Strategic Plan 

2023-2026 

Strategic Plan

Fiscal Year 2023–2026

Substance Abuse and Mental Health Services Administration 

National Mental Health and Substance Use Policy Laboratory
Strategic Plan: Fiscal Year 2023-2026

Acknowledgements

We would like to acknowledge all those who contributed to the development of the

2023-2026 SAMHSA Strategic Plan, especially SAMHSA’s Executive Leadership Team, Priority 

and Guiding Principle Leads and staff.

Strategic Plan: Fiscal Year 2023-2026 was prepared for the Substance Abuse and Mental 

Health Services Administration (SAMHSA) under contract number 

CMS75FCMC18D0047/75S20322F80003 with SAMHSA, U.S. Department of Health and 

Human Services (HHS). Donelle Johnson served as contracting officer representative.

Disclaimer

The views, opinions, and content of this publication are those of the author and do not 

necessarily reflect the views, opinions, or policies of SAMHSA. Nothing in this document 

constitutes a direct or indirect endorsement by SAMHSA or HHS of any non-federal entity’s 

products, services, or policies.

Public Domain Notice

All material appearing in this publication is in the public domain and may be reproduced or 

copied without permission from SAMHSA. Citation of the source is appreciated.

However, this publication may not be reproduced or distributed for a fee without the specific, 

written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access

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Recommended Citation

Substance Abuse and Mental Health Services Administration: Strategic Plan: Fiscal Year

2023-2026. Publication No. PEP23-06-00-002 MD: National Mental Health and Substance 

Use Laboratory, Substance Abuse and Mental Health Services Administration, 2023.

Originating Office

National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental 

Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, SAMHSA Publication 

No. PEP23-06-00-002. Released 2023.

Nondiscrimination Notice

The Substance Abuse and Mental Health Services Administration (SAMHSA) complies with 

applicable Federal civil rights laws and does not discriminate on the basis of race, color, 

national origin, age, disability, religion, or sex (including pregnancy, sexual orientation, and 

gender identity). SAMHSA does not exclude people or treat them differently because of race, 

color, national origin, age, disability, religion, or sex (including pregnancy, sexual orientation, 

and gender identity).

Publication No. PEP23-06-00-002 

Released 2023
1

Message from the Assistant Secretary 

for Mental Health and Substance Use, 

U.S. Department of Health and Human

Services

As the Assistant Secretary for Mental Health and Substance Use in the United States Department of 

Health and Human Services (HHS) and the leader of the Substance Abuse and Mental Health Services

Administration (SAMHSA), I am pleased to present our 2023-2026 Strategic Plan. 

This four-year plan emphasizes a more person-centered approach and introduces a new mission and 

vision, key guiding principles, and priorities. It will serve as a roadmap to improve and advance public 

health and service delivery efforts that promote mental health, prevent substance misuse and overdose, 

and provide treatments and supports to foster recovery while also ensuring equitable access and better 

outcomes. 

In order to achieve our mission, we have identified five priority areas to better meet the behavioral health 

care needs of the nation. The priorities include: 1) Preventing Substance Use and Overdose; 2) Enhancing 

Access to Suicide Prevention and Mental Health Services; 3) Promoting Resilience and Emotional Health 

for Children, Youth, and Families; 4) Integrating Behavioral and Physical Health Care; and 5) 

Strengthening the Behavioral Health Workforce. Our work is also guided by four key principles that are 

infused throughout the Agency’s programs and policies: Equity; Trauma Informed Approaches; 

Recovery; and Commitment to Data and Evidence. 

The Strategic Plan is driven by initiatives elevated by the White House, Congress, and HHS, such as the 

Unity Agenda, the Bipartisan Safer Communities Act, and the HHS Strategic Plan. It is our intent that our 

plan unite these efforts by facilitating actions to help fully integrate behavioral health services and 

supports within all health care programs and systems; develop a well-trained, diverse, and culturally 

competent workforce; reduce incidence, prevalence, and mortality related to substance use, overdose, 

mental illness, and suicide; and provide resources needed to develop, support, promote, and sustain 

resilience in children, youth, and families. 

In crafting this new Strategic Plan, it was essential to connect with the public to ensure our ideas and 

approaches are in line with what people are experiencing in real life as well as in the behavioral health 

field. We received numerous comments, and I am pleased to say that public input was influential in 

shaping our thinking. 

Furthermore, without our federal, state, tribal and local partners, as well as our many other stakeholders, 

SAMHSA cannot accomplish our goals and objectives. We hope this Strategic Plan informs and guides 

your planning as you work to develop and implement programs and policies that ensure people living 

with, affected by, or at risk for mental health and substance use conditions receive care, achieve wellbeing, and thrive.

Miriam E. Delphin-Rittmon, PhD

Assistant Secretary for Mental Health and Substance Use

U.S. Department of Health and Human Services
2023 - 2026 | SAMHSA Strategic Plan

1

Table of Contents

Introduction ................................................................................................................ 2

Strategic Framework.................................................................................................. 3

Mission .............................................................................................................. 3

Vision................................................................................................................. 3

Priorities and Guiding Principles........................................................................ 3

Purpose ............................................................................................................. 4

Guiding Principles.............................................................................................. 5

Equity ................................................................................................................ 5

Trauma-Informed Approaches........................................................................... 6

Recovery ........................................................................................................... 7

Commitment to Data and Evidence................................................................... 8

Priorities ............................................................................................................ 8

Priority 1: Preventing Substance Use and Overdose.............................................. 9

Priority 2: Enhancing Access to Suicide Prevention and Mental Health Services

...................................................................................................................................18

Priority 3: Promoting Resilience and Emotional Health for Children, Youth, and 

Families.....................................................................................................................30

Priority 4: Integrating Behavioral and Physical Health Care ................................42

Priority 5: Strengthening the Behavioral Health Workforce ................................. 49

Conclusion................................................................................................................57

Acronyms..................................................................................................................58

Glossary....................................................................................................................60

References................................................................................................................67
2023 - 2026 | SAMHSA Strategic Plan

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Introduction

The United States faces unprecedented mental health and substance use crises among 

people of all ages and backgrounds. Two out of five adults have symptoms of anxiety or 

depression, and under-served communities are disproportionately impacted.

1 Even before 

the COVID-19 pandemic, rates of depression and anxiety were increasing.

1 The grief, 

trauma, and physical and social isolation related to the COVID-19 pandemic have 

exacerbated these issues for many.

2 Among adults aged 18 or older in 2021, nearly 58 

million people had any mental illness and 14 million people had a serious mental illness in 

the past year. Drug overdose deaths have reached a historic high, devastating individuals, 

families, and communities. More than 107,600 people in the United States died due to an 

overdose in 2021, and over 46 million people met the diagnostic criteria for a substance 

use disorder (SUD) in the past year.

3,4

Despite these tragic numbers, many people are moving toward and achieving recovery. 

The most recent National Survey on Drug Use and Health (NSDUH) tells a more 

encouraging story: nearly 21 million adults who perceived they ever had a substance use 

problem and nearly 39 million who perceived they ever had a problem with their mental 

health considered themselves in recovery or recovered.

3

Behavioral health issues are challenging and complex and require multifaceted efforts. As

part of a comprehensive and nation-wide approach, in 2022 President Biden announced

the Unity Agenda, which highlights mental health and the overdose crisis as two of four 

key pillars.

2 The Substance Abuse and Mental Health Services Administration (SAMHSA) 

actively works to advance this agenda by strengthening system capacity, connecting more 

people to care, and creating a continuum of holistic and equitable behavioral health 

supports aimed to transform our health and social services infrastructure, including for 

historically under-served communities and populations. With this in mind, SAMHSA 

developed a new, four-year strategic plan to reflect these priorities. 

The 2023–2026 SAMHSA Strategic Plan presents a new person-centered mission and 

vision highlighting key guiding principles and presenting new priorities, goals, and 

objectives. This Plan aligns with various initiatives and goals of the Administration, 

Congress, and the U.S. Department of Health and Human Services (HHS). 
2023 - 2026 | SAMHSA Strategic Plan

3

Strategic Framework

This is a significant time in history. Federal, state, and territory governments; tribes and 

tribal organizations; communities; families; providers; and people with lived experience are

coming together to address the mental health and substance use crises. Agency 

leadership and staff; traumatic events such as school shootings; natural disasters such as 

hurricanes, tornadoes, and wildfires; and the innovative ideas and suggestions 

communicated by our many stakeholders informed this Strategic Plan. 

Mission 

SAMHSA’s mission is to lead public health and service delivery efforts that promote mental 

health, prevent substance misuse, and provide treatments and supports to foster recovery 

while ensuring equitable access and better outcomes.

Vision

SAMHSA envisions that people with, affected by, or at risk for mental health and 

substance use conditions receive care, achieve well-being, and thrive. 

Priorities and Guiding Principles

The Strategic Plan keeps the continuum of mental health and substance use services and 

supports at its core and emphasizes four overarching guiding principles across all policies 

and programs to support SAMHSA in achieving its mission and vision. These include

equity, trauma-informed approaches, a commitment to data and evidence, and recovery. 

The priorities and their corresponding goals and objectives focus on five key areas, 

described in detail further in this document: 
2023 - 2026 | SAMHSA Strategic Plan

4

Figure 1. Strategic Plan Priorities and Guiding Principles

Purpose

The 2023–2026 SAMHSA Strategic Plan supports the numerous initiatives and goals of 

the Administration, Congress, and HHS that prioritize behavioral health. Specifically, the 

President’s Unity Agenda identifies mental health as essential to overall health, and 

executive orders such as Executive Order 13985 highlight the importance of advancing 

racial equity and support for under-served communities.

5,6 The 2022 National Drug Control 

Strategy underscores the damaging consequences of the drug overdose epidemic and the 

urgent need for substance use prevention and early intervention, harm reduction, 

treatment, and recovery support for all who need it.7 

In concert, HHS released its 2022–2026 Strategic Plan, which calls for protecting and 

strengthening equitable access to high-quality and affordable health care as well as 

improving social well-being, equity, and economic resilience.

8 HHS published a Health 

Workforce Strategic Plan, which discusses enhancing care quality through professional 

development, collaboration, and evidence-based and evidence-informed practices and 

encourages the use of data to strengthen the health workforce.9 The Surgeon General 

developed an Advisory on Protecting Youth Mental Health, which emphasizes the role 

family, communities, policymakers, media, young people, and others play in increasing 

resiliency and supporting children and youth.10 SAMHSA also advances the National Tribal 

Behavioral Health Agenda (TBHA) with tribes and the federal government, to improve 

behavioral health and contribute to the well-being of American Indians and Alaska Native 
5

2023 - 2026 | SAMHSA Strategic Plan

people. The TBHA is a blueprint to strengthen policies and programs, align disparate 

resources, and facilitate collaboration.

11

Further illustrating behavioral health as a top priority for the nation, Congress passed the 

Bipartisan Safer Communities Act, which, among other directives, includes meaningful

investments in school-based mental health services and additional support for the 988

Suicide & Crisis Lifeline.

12 SAMHSA received extensive and thoughtful feedback from

stakeholders calling for action to improve well-being by heightening the importance of

behavioral health integration and focusing on trauma-informed, recovery-oriented, and 

person-centered care. 

SAMHSA received a total of $7.5 billion in the Consolidated Appropriations Act, 2023.

13

This is almost $1 billion over SAMHSA’s Fiscal Year 2022 level. This law reauthorized key

SAMHSA programs at increased funding levels and created new programs to improve

availability of recovery and peer supports. It contains provisions to improve access to

integrated care, increase the behavioral health workforce, and increase access to 

medications for opioid use disorder by removing the DATA 2000 waiver.

13

These federal efforts share similar themes and objectives. SAMHSA intends for the 2023–

2026 Strategic Plan to unite these undertakings by facilitating actions to help fully integrate

behavioral health services and supports within all healthcare programs and systems;

develop a well-trained, diverse, and culturally competent workforce; reduce incidence,

prevalence, and mortality related to overdose and suicide; and provide the resources

needed to develop, support, promote, and sustain resilience in children, youth, and 

families (see Figure 1). 

Guiding Principles 

The 2023–2026 Strategic Plan integrates four overarching guiding principles across all 

policies and programs to support SAMHSA in achieving its mission and vision.

Equity

Behavioral health equity is the right to access high-quality and affordable healthcare 

services and supports for all populations. Executive Order 13985 defines “equity” as the 

consistent and systematic, fair, just, and impartial treatment of all individuals, including 

those who belong to under-served communities that have been denied such treatment.

6

Under-served/historically marginalized populations: Black, Latino, Hispanic, and 

Indigenous and Native American persons; Asian Americans and Pacific Islanders 

and other persons of color; members of religious minorities; Lesbian, Gay, Bisexual, 

Transgender, Queer, and Intersex (LGBTQI+) persons; persons with disabilities; 

persons who live in rural areas; and persons otherwise adversely affected by 

persistent poverty or inequality.14
2023 - 2026 | SAMHSA Strategic Plan

6

As population demographics evolve, behavioral healthcare 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 under-served and historically marginalized 

populations and communities are important first steps to ensuring that all people are 

provided with fair opportunities to be as healthy as possible. 

For some populations, this is an ongoing challenge. The 2021 NSDUH survey reports that 

White people were more likely than Hispanic, Latino, or Asian people to have received 

substance use treatment at a specialty facility in the past year. Similarly, White and

Multiracial adults were more likely to receive mental health services in the past year than 

Black, Hispanic, Latino, or Asian American adults.

3 American Indian/Alaska Native adults

were more likely than White, Black, Hispanic, or Asian adults to have both any mental 

illness and a SUD.

3 Lesbian, Gay, and Bisexual (LGB) adults were more than twice as 

likely than heterosexual individuals (49.7 percent for LGB vs. 20.2 percent for 

heterosexual) to have used an illicit substance in the past year.

3 This has important 

implications for how behavioral health systems effectively outreach, engage, and retain 

these diverse groups in care. In conjunction with promoting access to high-quality services, 

behavioral health disparities can be mitigated by addressing social determinants of health

(SDOH), such as social injustice and racial exclusion, unemployment, level of education, 

lack of access to transportation, food insecurity, housing instability, and exposure to 

trauma.

14

Reducing the impact of SDOH in conjunction with promoting adherence to the National 

Culturally and Linguistically Appropriate Services Standards are important steps SAMHSA 

takes to reduce disparities.15 Unfortunately, language accessibility and assistance are 

often overlooked despite the fact that they are fundamental to engagement in treatment, 

quality of care, and the customer experience.16 For communities and populations where 

English is not the primary spoken language, provision of language assistance is not only a 

civil right regarding health care, but a necessary component of equitable care.

16

Trauma-Informed Approaches

Trauma-informed approaches recognize and intentionally respond to the lasting adverse 

effects of traumatic experiences, while promoting linkages to recovery and resilience for 

impacted individuals and families. Not only is trauma a widespread and costly public health 

problem that may occur from experiencing emotionally harmful events such as violence, 

abuse, neglect, or natural disasters, for those with mental health and substance use 

conditions trauma is an almost universal experience.17

Trauma negatively impacts both mental and physical health. These adverse effects may 

have both short-term and long-term consequences.

18,19,20,21,22 Many people who 

experience trauma may overcome it, becoming stronger and more resilient; but for others,

traumatic experiences can be overwhelming and disruptive to their daily lives.

17
2023 - 2026 | SAMHSA Strategic Plan

7

Whole communities can be profoundly shaped by traumatic experiences.

17 This can occur 

through a significant event such as a mass violence event. For many marginalized 

populations, experiences of historical and intergenerational trauma and daily experiences 

of interpersonal and structural racism and discrimination can significantly impact individual 

and community well-being.

17 

A trauma-informed approach is defined by six key principles: 

1. Safety: participants and staff feel physically and psychologically safe.

2. Peer support: peer support and mutual self-help are vehicles for establishing

safety and hope, building trust, enhancing collaboration, and utilizing lived

experience.

3. Trustworthiness and transparency: decisions are conducted with the goal of

building and maintaining trust.

4. Collaboration and mutuality: importance is placed on partnering and leveling

power differences.

5. Cultural, historical, and gender issues: cultural and gender-responsive services

are offered while moving beyond stereotypes/biases.

6. Empowerment, voice, and choice: organizations foster a belief in the primacy of

the people who are served to heal and promote recovery from trauma.

17

Recovery

SAMHSA defines recovery as a process of change through which individuals improve their 

health and wellness, live self-directed lives, and strive to reach their full potential.

23 This 

definition is realized through four major dimensions: 

1. Health: overcoming or managing one’s disease(s) or symptoms, and making

informed, healthy choices that support physical and emotional well-being.

