying mental illness early and creating a clear pathway to treatment for those in need, including through additional outreach and training for those who work with youth.
In addition to the $116 million in Now is the Time activities supported in FY 2015, the Budget includes $35 million in new funding to:
- Expand the partnership with the Health Resources and Services Administration by $21 million to a total of $56 million to increase the number of licensed behavioral health professionals and paraprofessionals available to serve in communities across the nation;
- Provide $10 million for a Peer Professionals program to increase the number of trained peers, recovery coaches, mental health and addiction specialists, prevention specialists, and pre-Master’s level addiction counselors in light of research showing people who regularly engage in peer-delivered interventions are more likely to abstain from substance abuse; and
- Provide $4 million to change the attitudes of Americans about mental and substance use disorders and their willingness to seek help.
Improving State and Local Crisis Response: The Budget includes a new, targeted demonstration grant program, Crisis Support, to help states and communities build, fund, and sustain crisis systems capable of preventing and de‑escalating behavioral health crises. This $10 million program will help build the evidence base by demonstrating models of effective, coordinated, and integrated crisis response systems and the accompanying array of crisis services and supports. Phase one of these grants will support planning activities to develop the necessary infrastructure for a comprehensive crisis response system. With effective prevention and planning efforts in place, this funding will also help curb demand for inpatient beds and focus attention on those with serious mental illness and substance use disorders.
Preventing Suicide: The Budget provides $62 million to prevent suicide, $2 million above FY 2015. This increase will bolster funding to implement the National Strategy for Suicide Prevention, the nation’s blueprint for reducing suicide over the next decade. This important funding will help develop and test the interventions that may be most effective for suicide prevention, such as suicide awareness, changes in provider training requirements at the accreditation level, emergency room referral processes and clinical care standards to maximize post-discharge continuity of care, among other activities.
SAMHSA’s suicide prevention programs provide funding to 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 organizations. In addition to basic prevention efforts, the Budget maintains the capacity of the National Suicide Prevention Lifeline, a hotline that routes calls across the country to a network of certified local crisis centers.
Improving Tribal Capacity to Promote Mental Health and Prevent Suicide and Substance Abuse: During a visit to Indian Country on June 13, 2014, the President reaffirmed the Administration’s partnership with tribal nations. Work remains to address behavioral health challenges faced by many tribes. SAMHSA and the Indian Health Service (IHS) will make new investments in behavioral health as part of the Administration’s Generation Indigenous initiative, created to remove the barriers to success for Native youth. As a part of Generation Indigenous, the Budget expands a promising demonstration grant program from $5 million to $30 million for tribal entities to promote mental health and address substance abuse among American Indian and Alaska Native young people. In collaboration with IHS and in consultation with tribal leaders, this funding will help to address the disproportionate burden of mental illness, substance abuse, and suicide faced in many American Indian/Alaska Native communities by helping tribes implement evidence-based suicide prevention programs and integrate systems that address issues of child abuse and neglect, family violence, trauma, and substance abuse.
Secretary’s Opioid Initiative
The Budget includes $99 million in new funding in CDC, SAMHSA, ONC, and AHRQ to support targeted efforts to reduce the prevalence and impact of opioid use disorders. These investments, including $35 million in new funding in SAMHSA, represent one aspect of a new, aggressive, multi-pronged initiative including policy changes, executive actions, and new funding. This initiative prioritizes activities backed by the best evidence available and the greatest opportunity for measurable impact.
Among other activities, CDC will lead the development of improved opioid prescribing guidelines, NIH will prioritize additional research and clinician education, FDA will incentivize the development of new opioid overdose and opioid use disorder treatments through expedited administrative review, and the will propose to expand initiatives that address safe and appropriate prescribing.
Improving Nationwide Substance Abuse Prevention and Treatment Efforts
The Budget includes $1.8 billion for the Substance Abuse Prevention and Treatment Block Grant, and $483 million for the Community Mental Health Services Block Grant, the same levels as in FY 2015, to implement evidence‑based strategies nationwide and to maintain the nation’s public behavioral health infrastructure. Examples of services which can be provided by these flexible sources of funding include medical services, provider education, supported employment and housing, rehabilitation, crisis stabilization and case management services, and wrap around services for children and families such as education, counseling, on-site child care or transportation of children, and parenting classes.
These block grants, which represent 32 percent of total state substance abuse agency funding and 1 percent of all state and federal spending on mental health care in the United States, are anticipated to provide services to approximately 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 necessary care not paid for by insurance.
