HHS FY 2017 Budget in Brief - SAMHSA
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||533||533||--|
|Programs of Regional and National Significance||371||407||406||-0.2|
|Children's Mental Health Services||117||119||119||--|
Set-Aside for Youth in the Prodrome Phase of Psychosis (non-add)
|Projects for Assistance in Transition from Homelessness||65||65||65||--|
|Protection and Advocacy for Individuals with Mental Illness||36||36||36||--|
|Evidence-Based Early Interventions (Mandatory)||--||--||115||+115|
|Subtotal, Mental Health||1,071||1,159||1,274||+115|
|Substance Abuse Treatment||2015||2016||2017||2017
|Substance Abuse Prevention and Treatment Block Grant||1,820||1,858||1,858||--|
|State Targeted Response Cooperative Agreements (Mandatory)||--||--||460||+460|
|Programs of Regional and National Significance||361||334||343||+9|
|Subtotal, Substance Abuse Treatment||2,181||2,192||2,661||+469|
|Substance Abuse Prevention||2015||2016||2017||2017
|Programs of Regional and National Significance||175||211||211||--|
|Subtotal, Substance Abuse Prevention||175||211||211||--|
|Health Surveillance and Program Support /1||2015||2016||2017||2017
|Public Awareness and Support||13||16||13||-2|
|Performance and Quality Information Systems||13||13||13||--|
|Data Request and Publications User Fees||2||2||2||--|
|Subtotal, Health Surveillance and Program Support||159||169||175||+6|
|SAMHSA Budget Totals, Program Level||2015||2016||2017||2017
|Total, Program Level||3,586||3,731||4,322||+590|
|Less Funds From Other Sources:|
|Evidence-Based Early Interventions (Mandatory)||--||--||-115||-115|
|Cohort Monitoring and Evaluation of MAT Outcomes (Mandatory)||--||--||-15||-15|
|State Targeted Response Cooperative Agreements (Mandatory)||--||--||-460||-460|
|PHS Evaluation Funds||-134||-134||-214||-80|
|Prevention and Public Health Fund||-12||-12||-28||-16|
|User Fees for Data Request and Publications||-2||-2||-2||--|
|Total, Discretionary Budget Authority||3,439||3,584||3,489||-95|
1/ Comparably adjusted to reflect the transfer of the Behavioral Health Workforce Education and Training Program from SAMHSA to HRSA in FY 2017 and single appropriation for the Minority Fellowship Program.
SAMHSA Programs and Services
The FY 2017 Budget requests $4.3 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA), $590 million above FY 2016. SAMHSA programs help provide treatment and services for people with mental and substance use disorders, support the families of people with mental and substance use disorders, build strong and supportive communities, prevent costly behavioral health conditions, and promote better health for all Americans.
The Budget makes critical new investments to help to ensure that every American who wants treatment for opioid use disorder can access it, improve care to those with serious mental illness, promote mental health, prevent suicide across the entire lifespan, and help communities establish effective crisis response systems. The FY 2017 Budget continues the Administration’s commitment to tackling the epidemic of overdose deaths related to opioids—a class of drugs that include prescription pain relievers and heroin—that is claiming the lives of 78 Americans every day.
Untreated behavioral health conditions have serious effects on individuals' lives and on health care costs. For example, co-occurring psychiatric conditions and chronic medical conditions are associated with significantly more expensive care due in large part to poor self-care and more acute episodes of needed healthcare. These increased costs, however, still leave people with a serious mental illness with an average life expectancy 8 years shorter than those without these conditions. Treatment of mental and substance use disorders however can lead to improved physical health and lower overall health care costs. To this end, the Budget proposes a near 16 percent increase for SAMHSA.
Improving America’s Behavioral Health
The Budget includes a series of new investments in SAMHSA to better address the mental and other behavioral health care needs of the American people by engaging individuals with serious mental illness in care, ensuring the behavioral health care system works for everyone, and expanding service and workforce capacity.
Engaging Individuals with Serious Mental Illness in Care
While individuals with mental illness are more likely to be victims of violence than perpetrators, recent tragedies continue to highlight a crisis in America’s mental health system. Today, less than half of children and adults with diagnosable mental disorders receive the treatment they need. The Budget proposes $137 million in key new investments in SAMHSA in FY 2017 to improve access to care for those with mental disorders and proposes new flexibilities to ensure that communities have systems-wide approaches for identifying and serving individuals in or at risk of a behavioral health crisis.