2. Home: having a stable and safe place to live.

3. Purpose: conducting meaningful daily activities, such as a job, school,

volunteerism, family caretaking, or creative endeavors, and the independence,

income, and resources to participate in society.

4. Community: having relationships and social networks that provide support,

friendship, love, and hope.

23

Recovery promotes the expectation that all individuals, including those with SUDs and 

mental illnesses, can thrive. Recovery is more than abstinence or symptom remission, 

rather it is based on the goal and expectation of living well and thriving. SAMHSA not only 

envisions individuals achieving recovery, but also supports developing and sustaining 

recovery-oriented systems of care and creating recovery-facilitating environments. We 

intend that when anyone with a behavioral health condition seeks help, they are met with 
2023 - 2026 | SAMHSA Strategic Plan

8

the knowledge and belief that they can recover and/or manage their conditions 

successfully. SAMHSA recognizes that recovery considers cultural and community 

expectations and is understood and embraced differently across diverse populations.

SAMHSA instrumentally advances recovery support systems to promote partnering with 

people in recovery and their family members to guide the behavioral health system. This 

includes promoting individual, program, and system-level approaches that foster health 

and resilience; increasing housing to support recovery; reducing barriers to employment, 

education, and other life goals; and securing necessary social supports in their chosen

community. 

Commitment to Data and Evidence

Timely, high-quality data help public health officials, policymakers, community 

practitioners, and the public to understand mental health and substance use trends and 

how they evolve; inform the development and implementation of targeted evidence-based 

interventions; focus resources where needed most; and evaluate programs and policy 

success. SAMHSA aims to decrease burden on stakeholders while expanding and 

improving data collection, analysis, evaluation, and dissemination. To achieve this 

objective, we are streamlining and modernizing data collection efforts and coordinating 

cross-agency evaluation to ensure data-driven funding and policies. SAMHSA uses

rigorous evaluation and analytical processes in alignment with the Foundations for 

Evidence-Based Policymaking Act of 2018.

24

SAMHSA leverages data and evidence to strengthen activities around our guiding 

principles and the five priority areas and inform agency policies and programs. Using

robust methods to collect, analyze, and report valid, reliable, trustworthy, and protected 

data is key to improving and impacting behavioral health treatment, prevention, and 

recovery for communities most in need. By using rigorous methods and improving the 

quality and completeness of program data, data can be disaggregated across different 

population groups to assess disparities within the behavioral healthcare system. 

Priorities 

The following sections describe SAMHSA’s priorities, strategic goals, and related

objectives. Each section discusses the key approaches, mechanisms, and strategies 

SAMHSA intends to engage in to deliver measurable results in advancing its mission and 

vision.
9

The isolation, anxiety, and reduced access to resources experienced by so many during

the COVID-19 pandemic exacerbated the overdose epidemic and contributed to a sharp 

rise in related deaths.2In response, the U.S. Department of Health and Human Services 

(HHS) released an Overdose Prevention Strategy (OPS) in October 2021, outlining four

pillars: Primary Prevention, Harm Reduction, Evidence-Based Treatment, and Recovery 

Support (see Figure 2).25 The OPS aims to maximize health equity using the best 

available data and evidence to inform policy and actions, integrating substance use 

disorder (SUD) treatment services into other types of health care and social services, and 

reducing stigma.

25 The Substance Abuse and Mental Health Services Administration 

(SAMHSA) commits to creating communities where individuals, families, schools, faithbased organizations, and workplaces take action to promote emotional health and reduce 

the likelihood of mental illness, early substance use initiation, substance misuse, SUDs, 

overdose, and suicide. 

Figure 2. HHS Overdose Prevention Strategy Substance Use Continuum

Primary prevention focuses on intervening before a disease or condition occurs. Highvalue benefits derived from primary prevention span multiple sectors, including health 

care, public safety, the criminal justice system, and beyond—both broadly speaking and 

within marginalized communities. Working to prevent higher-risk behaviors and disease 

from happening in the first place has many benefits, including financial benefits, prevention 

of unnecessary human suffering, and reduced negative societal impacts.

26,27 Estimates 

Priority 1

Preventing Substance Use and Overdose
2023 - 2026 | SAMHSA Strategic Plan

10

approximate a tenfold return on investments made in evidence-based substance use 

prevention programs and activities.

27

People from under-served communities face particularly complex challenges with 

substance use and misuse; however, these communities also have strengths and 

protective factors such as faith-based organizations, civic associations, community-based 

organizations, and other natural supports that can work in conjunction with evidence-based 

practices to support people facing substance use issues.23 Addressing substance use, 

misuse, and SUDs among under-served racial, ethnic, and Lesbian, Gay, Bisexual, 

Transgender, Queer, and Intersex (LGBTQI+) populations includes (1) incorporating 

culturally and linguistically effective policies, programs, practices, and engagement 

strategies; (2) being community-centered; (3) offering comprehensive services that 

address participants’ substance use and misuse, SUD(s), health care, and social needs; 

and (4) using culturally appropriate harm reduction and healing-centered approaches to 

care and recovery.

23

For individuals who may have a SUD or need more intensive services, SAMHSA supports 

a range of more targeted mitigation services, including harm reduction approaches such as 

distribution of naloxone and fentanyl test strips to those at high risk for overdose.

SAMHSA’s treatment and recovery support programs, such as the State Opioid Response, 

Tribal Opioid Response, and Building Communities of Recovery grants, include a range of 

evidence-based services. These services link people with SUDs and those who have 

experienced an overdose to low-barrier access to medication and non-pharmacologic 

treatment options and peer support and recovery services to reduce repeat overdoses. 

Together, these efforts meet people wherever they are on the behavioral health 

continuum, through targeted services and supports that are culturally appropriate and 

driven by public health data. 

Goal 1. To reduce and prevent substance use and misuse, SAMHSA will support 

efforts to strengthen prevention programs, policies, and practices.

Primary prevention appropriately underscores a need for earlier and broader work to 

benefit all of SAMHSA’s priorities. Central to a comprehensive prevention system are (1) 

environmental strategies for capacity building via steady economic investments; (2)

strategic focus on increasing protective factors across the lifespan in order to mitigate risks 

to individual- and population-level well-being and resilience; (3) support for communication 

across the prevention system to raise public awareness about substance use and misuse 

and build support for prevention programming; (4) investments in evidence-based and/or 

evidence-informed programming and technical assistance (e.g., workforce development 

and tool accessibility) to ensure broad implementation of culturally appropriate policies, 

programs, and practices; and (5) strong community relationships and engagement that 

enable stakeholders to work together to address health-related issues and promote wellbeing to achieve positive health impact and outcomes. SAMHSA’s contributions to these 

efforts begin upstream with primary prevention policies, programs, and practices that 
2023 - 2026 | SAMHSA Strategic Plan

11

address individual and population health and involve state, territorial, tribal, and community 

sectors. 

Objective 1.1. Provide support to states, territories, tribes, and communities for

programs and projects that address the prevention and reduction of substance use 

and misuse.

The healthcare system lacks enough providers and resources to offer quality treatment to 

everyone in need. However, a broader prevention approach has the capacity to strengthen 

our nation to reduce treatment demand altogether. Broader and earlier approaches to 

primary prevention include strengthening social determinants of health (SDOH), supporting 

healthy social and emotional development, reducing and addressing childhood and other 

trauma, supporting parents and strengthening families, expanding evidence-based

programs in schools, and improving the safety and livability of community environments. 

SAMHSA’s Strategic Prevention Framework (SPF) is a dynamic, data-driven planning 

process to support effective primary prevention work starting at the community level. In 

The SAMHSA-funded Prevention Technology Transfer Center (PTTC) Network

develops and strengthens the specialized behavioral healthcare and primary 

healthcare workforce that provides prevention services for SUDs and mental illness. It 

also improves implementation and delivery of effective substance use prevention 

interventions and provides training and technical assistance services to the 

prevention field.

The Strategic Prevention Framework-Partnerships for Success Program is 

designed to help state, territorial, tribal, and community organizations reduce the 

onset and progression of substance misuse and its related problems by supporting 

the development and delivery of prevention services. The program extends 

established cross-agency and community-level partnerships by connecting prevention 

programming to departments of social services and their community service 

providers. This includes working with populations disproportionately impacted by the 

consequences of substance misuse (e.g., children entering the foster care system 

and transitional aged youth) and individuals who support persons with substance

misuse issues (e.g., women, families, parents, caregivers, and young adults).

The Grants for the Benefit of Homeless Individuals program supports the 

development and/or expansion of local implementation of a community infrastructure 

that integrates treatment and recovery support services for SUDs or co-occurring 

disorders, permanent housing, and other critical services for individuals (including 

youth) and families experiencing homelessness.

Preventing Substance Use and Overdose

Goal 1 Example Programs
2023 - 2026 | SAMHSA Strategic Plan

12

general, programs and practices must operate in a variety of community settings and 

influence local risk and protective factors at both the individual and environmental levels. 

The Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block 

Grant is the cornerstone of the nation’s prevention, treatment, and recovery systems. The 

program provides funds to all 50 states, the District of Columbia, Puerto Rico, the U.S. 

Virgin Islands, the Northern Mariana Islands, Guam, American Samoa, 3 Pacific 

jurisdictions, and 1 tribal entity to prevent substance use and misuse and treat SUDs. The 

SUPTRS Block Grant affords grantees the flexibility to tailor their substance use-related 

services to meet the needs of their populations. SAMHSA requires that grantees spend no

less than 20 percent of their allotment on substance use primary prevention strategies. 

Grantees must also develop a comprehensive primary prevention program that includes 

activities and services provided in a variety of settings targeting both the general 

population and subgroups at high risk for substance use, misuse, and use disorders. 

Additionally, the program must include, but is not limited to, the following strategies: 

information dissemination, education, alternatives, and problem identification and referral.

Objective 1.2. Enhance protective factors in preventing or delaying initiation of 

substance use. 

Risk and protective factors are conditions in environments that can significantly impact 

health and overall well-being.28 Protective and risk factors are behaviors, experiences, or 

conditions that either decrease or increase the impact on individual and community health, 

wellness, and well-being, including an individual’s likelihood of consuming substances. 

Protective factors include social coping and effective problem-solving skills, strong 

interpersonal relationships, employment, and community supports. Alternatively, risk 

factors include adverse childhood experiences (ACEs), social pressure, living in 

communities with negative SDOH, and trauma. ACEs can have lasting, negative effects on 

health and well-being, including behavioral health. Creating and sustaining safe, stable, 

nurturing relationships and environments for all children and families can prevent ACEs 

and help all children reach their full potential. Protective factors can help buffer individuals 

from influences that make them more inclined to start using or misusing substances.29,30

Through grant funding and stakeholder partnerships, SAMHSA will support strengthsbased approaches that enhance protective factors. Approaches include enhancing cultural

connections, bolstering community-based resources, strengthening family relationships,

and offering a variety of afterschool programs. 

Objective 1.3. Increase public awareness of negative consequences of substance 

use and misuse for individuals, families, and communities. 

For the past 30 years, SAMHSA has raised public awareness about the effects and harms 

of substance use and misuse and related consequences on the health, wellness, and wellbeing of individuals, families, and communities. To meet the unique needs of diverse 

communities across the nation, SAMHSA utilizes various evidence-based and/or evidence-
13

2023 - 2026 | SAMHSA Strategic Plan

informed programs, campaigns, social media platforms, curricula, and trainings to educate 

the public and the prevention workforce. As a result, individuals, families, and communities

receive the knowledge and skills to seek help and/or help others access support services.

These public awareness efforts promote community mobilization to improve life trajectories

for youth and adults who may be using or misusing substances or may be at risk for, or 

living with, SUDs. Effective communication to raise awareness relies on alignment of 

prevention messaging (e.g., "Talk. They Hear You.”®) with public health interventions such 

as policies, programs, and practices. 

Objective 1.4. Provide technical assistance and training to communities and

organizations interested in establishing and expanding prevention programs 

seeking to implement evidence-based and/or evidence-informed practices. 

SAMHSA provides a range of technical assistance resources and trainings to enable 

community needs assessments, community improvement plans, logic models, and 

workplans. The Strategic Prevention Technical Assistance Center assists prevention 

providers in developing culturally appropriate and evidence-based and evidence-informed 

substance misuse prevention programs in alignment with the SPF. This work focuses on 

enhancing data-driven decision making and reducing behavioral health disparities

experienced by historically disenfranchised communities. 

Through the Prevention Technology Transfer Center (PTTC) Network, SAMHSA provides

comprehensive training and technical assistance to the nation’s substance use prevention 

field. The PTTC Network improves implementation and delivery of effective substance use 

prevention interventions by developing and disseminating tools and strategies needed to 

improve the quality of substance misuse prevention efforts; providing intensive technical 

assistance and learning resources to prevention professionals to improve their 

understanding of prevention science, epidemiological data, and their implementation of 

evidence-based and promising practices; and developing tools and resources to engage 

the next generation of prevention professionals. 

Goal 2. To prevent overdose deaths in America, SAMHSA will support efforts to 

transform systems and services that increase access to and utilization of harm 

reduction approaches and effective treatments. 

As the overdose crisis evolves, SAMHSA will engage in an evidence-based approach to 

saving lives, reducing risk, and removing barriers to effective interventions. With this 

approach, SAMHSA will promote care and services that respect the health and dignity of 

people who use drugs. System changes include data-driven performance improvement 

informed by impacted individuals, families, and communities to achieve outcomes that 

reduce risk, save lives, and provide equitable pathways to recovery. System 

transformation will occur within clinical and community-based settings, focusing on priority 

populations across the lifespan and throughout the continuum of care.
2023 - 2026 | SAMHSA Strategic Plan

14

Telehealth is an important modality to expand services and increase equitable access to

services. SAMHSA will promote telehealth options through educational offerings, technical 

assistance, and collaboration with other federal partners such as the Drug Enforcement 

Administration (DEA) to support and advance telehealth service expansion under their 

respective authorities. SAMHSA will support revisions to opioid treatment program 

regulations to lower barriers to accessing and engaging with treatment services.

Objective 2.1. Increase utilization of medications for opioid use disorder.

The Food and Drug Administration (FDA) has approved three medications for the

treatment of opioid use disorder (MOUD): buprenorphine, methadone, and naltrexone. 

Available in different formulations, significant evidence supports the effectiveness of these

medications in improving outcomes for people with opioid use disorder (OUD).

31 Studies 

show that methadone and buprenorphine reduce opioid-related mortality by over 50

percent. Treatment that includes MOUD is also associated with significant reductions in 

human immunodeficiency virus and viral hepatitis disease transmission, and with 

improvements in recovery-related outcomes such as employment, educational attainment, 

and quality of life.32 Despite policy changes seeking to expand access to MOUD, these 

medications continue to be vastly underutilized.33,34

To foster the utilization of MOUD, SAMHSA will partner with other entities in the federal 

government and externally. This includes implementing policy changes that remove the 

DATA 2000 waiver (X-waiver) for prescribing buprenorphine for the treatment of OUD and 

revised regulations for the provision of methadone. Removal of the X-waiver seeks to 

The Substance Use Prevention, Treatment, and Recovery Services Block Grant 

provides funds to states, territories, and tribes to help plan, implement, and evaluate 

activities that support prevention, treatment, and recovery from SUDs. SAMHSA 

strongly encourages grantees to use a portion of their funding for recovery support 

services.

State/Tribal Opioid Response Programs prevent overdose deaths from opioids and 

stimulants, reduce unmet treatment need, and support recovery for people with, or at 

risk for, opioid use disorder and/or stimulant use disorders and related conditions. The 

programs also include a robust technical assistance center.

The Harm Reduction Program Grant supports community-based overdose 

prevention programs, including naloxone distribution, syringe services programs, 

health and harm reduction education, and linkages to care, including for infectious 

diseases. 

Preventing Substance Use and Overdose

Goal 2 Example Programs
2023 - 2026 | SAMHSA Strategic Plan

15

reduce barriers to treatment availability by allowing more practitioners to prescribe

buprenorphine for OUD.

35 To increase treatment capacity and decrease stigma, SUD

management education will be a requirement of all DEA-registered providers as part of 

usual healthcare practitioner curricula.

35 SAMHSA partners with other stakeholders to

expand access to and use of methadone and buprenorphine in correctional settings, 

addressing stigma of MOUD, and addressing other factors impacting equitable uptake and 

continued treatment, particularly among populations most affected by the overdose crisis.

SAMHSA will require the provision of MOUD wherever possible, including in the Certified 

Community Behavioral Health Clinics program, which now has nearly 500 sites across 46 

states.36

Objective 2.2. Increase uptake of evidence-based interventions.

