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SAMHSA’s

Behavioral Health 

Equity Fact Sheet

SAMHSA’s Strategic Efforts to Advance Behavioral Health Equity

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the federal agency charged with leading public 

health and service delivery efforts in behavioral health. SAMHSA’s mission is to promote mental health, prevent substance 

misuse, and provide treatments and supports to foster recovery while ensuring equitable access and improved outcomes for 

all populations. As emphasized in SAMHSA’s 2023-2026 Strategic Plan, the agency’s work is guided by the core principles of 

equity, trauma-informed approaches, recovery, and a commitment to data and evidence. The equity principal builds upon 

Executive Order 13985 Advancing Racial Equity and Support for Underserved Communities Through the Federal Government

that defines “equity” as the consistent and systematic, fair, just, and impartial treatment of all individuals, including those 

who belong to underserved communities that have often been denied such treatments. Behavioral health care systems must 

expand their ability to effectively meet the growing needs of a diverse population. Improving access to care, promoting quality programs and practice, and reducing persistent disparities in mental health and substance use services for underserved 

and historically marginalized communities are important first steps to ensuring that all people are provided with fair opportunities to be as healthy as possible. This principle is integrated into all aspects of SAMHSA activities and reflects a commitment of SAMHSA’s various centers and offices to ensure that their investments are reaching and supporting underserved 

communities.

SAMHSA’s Office of Behavioral Health Equity (OBHE) is the office within SAMHSA that has a dedicated mission to ensure 

that underserved, under-resourced communities are equitably included in SAMHSA’s mission. Under the leadership of the 

Biden-Harris Administration, equity has become a driving force to redesign behavioral health systems to effectively address 

the unique and high-burden challenges of underserved groups, delineated in the Executive Order by race, ethnicity, religion, 

income, geography, gender identity, sexual orientation, and disability. These efforts have also emphasized the significant role 

of community voice in advancing equity.

The following sections detail selected activities undertaken by SAMHSA Offices and Centers to advance behavioral health equity. The description of each activity is determined by the health equity goal set by the SAMHSA center/office administering 

the activity, followed by a description of the action, and its impact.

OFFICE OF BEHAVIORAL HEALTH EQUITY 

(OBHE)

Health Equity Goal

Promote policy initiatives that strengthen the impact of 

SAMHSA grant programs, initiatives, and operations in 

improving behavioral health outcomes for underserved 

populations.

ACTIONS TO DATE:

3 Disparity Impact Strategy 2.0. In October 2022, 

SAMHSA’s Office of Behavioral Health Equity led the 

development and launch of the updated version of the 

Disparity Impact Strategy (DIS 2.0). This strategy requires 

that SAMHSA discretionary funded grant recipients 

submit a statement identifying a disparity-vulnerable, 

underserved ethnic/racial minority population; and 

develop a quality improvement plan to address the 

identified disparities. The grantee must describe how 

they will outreach and engage this population and 

improve access, services, and outcomes. All grantees 

submit data on their service population and outcomes 

as part of their federal performance measurement 

requirements. Additional tools and rubrics for assessing 

the DIS have been developed for government project 

officers (GPOs) and grantees who must establish quality 

improvement plans that include a focus on social 

determinants of health and incorporate the National 

Culturally and Linguistically Appropriate Services 

Standards. OBHE is working with SAMHSA’s Center for 

Behavioral Health Statistics and Quality (CBHSQ) to 

develop DIS Dashboards to track grantees’ performance 

on their disparity impact strategy.

Impact: Through the DIS 2.0, SAMHSA grantees will 

be more inclusive of and improve outcomes for 

underserved populations.
SAMHSA’s Behavioral Health Equity Fact Sheet

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3 Guide to Equity Terminology [coming soon]. This is 

a decision-support tool focused on the use of equity 

terminology. As terminology has proliferated around 

equity and disparity issues, OBHE has developed a 

job-aide and decision-support tool to reduce confusion 

among behavioral health stakeholders. More information 

can be found in the blog: Guide to Equity Terminology: 

Promoting Behavioral Health Equity through the Words 

We Use.

Impact: Increase clarity and understanding of equity 

among behavioral health stakeholders.

3 Embedding Equity in 988. Listening sessions were held 

with representatives of underserved communities to 

gauge understanding about and willingness to utilize 988. 

OBHE is represented on the National Advisory Council for 

988 and participates in 988 webinars. 

Impact: Educating and engaging underserved 

communities about 988.

3 Language Access and Justice. OBHE participated in 

the Office of Civil Rights’ Language Access Steering 

Committee and its five subgroups. Participating staff 

are developing SAMHSA’s Language Access Plan to 

be completed in May 2024. SAMHSA’s plan cascades 

from the Department of Health and Human Services 

(HHS) 2023 Language Access Plan and highlights unique 

challenges for behavioral health. OBHE and the Office of 

Communications are developing the plan together.

Impact: Populations with Non-English Language 

Preference will have access to translated materials. 

Website-based services such as FindSupport.gov, the 

Treatment Facility Locator, and the 988 Suicide and Crisis 

Line will continue to assess needs for expanded language 

access. 

3 Elevate CBOs. This initiative provides a training series 

to build capacity for community-based organizations 

(CBOs) serving primarily underserved racial and ethnic 

communities. In contrast to clinical trainings and 

interventions, this effort is focused on strengthening 

organizational business processes. This includes securing 

grants and contracts, developing partnerships with state 

agencies to optimize contracting opportunities, utilizing 

administrative and community data, and sustaining its 

workforce. In the three most recent training sessions, 

there were over 1,200 participants. 

Impact: CBOs in underserved communities improve 

their organizational business practices, understanding of 

the grant-making process, and relationships with state 

agencies, thus better positioning their organizations to 

successfully compete for federal, state, and foundation 

funding. 

3 Equity Dialogues with Community Leaders, CBOs, and 

SAMHSA Staff. Ongoing virtual and in-person dialogues 

with CBOs and OBHE staff have been established to learn 

more about the issues faced by CBOs and strategies for 

overcoming these challenges.

Impact: Federal staff gain a firsthand understanding of 

the burden of mental and substance use disorders in 

low-resourced, underserved communities, community 

strategies that mitigate burden, and federal and state 

policies that often inadvertently exacerbate the burden 

of care.

