SAMHSA 

Substance Abuse and Mental Health 

Services Administration 

5600 Fishers Lane• Rockville, MD 20857 

www.samhsa.gov • 1-877-SAMHSA-7 (1-877-726-4727) 

FEB 1 1 2020 

Dear Commissioner: 

It has recently come to our attention at the Substance Abuse and Mental Health Services 

Administration that there is some confusion about whether Community Mental Health Services 

Block Grant (MHBG) funds can be used in the care and treatment of individuals with serious 

mental illness who have interactions with the criminal justice system including incarceration or 

who have a criminal case pending. This letter serves to clarify that treatment during 

incarceration is an allowable use of the MHBG, provided that the treatment services as well as 

provider of such services meets the statutory requirements of the MHBG. 

The purpose of the MHBG is to provide community-based mental health services. The MHBG 

statute requires states to provide comprehensive services through appropriate qualified 

community programs. The providers of services for which MHBG funds can be used include 

community-based mental health centers, child mental health programs, psychosocial 

rehabilitation programs, mental health/peer support services, and mental health primary 

consumer-directed programs. Mental health centers principally serve individuals in a defined 

geographic area, provide outpatient services to those with serious mental illness, children with 

serious emotional disturbance, and those recently discharged from an inpatient level of care and 

needing intensive outpatient services. Allowable services include 24-hour a day crisis 

intervention services, day treatment/partial hospital, intensive outpatient treatment, and 

psychiatric rehabilitation services. Further, funding may be used to screen individuals who may 

be in need of state hospital services for psychiatric care. Funds may not be used to pay for 

inpatient services, to make cash payments to intended recipients of health care services, to 

purchase land or improve structural facilities or to purchase major medical equipment, to use as a 

required match for other federal programs, or to provide financial assistance other than to a 

public or private, non-profit entity. 

One of the primary aims of these funds is to provide for care and treatment of those living with 

serious mental illness who may face severe limitations on their ability to successfully navigate 

community living as a result of the severity of their mental illness. Too often, such individuals 

lack insight into their illness and reject traditional treatment approaches. With worsening 

symptoms, infractions of criminal codes may occur which lead to the arrest and incarceration of 

the seriously mentally ill. Such individuals are in great need of behavioral healthcare services 

including psychiatric medical services and other supports such as psychotherapeutic 

interventions. Provision of mental health services during incarceration using block grant funds 

that pay for services which are provided by community-based mental health practitioners has 

been thought to be prohibited. Further, in some instances, an individual with serious mental 

illness may be in need of services that have been referred to as "competency restoration" so that 

they can understand charges against them and participate in their own defense. This term, and 

the fact that in some cases, the individual is not able to post a bond to be released until the time 

Behavioral Health is Essential To Health • Prevention Works • Treatment is Effective • People Recover 
Page 2 - Commissioner 

of their trial, has also resulted in a decision path that has denied them access to federal block 

grant funding to assist in their treatment and recovery. Competency restoration is a legal term. 

In medical terms it entails evaluation, treatment of the psychiatric disorder, and community 

recovery services. All of these services are allowable uses of these block grant funds. Further, 

these services can be delivered either in the community or in the jail/prison/forensic setting when 

provided by a community mental health service provider who otherwise meets the criteria 

outlined above. 

It is imperative that MHBG funds to the states be used to serve those in greatest need-the most 

vulnerable Americans with serious mental illness. Jails and prisons for too long have been de 

facto mental health facilities, in part, because of a misunderstanding of how the mental health 

block grant funds can be used. I urge all states to examine their current approach to the issue of 

providing mental health services to the incarcerated seriously mentally ill population including 

those also receiving what has been termed 'competency restoration' services and re-define these 

services as those basic to serving our most seriously mentally ill citizens. States should structure 

the provision of MHBG funded services in communities to routinely include community-based 

mental health service providers going into jails and prisons to render necessary psychiatric 

services. This would entail the delivery of comprehensive, individualized treatment and 

recovery services to those serving sentences as well as to those receiving services that have a 

history of being termed 'competency restoration,' both for those incarcerated and those living in 

the community. To do so will make a major contribution to addressing the plight of those with 

mental illnesses so severe that they are unable to care for themselves and who, too often, are 

incarcerated where they are currently unlikely to receive appropriate services. 

SAMHSA stands ready to assist states in these efforts. Your questions are welcome. We look 

forward to working with you on this important goal. 

Sincerely, 

Elinore F. McCan=-~ll, ~;~Ph.D. 

Assistant Secretary for Mental Health 

and Substance Use 

Substance Abuse and Mental Health Services Administration 

1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD)• www.samhsa.gov