To combat morbidity and mortality related to SUDs, SAMHSA supports several evidencebased interventions like opioid education and naloxone distribution to reverse overdose, 

and syringe services programs to reduce infectious disease spread.31 In the absence of 

pharmacological treatments, behavioral interventions are often employed as mainstays. 

For example, the lack of effective, FDA-approved pharmacological treatments for stimulant 

use disorder elevates contingency management as a lifesaving option. Contingency 

management is an evidence-based intervention to support SUD recovery efforts among 

adults, in which individuals receive incentives to reinforce desired behaviors.37 Decades of 

research demonstrates the effectiveness of contingency management for recovery from 

various SUDs across racially and socioeconomically diverse populations by producing 

higher abstinence rates and higher retention in treatment compared to other 

interventions.

37

Through grant funded training, technical assistance, and strategic partnerships, SAMHSA 

promotes non-pharmacological evidence-based interventions, such as overdose 

education, and contingency management, that are proven to save and improve lives. 

SAMHSA also supports permissible expenditures in service delivery grants.

Objective 2.3. Achieve universal access to overdose prevention strategies and 

education competencies.

SAMHSA will support federal, state, territorial, tribal, and community partnerships by 

promoting universal and focused public education campaigns. These campaigns raise 

awareness of overdose mitigation strategies such as naloxone and fentanyl test strip 

distribution/drug checking, stigma reduction, overdose prevention training, and low-barrier 

treatment.

To address populations at heightened risk for overdose fatality, SAMHSA supports

targeted and data-driven public health strategies including pre-arrest diversion and referral 

to harm reduction programs, naloxone upon release programs, programs that are culturally 

appropriate for under-served and marginalized populations, post-overdose response 

programs, and naloxone distribution at treatment programs. 
2023 - 2026 | SAMHSA Strategic Plan

16

Additionally, SAMHSA collaborates with states, territories, tribes, and communities to 

achieve naloxone saturation, which is typically considered the amount of naloxone needed 

to ensure its availability for immediate use in 80 percent of witnessed overdoses.

38 We 

support harm reduction organizations’ access to naloxone and support public health 

interventions to increase knowledge and capabilities in naloxone distribution. SAMHSA 

prioritizes training and education that facilitates low-barrier services by promoting

partnerships between harm reduction and treatment organizations. 

Goal 3. To advance recovery, SAMHSA will support strengths-based approaches to 

reduce barriers and create more opportunities to thrive.

This goal will impact those at risk for a SUD and/or for an overdose as well as help 

individuals, families, and communities facilitate greater opportunities for recovery. Primary 

prevention includes strategies and interventions mainly focused on the general population

that aim to delay or prevent substance use, and strategies and interventions that prioritize 

subgroups at higher risk for substance misuse and overdose to prevent the likelihood of 

developing a SUD or experiencing an overdose. A strengths-based recovery approach 

recognizes and cultivates the unique strengths and abilities individuals possess to better 

cope with and overcome behavioral health challenges.

23 Recovery support services are 

designed to leverage the assets of individuals, families, and community resources to 

improve health and well-being.23

The Substance Use Prevention, Treatment, and Recovery Services Block Grant

requires that grantees spend no less than 20 percent of their allotment on primary 

prevention strategies. While a similar set-aside has yet to be included for recovery 

support, SAMHSA strongly encourages states to use a portion of their funding for 

recovery support services.

The Peer Recovery Center of Excellence is a peer-led national center that provides 

training and technical assistance related to SUD recovery.

Preventing Substance Use and Overdose

Goal 3 Example Programs

Objective 3.1. Establish recovery-oriented systems of care as the framework for 

promoting individual, family, and community health.

A recovery-oriented system of care is a network of community-based services and 

supports that is person- and family-centered, is culturally appropriate, and builds on the 

strengths and resiliencies of individuals, families, and communities to achieve improved 

health, wellness, and quality of life for those with or at risk for behavioral health 

problems.

23 Community-based services and supports draw on the resources within the 
2023 - 2026 | SAMHSA Strategic Plan

17

community, including clinical and non-clinical services. This ensures ongoing and 

seamless connections to individuals for as long as needed. Services are designed to 

support individuals across the lifespan, understanding that needs and resources change 

and shift over the course of recovery and time. 

To further this objective, SAMHSA will adapt or adopt policies and practices that are 

informed by the most recent data and reflect scientific advances. This approach directs 

resources and technical assistance to advance community-based systems and services 

oriented to recovery, resiliency, wellness, and social inclusion. SAMHSA engages people 

with lived experience and federal, state, territorial, tribal, and community partners to 

advance health equity and address SDOH so that people in every community can thrive 

and reach their fullest potential.

Objective 3.2. Expand resources for families and caregivers impacted by overdose.

Families and caregivers impacted by overdose need access to resources to support the 

well-being of a person at risk of or who has experienced an overdose. Resources can 

include programs, activities, or services that help promote the well-being of families and 

caregivers to help prevent substance use among other family members. SAMHSA will 

partner with other federal agencies to develop informational materials and programs that 

are consistent with the 2022 National Strategy to Support Family Caregivers.

39

SAMHSA will direct resources to ensure the inclusion and participation of family members 

and informal caregivers in program development, implementation, and evaluation of 

funded services and technical assistance. Families and caregivers from diverse and underserved communities will be a population of special focus for culturally appropriate

outreach, education, and mitigation tools in partnership with local entities. 
2023 - 2026 | SAMHSA Strategic Plan

18

The continuum of mental health services includes mental health promotion and early

intervention, crisis care, suicide prevention, treatment, and recovery support services. 

Individuals with any mental health condition, including serious mental illness (SMI), too

often lack timely access to care. Additionally, mental health services are often fragmented 

such that transitions from one level of care to another are challenging. Many communities

experience service gaps across the continuum such that persons are not able to receive

what they need, when they need it.

The Substance Abuse and Mental Health Services Administration (SAMHSA) aims to lead 

our nation in increasing access to a full continuum of care that provides timely and highquality services to anyone who needs them. In part, this priority aims to enhance access to 

suicide prevention and crisis care as crucial elements of the mental health continuum of

care, so that people experiencing suicidal ideation and other behavioral health crises can 

receive the care they need and want in order to thrive and achieve well-being (see Figure 

3). 

Figure 3. The Mental Health Continuum

Mental Health Promotion & Early Intervention

Multiple risk factors increase the risk for developing a mental health condition. Example 

risk factors include early childhood exposure to adverse experiences like abuse or neglect; 

adverse social and environmental determinants of health, such as low education

Priority 2 

Enhancing Access to Suicide Prevention 

and Mental Health Services
2023 - 2026 | SAMHSA Strategic Plan

19

opportunity, housing instability, unemployment, high crime, neighborhood violence, and 

others; and experiencing bullying or other violent acts at any age. Effectively recognizing 

and addressing these risk factors through structures and services can prevent the 

development of a disorder or lessen the impact or severity of a mental disorder. SAMHSA 

works through several grants and technical assistance programs to promote access to 

effective prevention and early intervention services and supports. 

SAMHSA’s Community Mental Health Services Block Grant (MHBG) set-aside for early 

SMI/first episode psychosis (FEP) is an effective early intervention approach, increasing 

the number of FEP coordination specialty care programs to over 350 since its start in

2014. Project Advancing Wellness and Resiliency in Education (Project AWARE) provides 

training for school personnel and other adults who interact with school-aged youth to 

detect and respond to mental health challenges and connects school-aged youth who may 

present with behavioral health challenges, and their families, to needed services. 

SAMHSA’s Project Linking Actions for Unmet Needs in Children’s Health (Project 

LAUNCH) promotes the wellness of children from birth to age 8 by disseminating effective 

and innovative early childhood mental health practices and services, ultimately leading to 

better outcomes for young children and their families. Project LAUNCH builds the 

capacities of adult caregivers of young children to promote healthy social and emotional 

development; prevents mental, emotional, and behavioral disorders; and identifies and 

addresses behavioral concerns before they develop into serious emotional disturbances 

(SEDs). 

SAMHSA supports Mental Health Awareness Training (MHAT), which prepares individuals 

and communities to respond appropriately and safely to persons with SMI and/or SED. 

Through MHAT, individuals receive the knowledge, skills, confidence, and resources to 

engage with someone experiencing mental health and/or substance use challenges. 

Trained individuals use these skills and resources to help others access needed mental 

health care or other services from within their own families, places of employment, 

communities, or places of worship.

Mental Health Crisis Care & Suicide Prevention

Suicide is a leading, and preventable, cause of death for adults and youth. During the

COVID-19 pandemic, suicidal behaviors among young people significantly increased.40 In 

2021, suicide was the second leading cause of death for youth ages 10–14 and the third 

leading cause among youth ages 15–24 in the United States.41 Data from the 2021 

National Survey on Drug Use and Health (NSDUH) estimated that the number of adults 

with serious thoughts of suicide was 12.3 million, those with plans for suicide was 3.5 

million, and those who attempted suicide was about 1.7 million.3 Fully addressing suicide 

involves preventive interventions and includes mental health workforce improvements. All

providers should identify and provide basic care and support to those at risk for suicidal 

ideation and behaviors, and family members of these individuals. 
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20

As SAMHSA’s 2020 National Guidelines for Behavioral Health Crisis Care indicate, 

comprehensive crisis care systems include core services, such as crisis contact centers, 

mobile crisis teams, and crisis receiving and stabilizing facilities.42 In 2022, SAMHSA 

provided guidance on crisis care for youth in the National Guidelines for Child and Youth 

Behavioral Health Crisis Care, which supports a developmentally tailored approach to 

crisis care for young people. It emphasizes appropriate home- and community-based 

stabilization supports, and “a safe place to be” while prioritizing safety.

43 These services 

address the acute behavioral health needs of people in crisis. Additionally, these services 

are consistent with goals to prevent suicide, overdose, and other adverse crisis-related 

outcomes and are linked to subacute and outpatient services with a goal of ongoing 

engagement toward harm reduction, treatment, and recovery. Robust, culturally 

appropriate, and responsive systems will be essential to meeting crisis care needs across 

the nation. Crisis services must be trauma-informed and avoid re-traumatizing individuals 

seeking help by avoiding use of restraint and seclusion practices. Together these 

components, when person-centered and coordinated with other services, can address the 

goal of serving anyone, at any time, from anywhere across the country. 

To help achieve this goal, on July 16, 2022, the National Suicide Prevention Lifeline 

transitioned to the 988 Suicide & Crisis Lifeline.

44 Persons who use this number are put in 

direct contact with a trained counselor and referred to services. Counselor training includes 

work across the lifespan; approaches for individuals with disabilities; attention to historical 

trauma, stigma, and discrimination in marginalized communities; and knowledge of 

population-specific factors that may influence engagement with crisis workers. For 

imminent risk situations or if a crisis is ongoing, a responder such as a mobile crisis 

response unit can go where the caller is and/or identify a place the caller can go for help. 

SAMHSA continues to invest in key suicide prevention efforts such as the Garrett Lee 

Smith (GLS) Youth Suicide Prevention and Zero Suicide programs, as well as to provide 

needed technical assistance to the field through the Suicide Prevention Resource Center 

(SPRC). 

Recovery & Treatment

Recovery and improved health and well-being are the goals of mental health care for 

individuals with a mental health condition. Individuals often take different pathways to 

engage with behavioral health services and initiate and sustain recovery. Because a 

mental and/or substance use disorder (SUD) crisis often results from environmental 

challenges and events, such as trauma, job loss, or financial or interpersonal stressors, 

addressing these issues is crucial to sustaining recovery. The recovery process is highly 

personalized, with individuals engaging in a variety of services and supports that may 

include treatment as well as recovery support services.

Goal 1. To improve health and well-being of all Americans, SAMHSA will support 

mental health promotion and early intervention programs and services for 

individuals at risk for or living with mental health conditions.
2023 - 2026 | SAMHSA Strategic Plan

21

Mental health promotion and early intervention programs and services for individuals at 

risk for or living with mental health conditions is an important focus for SAMHSA. This is 

guided by many factors, such as national negative trends in mental health. Efforts include 

optimizing positive mental health before mental health problems have been identified, or 

soon after, with the goal of improving mental health for the population.45 Recent research 

shows the positive effects of mental health promotion and early interventions through a 

public health approach.

46

Objective 1.1. Expand mental health literacy through outreach, training, and 

technical assistance. 

In alignment with SAMHSA’s mental health promotion initiatives, SAMHSA programs 

implement outreach activities with communities, schools, and individuals; implement

training activities on mental health symptoms and evidence-based practices; and provide 

technical assistance on service provision and program implementation. All these activities, 

implemented and adapted through a culturally appropriate lens, are important components 

of mental health literacy expansion as the programs reach people with various mental 

health needs and numerous backgrounds. 

Continuing to implement these initiatives will expand mental health literacy in areas such 

as increasing awareness of mental health symptoms in general, culturally specific 

experiences of mental health symptoms, and understanding and implementation of 

evidence-based and evidence-informed practices, and will ultimately increase the number 

of individuals trained on how to respond to individuals with mental disorders appropriately 

and safely. 

Mental Health Awareness Training (MHAT) trains individuals (e.g., school 

personnel, fire department and law enforcement staff, and veterans, military members, 

and their families) to recognize the signs and symptoms of mental disorders and how 

to safely de-escalate crisis situations involving individuals with a mental illness. MHAT 

also provides education on local mental illness resources and other tools, such as how 

to establish links with school- or community-based mental health agencies.

Community Programs for Outreach and Intervention with Youth and Young

Adults at Clinical High Risk for Psychosis provide evidence-based interventions to 

youth and young adults who are at clinical high risk for psychosis by improving 

symptoms and behavioral functioning, enabling youth and young adults to resume 

age-appropriate activities, delaying or preventing the onset of psychosis, and 

minimizing the duration of untreated psychosis for those who develop psychotic 

symptoms.

Enhancing Access to Suicide Prevention and Mental Health Services 

Goal 1 Example Programs
2023 - 2026 | SAMHSA Strategic Plan

22

For example, the Project AWARE program has increased mental health literacy in schools 

and communities, removed barriers to finding care, and ensured cultural relevance for 

school programs. With SAMHSA’s support, Project AWARE will focus on improving the 

school environment and trauma-informed programming to improve care for school-aged 

youth. Additionally, through the MHAT grant program, SAMHSA reinforces positive 

partnerships between law enforcement and communities, which increases public trust and 

enhances public safety. SAMHSA’s advisory promotes MHAT implementation by broadly 

targeting the workplace, from traditional work settings to places in the community that

people frequent.

SAMHSA recognizes the need for technical assistance in many areas of mental health 

promotion, including early childhood and social media. SAMHSA addresses these through 

Centers of Excellence, such as the National Center of Excellence for Infant and Early 

Childhood Mental Health Consultation and the Center of Excellence on Social Media and 

Mental Wellbeing. These Centers of Excellence develop and disseminate information, 

guidance, and training for mental health practitioners addressing the spectrum of mental 

health needs and applicable services and interventions, including prevention and 

promotion. SAMHSA supports and expands mental health literacy with these initiatives. 

Objective 1.2. Encourage states and tribes to focus resources on mental health 

promotion and early intervention services. 

SAMHSA encourages states and tribes to focus resources on mental health promotion and 

early intervention through infrastructure and services grants, and through technical 

assistance. 

Infrastructure-focused grants allow SAMHSA to partner with tribal communities and state 

agencies to develop culturally appropriate service delivery systems. Some of these 

programs include Planning and Developing Infrastructure to Promote the Mental Health of 

Children, Youth and Families in American Indian/Alaska Native (AI/AN) Communities

(Circles of Care); Project AWARE, including state-level educational systems; and Grants 

for Expansion and Sustainability of the Comprehensive Community Mental Health Services 

for Children with Serious Emotional Disturbance (the Children’s Mental Health Initiative or 

CMHI), funded in tribal communities and with state-level agencies. SAMHSA’s grant 

programs also support direct mental health services in tribal communities, as funded 

through Linking Actions for Unmet Needs in Children’s Health in AI/AN Communities, U.S. 

Territories, and Pacific Jurisdictions Cooperative Agreements (Indigenous – Project 

LAUNCH) and in state-level agencies as funded through CMHI. 

SAMHSA prioritizes specific support for tribes through various initiatives that promote 

mental health and early intervention. The Tribal Training and Technical Assistance Center

offers training and technical assistance on mental and SUDs, suicide prevention, and 

mental health promotion. SAMHSA’s efforts reflect a commitment to upholding the federal 

government’s historical and unique legal relationship with Federally Recognized Tribes
2023 - 2026 | SAMHSA Strategic Plan

23

through consultation, outreach, education, and engagement when developing initiatives 

specific to AI/AN. 