3 Behavioral Health Equity Challenge. The goal of the 

April 2023 “Behavioral Health Equity Challenge for 

Underserved Racial and Ethnic Communities” was 

to identify and highlight outreach and engagement 

strategies used by CBOs to increase access to behavioral 

health services for racial and ethnic underserved 

communities. There were 427 submissions, ten winners 

received $50,000 each in prize money.

Impact: In addition to an unrestricted cash prize, 

Challenge winners increased their visibility and gained 

multiple opportunities to showcase their outreach 

and engagement strategies. OBHE will continue using 

the submissions to learn more about outreach and 

engagement strategies that connect communities with 

behavioral health services, and to recognize and reward 

CBOs that demonstrate innovative outreach strategies.

Health Equity Goal 

Reconceptualize the behavioral health workforce, combining 

new and emerging roles with existing, traditional specialty 

roles to improve outreach, engagement, and quality of care 

for underserved populations.

ACTIONS TO DATE:

3 Re-Envisioning the Behavioral Health Workforce with a 

Focus on Underserved Communities: A Technical Experts 

Panel. In January 2024, OBHE convened this technical 

expert panel to address the behavioral health workforce 

crisis. Experts across disciplines, sectors, population 

groups, and public and private payers assembled to 

develop strategies to address this growing crisis that 

significantly limits access to care. Discussion focused 

on new roles in the workforce, such as behavioral 

health support specialists and community-initiated 

care providers; career pathways in behavioral health 

for people from underserved communities; and the 

infrastructure (e.g., financing, reimbursement, licensing 

policies, etc.) necessary to sustain and grow these roles.

Impact: Innovative workforce strategies in communities 

and states emerged from this expert panel and will be 

the foundation for a Workforce Academy for state and 

local leaders in behavioral health.
SAMHSA’s Behavioral Health Equity Fact Sheet

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3 AANHPI Behavioral Health Center of Excellence (‘Ohana 

CoE). In September 2022, OBHE awarded the Hawaii 

Department of Health/Behavioral Health Administration, 

the Asian American, Native Hawaiian, and Pacific Islander 

Behavioral Health Center of Excellence. This is the firstever Center focusing on the behavioral health needs 

of the AANHPI population. A major focus of the CoE is 

training and technical assistance (TA) to increase provider 

capacity to deliver culturally appropriate care; conducting 

community assessments to determine levels and focus 

of need and maintaining a repository of culturally and 

linguistically appropriate evidence-based, behavioral 

health resources and products. Following the wildfire 

disaster in Maui in 2023, the CoE provided crisis response 

and culturally based healing practices.

Impact: Supports access to culturally informed, 

behavioral health care services and better outcomes.

3 Hispanic/Latino Behavioral Health Center of Excellence.

In September 2023, OBHE awarded the Hispanic/Latino 

Behavioral Health CoE to the Universidad del Caribe in 

Puerto Rico. The CoE provides training and TA to increase 

providers’ capacity to deliver culturally informed and 

responsive care, provide interpreter training, and develop 

and implement strategies to increase the Hispanic/

Latino behavioral health workforce. The CoE will increase 

provider capacity to conduct community assessments 

to determine levels and focus of need and maintain a 

repository of culturally and linguistically appropriate 

evidence-based, behavioral health resources and 

products. 

Impact: Supports access to culturally informed, 

behavioral health care services and better outcomes.

3 The African American Behavioral Health Center of 

Excellence. In October 2020, the African American 

Behavioral Health Center of Excellence was awarded to 

the National Center for Primary Care in the Morehouse 

School of Medicine. This CoE is taking a highly 

collaborative public health approach toward cultural 

and practical transformation of behavioral health 

systems; intervention, treatment, and recovery support 

practices; training and support for the professional and 

nonprofessional workforce focused on the Black/African 

American community. In July 2023, the CoE participated 

in the Black Youth Suicide Policy Academy that was 

hosted by the Center for Mental Health Services. The CoE 

continues to provide training and TA on African American 

behavioral health issues. It also works closely with the 

Historically Black Colleges and Universities (HBCU) 

Center for Excellence.

Impact: Supports access to culturally informed, 

behavioral health care services and better outcomes. 

Created visibility on this crisis among Black youth, and 

developed strategies tailored to the unique needs of 

Black communities to prevent suicide. 

3 LGBTQ+ Behavioral Health Center of Excellence. The 

LGBTQ+ Behavioral CoE was established in October 

2020 and is currently situated at the School of Social 

Work at the University of Connecticut. The Center 

provides training and TA to providers, organizations, and 

communities on LGBTQ+ behavioral health issues. The 

CoE supports the implementation of change strategies 

within mental health and substance use disorder 

treatment systems to address disparities impacting the 

LGBTQ+ community. It provides knowledge and skills 

about effective strategies to decrease health disparities 

and stigma including through evidence informed 

practices and evidence-based practice. 

Impact: Supports access to culturally responsive and 

LGBTQI-community-informed behavioral health care 

services and better outcomes. 

3 White House Summit on AA and NHPI Mental Health.

On July 20, 2023, in collaboration with the White House 

Initiative on Asian Americans, Native Hawaiians, and 

Pacific Islanders (WHIAANHPI), and at the request of 

the President, OBHE convened an in-person, invitational 

National AA and NHPI Mental Health Summit. Panels and 

facilitated discussions focused on key topics that impact 

mental health, including: anti-Asian hate, 988 suicide 

prevention and crisis line and engagement of AA and 

NHPI communities, language access, integrated care, and 

workforce issues.

Impact: The Summit highlighted factors that impact the 

mental health of the AANHPI population and established 

networks to tackle these issues.

3 Pathways Forward: Action Plans to Advance AA, NH, 

and PI Mental Health. On August 28-29, 2023, OBHE 

convened a working meeting building upon the issues 

emerging from the Mental Health Summit. Co-facilitators 

worked with each of the four work groups and developed 

an Action Plan for a two-year period. Federal agencies 

and invited participants shaped these plans and made 

various levels of commitments to aspects of the action 

plans. This meeting kept the momentum going from the 

Summit on July 20, 2023.