Improving Health Care Quality by the Integration of 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. Individuals with substance abuse issues too rarely successfully complete referral to other care. By co‑locating primary and specialty care medical services, this program increases the likelihood that patients will receive primary care services, which has been shown to lower health care costs. Drawing on lessons from the successful and ongoing Primary and Behavioral Health Care Integration program, this program will fund implementation, technical assistance, and evaluation efforts, including dissemination of successful approaches.
Responding to Abuse, Misuse, and Overdose of Prescription Drugs and Opiates including Heroin:
Across the nation, over 20,000 individuals die from prescription opioids and heroin use each year. Preventing opioid misuse and abuse, including opioid-related overdoses and deaths, requires prevention, treatment, and recovery support services. The Budget addresses each of these key areas and provides funding to expand access to medication-assisted treatment for opioid addiction and to equip first responders with training and emergency devices used to rapidly reverse the effects of opioid overdoses.
Behavioral Health Workforce
The Budget includes a substantial expansion of a partnership with the Health Resources and Services Administration to increase the number of licensed behavioral health professionals and paraprofessionals available to serve in communities across the nation.
In FY 2014 and FY 2015, the partnership is projected to result in 3,500 additional behavioral health professionals and paraprofessionals annually.
In FY 2016, the Budget includes an additional $21 million for this effort, to total $56 million, and will result in an additional 5,600 professionals and paraprofessionals entering the behavioral health workforce annually.
The Budget proposes $99 million in new funding across the Department, including $35 million in SAMHSA, to address prescription drug and opioid misuse, abuse, and prevention of overdose death. Within SAMHSA, this new investment will include $13 million to increase access to medication assisted treatment in communities suffering from high rates of addiction to opioids such as heroin. This program will allow grantees to offer pharmacotherapies such as methadone, buprenorphine, and others as part of a full array of evidence-based opioid addiction treatment services and recovery supports. It will also increase provider and community awareness of this important, evidence-based approach.
This initiative also includes $12 million for a new grant program to complement current opioid overdose prevention efforts through grants to states to purchase naloxone, an overdose-reversing drug, equip first responders in high-risk communities with this drug and training on its use, prepare overdose kits, and provide education to the public.
In addition, the Budget includes $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.
Promoting Continuous Innovation
Enabling Americans to Live Healthy and Productive Lives through Innovative Approaches to Health Care: SAMHSA’s Programs of Regional and National Significance have long fostered innovative solutions to emerging issues in substance abuse and mental health services. These programs are intended to be small and agile, and are a key part of SAMHSA’s role in the health care system: to evaluate promising approaches to the nation’s most challenging behavioral health concerns. For example, SAMHSA’s National Registry of Evidence‑Based Programs and Practices, a searchable online database of independently assessed mental health and substance abuse interventions, now includes more than 340 interventions, up from 320 last year. This resource helps inform the public and the medical community about the effectiveness and readiness for dissemination of interventions. The Budget includes $909 million, $2 million above FY 2015, for Programs of Regional and National Significance.
Programs in these areas are in most cases proposed at the same level as last year or are discontinued because the programs have been tested and if successful are able to be supported through other funding sources such as block grants or public or private insurance.
For example, after the successful launch of a Mental Health First Aid program associated with the President’s Now is the Time initiative, the Budget proposes to establish a sister program of $4 million to reach or train 55,000 individuals to focus on veterans and their families. The Budget discontinues the Access to Recovery program. SAMHSA will provide training and technical assistance in FY 2015 to states and Access to Recovery grantees to increase the adoption and implementation of integrated, peer-driven recovery services and supports for people with substance use disorders and mental health problems. This effort will ensure that essential recovery support services typically not paid for by insurance, such as transportation, housing, and employment support, will continue from other sources of funding such as block grants. The integration of proven interventions into larger, more flexible sources of funding allows SAMHSA to broaden the evidence base and promote continuous innovation through targeted use of limited resources.
Responsible Management and Program Integrity
Health Surveillance and Program Support:
The Budget provides a one-time increase of $7 million for additional costs associated with the end of SAMHSA’s building lease. These costs include rent, move, and reconfiguration costs and are part of government-wide efforts to reduce long-term rent and utility costs by reducing per person space use and periodically re-evaluating competing lease offers.
The Budget continues support at the same level as FY 2015 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 other health care stakeholders, to inform mental health and substance abuse policy.