Goal 2. To save lives and improve well-being, SAMHSA will lead public health efforts 

to reduce suicidal ideation and behavior. 

This goal aligns with the Surgeon General’s 2021 Call to Action to Implement the National 

Strategy for Suicide Prevention. Through grant funding, coordination, dissemination of 

practice and policy recommendations, data collection, and evaluation, SAMHSA is key to

strengthening service development to promote access to quality suicide prevention care, to 

improve engagement of service recipients and providers, and to ensure that resources are 

aligned with practices that are more impactful. 

The nexus between substance use and suicide requires a public health approach. 

Because risk and protective factors for the two overlap, SAMHSA supports collaboration 

across the continuum to ensure all parts of the system can implement appropriate 

programming. Building and strengthening connections among suicide prevention, 

substance use prevention, treatment for mental illness, and SUD treatment—along with 

recovery support services—are necessary to reduce suicidal behavior and suicide rates. 

Objective 2.1. Improve access to suicide prevention services.

Reducing barriers and enhancing equitable, culturally appropriate, trauma-informed, and 

linguistically responsive access to the 988 Suicide & Crisis Lifeline and other core 

The Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early 

Intervention Program supports states and tribes with implementing youth suicide 

prevention and early intervention strategies in schools, the juvenile justice system, 

substance use and mental health programs, foster care systems, pediatric health 

programs, and other child and youth-serving organizations. The program reduces 

suicides and suicide attempts among youth. 

The Suicide Prevention Resource Center advances suicide prevention infrastructure

and capacity building through consultation, training, and resources to states, tribes, 

communities, colleges and universities, health systems and other settings, and 

organizations that serve populations at risk for suicide.

The National Strategy for Suicide Prevention grant program supports efforts to 

implement suicide prevention and intervention programs. The grant program raises 

awareness of resources available to prevent suicide, promotes help-seeking behavior, 

establishes referral processes, and improves outcomes for individuals at risk for 

suicide.

Enhancing Access to Suicide Prevention and Mental Health Services

Goal 2 Example Programs
2023 - 2026 | SAMHSA Strategic Plan

24

components of the crisis services continuum will offer immediate support to those in 

distress and can decrease the development of future crisis situations. Suicide prevention 

services must also be embedded through the broader public health and healthcare 

systems. To reinforce these programmatic attributes, states and territories are required to 

report on their systemic suicide prevention activities in the Community MHBG application.

An example of this work can be seen in the Zero Suicide grant program, which supports 

the implementation of the Zero Suicide intervention and prevention model for adults 

throughout a health system or systems.

Building suicide prevention services does not guarantee that all populations will be aware 

of or use them. For populations with deep-seated mistrust of healthcare systems, 

engagement strategies with the community and community gatekeepers will be essential 

to facilitating trust and use of these services. Offering in-language services also builds trust 

and is essential in crisis situations for communities where English is not the preferred or 

primary language.

SAMHSA will support the expansion of community health and healthcare-based wellness, 

recovery, and suicide prevention programs that work to prevent future crisis encounters. 

Efforts include preventing suicide attempts and the emergence of suicidality, increasing

primary care providers’ skills in identifying suicidality, assessing safety and talking about 

lethal means restrictions, implementing safety planning, and increasing behavioral health 

providers’ knowledge and implementation of evidence-based practices to treat suicidality 

and deliver behavioral health crisis care. To support these efforts, programs like the GLS

program use strategies such as working with a range of youth-serving systems (e.g., 

schools and child welfare, juvenile justice, and pediatric services). Other SAMHSA efforts 

include engaging systems serving military personnel, veterans, and older adults; 

workplaces; faith-based communities; and tribal communities.

Considerations regarding equity are also critical to these efforts. For example, the 

SAMHSA Native Connections Grant Program supports grantees 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. Furthermore, the National Action Alliance for Suicide 

Prevention, with SAMHSA’s SPRC, is conducting a formative audience evaluation to 

ensure 988 Suicide & Crisis Lifeline efforts are informed by populations at high risk for, or 

disproportionately impacted by, mental health conditions or suicide-related behaviors. This 

will include qualitative and quantitative data collection from groups such as African 

American youth and adults; AI/AN; older rural adults; Lesbian, Gay, Bisexual, 

Transgender, Queer, and Intersex (LGBTQI+) individuals; and Latino and Hispanic youth 

and adults. 

Objective 2.2. Improve the quality and effectiveness of suicide prevention services.

SAMHSA will enhance suicide prevention services by supporting training standards and 

promoting the adoption of practices that are evidence-based, evidence informed, or 
2023 - 2026 | SAMHSA Strategic Plan

25

promoted through expert consensus. This includes, but is not limited to, ensuring 988 

Suicide & Crisis Lifeline staff are well trained and responsive to the needs of all individuals 

who call, text, or chat, including those from under-served communities. Training will be 

supported through implementation of core curriculum modules with subsequent evaluation 

of worker skill.

An example of an evidence-based practice is strengthening follow-up protocols for 

individuals who have experienced a behavioral health crisis, including but not limited to 

emergency department visits, inpatient psychiatric admissions, and other behavioral health 

crisis care encounters. Collecting, analyzing, and reporting data (e.g., training and policy 

changes, screening, model fidelity, practice adoption) must accompany practice 

implementation to inform quality improvement efforts. This type of work is supported 

through the Zero Suicide grant program that supports the implementation of the Zero 

Suicide intervention and prevention model for adults throughout a health system or 

systems. 

Goal 3. To deliver crisis care across all communities, SAMHSA will improve the 

quality and accessibility of the crisis care system.

An adequately resourced, responsive behavioral health crisis system provides personcentered, trauma-informed responses that decrease reliance on law enforcement and 

hospital emergency department use. Often, people with mental health and SUD treatment 

needs cannot access the care they need when they need and want it, or they get lost in 

transition across a highly fragmented and inadequately funded system. Under-served and 

marginalized populations, such as those from racial, ethnic, sexual, and gender minority 

groups and rural communities, often face additional barriers with respect to access and 

outcomes.

42

The growth of a robust behavioral health crisis response system will require leadership at 

multiple levels throughout mental health and substance use services systems. This 

includes a role for federal partners as well as state, territory, tribal, and community leaders, 

and people with lived experience. In a highly fragmented and disjointed system, there is a 

clear role for SAMHSA. Through the 988 and Behavioral Health Crisis Coordinating Office, 

in conjunction with the agency’s Centers and Offices, SAMHSA will work with partners to 

convene, coordinate, and disseminate information, including updated evidence and best 

practices; provide ongoing learning and technical assistance; facilitate awareness and 

behavior change campaigns; and support the measurement and evaluation of system 

performance across the crisis continuum. In this role, SAMHSA can identify strategies and 

resources to address policy issues including regulatory, governance, and funding or 

obstacles faced by jurisdictions. Through SAMHSA’s State Program Improvement 

Technical Assistance contract, the agency supports states’ use of the Crisis Services Setaside of the Community MHBG to implement evidence-based crisis services. 

SAMHSA’s crisis care system is centered on three elements—“someone to talk to,” 

“someone to respond,” and “a place to go.”42 Mobile crisis services play a key role in crisis 
2023 - 2026 | SAMHSA Strategic Plan

26

response as the second element of the crisis continuum—“someone to respond.” A 

fundamental tenet of mobile crisis is to serve anyone, anytime, anywhere. This means that 

any individual experiencing a behavioral health crisis can be supported where they are, 

regardless of age, language, diagnosis, ability to pay, or location. Mobile crisis services

allow individuals to receive care in their communities, and limit unnecessary involuntary 

transportation, hospitalization, incarceration, and detention.

In some communities specialized teams serve youth, veterans in crisis, individuals with 

intellectual and developmental disabilities, and individuals experiencing homelessness. 

This specialized attention is important, but mobile crisis teams should be equipped to 

skillfully support all populations. Well-designed mobile crisis services include coordination 

with law enforcement so that first responders to behavioral health crises can be mobile 

crisis staff. 

SAMHSA envisions that mobile crisis services will be universally available in every 

community and will be able to meet the needs of all individuals. SAMHSA supports efforts 

to make that vision a reality. 

The 988 State and Territory Grant Program improves state and territory response 

to 988 Suicide & Crisis Lifeline contacts by recruiting, hiring, and training the 

behavioral health workforce to staff local 988/Lifeline centers to respond, intervene,

and provide follow-up to individuals experiencing a behavioral health crisis; engaging 

Lifeline crisis centers to unify 988 Suicide & Crisis Lifeline response across

states/territories; and expanding the crisis center staffing and response structure

needed to successfully implement the 988 Suicide & Crisis Lifeline. 

The Community Mental Health Services Block Grant (MHBG) program provides

state/territory formula grants that offer optimal flexibility to enable states to meet the 

unique needs of individuals with SMI or SED. Grantees are required to set aside 5 

percent of their MHBG allocation to support evidence-based crisis system 

components. States and territories use this funding to support transitions from their

previous call center networks to a more centralized response paired with new

capabilities to coordinate with additional crisis services such as mobile crisis

outreach and crisis stabilization units.

The Community Crisis Partnerships Program enhances existing mobile crisis

response teams to divert adults, children, and youth experiencing a mental health 

crisis from law enforcement in high-need communities. The program recognizes

high-need communities as a community in which mobile crises are responded to by 

first responders and/or where first responders are not adequately trained or

equipped to diffuse mental health crises. 

Enhancing Access to Suicide Prevention and Mental Health Services 

Goal 3 Example Programs
2023 - 2026 | SAMHSA Strategic Plan

27

Objective 3.1. Improve the experience for people in crisis and for crisis care 

providers.

SAMHSA will lead the nation in promoting the development of crisis and related services 

so the needs and experience of people in crisis are prioritized. The foundation SAMHSA 

relies on in the design of crisis services starts with the individual. First one must ask, “what 

does a person in crisis need?” As noted earlier, the person needs three broad categories

of services: “someone to talk to,” “someone to respond,” and a safe “place to go.” Using a 

whole-population approach, SAMHSA asks states and other stakeholders to start their 

planning by thinking about the needs, circumstances, and situation of a person in crisis. 

Through this whole-population approach, SAMHSA aims to continuously increase support 

through the development of technical assistance documents, reports, and meetings and by 

monitoring evolving research on best practices in crisis services. SAMHSA will promote 

and enhance genuine engagement with persons who have experienced crisis and are 

living with or are in recovery from mental illnesses or SUDs by developing several

initiatives that will improve and serve as a model for state and community systems on 

consumer engagement in services design and delivery. SAMHSA also aims to lead efforts 

to reduce barriers and enhance equitable, culturally and linguistically appropriate access to 

the 988 Suicide & Crisis Lifeline; strengthen coordination between 988 and 911 Public 

Safety Answering Points, including the support of programs that divert calls from 911 to 

988 to decrease unnecessary law enforcement response to crisis encounters; promote the 

improvement of law enforcement interactions; and increase the influence of those with 

lived experience in planning, implementation, delivery, and evaluation of the behavioral 

health crisis continuum. The incorporation of person-centered, trauma-informed principles 

will promote engagement and improvements in quality crisis service delivery. Through 

these efforts as well as collaborations with national partners, SAMHSA will lead the nation 

in the development and dissemination of best practices in crisis care.

It is important to recognize that individuals remain at elevated risk of suicide following crisis 

encounters. This includes time after crisis calls, emergency department discharges, and 

inpatient psychiatric hospitalizations. Research found that 43 percent of callers 

experiencing a suicidal crisis who completed evaluation follow-up assessments 

experienced some recurrence of suicidality (ideation, plan, or attempt) in the weeks after 

their crisis call, and only 22.5 percent of those callers had been seen by someone in the 

mental healthcare system to which they had been referred.

47 Recent national approaches 

to follow-up care have included safety planning interventions followed by a follow-up phone 

contact—a model that has been shown to be effective in patients discharging from 

emergency department settings. Outcomes include improved treatment engagement, 

decreased risk of hospitalization, and reduced suicidal behaviors.

47,48,49,50 The Crisis 

Center Follow-Up Program aims to significantly enhance continuity of care with 

engagement of hospitals, behavioral health organizations and services, as well as 

911/Public Safety Answering Points, mobile crisis outreach, and police, to improve the 

well-being of individuals who are at risk of suicide through continual engagement after

initial contact through 988.
2023 - 2026 | SAMHSA Strategic Plan

28

Objective 3.2. Improve allocation of resources across the crisis care ecosystem. 

There are significant variations in crisis service definitions and gaps in the evidence base 

supporting specific model implementation. The crisis system must adapt to emerging 

needs and evidence, and resources need to be aligned and scaled to respond to this 

growth and evolution. A multi-faceted financing strategy will create flexibility in allowing 

partners to construct sustainable funding approaches for crisis services. SAMHSA will 

support alignment of policy and program incentives to drive effective, safe, high-quality 

community-based care. SAMHSA will focus on promoting opportunities for sustaining crisis 

services through grant opportunities, and public and commercial payors. Resource 

allocation must be consistent with equity goals to overcome historical barriers and address 

inequities in access and outcomes. 

Goal 4. To improve the quality and accessibility of care, SAMHSA will strengthen

treatment and recovery services for individuals at risk for or living with mental 

health conditions. 

SAMHSA’s NSDUH survey consistently demonstrates that many individuals with mental 

illness do not receive treatment, including those with SMI. Among the many reasons for

this are an insufficient number of mental health professionals and long wait lists for 

outpatient appointments. Additionally, there is tremendous variability in the level and 

quality of services individuals receive once they are in care. SAMHSA works to increase 

access to effective evidence-based programs through several efforts like services grants 

and technical assistance. 

The Transforming Lives through Supported Employment grant program 

enhances state and community capacity to provide evidence-based supported 

employment programs for adults and youth with SMI or SED with the goal for 

individuals to achieve competitive employment and build paths to self-sufficiency 

and recovery. 

Certified Community Behavioral Health Clinics (CCBHCs) are designed to 

ensure access to coordinated comprehensive behavioral health care. CCBHCs 

serve anyone who requests care for mental health or substance use, regardless of 

their ability to pay, place of residence, or age—including developmentally 

appropriate care for children and youth.

Behavioral Health Partnerships for Early Diversion grants establish or expand 

programs that divert adults and youth with a mental illness or a co-occurring

disorder from the criminal or juvenile justice system to community-based mental 

health and substance use disorder services and other supports. 

Enhancing Access to Suicide Prevention and Mental Health Services

Goal 4 Example Programs
2023 - 2026 | SAMHSA Strategic Plan

29

Objective 4.1. Expand community efforts to provide a continuum of treatment and 

recovery supports for individuals living with SMI or SED, and their families and 

caregivers. 

Persons living with mental illness should have access to treatment and services that 

enhance and support their ability to receive care, achieve well-being, and thrive. Over the 

past 60 years, community services have developed in fragmented and divergent ways. To 

offer states and territories optimal flexibility in meeting the unique needs of adults with SMI 

or children with SED, SAMHSA funds the Community MHBG program which is designed 

to provide comprehensive community mental health services. 

The Certified Community Behavioral Health Clinic (CCBHC) model incorporates nine 

treatment and recovery support services including crisis services and SUD treatment for 

children and adults. SAMHSA will continue to expand this model through both its CCBHC 

Expansion Grants and work with the Centers for Medicare & Medicaid Services on the 

Medicaid Demonstration Programs for CCBHCs. For example, in 2023 SAMHSA provided 

15 new planning grants for states to prepare to potentially join the CCBHC Medicaid 

demonstration that was expanded by the Bipartisan Safer Communities Act. 

SAMHSA will continue to support recovery services so that individuals live well and thrive

through programs such as the Statewide Consumer Network Grant Program. This program 

aims to enhance the ability of statewide mental health consumer-run organizations to 

promote mental health, and to improve related service system capacity and infrastructure 

development to be consumer-centered and targeted toward recovery and resiliency. The 

program supports consumer-driven improvements by promoting the use of consumers as 

agents of transformation. The Mental Health Technology Transfer Center supports efforts 

to ensure that high-quality, evidence-based, and effective mental health condition 

treatment and recovery support services are available for all individuals with mental 

disorders including, in particular, those with SMI. Additionally, the Recovery Community 

Services Program provides peer recovery support services via recovery community 

organizations to individuals with SUDs or co-occurring substance use and mental 

disorders, or those in recovery from these disorders. The program’s foundation is the value 

of peers’ lived experience to assist others in achieving and maintaining recovery. These 

services, with clinical treatment services, are an integral component of the recovery 

process.
30

Most individuals with mental health and substance use conditions first manifest signs in 

childhood, adolescence, and young adulthood.51 In fact, half of all mental illnesses emerge 

by the time a youth turns age 14, and nearly 75 percent by the time a person is 24 years

old.51 There is a significant correlation between adverse childhood experiences and

aspects of the child’s environment that can undermine their sense of safety, stability, and 

bonding and contribute to poor physical and behavioral health outcomes in adulthood.52

Even before the COVID-19 pandemic, the nation’s youth were experiencing significant 

mental health and substance use challenges. Nearly 1 in 5 youth had a diagnosable 

mental health condition, and 1 in 10 had a serious emotional disturbance (SED) that 

negatively impacted their ability to function at home, in school, or in the community.53,54

Additionally, more than 1 in 10 youth ages 12–20 had a substance use disorder (SUD), 

inclusive of alcohol or illicit drugs.