Impact: Established cross-sector work groups that 

committed to an action plan designed specifically to 

advance mental health issues for AANHPI communities.
SAMHSA’s Behavioral Health Equity Fact Sheet

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3 NNED and NNEDLearn. The National Network to 

Eliminate Disparities in Behavioral Health (the NNED) is a 

virtual network that brings together community-, ethnic-, 

and faith-based organizations; knowledge institutions; 

and national behavioral health organizations to share and 

promote policies, standards, research, and innovative 

practices to eliminate behavioral health disparities 

in diverse racial, ethnic, cultural, and sexual/gender 

minoritized communities. The NNED conducts trainings 

through Virtual Roundtables, manages a shared site of 

culturally adapted and culturally based practices, issues 

the NNED Note E-newsletter, and maintains a pulse 

on community issues through its Steering Committee. 

The NNED has grown to nearly 1,500 member CBOs 

across the country. The 13th annual NNEDLearn training 

meeting was held in April 2023 with five training tracks 

and follow-up coaching calls. This is a professional 

development opportunity for NNED members to 

receive training in evidence-supported and culturally 

appropriate mental health and substance use prevention 

and treatment practices and to support practice 

implementation.

Impact: NNED members have implemented new 

culturally informed practices and generated positive 

outcomes in their communities and have networked 

with other CBOs serving similar populations. Some have 

been successful in getting federal awards and bringing 

resources to their communities.

3 Family Counseling and Support for LGBTQI+ Youth and 

Their Families Grant Program. The purpose of this new 

grant program is to prevent health and behavioral health 

risks (e.g., suicide, depression, homelessness, drug use, 

and HIV) and to promote well-being for LGBTQI+ youth 

in the context of their families/caregivers, cultures, and 

communities by establishing LGBTQI+ family counseling 

and support programs and training providers on family 

counseling and support interventions. 

In 2024, SAMHSA announced four awards totaling $5.1 

million for Family Counseling and Support for Lesbian, 

Gay, Bisexual, Transgender, Queer/Questioning, Intersex+ 

Youth and their Families. These grants are in addition 

to $1.7 million in grant funding previously awarded in 

2023 to four other recipients. All eight awardees will be 

engaging LGBTQI+ youth and their families to prevent 

risk of health conditions, including behavioral health 

conditions and promote well-being for LGBTQI+ youth 

by establishing family counseling and support programs 

and training providers on family counseling and support 

interventions tailored for LGBTQI+ families.

Impact: The intended impact is for LGBTQI+ youth to 

experience less rejection from their families and more 

acceptance in their communities.

OFFICE OF COMMUNICATIONS (OC)

Health Equity Goal

Provide behavioral health resources, including prevention, 

treatment, and recovery of substance use and mental health 

disorders, to underserved populations.

ACTIONS TO DATE:

3 Launched EncuentraApoyo.gov, the Spanish language 

version of FindSupport.gov. This is a user-friendly 

website designed to help people identify available 

resources, explore information about various treatment 

options, and learn how to reach out to get the support 

they need for issues related to mental health, drugs, or 

alcohol. EncuentraApoyo.gov is not a direct translation 

of the English website. The content has been culturally 

adapted to the Hispanic audience and includes materials 

reflecting the Latino experience in the United States.

3 Used Social Media. Regularly posts information about 

behavioral health resources for underserved populations 

on SAMHSA social media channels.

Impact: Created awareness of SAMHSA resources, useful 

tools, helplines, and materials for Spanish-speaking 

populations. 

OFFICE OF FINANCIAL RESOURCES (OFR)

Health Equity Goal 

Create a simplified Notice of Funding Opportunity (NOFO) to 

expand the applicant pool by ensuring equity and simplicity.

ACTIONS TO DATE:

3 The Office of Financial Resources (OFR) coordinated 

an effort led by the HHS to simplify language in the 

Notice of Funding Opportunities (NOFOs). The goal of 

the Simpler NOFOs initiative was to reduce the burden 

associated with applying for grant opportunities for 

qualified applicants, especially those representing and/

or providing services to underserved communities. Four 

agencies across HHS were involved in this initiative, 

including SAMHSA. The Simpler NOFOs initiative led 

to the development and posting of a prototype for the 

SAMHSA Cooperative Agreement for the Refugee and 

Migrant Behavioral Health Technical Assistance Center.

Impact: Developed a template for a more simplified 

NOFO that may be more feasible and doable for 

underserved communities with less experience with 

federal grant applications. SAMHSA’s prototype was 

chosen by the post-admission applicant survey as the 

easiest to understand and navigate. More than 71 

percent of applications received a score of 82 or higher.
SAMHSA’s Behavioral Health Equity Fact Sheet

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OFFICE OF INTERGOVERNMENTAL AND 

PUBLIC AFFAIRS (OIPA)

Health Equity Goal

Increase equity-focused efforts in HHS/SAMHSA’s Regions.

ACTIONS TO DATE:

3 Consolidated Behavioral Health Meeting of the U.S. 

Territories, Jurisdictions and Protectorates, and SAMHSA 

Leadership. In March 2023, SAMHSA Regional Directors 

from HHS Regions Two and Nine hosted a meeting 

of behavioral health leadership from the Caribbean 

Basin, the Pacific Jurisdictions and Protectorates, and 

SAMHSA leadership at the SAMHSA headquarters. This 

first-ever meeting was a rich networking opportunity 

and information exchange that enabled SAMHSA 

leadership and staff to better understand the mental 

health and substance use challenges in these areas and 

for the jurisdiction leadership to learn about SAMHSA’s 

operations, expectations, and opportunities for grantees.

Impact: Strengthened relationships; promoted mutual 

benefit of information-sharing for all participants 

including increased understanding of jurisdictional 

challenges and federal government operations, 

requirements, and expectations. 

OFFICE OF RECOVERY (OR)

Health Equity Goal

Increase equity and opportunities for recovery for 

underserved and under-resourced populations and 

communities (including people of color, youth, older adults, 

women, and girls, LGBTQI+, rural, veterans and people with 

disabilities).

ACTIONS TO DATE:

3 Convened Tribal Recovery Summit. In August 2023, 

the Office of Recovery and the Office of Tribal Affairs 

and Policy jointly hosted a hybrid meeting, the 

Tribal Recovery Summit in Dallas, TX in partnership 

with SAMHSA’s Region 6 Office. The purpose of the 

summit was to share best practices and experiences 

related to expanding recovery-related programs and 

opportunities within the American Indian and Alaska 

Native Communities (AI/AN). It provided nearly 270 

attendees with valuable insight and information that can 

help improve recovery-related outcomes and showcased 

multiple pathways to recovery to support American 

Indian/Alaska Native tribes. A SAMHSA blog, Pathways 

to Recovery – Highlighting Tribal Recovery Efforts, 

was published in December 2023 to share important 

outcomes from the summit and increase knowledge 

about recovery efforts in the tribal communities.