The Budget proposes $115 million new mandatory investment in each of FY 2017 and 2018 for a new formula grant for states for evidence-based early intervention programs for individuals with serious mental illnesses. This effort builds on research funded by the National Institute of Mental Health, the Recovery After an Initial Schizophrenia Episode (RAISE) study, and experiences of states implementing a new set-aside within the Community Mental Health Services Block Grant. The RAISE study found that engaging individuals with or at risk for serious mental illness in to care early can reduce the disability associated with mental illness. This program enables all states to establish at least one early intervention program and enable states that already have such programs to further expand their efforts.
The Budget continues to provide $533 million, the same level as FY 2016, for the Community Mental Health Services Block Grant. Although this funding represents only one percent of all state and federal spending on mental health care in the United States, it provides significant leverage to assist public mental health systems that serve nearly 8 million individuals with serious mental illness through flexible funding for services that may not otherwise be available to them. Within this amount, the Budget maintains the 10 percent set-aside of $50 million for evidence‑based programs which intervene early in the onset of serious mental illness.
The Budget also proposes a set-aside within the Children's Mental Health Services Program to dedicate up to 10 percent of the $119 million for this program to focus on youth and young adults who are at clinical high risk for developing a first episode of psychosis. This approach builds on the abundance of data accumulated over the past two decades, including a large-scale research initiative launched in 2009 by the National Institute of Mental Health, which strongly indicate that coordinated and specialized services offered during or shortly after a first episode of psychosis are effective for improving clinical and functional outcomes among youth and young adults at risk for serious mental illness. This new demonstration will apply this research to those at high risk of first episode psychosis as well. Along with the base program, this demonstration will continue to focus on reducing the impact of serious mental illness through the development of comprehensive, community-based services that incorporate family-driven, youth-guided care.
Expanding Access to Treatment to Reduce Prescription Drug Abuse and Heroin Use
The Budget includes $1 billion in new mandatory funding in SAMHSA and the Health Resources and Services Administration over two years to close the gap between those who seek treatment for opioid use disorder and those who can access it. In addition to ongoing efforts to assist individuals to get into care, the Budget invests this new mandatory and discretionary funding to expand the behavioral health workforce, through new loan repayment awards, including enhanced loan repayment to clinicians with medication assisted treatment training in the National Health Service Corps, supporting innovative medication-assisted treatment delivery programs, and supplementing treatment costs for uninsured and underinsured patients. In addition, funds within this program will support additional investments in telehealth and health information technology integration.
In addition, the Budget continues a new program first funded in FY 2016, Assisted Outpatient Treatment for Individuals with Serious Mental Illness. This $15 million program will provide grants to communities to test approaches to reduce hospitalization, homelessness, and interaction with the criminal justice system while improving the health and social outcomes of the patient. Grantees will evaluate the medical and social needs of the patients who are participating in the program. Grantees also will implement a treatment plan that includes criteria for completion of court‑ordered treatment and provides for monitoring of the patient’s compliance with the treatment plan.
The Budget also responds to a national need for improved service and workforce capacity to respond to behavioral health crises at the state and community level through a new, targeted demonstration grant program, Crisis Systems. This $10 million program will help states and communities build, fund, and sustain crisis response systems. The funded crisis systems will be capable of preventing and de-escalating behavioral health crises. This demonstration will test models of effective, coordinated, and integrated crisis response systems. After assisting grantees to develop the necessary infrastructure for a comprehensive crisis response system, such as prevention and planning efforts, the grants will help mitigate demand for inpatient beds by those with serious mental illness and substance use disorders by coordinating effective crisis response with ongoing outpatient services and supports.
Ensuring that the Behavioral Health Care System Works for Everyone
The Budget continues to drive services toward evidence-based practices and reach children, adolescents and young adults in the earliest stages of psychosis to prevent escalation of behavioral health conditions.
The President’s Now is the Time initiative continues to lay out changes toward a healthier and safer country. The Budget invests a total of $198 million across the Department, an increase of $39 million above FY 2016. This funding will continue to support SAMHSA and HRSA in improving access to mental health services for young people and CDC in researching the causes of and best ways to reduce gun violence. Within SAMHSA, a total of $108 million, an increase of $15 million, will help make sure students and young adults get treatment for mental disorders. These efforts will reach one million 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.