55 The pandemic made this situation worse, with 

depression and anxiety doubling in youth, especially youth of color, compared to prepandemic levels;

53 moreover, more than 215,000 children in the United States have 

experienced the death of a primary or secondary caregiver due to COVID-19, with children 

of Black, Indigenous, and other people of color disproportionately impacted.56,57,58 The 

Centers for Disease Control and Prevention (CDC) also released data indicating that 1 in 3 

high school students experienced poor mental health during the pandemic and nearly half 

of students felt persistently sad or hopeless.59,60 

Unfortunately, many young people do not receive the treatment supports they need. 

According to the 2021 National Survey on Drug Use and Health, over half of children and 

youth with mental health needs did not receive services, and over 98 percent of young 

adults with a SUD did not receive appropriate treatment.

3,61 Furthermore, those seeking 

treatment experienced longer delays, including days-long stays in the emergency 

department for those needing an inpatient hospital bed.62

The Substance Abuse and Mental Health Services Administration (SAMHSA)’s vision for 

youth behavioral health is that all children, youth, and their families thrive in their homes 

and communities. SAMHSA will achieve this through a tiered public health approach that 

matches each child, youth, young adult, and their families with the right intervention at the 

right time. This can be achieved by working upstream and acting early in the risk trajectory 

through a continuum of care. This approach uses mental health promotion, primary 

prevention measures, early identification, and effective interventions, when indicated; it 

also applies implementation science to maximize broad strategy application in the context 

of community engagement so that youth and their families will achieve and sustain good 

health and well-being. It is also important to provide specialized evidence-informed and 

evidence-based treatment for those at risk of and who have SED, serious mental illness

(SMI), and SUDs.

Priority 3 

Promoting Resilience and Emotional Health 

for Children, Youth, and Families
2023 - 2026 | SAMHSA Strategic Plan

31

Goal 1. To ensure the wellness and resilience of children and youth, SAMHSA will 

support mental health promotion and primary prevention of substance use. 

There are many risk and protective factors that can contribute to either the mitigation or 

exacerbation of mental health and substance use conditions that manifest in childhood, 

adolescence, and young adulthood. Thus, it is critical that we start early—“upstream”—to 

foster positive development, build coping skills, and equip young people and their parents/

caregivers with the tools they need to navigate life’s challenges. By doing this, we will help 

enhance wellness and build resilience so that our nation’s youth thrive. Promoting 

wellness and resilience is cost-effective. There is strong evidence demonstrating that 

prevention programs provide significant returns on investment. 64

SAMHSA supports a wide range of mental health promotion and substance use 

prevention services that include screening, identification, and referral; warm hand-offs 

(e.g., mental health promotion, suicide prevention); parent training; school-based 

prevention; student assistance; community awareness; community-based education; and 

community linkages. In addition, SAMHSA focuses efforts on young children through the 

Infant and Early Childhood Mental Health Grant Program and Linking Actions for Unmet 

Needs in Children’s Health, which both aim to reduce the number of children and youth 

experiencing mental health or substance use issues.

Children, youth, and families is inclusive of those under 26 years of age (including 

young adults) and their families. Families can include biological parents and their 

partners, adoptive parents and their partners, foster parents and their partners, 

grandparents and their partners, siblings and their partners, caregivers, friends, and 

others as defined by the family.

63
2023 - 2026 | SAMHSA Strategic Plan

32

Objective 1.1. Expand mental health promotion and primary prevention of substance 

use through outreach, training, and technical assistance. 

Mental health promotion and primary prevention of substance use programs strive to 

increase the protective factors and healthy behaviors that promote positive mental, 

emotional, and behavioral development at home, in school, and in the community. These 

programs also seek to mitigate the risk factors that can lead to the development of 

substance misuse and mental illness. These risk factors can be at the individual, family, or 

community level, such as family history of substance use, favorable parental attitudes 

toward substance use, lack of school connectedness, and childhood trauma. Primary 

prevention of substance also focuses on providing the information and skills necessary to 

avoid substance use and misuse. Collectively, these strategies are often referred to as the 

“universal” approach because the interventions address an entire population, and all 

children and youth can benefit from the programs and services.

Training, technical assistance, and evidence-based interventions are essential 

components of mental health promotion and primary prevention of substance use. 

Examples of training programs include mental health first aid, suicide prevention, traumainformed care, and cultural competency. Providing these trainings to diverse groups of 

individuals (e.g., youth and families, educators, healthcare providers, first responders, and 

community leaders) will create a network of people who can promote wellness, identify 

The “Talk. They Hear You.”

® campaign helps parents and caregivers, educators,

and community members get informed, be prepared, and take action to prevent

underage drinking and other substance use.

The Enhancement and Expansion of Treatment and Recovery Services for

Adolescents, Transitional Aged Youth, and their Families program enhances and

expands comprehensive outpatient-based treatment, early intervention, and recovery

support services for adolescents (ages 12–18) and transitional aged youth (ages 16–

25) with SUDs and/or co-occurring substance use and mental disorders, and their

families/primary caregivers. The services include screening, assessment, treatment,

and wraparound services in ambulatory settings.

The Sober Truth on Preventing Underage Drinking Act (STOP Act) Grant 

Program enables organizations to strengthen collaboration and coordination among

stakeholders to achieve a reduction in underage drinking in their communities. The

STOP Act Program aims to (1) address norms regarding alcohol use by youth; (2) 

reduce opportunities for underage drinking; (3) create changes in underage drinking 

enforcement efforts; (4) address penalties for underage use; and/or (5) reduce 

negative consequences associated with underage drinking.

Promoting Resilience and Emotional Health for Children, Youth, and Families 

Goal 1 Example Programs 
2023 - 2026 | SAMHSA Strategic Plan

33

early signs of concerns, offer appropriate support, and refer individuals to necessary 

services. 

Evidence-based programs and interventions that support social-emotional development, 

self-management, and resiliency and improvement of parental, school, and community 

connections have shown evidence of reducing the development of problem substance use 

behaviors.65

Tailoring initiatives to reach multiple settings (e.g., home, school, employment, community, 

faith organizations) is also important to raise awareness about behavioral health, reduce 

prejudice and discrimination, and promote healthy lifestyles. Such efforts can include 

organizing behavioral health awareness campaigns, hosting workshops and seminars,

disseminating educational materials, and using digital platforms and social media to reach 

a broad audience. Providing accurate information, resources, and support empowers 

individuals, organizations, and policymakers to prioritize behavioral health, recognize the 

signs of distress, and seek support when needed. SAMHSA provides technical assistance

in various programs that also provide guidance and resources to individuals and 

organizations to implement evidence-based prevention programs, evaluate their 

effectiveness, and make data-driven improvements.

Objective 1.2. Lead efforts with federal partners to reduce substance use by those 

under the age of 21. 

Establishing and enhancing key partnerships assists in reducing substance use rates 

among children and youth. SAMHSA leads the federal Interagency Coordinating 

Committee on the Prevention of Underage Drinking, which includes 23 federal agencies 

and focuses on a multi-faceted approach to lower the prevalence and negative 

consequences of underage drinking. 

SAMHSA also partners with other federal efforts to improve substance use prevention 

efforts, including the Community Preventive Services Task Force (CPSTF) that is 

managed by the CDC. The CPSTF works to improve the health of communities by issuing 

evidence-based findings and recommendations on public health interventions used in realworld settings. Together, the CPSTF and SAMHSA developed recommendations for 

CDC’s Community Guide related to family-focused and community-based interventions to 

prevent substance use.

SAMHSA also partners with the National Institute on Drug Abuse and the National Institute 

on Alcohol Abuse and Alcoholism. These institutes conduct research related to substance 

use and misuse and play critical roles in informing prevention and treatment efforts. In 

addition, SAMHSA engages with local governments, organizations, and tribal and 

community leaders to create a comprehensive and integrated system of care that 

advances collective impact and fosters healthier and safer environments for all children, 

youth, and families. Together, these programs and activities constitute a complementary 

and coordinated federal approach that has helped reduce underage substance use.
2023 - 2026 | SAMHSA Strategic Plan

34

Goal 2. To ensure that all children, youth, and families have opportunities to thrive, 

SAMHSA will increase access to a comprehensive array of equity-driven behavioral 

health programs by increasing program integration and expanding pediatric 

behavioral health capacity. 

SAMHSA will emphasize the importance of promotion, prevention, early intervention, 

treatment, and recovery by engaging with multiple child- and youth-serving sectors, 

especially schools and primary care; create a specialized focus for children, youth, and 

families as part of the crisis continuum; and strengthen workforce capacity and skills. 

The Children’s Mental Health Initiative provides resources to improve the mental 

health outcomes for children and youth (birth through age 21) at risk for or with SED 

and their families. This program supports the implementation, expansion, and 

integration of the System of Care approach by creating sustainable infrastructure and 

services that are required as part of the Comprehensive Community Mental Health 

Services for Children and their Families Program (also known as the Children’s Mental 

Health Initiative or CMHI). With this program, SAMHSA aims to prepare children and 

youth with or at risk of SED for successful transition to adulthood and assumption of 

adult roles and responsibilities.

Circles of Care provide tribes and tribal organizations with the tools and resources to 

plan and design a family-driven, community-based, and culturally and linguistically 

competent system of care. With this program, SAMHSA aims to increase resilience and 

improve emotional health for American Indian and Alaska Native children, youth, and 

families.

The Project for Advancing Wellness and Resiliency in Education (Project 

AWARE) program develops a sustainable infrastructure for school-based mental 

health programs and services. Recipients build collaborative partnerships with the 

state education agencies, local education agencies, and tribal education agencies or 

expand the capacity of state education agencies, in partnership with state mental 

health agencies, community-based providers of behavioral healthcare services, school

personnel, community organizations, families, and school-aged youth. Project AWARE 

leverages mental health-related promotion, awareness, prevention, and resilience 

activities for school-based youth. By building or expanding capacity, the program 

advances wellness and resiliency in education by increasing mental health awareness 

in schools across states, territories, and tribal communities. 

The Protection & Advocacy for Individuals with Mental Illness Program is 

intended to protect and advocate for the rights of children or adults with serious 

emotional disturbances with significant (serious) mental illness through activities to 

ensure the enforcement of the Constitution and federal and state statutes.

Promoting Resilience and Emotional Health for Children, Youth, and Families

Goal 2 Example Programs
2023 - 2026 | SAMHSA Strategic Plan

35

Objective 2.1. Strengthen the nation’s youth behavioral health system by integrating

behavioral health services across youth-serving systems, including child welfare

and juvenile justice, with a particular emphasis on education and pediatric primary 

care.

SAMHSA will expand the use of the “System of Care” framework, which seeks to organize 

services and supports into a coordinated network, build meaningful partnerships with youth 

and families, and address their cultural and linguistic needs.

66 Services and supports are 

coordinated across systems, individualized, and delivered in the most appropriate, least 

restrictive setting to help young people reach their full potential and thrive. The foundation 

of this work has been created through the Expansion and Sustainability of the 

Comprehensive Community Mental Health Services for Children with Serious Emotional 

Disturbances program (also known as the Children’s Mental Health Initiative or CMHI). 

Additionally, Community Mental Health Services Block Grant funds are contingent on

states submitting a plan for an evidence-based system of care for children and families 

and reporting on all aspects of the work in the public mental health system for children. 

States and territories actively work with community mental health agencies, other 

community mental health providers, and school systems to provide comprehensive 

services for children with mental health support needs.

Schools 

To address students’ behavioral health needs and ensure that schools are secure and 

safe, SAMHSA will emphasize the Advancing Comprehensive School Mental Health 

Systems (CSMHS) framework and the use of a multi-tiered system of supports (MTSS).67

The CSMHS framework and MTSS approach are designed to provide a continuum of 

instructional and behavioral supports that can positively impact an entire school and create 

a supportive school culture, as well as offer specific interventions to meet the individual 

needs of each student. The Project Advancing Wellness and Resiliency in Education

(Project AWARE) program provides training for school personnel and other adults who 

interact with school-aged youth to detect and respond to mental health challenges, and 

connects school-aged youth, who may present with behavioral health challenges, and their 

families to needed services. Additionally, SAMHSA funds the School-Based TraumaInformed Support Services program to further enhance and improve trauma-informed 

support and mental health services for children and youth.

68 

Although some schools can provide direct services (i.e., school-based interventions), many 

others do not have such capabilities and therefore must link with services in the community 

(i.e., school-linked services). These linkages with community-based organizations help 

school staff identify and address the unique needs of students, which can allow for more 

comprehensive assessments, reduce service gaps, and lead to better outcomes. These 

programs focus on emotional and behavioral wellness and resilience, substance use 

prevention, and services and supports for youth who have SED, SMI, or SUDs. 
2023 - 2026 | SAMHSA Strategic Plan

36

In addition to school staff, it is important to train and collaborate with other community 

professionals and paraprofessionals, including members of a family’s social support 

network, youth peer specialists, coaches and mentors, and others who serve as providers 

of care or extensions of the behavioral health workforce. These individuals have direct and 

frequent interactions with children and youth, allowing them to observe behavioral 

changes, promote healthy coping and resilience, provide early intervention, and create a 

supportive and nurturing environment. Establishing partnerships among schools, 

healthcare providers, and other community supports creates a more seamless and 

coordinated system of care, and improves outcomes for children, youth, and families.

Pediatric Primary Care

SAMHSA seeks to improve the integration of youth behavioral health and pediatric primary 

care. Pediatric primary care is the point of initial care delivery for 75 percent of children

and youth and can be the key to early identification of complex needs, effective referral, 

and coordination of care.69 Best practice related to integrating behavioral health and 

primary care requires an infrastructure of evidence-based primary prevention, mental 

health promotion, screening, measurement-based care (MBC), psychiatric and medicine

consultation, and collaboration among service providers. 

The Consolidated Appropriations Act, 2023 included provisions that prioritized integrating 

primary and behavioral health care.

13 Section 1301 of the law reauthorized and augmented 

SAMHSA’s Primary and Behavioral Health Care Integration program.

13 This provision 

requires 10 percent of appropriated program funds be allocated to implement the 

psychiatric collaborative care model by primary care practices.

13

Objective 2.2. Ensure that plans to develop the crisis continuum, in conjunction with 

the transition to the 988 Suicide & Crisis Lifeline, incorporate a specialized focus for

children, youth, and their families.

The nation’s crisis system is in a state of major growth and development. Crisis services 

do not adequately meet the specialized needs of youth, nor do they function as a 

coordinated system. This prevents children and youth from getting the services they need 

when and where they need them. Ideally children and youth in crisis receive services in 

their communities, but emergency departments and law enforcement are often the first 

point of entry into the behavioral health system. Therefore, in 2022, SAMHSA released 

The National Guidelines for Child and Youth Behavioral Health Crisis Care, offering best 

practices, implementation strategies, and practical guidance for the design and 

development of services that meet the needs of children, youth, and their families 

experiencing a behavioral health crisis.

43

Crisis and mobile response teams can de-escalate behavioral health emergencies and are 

an important part of the array of available services.

43 These teams often serve as a 

diversion from hospital-level care and involvement in the juvenile justice and child welfare 

systems.43 Mobile response and stabilization teams focused on children and youth are 
2023 - 2026 | SAMHSA Strategic Plan

37

necessary to ensure that services are provided by the right people with the appropriate 

expertise.43 Some youth may need more than mobile crisis response and may also need a 

“safe place to be.”43 Efforts should prioritize stabilization with the youth and their family 

such that the youth can remain at home, while prioritizing safety. For youth, home-based 

and/or community-based stabilization services can be delivered over a period of several 

weeks. When situations cannot be resolved in home or when the home is unsafe, youth 

may need more intensive services such as a crisis stabilization unit, emergency 

department, or inpatient treatment. 

SAMHSA recognizes that when a child or youth is in crisis, the family is in crisis. As a 

result, it is important to expand opportunities for parents, caregivers, and family members 

to engage in their child’s treatment and receive support from individuals who understand 

them. SAMHSA will create strategies for youth and families with lived experience to 

provide support to their peers facing similar behavioral health challenges.