Impact: Increased knowledge about recovery efforts and 

best practices for tribal communities. 

3 Created the SAMHSA Program to Advance Recovery 

Knowledge (SPARK). Provides technical assistance 

and education to people in recovery, family members, 

caregivers, and others with a focus on equity to increase 

recovery opportunities to underserved and under 

resourced populations and taking into consideration 

culturally based healing practices. The SPARK is accepting 

new training and technical assistance opportunities to 

expand recovery supports and services in states, tribes, 

territories, and communities. Requests for information, 

resources, training, and consultation can be made on the 

website.

Impact: Increases knowledge about recovery supports 

and services, including culturally based healing practices, 

for underserved and under resourced populations. 

OFFICE OF TRIBAL AFFAIRS AND POLICY 

(OTAP)

Health Equity Goal

Increase culturally informed and evidence-based behavioral 

health resources for American Indians and Alaska Natives.

ACTIONS TO DATE:

3 The American Indian and Alaska Native Behavioral 

Health Center of Excellence was awarded to the 

University of Arizona in August 2023. The Center of 

Excellence is expected to develop and disseminate 

culturally informed, evidence-based behavioral health 

information. It also will provide technical assistance and 

training on issues related to addressing behavioral health 

disparities in these communities, which have consistently 

experienced disparities in access to health care services, 

funding, and resources; quality and quantity of services; 

treatment outcomes; and health education and 

prevention services.

Impact: Provides technical assistance and education 

to underserved American Indian and Alaska Native 

communities, and providers serving those communities, 

to ensure access to culturally informed, behavioral health 

care services, and better outcomes.
SAMHSA’s Behavioral Health Equity Fact Sheet

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988 & BEHAVIORAL HEALTH CRISIS 

COORDINATING OFFICE (BHCCO)

Health Equity Goal

Expand access to the 988 Suicide & Crisis Lifeline for 

underserved and high-risk populations.

ACTIONS TO DATE:

3 Population-Specific Access and Response. Expanded 

988 with Spanish text and chat services to allow 

Spanish speakers in crisis to reach trained and culturally 

competent crisis counselors. Created specialized call, 

chat, and text supports for LGBTQI+ youth and young 

adults. Developed American Sign Language (ASL) and 

videophone services for people who are deaf or hard 

of hearing and for whom videophone and chat is a 

preferred method of communication.

3 Population-Specific Outreach and Technical Assistance.

Funded and provided technical assistance to 38 tribal 

organizations through the 988 Tribal Response Program. 

Conducted targeted 988 outreach and awareness efforts 

focused on African American young adults, especially in 

Historically Black Colleges and Universities (HBCUs), faithbased organizations, people with disabilities, and rural 

populations, specifically farmers.

From August through December 2023, SAMHSA and 

the 988 Lifeline administrator ran a Spanish Text and 

Chat Campaign to build awareness of Spanish-language 

988 services within the Hispanic/Latino community. 

The Hispanic/Latino community saw 988 Spanish Text 

and Chat information on social media and in their local 

supermarkets, pharmacies, outside of bodegas, hair and 

nail salons, barber shops, and laundromats. 

3 Embedding Equity Webinar Series. The 988 and BHCCO 

launched a quarterly webinar series, Embedding Equity in 

988 and the Crisis Response System, in January 2024 for 

988 state, territory, and tribal grantees, crisis centers, and 

behavioral health organizations and providers exploring 

the importance of embedding equity in 988 and crisis 

response systems. The series will also share innovative 

models, strategies, tools, and examples of equity-focused 

efforts in 988 and the crisis response system.

3 Embedding Equity Learning Collaborative. The 988 

and BHCCO initiated the Embedding Equity Learning 

Collaborative in February 2024 to bring together 988 

states, territories, and tribal grantees to learn from each 

other’s experiences and subject matter experts in equity 

and crisis response. The goals are to provide support, 

facilitated peer to peer learning, and provide tailored 

support to teams based on their unique communities’ 

needs.

Impact: Through these actions, there has been increased 

support for underserved populations with a focus on 

improving access and quality and reducing disparities. 

NATIONAL MENTAL HEALTH AND 

SUBSTANCE USE POLICY LABORATORY 

(NMHSUPL)

Health Equity Goal 

Improve behavioral health outcomes of individuals 

experiencing homelessness or criminal justice involvement 

or re-entering the community from incarceration.

ACTIONS TO DATE:

3 Published Advisory on Behavioral Health Services for 

People Who Are Homeless.

3 Published Evidence-Based Guide on Best Practices for 

Successful Reentry from Criminal Justice Settings for 

People Living with Mental Health Conditions and/or 

Substance Use Disorders.

Impact: Publicly disseminate evidence-based information 

focused on at-risk populations. All the above referenced 

Resource Guides are free, evidence-based, and available 

via the SAMHSA website.

Health Equity Goal 

Improve community capacity to meet behavioral health 

needs among under-resourced populations.

ACTIONS TO DATE:

3 Published Advisory on Using Technology-Based 

Therapeutic Tools in Behavioral Health Services and on 

Digital Therapeutics for Management and Treatment in 

Behavioral Health.

3 Published Evidence-Based Guide on Community 

Engagement: An Essential Component of an Effective 

and Equitable Substance Use Prevention System and 

began development of advisory on preventing substance 

misuse among persons with disabilities.

Impact: Publicly disseminate evidence-based information 

focused on at-risk populations. All the above referenced 

Resource Guides are free, evidence-based, and available 

via the SAMHSA website.
SAMHSA’s Behavioral Health Equity Fact Sheet

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Health Equity Goal 

Improve access to overdose prevention efforts in rural 

communities.

ACTIONS TO DATE:

3 Since 2020, SAMHSA has funded the Rural Emergency 

Medical Services (EMS) Training grant program. SAMHSA 

recognizes the significant need for emergency services 

in rural areas and the critical role EMS personnel serve 

across the country. Recipients use the grant funds to 

train EMS personnel on substance use disorders and 

co-occurring disorders; trauma-informed, recoverybased care for people with such disorders in emergency 

situations; and, as appropriate, to maintain licenses and 

certifications relevant to serve in an EMS agency. With 

this program, SAMHSA aims to develop the capacity of 

EMS staff to support residents in rural communities.