The Budget includes an additional net increase of $15 million for Now is the Time within SAMHSA for:
- Project AWARE State Grants, a $57 million program, an increase of $7 million above FY 2016, to serve more than four million children by improving local coordination of resources and responding to youth with signs of mental illness. This successful program helps those in contact with youth understand how to make a critical first referral to treatment, and helps communities ensure that treatment is coordinated; and
- Peer Professionals, a new $10 million 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.
National Strategy for Suicide Prevention: Aligning Resources with Needs
The Budget includes $28 million in new funding to expand implementation of the National Strategy for Suicide Prevention. This funding, including $26 million for a new Zero Suicide initiative, is designed to bring the most effective strategies targeting the most critical populations to scale. In FY 2016, 76 percent of SAMHSA suicide prevention funding was targeted to youth and young adults through age 24. However, 70 percent of suicides are completed by individuals between the ages of 25 and 64. The Budget increases suicide prevention funding for all ages to implement recommendations of the National Strategy for Suicide Prevention to focus on the entire lifespan and to enable health systems to adopt the Zero Suicide approach.
The Budget provides $88 million, an increase of $28 million above FY 2016, to prevent suicide. Suicide is the 10th leading cause of death for all ages, representing nearly 43,000 deaths in 2014. The Budget provides a critical increase in funding to expand the implementation of recommendations of the National Strategy for Suicide Prevention, the nation’s blueprint for reducing suicide over the next decade. Within this increase, $26 million will support Zero Suicide, a comprehensive, multi-setting approach to suicide prevention in health systems, and $2 million to implement other recommendations of the National Strategy. Examples of the recommendations are changes in provider training requirements at the accreditation level, emergency room referral processes, and clinical care standards to maximize post-discharge continuity of care. Zero Suicide’s focus on prevention within existing health systems and among a population at highest risk, such as adults between the ages of 25 and 64, will ensure the most effective use of funds toward this critical issue. This initiative will include a 20 percent set-aside for tribal communities.
In addition to these new activities, SAMHSA will continue to operate the Garrett Lee Smith and American Indian and Native Alaskan Suicide Prevention Initiative, which provides funding to states and Tribes to develop and implement youth suicide prevention and early intervention strategies. These programs operate in partnership with education and juvenile justice systems, youth support organizations, and other community organizations. The Budget also maintains the capacity of the National Suicide Prevention Lifeline, a free-to-call hotline of certified local crisis centers which answered over 1.3 million calls from those in need in 2014.
Promoting Mental Health and Preventing Suicide and Substance Abuse among Tribes
As part of the Administration’s Generation Indigenous initiative, created to remove the barriers to success for Native youth, SAMHSA and the Indian Health Service (IHS) will continue to support expanded tribal behavioral health efforts. The Budget provides $30 million in SAMHSA for Tribal Behavioral Health Grants to 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 and 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. In addition, $5 million in new funding will be available under Zero Suicide to ensure Tribes have access to the best evidence-based practices to prevent suicide within existing health systems.
Expanding Prevention and Treatment of Substance Abuse Prevention
The Budget includes $1.9 billion for the Substance Abuse Prevention and Treatment Block Grant. The block grant program maintains the nation’s public substance abuse prevention and treatment infrastructure through grants to states and represents 32 percent of total state substance abuse agency funding. The block grant will support services provided through public health care systems to approximately 2 million individuals, including medical services, provider education, supported employment and housing, rehabilitation, crisis stabilization, and case management services. The program will also provide wrap around services for children and families such as education, counseling, on-site child care or transportation of children, and parenting classes. These resources provide necessary care for the uninsured and support services not paid for by insurance.
Addressing the Prescription Drug Abuse and Heroin Use Epidemic
Across the nation in 2014, nearly 29,000 individuals died from opioid overdose, primarily prescription pain relievers and heroin. Prescription opioid abuse costs alone were estimated in 2011 to be over $50 billion per year, including health care costs, workplace costs such as lost productivity, and criminal justice costs. States play a central role in the prevention, treatment, and recovery efforts for this growing epidemic.
The Budget provides $559 million in new mandatory and discretionary funding in FY 2017 across the Department to address this growing epidemic, for a total of $686 million. In FY 2016, Congress provided $93 million in new resources above FY 2015 to address this critical issue, in response to requests in the President’s Budget. The Budget continues to implement and expand the Secretary’s Opioid Initiative through three priority areas: improving prescribing practices, expanding the use of medication-assisted treatment, and expanding the use of the overdose‑reversal agent naloxone. Within SAMHSA, the Budget provides mandatory and discretionary increases of $510 million above FY 2016, for a total of $557 million in programs that will expand the availability of naloxone and medication‑assisted treatment, as well as improve state planning and coordination efforts.