Objective 2.3. Increase opportunities across multiple settings for screening, early 

identification, and early and brief intervention. 

By increasing opportunities to integrate screening and early intervention for mental health 

and substance use concerns across multiple settings, SAMHSA will create a more 

comprehensive and accessible system of care that encourages early identification and 

early intervention and creates support for young people experiencing behavioral health 

challenges. These services and supports can be expanded or incorporated into schools, 

pediatric primary care settings, and community organizations and settings as these are 

well positioned to identify early signs of behavioral health concerns. Digital technology, 

such as online screening tools or mobile apps, can also be leveraged. By using 

standardized screening tools, providing training to help identify symptoms, establishing 

clear referral pathways, and implementing integrative care models, appropriate and timely 

interventions can be provided to those in need.

Objective 2.4. Work collaboratively with other federal agencies and external 

stakeholders to develop strategies to increase capacity to deliver behavioral health 

services for children, youth, and their families. 

The pediatric behavioral health workforce shortage will ultimately lead to long-term 

negative outcomes across countless dimensions, particularly in under-served 

communities, with more pronounced inequities across communities of color.70,71 In 

addition, low reimbursement rates for youth behavioral health services and limited 

behavioral health benefit packages have contributed to ongoing challenges related to 

obtaining and paying for services and supports.

69 To ensure quality care is available to 

children, youth, and families, it is of paramount importance to address funding 

mechanisms and the need to expand access. To respond to this need, a responsive and

culturally, racially, and ethnically diverse workforce comprising youth and family peers, 

paraprofessionals, allied professionals, and clinicians must be mobilized. One specific area 
2023 - 2026 | SAMHSA Strategic Plan

38

of focus will be to provide guidance regarding how to implement services and obtain 

reimbursement to integrate pediatric primary care and youth behavioral health. 

To expand the workforce, SAMHSA has a long history of collaborating with federal 

partners. Similarly, non-federal partnerships can drive the state, territorial, tribal, and 

community dissemination of resources. SAMHSA will continue collaborative efforts to 

expand the youth behavioral health workforce, address behavioral health issues related to 

child welfare and juvenile justice, and identify strategies to fund quality behavioral health 

services for youth. 

Despite Medicaid and/or the Children’s Health Insurance Programs insuring 36 percent of 

American children, significant challenges remain for children and youth accessing innetwork providers. SAMHSA will commission a study to evaluate the barriers to behavioral 

health provider participation in public insurance programs.72 Although SAMHSA 

encourages care in the least restrictive environment, there is the growing issue of a lack of 

available inpatient and residential treatment beds for children who require them. This 

situation has significant downstream effects, like increased emergency department 

boarding times for children in behavioral health crisis. SAMHSA will evaluate the reasons 

behind bed closures and engage partners in discussing opportunities to develop funding 

mechanisms for youth crisis services to prevent the unnecessary utilization of inpatient and 

residential levels of care.

Goal 3. To meet the specific needs of children, youth, and their families, SAMHSA 

will support the dissemination and implementation of evidence-based and culturally

appropriate services. 

SAMHSA will encourage the use of evidence-informed and evidence-based services that

promote well-being by developing positive attributes (promotive) and that prevent 

substance use, misuse, and harm (preventive). Points of access for these services occur

at the youth and family level; within schools; within primary and other healthcare settings; 

and as part of national, state, territory, tribal, and community efforts to improve population 

health.

Studies demonstrate that the use of evidence-based practices to address child and youth 

behavioral health conditions improves outcomes.73 These treatments consistently 

outperform control conditions for the most common youth disorders, including anxiety, 

depression, and disruptive behavior.

Evidence-based interventions are needed and should demonstrate improved outcomes, 

relevance, and effectiveness for culturally diverse populations.

73 Although SAMHSA is not 

a research entity, the agency often supports necessary adaptations to evidence-based

services to align with cultural and linguistic needs of populations served. SAMHSA will 

encourage the use of an MBC approach. MBC is an evidence-based strategy to improve 

service outcomes that involves the systematic administration of symptom rating scales and 

use of the results to drive clinical decision making. Research demonstrates routine data 
2023 - 2026 | SAMHSA Strategic Plan

39

collection, as part of MBC processes that inform treatment planning, improves treatment 

outcomes. 

Objective 3.1. Reduce health disparities and ensure effectiveness of SAMHSA 

programs by establishing an equity-informed approach to data, evaluation, technical 

assistance, and service delivery that is specific to young people and their families. 

Increasing timely data collection and analysis is needed to more immediately respond to 

youth behavioral health needs.

73 Data are also needed to develop, implement, and 

evaluate interventions to determine if they meet requirements to be identified as evidencebased practices and to ensure the inclusion of marginalized groups in the interventions 

that are provided. Relevant and timely data analysis is critical to evaluating the 

effectiveness of SAMHSA’s programs and services and to understanding the needs of 

diverse populations. Data can help inform the implementation of high-quality programs, 

practices, and policies that are responsive, upstream-focused, recovery-oriented, traumainformed, and equity-driven (culturally and linguistically appropriate). This objective 

focuses on creating data strategies that understand the unique needs of children and 

youth and support programs that reduce and eliminate behavioral health inequities. 

Population-inclusive data can help identify specific needs and can be used to develop 

focused interventions. Significant inequities exist across a range of behavioral health areas 

for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+); Black; and 

Indigenous children and children of color.

10 These range from rates of diagnosis of 

attention-deficit/hyperactivity disorder to disparate treatment with antipsychotics for 

impulsivity, to the startling morbidity and mortality among Black youth by suicide.10 Given 

The Enhancement and Expansion of Treatment and Recovery Services for 

Adolescents, Transitional Aged Youth, and their Families (Youth and Family 

TREE) grantees provide a comprehensive, family-centered, trauma-informed, 

culturally appropriate, and evidence-based integrated outpatient system of care, 

which includes early intervention and recovery support services to meet the complex 

needs of the population of focus. The benefits include screening, assessment, 

treatment, and wraparound care, and they must be provided in outpatient, intensive 

outpatient, or day treatment settings.

The National Child Traumatic Stress Initiative program increases access to 

effective trauma- and grief-focused treatment and service systems for children, 

adolescents, and their families who experience traumatic events. With this program, 

SAMHSA aims to raise the standard of care and improve access to evidence-based 

services for children experiencing trauma across the nation.

Promoting Resilience and Emotional Health for Children, Youth, and Families 

Goal 3 Example Programs 
2023 - 2026 | SAMHSA Strategic Plan

40

this, there is an explicit need to address the social and structural determinants of mental 

illness and SUD—paying particular attention to behavioral health equity. 

Objective 3.2. Promote and coordinate technical assistance for youth behavioral 

health that provides guidance and expertise to professionals, organizations, and the 

public. 

SAMHSA provides technical assistance to support professionals, organizations, and the 

public as they develop and implement plans to address youth behavioral health 

challenges. SAMHSA’s current efforts in this area are limited. Building on existing efforts, 

SAMHSA will create a robust specialized national technical assistance center for youth 

behavioral health to assist individuals, organizations, and communities in improving and 

reforming youth behavioral health services and systems. This comprehensive center will 

use a public health approach to provide technical assistance related to wellness and health

promotion, primary prevention, early identification and intervention, and treatment and 

recovery approaches across the developmental spectrum. Technical assistance will focus 

on improving clinical services and programs, addressing specialized topics such as 

reducing health disparities and financing service delivery, expanding capacity and access 

to youth and family peer support, and providing interventions that are trauma- and griefinformed and recovery/resilience-oriented. 

Objective 3.3. Increase the inclusion of young people and family members with lived 

and living experience in the development, implementation, and evaluation of 

programs and services. 

An increasing body of evidence shows that outcomes improve when young people and 

their families are engaged in their own treatment decisions and in the development of 

policies and procedures governing care.74,75,76 Youth and family members with lived and 

living experience provide a perspective and descriptive information that contextualizes and 

complements the interventions delivered, and highlights areas for system improvement 

and reform. 

SAMHSA incorporates the child, youth, young adult, and family lived experience 

perspective through programs such as the Statewide Family Network Program, 

implemented by family-driven organizations; the Healthy Transitions program serving 

youth and young adults ages 16–26 with or at risk for serious mental health conditions; 

and other programs requiring key personnel positions or advisory groups including young 

people and family members with lived experience. In addition to this, SAMHSA will obtain 

feedback from people receiving services for continuous quality improvement and to 

promote opportunities for leadership and positive development. This includes engaging 

young people and their family members on SAMHSA National Advisory Council and

educational activities, and in the development and implementation of training and technical 

assistance to grantees and the public. 
2023 - 2026 | SAMHSA Strategic Plan

41

Objective 3.4. Guide the optimal use of technology to support the behavioral health 

of children, youth, young adults, and families. 

Technology use significantly impacts the nation’s children, youth, and families.

10 The use 

of telehealth services in particular greatly expanded as a result of the COVID-19 pandemic 

and has improved access to mental and substance use disorder services.10 Technology 

also has the potential to provide robust social support. For example, social media provides 

youth who identify as LGBTQI+ with an environment that fosters peer connections and 

supports emotional well-being.77 Additionally, youth use of crisis supports through text and 

chats has risen exponentially since the transition to the 988 Suicide & Crisis Lifeline.

78 An 

emerging area of work is to better understand the role of digital technologies to assist in 

the treatment of behavioral health conditions, from apps to wearables, which show promise 

for the future of behavioral health service delivery. 

Unfortunately, social media can also be harmful to child, youth, young adult, and family 

mental health. According to a 2022 Pew Research Survey, nearly half of U.S. teens ages 

13 to 17 experienced bullying and harassment online, and 53 percent identify it as a “major 

problem.”79 Such negative influences can create or exacerbate conditions like anxiety and 

depression, and excessive use of social media has been linked to impulsive behavior and 

loneliness. Nearly all adolescents and young adults use social media and digital 

communications, and they are uniquely vulnerable to the negative effects of social media

and highly susceptible to peer influences.80 Understanding the influences of increased 

technology use and new digital platforms on the initial use and progression of potentially 

harmful drug use, behaviors, and the mental health of young people is key to adapting 

policy and practices. SAMHSA’s Center of Excellence on Social Media and Mental 

Wellbeing develops and disseminates information, guidance, and trainings on the impact 

of youth social media and technology use, particularly the potential benefits and risks that 

these platforms may pose to mental wellness and resilience. 
2023 - 2026 | SAMHSA Strategic Plan

42

People with behavioral health conditions often experience challenges getting the care they 

need. Forty-four million people ages 12 and older in the United States needed substance 

use treatment in the past year; however, only 6.3 percent reported receiving any. Close to 

58 million adults ages 18 or older had any mental illness during the same time period, but 

less than half (47.2 percent or 26.5 million) reported receiving mental health services in the 

past year.

3 Systemic factors, such as lack of stable housing and transportation, food 

insecurity, condition-related stigma and discrimination, and high rates of past trauma, 

racism, and homophobia, may pose significant barriers for people and families to trust and 

effectively engage with behavioral and other healthcare services. These factors apply no 

matter the age of the individual as they have impacts across the lifespan. 

Although mortality can be directly related to mental and substance use disorders (SUDs), 

people living with these conditions are also at higher risk for poor health outcomes 

associated with preventable chronic physical health problems. Healthcare services 

systems, including primary care, are often ill equipped to meet the myriad of complex 

needs of people with mental health and substance use disorders, especially when the 

support and attention that would be most helpful is beyond what is available or feasible 

within these setting.

81 This may complicate efforts for people with serious mental illness 

(SMI) and SUDs to access or effectively engage with different types of health care from 

which they could benefit. This is a contributing factor to the shorter life expectancies 

among people with SMI and SUDs compared to their peers without these conditions.

81

Integrating behavioral health and physical health care is particularly important for older 

adults, who often prefer to seek behavioral health care in primary care settings for several

reasons.

79 Nineteen percent of adults over age 65 reported they could not function at all or 

had a lot of difficulty with at least 1 of 6 functioning domains: vision, hearing, mobility, 

communicating, cognition, and self-care.

82 Older age groups had the highest (85+) or 

among the highest (75–84) suicide rates for any age group.

83 Additionally, approximately 3 

million adults 50 or over reported having any SMI; 17.7 million reported any mental illness; 

11.4 percent reported binge drinking in the past month; and 11.3 percent reported having a 

SUD.±

Improving health more holistically can be accomplished through the integration of 

behavioral and physical health care by using systematic, evidence-based, cost-effective 

approaches to improve person-centered comprehensive care in all settings. Recognizing 

the multidimensional elements to health, a whole-person approach considers the individual 

at the center of care regardless of treatment setting, integrates their goals and priorities 

into a person-centered care plan, is culturally appropriate, and aims for the creation of 

health and well-being—not just the absence of disease. 

Priority 4

Integrating Behavioral and Physical Health 

Care 
2023 - 2026 | SAMHSA Strategic Plan

43

A key to achieving a whole-person care approach is advancing the bi-directional 

integration of behavioral health with all other healthcare services and systems. The

Substance Abuse and Mental Health Services Administration (SAMHSA)’s integration 

efforts provide support in areas integral to its mission, including grant programs, technical 

assistance, training resources, and policy activities. These efforts include the education 

and training of primary care providers to better promote prevention, screening, and early 

behavioral health interventions; self-management approaches including shared decision 

making so individuals and families can fully participate in care; as well as investing in 

models that connect individuals with behavioral health issues to needed physical health 

screening and associated care. 

SAMHSA funds the National Center of Excellence for Integrated Health Solutions (CIHS), 

which houses some of the newest evidence-based resources, tools, and support for 

organizations working to integrate primary and behavioral health care. This team of 

experts in organizational readiness, integrated care models, workforce and clinical 

practice, health and wellness, and financing and sustainability partner with providers to 

create a customized approach to advance integrated care and health outcomes. SAMHSA 

also works with federal, state, territorial, tribal, and community partners to eliminate the 

barriers that providers encounter when trying to deliver whole-person health care and 

supports. These barriers are especially profound when serving communities 

disproportionately affected with co-morbid infectious disease conditions. 

Goal 1. To promote whole-person care and improve health outcomes, SAMHSA will 

advance bi-directional integration of healthcare services across systems for people 

with behavioral health conditions. 

Bi-directional care integration focuses on improving access to and delivering whole-person 

care. It also includes addressing physical and behavioral health in an integrated system 

where providers work together to deliver and coordinate care.

84 SAMHSA acknowledges 

that bi-directional care integration is not a “one-size-fits-all” endeavor. Specialty behavioral 

health and primary care settings differ in significant ways, including patient populations, 

provider expertise and background, resource needs, financing and information technology 

systems, and primary drivers of care.

84 These differences need to be factored into any 

integration activities. 

Despite these differences, consistently applying a whole-person care approach equitably, 

no matter the setting, can improve health outcomes for people with behavioral health 

conditions.

85 Non-specialty healthcare settings, whether emergency departments, 

hospitals, or primary care, may be the first place for an encounter with an individual in 

need of behavioral health services. These encounters represent significant opportunities 

for screening, diagnosis, and engagement in effective services and supports, not only for 

physical and behavioral health conditions but also for supports that pay attention to social

determinants of health (SDOH).

81 Providing treatment for behavioral health conditions in 

primary care not only expands access to these services but allows for attention to other 

acute and chronic health conditions.

81 Interventions for behavioral health conditions in 
2023 - 2026 | SAMHSA Strategic Plan

44

primary care especially reach the large population of individuals with less complex or 

stable mental and SUD.

85

To be successful, this goal will require partnerships and educational efforts among all 

stakeholders. That includes actively and closely engaging, building on, and working with 

federal partners prominent in this area, including the Health Resources and Services

Administration (HRSA), the Centers for Disease Control and Prevention, the Office of the 

Assistant Secretary, the Veterans Administration (VA), and others. For example, the 

SAMHSA-HRSA CIHS assists providers in integrating primary and behavioral health 

services to better address the needs of individuals with mental health and substance use 

conditions, whether seen in specialty behavioral health or primary care provider settings. 

Objective 1.1. Increase resources and service capacity through grants, educational 

materials, and technical assistance for mental health and substance use disorder

education, screening, prevention, treatment, and recovery in physical healthcare 

settings. 

Historically there has always been an unmet need for behavioral healthcare services, with 

many people living with behavioral health conditions not receiving treatment.

3 The COVID19 pandemic resulted in increased symptoms of anxiety and substance use that call for 

additional investments to address these concerns across more integrated treatment 

settings.

3 Physical healthcare settings play important roles in preventing, identifying, 

mitigating, treating, and supporting the recovery of people with, or at risk for, behavioral 

health conditions.