3 The Rural Opioid Technical Assistance Regional Centers 

(ROTA-R) disseminate training and technical assistance 

addressing opioid and stimulant misuse affecting rural 

communities. The 10 regional centers facilitate the 

identification of model programs, develop and update 

materials related to the prevention, harm reduction, 

treatment, and recovery activities for opioid use disorder 

(OUD) and/or stimulant use disorder, and ensure that 

high-quality training is provided.

Impact: Expands rural access to behavioral health 

services, enabling EMS organizations to recruit and 

train new staff and provide advanced training for 

existing staff. This program has also helped to build 

community engagement across different towns, build 

interdepartmental relationships in hopes of future 

collaboration, and strengthen partnerships and 

awareness of resources they can share. 

CENTER FOR BEHAVIORAL HEALTH 

STATISTICS AND QUALITY (CBHSQ)

Health Equity Goal

Provide nationally representative data to highlight 

behavioral health disparities impacting underserved 

communities.

ACTIONS TO DATE:

3 Released the report on Lesbian, Gay, and Bisexual 

Behavioral Health: Results from the 2021 and 2022 

National Surveys on Drug Use and Health. This report 

describes key substance use and mental health indicators 

by sexual identity (gay/lesbian, bisexual, and straight) 

and gender among adults aged 18 or older in the United 

States. Estimates were based on combined data from the 

2021 and 2022 National Surveys on Drug Use and Health 

(NSDUH) and were age-adjusted to facilitate comparisons 

between groups.

Impact: Visually present data about substance misuse, 

substance use disorder, mental health conditions, and 

suicidality among LGB adults. This information can be 

further used by policymakers, researchers, and health 

professionals to eliminate inequities experienced by this 

community.

3 Published the NSDUH 2022 Highlighted Population 

Slides, a series of slide decks presenting the latest 

substance use and mental NSDUH data among nine 

highlighted populations: American Indian and Alaska 

Native Population (AIAN); Asian Population; Black 

or African American Population; Female Population; 

Hispanic or Latino Population; Lesbian, Gay, or Bisexual 

(LGB) Adult Population; Multiracial Population; Native 

Hawaiian and Other Pacific Islander Population (NHOPI); 

Veteran Population.

Impact: These slides provide the latest national 

substance use and mental health data for multiple 

underserved communities in a convenient, easy-tounderstand format. This data will be most useful to state 

and local policymakers and leaders from underserved 

communities.

3 Released the report Key Substance Use and Mental 

Health Indicators in the United States: Results from the 

2022 National Survey on Drug Use and Health, which 

presents and compares numerous mental health and 

substance use measures by age and race/ethnicity.

Impact: This report provides the latest national 

substance use and mental health data by race/ethnicity 

for numerous measures and will be useful for state 

and local policymakers and leaders from underserved 

communities.

3 NSDUH questions were changed to capture more 

comprehensive gender identity and sexual identity data. 

In 2022, NSDUH collected population data on gender 

with a binary measure (male or female). It also asked 

adult respondents about their sexual identity (response 

options: lesbian or gay, bisexual, or heterosexual/

straight). Beginning with the 2023 NSDUH, the survey 

asks respondents their sex at birth and their gender 

identity, including whether they identify as male, female, 

transgender, or another identity. The 2023 NSDUH 

also asks all respondents about their sexual identity, 

regardless of age. In addition to choices for heterosexual/

straight, gay or lesbian, and bisexual, NSDUH respondents 

in 2023 can report that they use a different term (and 

specify the other term), they are not sure about their 

sexual identity, or they do not know what the sexual 

identity question is asking.

Impact: These added major revisions to the NSDUH 

survey to capture more comprehensive national data on 

gender identity and sexual identity.
SAMHSA’s Behavioral Health Equity Fact Sheet

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Health Equity Goal

To support data driven policies and programs toward 

advancing behavioral health equity.

ACTIONS TO DATE:

3 The Advancing SAMHSA Programs in Reaching Equity 

(ASPIRE) Dashboard was approved by SAMHSA 

leadership in fall of 2023. ASPIRE encapsulates SAMHSA’s 

core principles of equity and commitment to data/

evidence and supports the Executive Order on Advancing 

Racial Equity and Support for Underserved Communities 

(EO 13985). The goal of ASPIRE is to advance SAMHSA’s 

understanding and use of client-level demographic 

data. ASPIRE is an interactive, performance dashboard 

designed for SAMHSA leadership and staff to support 

data driven policies and programs toward advancing 

behavioral health equity. The ASPIRE dashboard includes 

over four years of client-level, discretionary grant, 

performance measurement data. The ASPIRE dashboard 

supports SAMHSA’s guiding principles of equity and 

commitment to data and evidence. ASPIRE focuses on 

answering the following questions pertaining to reach, 

retention, and resources: (1)Who is SAMHSA reaching 

with its discretionary grant programs? Available data 

include race, ethnicity, gender, sexual orientation, 

age, housing status and veteran status.; (2) Who is 

SAMHSA retaining in its discretionary grant programs? 

This includes demographic date as well as reason for 

discharge; and (3) Where is SAMHSA funding going? Are 

resources awarded to underserved areas?

Impact: With this dashboard, SAMHSA leadership 

and staff can use the drop-down features to quickly 

access over 4 years of data (FY19-FY23 (Q1)) that 

include demographic information for over 2 million 

individuals from over 3000 grants awarded to 58 states 

and territories. ASPIRE is a dashboard that enables 

programmatic and policy staff to disaggregate more 

than four years of grant date by priority group, allowing 

for rapid evaluation and performance monitoring. For 

example, recruitment and retention in specific grant 

programs by race/ethnicity can be viewed. 

CENTER FOR SUBSTANCE ABUSE 

PREVENTION (CSAP)

Health Equity Goal

Elevate Community-Based Organizations.

ACTIONS TO DATE:

3 In 2023, the Division of Primary Prevention modified 

the Partnerships for Success funding opportunity 

(Notice of Funding Opportunity (NOFO) to include the 

development of two NOFOs: One NOFO focused on 

communities and the other focused on states.