The Budget includes a new mandatory investment of $1 billion across the Department over two years to help ensure every American who wants help for opioid use disorder can access it by making medication-assisted treatment affordable and available. Within SAMHSA, this investment includes $460 million per year for two years for cooperative agreements with states to support evidenced-based programs that help people access treatment and recovery support. This program will target the barriers individuals most commonly identify as preventing them from seeking and successfully completing treatment and achieving recovery.
The Budget doubles funding to $50 million within SAMHSA for Medication‑Assisted Treatment for the Prescription Drug and Opioid Addiction Program in communities suffering from high rates of addiction to opioids. This funding will reach 45 states. Medication‑assisted treatment is proven to be an effective intervention for individuals suffering from opioid use disorder. This program will allow grantees to offer Food and Drug Administration-approved, evidence‑based opioid addiction treatment services and recovery supports. These approved services and supports will include pharmacotherapies such as methadone, buprenorphine, and naltrexone, and will also increase provider and community awareness of this important, evidence-based approach.
In addition, the Budget includes $15 million per year for two years in mandatory funds to better monitor the effectiveness of treatment programs employing different treatment modalities under real-world conditions. The program would evaluate the short-, medium-, and long-term outcomes of substance abuse treatment programs in order to increase effectiveness in reducing opioid use disorder, overdoses, and opioid‑related death.
SAMHSA will continue to use $12 million, the same level as FY 2016, for grants to Prevent Prescription Drug and Opioid Overdose Related Deaths. The grants are for 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. This funding complements ongoing opioid overdose prevention efforts by ensuring communities are prepared not only to resuscitate those experiencing an overdose, but also to connect them effectively to care.
The Budget also continues $10 million in the Strategic Prevention Framework: Rx Program for grants to states to enhance, implement, and evaluate strategies to prevent prescription drug misuse and abuse. The program also helps to improve collaboration on the risks of overprescribing and the use of monitoring systems between states’ public health and education authorities and between pharmaceutical and medical communities.
In addition, the Budget provides $10 million in new funding to establish a Buprenorphine Prescribing Authority Demonstration to test the impact of expanding buprenorphine prescribing authority to non‑physicians on both accesses to medication‑assisted treatment and the diversion of drugs for non‑legitimate purposes.
More must be done to address the shortage of providers of this medication, however. In addition to and separately from investigating the optimal types of providers, the Department is working on rulemaking to update federal regulations to take advantage of every authority available to address the need for improved access to medication-assisted treatment. Physicians are limited to prescribing buprenorphine to a maximum of 30 patients during the physician’s first year of participation in the program. After 1 year, the physicians may request authorization to prescribe up to a maximum of 100 patients.
Developing Innovative Solutions for Tomorrow
Encouraging Innovative Approaches to Heath Care
SAMHSA’s Programs of Regional and National Significance are intended to be laboratories fostering innovative solutions to substance abuse and mental health needs. The Budget includes $961 million for these programs in SAMHSA for small-scale, agile evaluations of promising approaches to the nation’s most challenging behavioral health concerns.
For example, the Budget proposes a new set-aside within the Pregnant and Postpartum Women Program. Up to 25 percent of this $16 million program will be used to explore strategies to serve more women and families through direct payment of outpatient services and to establish collaborative approaches to address these needs once the grant has ended. Both the base and set-aside components of the program will continue to support the availability of comprehensive, residential substance abuse treatment, prevention, and recovery support services for pregnant and postpartum women.
The Budget also continues important ongoing efforts that support the behavioral health community at large. 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 350 interventions, up from 340 last year. This resource helps inform the public and the medical community about the effectiveness and readiness for dissemination of interventions.
Ensuring Continued Improvements in Program Management
Health Surveillance and Program Support
The Budget provides a total of $125 million to ensure responsible and prudent management of federal resources. This amount is a reduction of $2 million below FY 2016 attributable to the elimination of one‑time costs and is for the relocation of SAMHSA’s headquarters in FY 2016.
The Budget continues to support national survey efforts and the analyses conducted through them, which are used by federal, state, and local authorities, as well as other health care stakeholders, to inform mental health and substance abuse policy. In addition, the Budget continues other administration and monitoring of SAMHSA programs and grantees at the same level as FY 2016. The Budget also includes a focus on program integrity to ensure that scarce resources are appropriately and responsibly monitored.