85 Meeting these functions presumes that practitioners have the requisite 

education, support, and resources to adequately deliver these services. An example can 

be found in the Consolidated Appropriations Act, 2023, which amended the Public Health 

Service Act to reauthorize and augment the Primary and Behavioral Health Care 

Integration program by requiring a 10 percent allocation of appropriated funds to 

implementing the psychiatric collaborative care model by primary care practices.13

The Promoting the Integration of Primary and Behavioral Health Care program

promotes full integration and collaboration in clinical practice between primary and 

behavioral health care and promotes integrated care services related to screening, 

diagnosis, prevention, and treatment of mental and SUDs, and co-occurring physical 

health conditions and chronic diseases.

Screening, Brief Intervention, and Referral to Treatment grants implement 

screening, brief intervention, and referral to treatment services for children, 

adolescents, and/or adults in primary care and community health settings with a focus 

on screening for underage drinking, opioid use, and other substance use.

Integrating Behavioral and Physical Health 

Care Goal 1 Example Programs 
2023 - 2026 | SAMHSA Strategic Plan

45

SAMHSA will continue to support training and technical assistance using a whole-person 

care framework for all practitioners, health systems, and other organizations that seek to 

provide behavioral health care. These efforts align with and complement a range of 

SAMHSA’s programs supporting the continuum of prevention, treatment, recovery support, 

and mental health promotion services across primary care, emergency departments and 

hospital settings, infectious disease clinics, and criminal justice-related healthcare services 

such as grants to expand SUD treatment in drug courts and technical assistance through 

the CIHS. 

Objective 1.2. Increase resources and service capacity through grants, educational 

materials, and technical assistance for physical health condition education, 

screening, prevention, treatment, and recovery in behavioral healthcare settings. 

Specialty behavioral healthcare settings may be the primary and only places where people 

with mental and substance use conditions encounter and engage with health professionals 

on a longer-term basis. To improve health outcomes for their clients, behavioral health 

organizations must be prepared to address physical health conditions and integrate 

services for the people they serve. 

Several of SAMHSA’s programs, including the Certified Community Behavioral Health 

Clinics, the Minority Acquired Immunodeficiency Syndrome (AIDS) Initiative, and the

Promoting the Integration of Primary and Behavioral Health Care grants, incorporate

aspects of wellness-focused and whole-person care requirements such as primary 

healthcare screenings and referrals. SAMHSA will expand these activities to all relevant 

grant programs. 

Objective 1.3. Increase availability and improve uptake of training, education, and 

technical assistance on evidence-based, trauma-informed, integrated whole-person 

care. 

SAMHSA has a long history of providing training, education, and technical assistance to a 

range of healthcare audiences to advance the behavioral health needs of the nation. With 

a growing emphasis on wellness-focused, whole-person care, SAMHSA will focus on 

these activities to ensure inclusion of trauma-informed, integrated care approaches. Work 

from various stakeholders and partner federal agencies such as the VA and the National 

Institutes of Health on whole-person care models will also inform efforts.85,86 SAMHSA will 

employ its strategic data collection revisions in measuring acceptance and uptake of these 

training and technical assistance efforts, including the Whole Health Action Management

model that SAMHSA plans to review and revise. 

Goal 2. To promote whole-person care and improved health outcomes, SAMHSA will

advance policies and programs to address social determinants of health. 

SAMHSA recognizes the importance of addressing SDOH as key levers to achieving 

improved outcomes for people with behavioral health conditions. SAMHSA addresses 

various SDOH through our service delivery grants, training, and technical assistance 
2023 - 2026 | SAMHSA Strategic Plan

46

programs. Wraparound services for transportation assistance, case management, and 

supportive and recovery housing are a few examples of allowable activities that can be 

supported with SAMHSA grant funds. In addition, SAMHSA collaborates with other federal 

partners to support the Homeless and Housing Resource Center, a technical assistance

program. 

Many individuals with behavioral health conditions encounter the criminal justice system at 

different points. Recognizing this intersection, SAMHSA also supports programs, such as 

diversion, drug court, and reentry, that aim to interrupt the cascade of negative events from 

this involvement. 

Objective 2.1. Strengthen factors to improve health, home, purpose, and community 

to address social determinants of health.

Improving socioeconomic factors (such as environmental conditions, economic factors, 

and interpersonal relationships) is essential to strengthening SDOH, which reduces the 

risk of substance misuse, promotes equity, and improves overall health and well-being.

The Treatment for Individuals Experiencing Homelessness program

supports the development and/or expansion of local implementation of an

infrastructure that integrates behavioral health treatment and recovery support

services for individuals, youth, and families with an SMI, serious emotional

disturbance, or co-occurring disorder who are experiencing homelessness.

Adult Treatment Drug Court programs support a variety of services including 

direct treatment services for diverse populations, wraparound and recovery

support services such as recovery housing and peer recovery support services

designed to improve access to and retention in care, drug test monitoring for

illicit substances, educational support, relapse prevention and long-term

disease management skills development, and human immunodeficiency virus

and viral hepatitis B and C testing and/or referral, conducted in accordance

with state and local requirements.

Adult Reentry Program grants provide screening, assessment,

comprehensive treatment, and recovery support services for diverse

populations reentering the community from incarceration. Other supported

services include providing drug testing as required for supervision, treatment

adherence, and therapeutic intervention; provision of case management and 

person-centered case management planning; and screening for infectious

diseases. 

Integrating Behavioral and Physical Health 

Care Goal 2 Example Programs 
2023 - 2026 | SAMHSA Strategic Plan

47

To help strengthen these linkages, SAMHSA will provide funding to eligible entities for 

screening, intervention, referral, linkage to care, and warm hand-off support services 

focused on substance misuse prevention and/or cessation, infectious disease prevention 

and treatment, mental health, primary care, pre-arrest diversion/deflection, housing, 

employment, education, peer support, and other psychosocial needs. SAMHSA works with 

federal partners and other stakeholders, such as through the Interdepartmental Substance 

Use Disorders Coordinating Committee (ISUDCC), and will support policies and practices 

that address individual, family, and community needs associated with SDOH (including 

through efforts such as peer specialists, community health workers, community coalition 

volunteers, faith-based leaders, person-centered planning, case management, and 

others). The ISUDCC focuses on coordination across federal agencies and on strategies 

to improve federal programs and outcomes related to substance use prevention, 

treatment, and recovery. Specific activities include expanding access to services, 

assessing the alignment of federal and state prevention and treatment strategies, 

recommending strategies for public engagement regarding policy and program 

development, and recommending strategies to minimize duplicative programming. 

Objective 2.2. Adapt community-based services and supports to meet the needs of 

specific populations such as people experiencing homelessness.

Far too many individuals with behavioral health conditions become homeless. Engagement

with treatment that restores a person’s dignity, humanity, and mental health can help these 

individuals remain well and enable them in working with housing professionals to obtain 

and sustain successful housing. Often this treatment includes medication for those with 

SUD as well as medications that treat mental illnesses such as depression, bipolar 

disorder, or schizophrenia. 

SAMHSA leads many programs that provide identification of mental illnesses in individuals 

that are unhoused and promotes referral to treatment. These include the Projects for 

Assistance in Transitioning from Homelessness program as well as the Treatment for 

Individuals Experiencing Homelessness program. Additionally, SAMHSA provides 

technical assistance to shelters and other entities that are engaged with assisting our 

nation’s homeless individuals and developed a guide on Expanding Access to and Use of 

Behavioral Health Services for People Experiencing Homelessness. This guide highlights 

strategies for behavioral health and housing providers to conduct outreach and engage 

with individuals experiencing homelessness, initiate use of behavioral health treatment as 

they wait to receive stable housing, and retain them in their recovery efforts once housed.

SAMHSA intends to continue investments in programs and training opportunities that 

support linkage to and engagement with a range of recovery support services for persons 

with mental illness and SUDs, improving access to and retention in services, and reducing 

homelessness by partnering with and supporting homeless service organizations, housingrelated entities, and training and technical assistance resources that work to identify and 

provide sustainable housing options for persons with mental illness and SUDs. This 

includes Assertive Community Treatment Grants, Grants for the Benefit of Homeless 
2023 - 2026 | SAMHSA Strategic Plan

48

Individuals, and others. SAMHSA actively participates in the U.S. Interagency Council on 

Homelessness and will leverage its existing relationships to help advance the integration of

behavioral health into local U.S. Department of Housing and Urban Development 

Continuum of Care Program and associated Coordinated Entry Systems. 

Objective 2.3. Increase and improve care for people involved with the criminal 

justice system from all points of diversion to reentry. 

Too often Americans with behavioral health conditions are arrested and incarcerated 

rather than provided with opportunities to participate in effective treatment and recovery 

support services. With adequate crisis response and timely access to treatment and 

recovery supports, individuals with behavioral health conditions can receive treatment 

rather than face arrest and incarceration. 

To help individuals remain well in the community of their choice, SAMHSA will continue 

investments in programs that aim to divert individuals with behavioral health conditions 

from the criminal justice system, establish and expand drug courts, and assist offenders 

with behavioral health conditions with reentry. These programs all aim to move people with 

behavioral health conditions away from the criminal justice system and into community 

care. Programs include diversion programs such as support for mental health courts and 

SAMHSA’s long-standing Gather, Assess, Integrate, Network and Stimulate Center, which 

is a nationally recognized technical assistance center that provides resources on diversion 

from criminal justice as well as information on treatment of incarcerated individuals with 

mental illnesses and SUDs and best practices in release planning for those individuals. 

Individuals entering carceral settings still require treatments that they were receiving in the 

community. SAMHSA will continue educating and supporting medical staff across federal, 

state, tribal, and other systems on best practices for working with people with behavioral 

conditions in the criminal justice system. SAMHSA intends to conduct a series of activities, 

including listening sessions, policy academies, and training events, to advance service 

implementation. 

Recognizing that the overdose risk for people with a SUD leaving incarceration is far 

higher than that of the general population, SAMHSA will work with partners including the 

Drug Enforcement Agency, the Federal Bureau of Prisons, and other stakeholders to 

ensure increased access to medications for opioid use disorder and other services for 

individuals being released from prisons or jails.
49

The nation’s mental health and substance use workforce is critical to providing individuals 

with access to essential healthcare services. Prior to the COVID-19 pandemic, there was a 

projected shortage of behavioral healthcare providers, with acute shortages predicted for 

psychiatrists and substance use disorder (SUD) treatment counselors through 2030.87 The 

provider shortage is likely further exacerbated by the negative impact of COVID-19 and 

burnout.

88 Simultaneously, higher demands in services are predicted due to an increased 

prevalence of depression and anxiety disorders and substance use related to the COVID19 pandemic.89,90 The Substance Abuse and Mental Health Services Administration 

(SAMHSA) works closely with the Health Resources and Services Administration (HRSA) 

through the Behavioral Health Workforce Research Center to define and more clearly 

describe these needs.

Recognizing that a strong behavioral health workforce must meet people’s needs where 

they are, the 21st Century Cures Act directed SAMHSA to work with states and other 

stakeholders to develop and support recruitment and retention efforts specific to 

addressing mental health conditions and SUDs across the lifespan.

91 To assist with 

recruitment and retention efforts, SAMHSA engages with the field through numerous 

pathways, such as provision of training and technical assistance, encouraging the 

expansion of the use of paraprofessionals, and increasing the diversity and cultural 

competency of the workforce. Peer providers and paraprofessionals have been shown to 

play a crucial role in enhancing and extending care to communities.92 This expansion of 

workers from within the community served is important considering that lack of diversity in 

the workforce is a systemic issue that contributes to poor health outcomes for racial, 

ethnic, sexual, and gender minorities.

93 The use of telehealth and other technologies 

among behavioral health providers is also a promising strategy that can help increase 

access to mental illness and SUD treatment by addressing workforce shortages, which are 

often more pervasive in certain geographic areas.

94

Goal 1. To meet the behavioral health needs of the nation, SAMHSA will support the 

active recruitment, training, and retention of diverse, qualified individuals into the 

behavioral health workforce. 

Research shows positive impact on client outcomes when the clinicians providing care are 

of similar racial, ethnic, sexual orientation, and gender identity backgrounds as those 

receiving services.93 Further, behavioral health service accessibility, availability, 

affordability, and acceptability are enhanced when the workforce is accessible to all 

individuals, including those with disabilities, and is stable and established in a community.

Through grants, contracts, and technical assistance resources, SAMHSA will use bestand promising practices in recruitment and retention and will expand the reach of training 

Priority 5 

Strengthening the Behavioral Health 

Workforce
2023 - 2026 | SAMHSA Strategic Plan

50

and skill development to ensure the workforce reflects those receiving care (including 

racial, ethnic, sexual, and gender minority individuals; individuals with disabilities; and 

other under-served communities) and is qualified to provide the services offered. 

Objective 1.1. Expand the number of Minority Fellowship Program fellows and 

enhance the reach of the Historically Black Colleges and Universities Center of 

Excellence.

SAMHSA operates the Minority Fellowship Program (MFP) and Historically Black Colleges

and Universities Center of Excellence (HBCU-CFE) in Behavioral Health program that aim

to increase the number of behavioral health practitioners serving minority populations.

While both the MFP and HBCU-CFE programs successfully expand the number of

behavioral health providers that serve racial and ethnic minority populations, they are not

meeting increased demand to provide culturally appropriate behavioral health care.

Working with grantees and stakeholders, SAMHSA will reassess the MFP and HBCU-CFE

to expand and enhance their impact. By expanding the reach of these two programs,

SAMHSA can support increasing the total number of behavioral health practitioners that

treat and serve people of different cultural and ethnic backgrounds. 

Objective 1.2. Develop new pipeline programs by engaging high school, community

college, and four-year university students. 

While the MFP, HBCU-CFE, and Prevention Fellowship programs have experienced 

success in bolstering the behavioral health workforce, they are insufficient to meet the

Minority Fellowship Program (MFP) fellowships are open to people pursuing master’s 

or doctoral degrees in various fields of behavioral health. SAMHSA-sponsored, and

administered by 8 national behavioral health organizations, the MFP annually provides

approximately 200 master’s level and Ph.D. students with educational scholarships and

training. MFP fellows commit to working with under-served communities for a specified 

period after they complete their education.

The Historically Black Colleges and Universities Center of Excellence (HBCU-CFE)

recruits students to careers in behavioral health fields that address mental and SUD, 

provides training that can lead to careers in the behavioral health field, and prepares

students for obtaining advanced degrees in the behavioral healthcare field. HBCU-CFE

activities emphasize education, awareness, and preparation for careers in mental and

SUD treatment including addressing opioid use disorders, serious mental illness (SMI)

(including First Episode Psychosis), and suicide prevention. 

Strengthening the Behavioral Health Workforce 

Goal 1 Example Programs
2023 - 2026 | SAMHSA Strategic Plan

51

increasing demand. SAMHSA launched the Prevention Fellow Program to (1) develop and 

sustain a well-trained and knowledgeable cadre of prevention professionals who 

understand and exemplify the principles and best practices of substance misuse

prevention, and (2) prepare fellows to achieve certification. Nationally, there is a need to 

attract quality candidates into the behavioral health prevention, intervention, treatment, and 

recovery support fields. Programs that build awareness and educate people about these 

career fields establish a “pipeline” of new talent that eventually adds to the national 

behavioral health workforce. 

To build a sustainable workforce, it is necessary to attract candidates by educating them 

about the behavioral health field as early as possible. Targeted outreach efforts are 

needed to support those exploring entry-level careers and those who are completing their 

degrees and deciding with which populations they want to specialize. This is long-term 

work that will grow the pool of viable candidates for behavioral healthcare positions around 

the country.

Objective 1.3. Expand the availability of paraprofessionals and peer support 

providers. 

Peer support providers offer encouragement, practical assistance, guidance, and 

understanding to support recovery. Peer support providers walk alongside people in 

recovery, offering individualized supports and demonstrating that recovery is possible. 

They share their own experience including strategies for self-empowerment and achieving 

a self-determined life that can complement or, in some cases, replace clinical supports. 

They support people in recovery in connecting with their own inner strength, motivation, 

and desire to move forward in life, even when experiencing challenges. Peer support 

providers and recovery coaches are critical in engaging people into recovery; navigating 

complex service systems; providing support and hope; and modeling that people can 

manage or overcome their conditions and live full, healthy lives. Leveraging 

paraprofessionals and peer support providers can help licensed clinicians to serve a 

greater number of people. SAMHSA supports the Peer Recovery Center of Excellence to 

further the peer workforce and released the National Model Standards for Peer Support 

Certification to expand and improve the quality of the nation’s growing peer workforce.