Impact: This implemented change helped to support 

behavioral health equity through parity in the grant 

process and ensuring that both communities and states 

benefit from substance use prevention dollars.

3 As part of SAMHSA’s evidence-based resource guide 

series, the Center for Substance Abuse Prevention 

(CSAP) led the development of the guide, Community 

Engagement: An Essential Component of an Effective 

and Equitable Substance Use Prevention System.

Impact: This resource guide highlights research on 

community engagement in substance use prevention 

and provides practical guidance for the implementation 

and evaluation of engagement strategies. Throughout 

the guide, engagement examples represent the diversity 

of ethnic/racial populations, settings, and systems. The 

Prevention Technology Transfer Center (PTTC) providers 

have incorporated this content into their TA services.

3 The Communities Talk initiative was created to prevent 

alcohol and other drug misuse among individuals aged 

12-25 years old in communities nationwide. Since 2006, 

the initiative has provided prevention resources and 

stipends to thousands of community-based organizations, 

colleges, and universities.

Impact: More parents talk to their children and 

adolescents about alcohol and drug misuse, including 

families from underserved communities. More colleges 

and universities hold conversations about alcohol and 

drug misuse.

3 In 2023, the Substance Use Disorder Prevention 

Engagement Initiatives (SUDPEI) provided prevention 

resources and stipends to 500 organizations, including 

community-based organizations, high schools, and 

institutes of higher education.

Through this initiative, underserved communities hosted 

a number of prevention activities that educate and 

inform and inspire action regarding the consequences 

of alcohol and other substance use and misuse. This 

included rural communities, particularly in Guam and 

Puerto Rico, Historically Black Colleges and Universities, 

Hispanic Serving Institutions and Tribal Colleges and 

Universities.

Impact: These activities help to empower communities to 

use evidence-based approaches (including environmental 

prevention), reduce alcohol and other substance use and 

misuse, and mobilize communities around alcohol and 

other substance use and misuse prevention initiatives at 

the local, state, and national levels.
SAMHSA’s Behavioral Health Equity Fact Sheet

9

Health Equity Goal

Decrease language as a barrier to participation in SAMHSAfunded activities.

ACTIONS TO DATE:

3 CSAP adapted and translated existing materials into 

Spanish. 

Impact: Spanish language resources, including factsheets, 

guides, and data visualizations, are available on the 

Communities Talk website and in the SAMHSA Store. 

CENTER FOR MENTAL HEALTH SERVICES 

(CMHS)

Health Equity Goal

Build capacity of the workforce to serve underserved racial 

and ethnic populations.

ACTIONS TO DATE:

3 The Minority Fellowship Program reduces health 

disparities and improves behavioral health outcomes for 

underserved racial and ethnic populations by awarding 

fellowships to students pursuing degrees in behavioral 

health professions, including psychiatry, psychology, 

social work, marriage and family therapy, nursing, 

mental health, addiction medicine, and substance and 

addictions counseling. Jointly funded by CMHS, CSAP, 

and CSAT, about 200 fellows are awarded the MFP 

fellowships each year, which are provided through eight 

national behavioral health organizations. Since 1973, 

there have been over 5,000 MFP fellows. In June 2023, 

the 50th Anniversary of the Minority Fellowship Program 

was celebrated, providing an opportunity for grantees, 

fellows, alumni, and supporters to recognize the MFP’s 

contributions towards strengthening the behavioral 

health workforce.

Impact: Increased capacity of behavioral health 

professionals to serve racial and ethnic populations in a 

culturally appropriate manner.

Health Equity Goal

Decrease suicidality and deaths by suicide, including those 

occurring in underserved communities.

ACTIONS TO DATE:

3 In June 2022, CMHS established the Black Youth Suicide 

Prevention Initiative (BYSPI) to develop and implement 

strategies to address the Black youth suicide crisis. BYSPI 

aims to reduce the rates of suicidal ideation, behaviors, 

attempts, and suicide deaths among Black youth 

and young adults between the ages of 5 and 24. The 

BYPSI team includes representatives across CMHS and 

collaborates with other Offices within SAMHSA. To inform 

their work, the BYSPI team conducted a literature review 

and assembled and convened a national subject matter 

expert panel comprised of clinicians, community-based 

organizations, representatives from federal agencies, and 

young people with lived experience of surviving a suicide 

attempt. Following these initial events, the BYSPI team 

developed a strategic plan to guide the initiative and 

serve as a foundation for future work.

• BYSPI’s first major activity was a State Policy Academy, 

held in July 2023, convening eight state teams. The team 

comprised of the state suicide prevention coordinator, 

crisis center staff, a local clinician, individual(s) with 

lived experience and affected family member(s), and 

representatives from the state department of education, 

colleges and universities (preferably Historically Black 

Colleges and Universities [HBCUs]), and community- or 

faith-based organizations. SAMHSA and external subject 

matter experts delivered didactic presentations and 

provided technical assistance to help each team develop 

a state-specific action plan to implement policy, systems, 

and environmental change strategies to reduce suicidal 

ideation, attempts, and deaths among Black youth and 

young adults. BYSPI is currently planning a 2024 Policy 

Academy with eight new state teams.

• The Mental Health Services Block Grant Transformation 

Transfer Initiative (TTI) program provides $250,000 to 

community-based programs based on topics including 

enhancing equitable access to suicide prevention and 

crisis care for underserved communities. Some of the 

states that participated in the Policy Academy are using 

these funds to support implementation of the plans that 

were developed at the State Policy Academy.

• SAMHSA CMHS BYSPI also initiated a learning 

collaborative for the initial Policy Academy cohort, in 

which all eight state teams are participating.

3 In 2023, SAMHSA funded two new resource guides 

for improving equity in suicide prevention. Hope: A 

Guide for Faith Leaders to Help Prevent Youth Suicide

was published by SAMHSA-funded National Action 

Alliance for Suicide Prevention, SAMHSA-funded Suicide 

Prevention Resource Center, and the HHS Center for 

Faith-based and Neighborhood Partnerships (Partnership 

Center), designed to provide faith leaders with guidance 

for identifying and helping youth who may be at risk 

for suicide. The Suicide Prevention Resource Center 

also published Mental Health Promotion and Suicide 

Prevention for LGBTQIA2S+ Youth: A Resource Guide 

for Professionals, Families and Communities, a series of 

guides to help professionals, families, and communities 

support the mental well-being of LGBTQIA2S+ youth.

Impact: Improve the ability of providers, communities, 

and public health entities to prevent suicide for 

populations who are disproportionately affected by 

suicide.
SAMHSA’s Behavioral Health Equity Fact Sheet

10

Health Equity Goal

Decrease health disparities within behavioral health 

services.

ACTIONS TO DATE:

3 Community Behavioral Health Clinics (CCBHCs) are 

designed to ensure access to coordinated comprehensive 

behavioral health care. CCBHCs are required to serve 

anyone who requests care for mental health or substance 

use, regardless of their ability to pay, place of residence, 

or age. There are over 500 CCBHCs across the country 

that are supported through the CCBHC Medicaid 

Demonstration, the SAMHA administered CCBHC 

Expansion grant program, or through independent state 

programs. In March 2023, SAMHSA released the updated 

Certification Criteria for certifying CCBHCs. The criteria 

includes requirements for outreach to underserved 

populations, an equity-driven community health needs 

assessment, training on the National Standards for 

Culturally and Linguistically Appropriate Services (CLAS) 

standards, and an equity analysis of program outcomes, 

including the disaggregation of data collected as a part 

of quality improvement processes in order to assess for 

disparate outcomes among minorities within the clinic.

Integrated care is a critical strategy for advancing health 

equity among underserved and historically marginalized 

communities. In November 2023, the SAMHSA-supported 

Center of Excellence for Integrated Health Solutions

(CIHS) began a seven-session of learning opportunities, 

Advancing Health Equity through Integrated Care, to 

support health care operations teams make integrated 

and equitable changes within their organizations.

3 SAMHSA worked with CMS and ASPE to update the 

certification criteria that set requirements for Certified 

Community Behavioral Health Clinics (CCBHCs) in 

2023. Starting in 2024, more than 500 CCBHCs across 

the country will have to engage in quality improvement 

activities to address disparities disaggregating data to 

track and improve outcomes for populations facing 

health disparities.

Impact: Improving access to culturally responsive 

comprehensive healthcare services. 

Health Equity Goal

Improve behavioral health outcomes of refugee and migrant 

populations.

ACTIONS TO DATE:

3 In November 2023, SAMHSA awarded the new Refugee 

and Migrant Behavioral Health Technical Assistance 

Center. The TA Center will provide learning opportunities, 

training, and technical assistance, including consultation; 

interactive online learning modules; learning 

communities; targeted technical assistance and coaching; 

and online educational materials and resources that are 

culturally relevant, language-relevant, resiliency focused, 

and trauma-informed.

Impact: Increased a focus on health disparities by safetynet providers, improved infrastructure and training for 

behavioral healthcare of refugees and migrants.

Health Equity Goal

Improve access to a comprehensive array of behavioral 

health services for American Indian and Alaska Native youth.

ACTIONS TO DATE:

3 CMHS supports two grant programs for supporting 

American Indian and Alaska Native (AI/AN) youth. The 

Native Connections grant program supports AI/AN 

communities in reducing suicidal behavior and substance 

use among Native youth up to age 24; easing the impacts 

of substance use, mental illness, and trauma in Tribal 

communities; and supporting youth as they transition 

into adulthood. Grantees receive technical assistance 

on Community System Analysis, Community Readiness 

Model, strategic action plans, implementing strategic 

action plans, crisis response, youth at-risk procedures, 

postvention, and other grant activities. Circles of Care

provides Tribes and Tribal organizations with tools and 

resources to plan and design a family-driven, communitybased, and culturally and linguistically competent system 

of care for children.

Impact: Improved infrastructure and service delivery for 

behavioral healthcare of Native youth.

Health Equity Goal

Decrease the impact of the Social Determinants of Health on 

behavioral health outcomes.

ACTIONS TO DATE:

3 SSI/SSDI Outreach, Access, and Recovery (SOAR) helps 

states and communities end homelessness and decrease 

the impacts of the social determinants of health through 

increased access to Social Security disability benefits. 

The SOAR Center published a SOAR Diversity, Equity, 

and Inclusion (DEI) Implementation Toolkit for SOAR 

staff to understand how implicit biases may contribute 

to disparities in SOAR services. For example, this includes 

how SOAR services are accessed by and delivered to 

diverse groups, hiring and supporting staff, identifying 

eligible SOAR applicants, and writing a Medical Summary 

Report (MSR).

Impact: Health-related social needs are addressed.
SAMHSA’s Behavioral Health Equity Fact Sheet

11

Health Equity Goal

Improve access to quality behavioral healthcare for rural and 

remote communities.

ACTIONS TO DATE:

3 The first Local Behavioral Health Crisis System Policy 

Academy focused on the development of a crisis 

continuum for rural and remote communities was held 

by CMHS in 2023. The goals of the policy academy were 

for teams to develop person-centered action plans that 

focused on increasing access to crisis care, identifying 

and closing gaps within crisis systems, building system 

capacity, increasing interagency communication and 

collaboration, and incorporating evidence-based and 

best practices. The plans focused on identifying and 

addressing relevant policy, systems, and environmental 

changes to strengthen the local crisis continuum. Six 

teams participated, which included counties, regional 

collaboratives, and a territory. A second policy academy 

will be hosted in 2024.

Impact: Six local rural and remote communities (counties 

and one territory) developed a customized crisis 

continuum for rural and remote communities. 

ACTIONS TO DATE:

3 In August 2023, SAMHSA released the guide Rural 

Disaster Behavioral Health: A Guide for Outreach 

Workers and Crisis Counselors, which was designed 

to provide staff with knowledge and strategies to best 

support diverse rural communities. The guide considers 

risk factors, strengths, and common disaster reactions 

unique to rural communities to support best practices for 

ensuring disaster resilience and recovery.

Impact: Dissemination of improved knowledge about 

disaster response in rural communities.

Health Equity Goal

Provide disaster response supports to underserved 

communities.

ACTIONS TO DATE:

3 The SAMHSA Disaster Distress Helpline (DDH), the 

first national hotline dedicated to providing year-round 

disaster crisis counseling. This toll-free, multilingual, crisis 

support service is available 24/7 to through call, text, and 

American Sign Language (ASL) videophone to all residents 

in the U.S. and its territories who are experiencing 

emotional distress related to natural or human-caused 

disasters through call, text, videophone. DDH expanded 

the DDH Online Peer Support Communities for those 

impacted by natural or human-caused disasters, gained 

over 2,980 members in FY 2023. DDH counselors are 

equipped and trained to: assess the immediate level 

of behavioral health distress that callers/texters may 

convey or report in relation to extreme heat; encourage 

the callers/texters to follow up with their healthcare 

provider; and access local emergency services if it is 

determined that an imminent health threat related to 

extreme heat may be present for the DDH callers/texters.

Impact: Underserved communities experiencing disasters 

receive culturally responsive supports and services.

CENTER FOR SUBSTANCE ABUSE 

TREATMENT (CSAT)

Health Equity Goal

Build capacity of the workforce to serve racial and ethnic 

minoritized populations.

ACTIONS TO DATE:

3 The Minority Fellowship Program (MFP) aims to 

reduce health disparities and improve behavioral health 

outcomes for underserved racial and ethnic populations 

by: Increasing the knowledge of mental and substance 

use disorder practitioners on issues related to prevention, 

treatment, and recovery support for individuals who are 

from racial and ethnic minority populations and who 

have a mental or substance use disorder; improving the 

quality of mental and substance use disorder prevention 

and treatment services delivered to racial and ethnicity 

minority populations; and increasing the number of 

culturally competent mental and substance use disorder 

professionals who teach, administer services, conduct 

research, and provide direct mental or substance 

use disorder services to racial and ethnic minority 

populations. This program is jointly supported by CMHS, 

CSAP and CSAT.

Impact: Increased capacity of behavioral health 

professionals to serve racial and ethnic populations in a 

culturally appropriate manner.

Health Equity Goal

Increase CSAT’s reach to serve diverse unserved and 

underserved populations across its grant programs.

ACTIONS TO DATE:

3 Completed first of four phases of a project that analyzes 

pre- and post-award data in seven CSAT grant programs 

to: 1) assess diverse populations that are engaged and 

retained into SUD treatment and recovery support 

services; and 2) recommend new approaches that CSAT 

can adopt and/or existing approaches that CSAT can 

modify to advance equity through the grant-making 

processes and grant implementation.

Impact: Improved access and reduced barriers through 

CSAT’s grant programs for diverse unserved and 

underserved populations, who need SUD treatment and 

recovery support services.
SAMHSA’s Behavioral Health Equity Fact Sheet

12

3 Updated 42 CFR Part 8 that set the standard for opioid 

treatment program (OTP) accreditation, certification and 

treatment to expand access to care by reducing barriers 

to entry, allowing for the use of telehealth among OTPs, 

and by codifying mobile treatment units. This helps 

to overcome geographic disparities in access to care, 

particularly among rural populations.

Impact: Expanded access to care in opioid treatment 

programs, improving access to OTP services in other 

settings and reduced overdose deaths. 

3 Expanded access to Medications for Opioid Use Disorder 

(MOUD) within the Federal Bureau of Prisons (BOP), 

in state prisons and in jails across the country. These 

settings often have an over-representation of individuals 

from underserved minority communities. All BOP sites 

are now certified as OTPs. Increasing numbers of carceral 

settings are offering all MOUD either directly or through 

collaboration with OTPs.

Impact: Expanded access to care in state prisons to 

reduce Opioid Use Disorder (OUD) and overdose deaths.

3 In 2023, CSAT awarded Clark Atlanta University the 

Historically Black Colleges and Universities Center for 

Excellence (HBCU-CFE) designed to recruit students to 

careers in the behavioral health field to address mental 

and substance use disorders, provide training that can 

lead to careers in the behavioral health field, and/or 

prepare students for obtaining advanced degrees in 

the behavioral health field. This program aligns with 

Executive Order 14041 (White House Initiative on 

Addressing Educational Equity, Excellence, and Economic 

Opportunity Through Historically Black Colleges and 

Universities).

Impact: Aims to increase the number of students 

prepared to enter the behavioral health field and provide 

culturally competent services.

3 Required the integration of diversity, equity, and 

inclusion in the provision of services and activities 

throughout the Targeted Capacity Expansion – Special 

Population (TCE-SP) projects.

Impact: Identifies under resourced populations or unmet 

needs identified by the community.

3 Funded the Minority HIV/AIDS Fund: Integrated 

Behavioral Health and HIV Care for Unsheltered 

Populations Pilot Project (MHAF). The purpose of this 

program is to pilot an approach to comprehensive health 

care for racial and ethnic medically underserved people 

experiencing unsheltered homelessness through the 

provision of portable clinical care delivered outside that 

is focused on the integration of behavioral health and HIV 

treatment and prevention services.

Impact: Improved the health care for people 

experiencing unsheltered homelessness while learning, 

through the experience of funded grant recipients, best 

practices for HIV/HCV, SUD, and mental health service 

delivery by providing portable clinical care.

3 Minority AIDS Initiative: Substance Use Disorder 

Treatment for Racial/Ethnic Minority Populations 

at High Risk for HIV/AIDS program funded 44 grants 

in FY23. The purpose of this program is to increase 

engagement in care for racial and ethnic medically 

underserved individuals with substance use disorders 

(SUDs) and/or co-occurring SUDs and mental health 

conditions (COD) who are at risk for or living with HIV. 

Award recipients are expected to take a syndemic 

approach to SUD, HIV, and viral hepatitis by providing 

SUD treatment to medically underserved racial and 

ethnic individuals at risk for or living with HIV.

Impact: Increase engagement in care for underserved 

individuals with SUD, COD and mental health conditions 

at risk for or living with HIV.

3 Updated Notice of Funding Opportunities to allow 

activities that address behavioral health disparities 

and the social determinants of health using data to 

understand who is served and disproportionately served 

(e.g., overserved or underserved).

Impact: Aims to address health-related social needs for 

individuals impacted by substance use disorder (SUD) 

and to strengthen statewide recovery networks toward 

creating equitable and sustainable approaches.

3 Require Recovery Communities Services Program (RCSP) 

projects to conduct culturally appropriate and relevant 

outreach to individuals and community organizations to 

raise awareness of the availability of recovery support 

services and foster engagement in RSS.

Impact: Brings the recovery concept and programs to 

underserved communities.

March 2024