Recognizing their value, SAMHSA will work with stakeholders to educate them on what 

peer support providers and paraprofessionals are doing across the nation to help address 

the acute need for behavioral health care. This includes developing a model national peer 

specialist standard, conducting training and technical assistance to further the peer 

workforce, and working with federal, state, territorial, tribal, and community partners on 

issues such as financing, recruitment, and continuing education.

Objective 1.4. Increase the supply and capacity of the behavioral health workforce to 

provide new, innovative, and evidence-based treatment in community-based 

primary care settings.
2023 - 2026 | SAMHSA Strategic Plan

52

SAMHSA recognizes that the overall supply of the behavioral health workforce does not 

meet the current demand for behavioral health services.

87 In addition to increasing the 

overall supply of behavioral health practitioners, there are other ways, such as greater 

utilization of telehealth, to expand capacity.

94 More behavioral health care can be provided 

in primary care settings. However, these settings often do not have behavioral health 

providers embedded in the practice, requiring additional steps to access behavioral health

care. Overburdened primary care providers may not have the resources to stay abreast of 

new, innovative, and evidence-based behavioral health treatments.95 Recent additional 

funding has been provided through both SAMHSA and HRSA for primary health providers 

to offer behavioral health care, but primary health providers will need supports to 

understand what new, innovative, and evidence-based interventions are most effective and 

how to access them. 

SAMHSA will increase resources for education and training programs that enhance 

providers’ use of recovery-oriented, evidence-based strategies and tailor prevention and 

clinical interventions to be responsive to communities’ linguistic and cultural needs. 

SAMHSA will maintain and expand its Evidence-Based Practices Resource Center with 

easily searchable references to make information and tools that incorporate evidencebased practices available to practitioners for use in communities or clinical settings. The 

agency supports states, territories, tribes, and communities to ensure that credentialed 

prevention staff can deliver services with a comprehensive understanding of prevention 

and the latest evidence-based practices addressing substance use prevention. The design 

of the Targeted Capacity Expansion grant will highlight innovations to provide pathways to 

and knowledge about certification or licensing for prevention specialists.

Goal 2. To improve the quality of behavioral health care, SAMHSA will promote and 

support professional development initiatives to improve the competencies of 

service providers. 

A wide variety of professionals and paraprofessionals deliver mental health and SUD

prevention, treatment, and recovery services in greatly varied settings. Regardless of the 

setting, behavioral health care should be delivered using evidence-based and culturally 

appropriate practices. Working with professional organizations, licensing and credentialing 

boards, and SAMHSA’s Technical Assistance Centers (TACs) and Centers of Excellence, 

SAMHSA will work to improve behavioral health provider competencies. SAMHSA has 

seen improvement through our funded programs like the Providers Clinical Support 

System, which provides both training and clinical mentoring to providers treating SUDs.
2023 - 2026 | SAMHSA Strategic Plan

53

Objective 2.1. Increase the use of equity-oriented and trauma-informed approaches 

in SAMHSA’s training and technical assistance efforts for providers of behavioral 

health services. 

SAMHSA’s overall approach to training and technical assistance must be responsive to the 

communities in which the providers deliver service. With the great diversity in communities 

and disparities in access for under-served communities, all SAMHSA-funded training and 

technical assistance must include considerations for equitably increasing access and 

incorporating trauma-informed approaches, relevant to each setting. Services must be 

trauma-informed to respond to individual, family, community, and historical trauma that 

impacts populations. This includes working to prevent trauma, including adverse childhood 

experiences, and to prevent re-traumatizing those seeking care.

Objective 2.2. Improve training and supports for providers who work with young 

people with or at risk for behavioral health conditions. 

Behavioral health providers for children, youth, and young adults are historically difficult to 

attract and retain in the health workforce.

94 It is critical that providers are trained to 

respond to the diverse needs of all youth, spanning developmental ages, demographics, 

intellectual and developmental abilities, and socio-economic situations. 

SAMHSA currently supports the National Training and Technical Assistance Center for 

Child, Youth, and Family Mental Health (NTTAC). NTTAC provides an array of trainings, 

technical assistance, and resources to providers, organizations, and agencies from across 

the system of care. SAMHSA will review how to improve and expand these trainings and 

supports to get providers needed assistance. In addition, the development of the 

The Technology Transfer Centers (TTC) Program develops and strengthens the 

specialized behavioral healthcare and primary healthcare workforce that provides

prevention, treatment, and recovery support services for SUD and mental illness. The 

TTC program comprises three networks: the Addiction Technology Transfer Centers,

the Mental Health Technology Transfer Centers, and the Prevention Technology

Transfer Centers. Each network comprises a National Coordinator Center and 10

Regional Centers.

The Clinical Support System for Serious Mental Illness initiative, called Serious

Mental Illness (SMI) SMI Adviser, supports the use and implementation of evidencebased screening and treatment for SMI through education and consultation. The

technical assistance provider engages and leads more than 30 national mental health 

organizations that help guide this interprofessional project. SMI Advisor supports realworld clinical practice with education, data, and consultations.

Strengthening the Behavioral Health Workforce 

Goal 2 Example Programs
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SAMHSA-wide TAC will enhance the services and skill levels of providers who work with 

young people.

Similarly, many of SAMHSA’s Centers offer supports for practitioners aiding targeted 

communities, but they do not necessarily have offerings for children, youth, and young 

adults in these communities. SAMHSA will review how to create greater synergies and 

resources across its Centers to support providers who work with young people.

Objective 2.3. Increase awareness and utilization of practitioners’ education and 

training opportunities. 

Through its partners, SAMHSA offers a variety of education and training opportunities, but 

it is unclear whether practitioners sufficiently leverage these resources or even know about 

them. To ensure opportunities for practitioner self-development, SAMHSA will review the 

programming and delivery methods to ensure they accommodate providers’ busy 

schedules, address identified shortcomings, and mitigate barriers. SAMHSA will launch a 

communications campaign to ensure practitioner awareness of available resources. 

Objective 2.4. Promote evidence-based professional development to improve 

behavioral health providers’ competencies in line with the National Behavioral 

Health Quality Framework. 

The National Framework for Quality Improvement in Behavioral Health Care is an initiative 

established by SAMHSA after the passage of the Affordable Care Act to promote the 

quality of health among Americans and reduce costs of care. Major components of the 

framework include the patient, population, payor, system, plan, provider, and practitioner.

Achieving safe, high-quality, affordable behavioral health care for all Americans will be the 

product of millions of local actions in local communities—actions taken by doctors and 

nurses, patients and family members, and systems put in place by health and behavioral 

care organizations, providers, payors, and care managers to ensure high-quality, effective, 

and reliable care.

To enhance the utility of the framework, progress in achieving goals and priorities can be 

assessed in three separate but related domains: (1) among SAMHSA-funded programs 

and activities; (2) among behavioral health systems (e.g., states and counties) and 

providers (e.g., networks, managed care vendors); and (3) among the general population 

or subpopulations reflecting specific demographic and/or clinical characteristics.

Goal 3. To increase the accessibility of behavioral health providers in all 

communities, SAMHSA will reduce barriers to the continuum of high-quality 

services.

From the COVID-19 pandemic, we learned that accessing behavioral health providers in a 

virtual space expands service availability to people without access.96 Even with virtual 

service options, people still face barriers to receiving specialized behavioral health 

treatment, and some policy barriers have the potential to reduce the effectiveness.

96
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55

SAMHSA seeks to reduce barriers to high-quality services, regardless of how those 

services are delivered, and seeks to decrease disparities in access to care.

The use of telehealth among behavioral health providers is just one promising strategy that 

can help increase access to mental health services and SUD treatment by addressing 

workforce shortages, which are often more pervasive in certain geographic areas. In 

addition to providing services directly to the individual, the use of telehealth can increase 

the quality of treatment services. The Extension for Community Healthcare Outcomes

project model utilizes videoconferencing to train primary care clinicians to treat chronic 

illnesses and conditions, such as treatment for individuals with opioid use disorder or 

children with mild to moderate mental disorders.

Objective 3.1. Increase investments to reduce disparities in access to specialized 

behavioral health care. 

A variety of causes—cost, stigma, lack of transportation, personal mobility, hours of 

operation, and lack of access to information technology equipment (phone, computer, 

internet, etc.), among others—can limit access to specialized behavioral health services.

97

The underlying causes of disparities in access can be tied to a lack of infrastructure, lack 

of personal supports, and other reasons.

Some federal programs already exist to reduce barriers, such as the Federal 

Communications Commission’s (FCC) Rural Digital Opportunity Fund, and other FCC and 

U.S. Department of Health and Human Services programs to expand telehealth. 

Partnering with these and other stakeholders to expand access to behavioral health care 

has the potential to reach historically under-served communities. Additional programs to 

provide targeted populations with access to computer equipment serve as a model for 

SAMHSA to explore. 

The African American Behavioral Health Center of Excellence is designed to help 

the field transform behavioral health services for African Americans, making them safer, 

more effective, more accessible, more inclusive, welcoming and engaging, and more 

culturally appropriate and responsive. This is achieved through collaboration, training, 

technical assistance, and a variety of written and recorded resources. 

The Telehealth for the Treatment of Serious Mental Illness and Substance Use 

Disorders guide reviews ways that telehealth modalities can be used to provide 

treatment for serious mental illness and SUDs among adults, distills the research into 

recommendations for practice, and provides examples of how these recommendations 

can be implemented.

Strengthening the Behavioral Health Workforce 

Goal 3 Example Programs
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To address these causes and reduce barriers to specialized behavioral health care, 

SAMHSA will expand the availability and use of grant funds to invest in approvable 

strategies to mitigate these causes. The agency will also increase partnerships with other 

federal, state, territorial, tribal, and community philanthropic programs to decrease 

disparities in access. 

Objective 3.2. Increase funding opportunity announcements that allow resources to 

be used to expand virtual care. 

SAMHSA will clarify and expand, where possible, the approvable use of SAMHSA grant 

and contract dollars to support virtual care, including support for infrastructure (equipment), 

provider reimbursement, supervision, and evaluation of quality impact.

Objective 3.3. Decrease restrictions on credentialed practitioners working across 

state lines, particularly for under-served populations.

Individuals have long been able to cross state lines to receive care, but providers have 

been restricted to practice in the state in which they maintain active licenses.96 With the 

advancement of telehealth and other technologies, we learned that telehealth is effective in 

the delivery of behavioral health treatments and that telehealth can result in greater and 

more timely access to professional care.

96 Each state’s licensure requirements are under 

the jurisdiction of state government.

91 However, the federal government can facilitate 

greater reciprocity of acceptance of licensed practitioners across states so that there is 

greater access to providers. One such mechanism is HRSA’s work on interstate medical 

licensure compacts, which create agreements across state lines to accept professionals 

who are licensed in other states. 

SAMHSA will work with federal and state authorities involved with behavioral health, trade 

associations representing behavioral health providers, as well as credentialing, certifying, 

and licensing bodies to establish common scope of practice guidelines for behavioral 

health professionals and paraprofessionals. This work aims to decrease barriers to moving 

between states to practice and providing services across state lines as well as support

multidisciplinary, interprofessional collaborative care models. Such common scopes of 

practice can form the basis for cross-state compacts for credentialled professionals and 

certified paraprofessionals. 
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Conclusion

The behavioral health needs of the nation are unquestioningly complex. To address them 

as comprehensively as possible, it is critical to recognize that approaches must be personcentered and account for the great diversity of individuals, families, and communities. 

There is much work to do to build health systems and approaches that provide high-quality 

care and services to those who need them the most. As such, whole-person approaches

are key because they put people at the center, regardless of setting, and integrate their 

goals and priorities into individualized plans that are culturally appropriate. As the new 

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

vision clearly convey, the goal is for everyone to have opportunities to thrive and achieve 

better health outcomes.

The work before us will be challenging, but ultimately with this Strategic Plan, along with 

the many efforts of our federal partners and vast networks of stakeholders across a 

diverse range of disciplines, expertise, and lived experience, success is possible. As we 

continue in this work and build out new policies, programs, and strategies, it is also

essential to acknowledge that the individuals who comprise SAMHSA’s workforce are 

critical to achieving our goals and objectives. As an agency, we are aware that addressing 

some of our nation’s toughest challenges requires a dedicated, diverse, and highly skilled 

staff, as well as talented and engaged leadership that fosters innovation, collaboration, and 

culturally appropriate, data-driven solutions.

SAMHSA’s mission and vision recognize the role that our policies, programs, and grants 

play in providing opportunities to promote good mental health and support substance use 

disorder prevention, treatment, and recovery at all points along the continuum of care and 

lifespan. In a rapidly changing physical and social landscape, it is more important than 

ever that evidence-based practices and data-driven decision making inform our work to the 

greatest degrees possible. As we consider our great responsibility to improve the 

behavioral health of the nation, we must also keep at the forefront the essential tasks of 

building a robust and diverse workforce and supporting policies and programs that are 

equitable, accessible, adaptable, and sustainable.
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Acronyms

Term Definition

ACEs Adverse Childhood Experiences

AI/AN American Indian/Alaska Native

CCBHC Certified Community Behavioral Health Clinic

CDC Centers for Disease Control and Prevention

CIHS National Center of Excellence for Integrated Health Solutions

CMHI Children’s Mental Health Initiative

CPSTF Community Preventive Services Task Force

CSMHS Comprehensive School Mental Health Systems

DEA Drug Enforcement Administration

FCC Federal Communications Commission

FDA Food and Drug Administration

FEP First Episode Psychosis

GLS Garrett Lee Smith Suicide Prevention Program

HBCU-CFE Historically Black Colleges and Universities Center of Excellence

HHS U.S. Department of Health and Human Services

HRSA Health Resources and Services Administration

ISUDCC Interdepartmental Substance Use Disorders Coordinating 

Committee

LGB Lesbian, Gay, and Bisexual

LGBTQI+ Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex

MBC Measurement-Based Care

MFP Minority Fellowship Program

MHAT Mental Health Awareness Training

MHBG Mental Health Services Block Grant

MOUD Medication for Opioid Use Disorder

MTSS Multi-Tiered System of Supports

NSDUH National Survey on Drug Use and Health

NTTAC National Training and Technical Assistance Center for Children, 

Youth, and Family Mental Health

OPS Overdose Prevention Strategy
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Term Definition

OUD Opioid Use Disorder

PROJECT 

AWARE

Advancing Wellness and Resiliency in Education

PROJECT 

LAUNCH

Linking Actions for Unmet Needs in Children’s Health

PTTC Prevention Technology Transfer Center

SAMHSA Substance Abuse and Mental Health Services Administration

SDOH Social Determinants of Health

SED Serious Emotional Disturbance

SMI Serious Mental Illness

SPF Strategic Prevention Framework

SPRC Suicide Prevention Resource Center

STOP Act Sober Truth on Preventing Underage Drinking Act

SUD Substance Use Disorder

SUPTRS Substance Use Prevention, Treatment, and Recovery Services

TAC Technical Assistance Center

TBHA National Tribal Behavioral Health Agenda

TTC Technology Transfer Centers

VA Veterans Administration

X-Waiver DATA 2000 Waiver
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Glossary 

Term Definition

Adverse childhood 

experiences

Preventable, potentially traumatic events that occur 

in childhood (0–17 years) such as neglect, experiencing or witnessing 

violence, and having a family member attempt or die by suicide. Also 

included are aspects of a child’s environment that can undermine their 

sense of safety, stability, and bonding, such as growing up in a 

household with substance use; mental health problems; or instability 

due to parental separation or incarceration of a parent, sibling, or other 

member of the household. 

Appropriate See “Fit.” 

Behavioral health The promotion of mental health, resilience, and well-being; the 

treatment of mental health and substance use disorders; and the 

support of those who experience and/or are in recovery from these 

conditions, along with their families and communities. 

Behavioral 

healthcare setting

Treatment settings include those for specific substance use and mental 

health conditions, substance use disorder treatment centers, and

healthcare centers. 

Behavioral health 

condition See “Mental health conditions” and “Substance use disorder.” 

Behavioral health 

continuum

An integrated system of care with varying levels of service intensity and 

settings in response to an individual’s behavioral health needs.

Behavioral health 

crises 

May follow trajectories that include intense feelings of personal distress 

(e.g., anxiety, depression, anger, panic, hopelessness), obvious 

changes in functioning (e.g., neglect of personal hygiene, unusual 

behavior), or catastrophic life events (e.g., disruptions in personal 

relationships, support systems, or living arrangements; loss of 

autonomy or parental rights; victimization or natural disasters).

Behavioral health 

equity

The right to access high-quality and affordable healthcare services and 

supports for all populations, including Black, Latino, and Indigenous 

and Native American persons; Asian Americans and Pacific Islanders 

and other persons of color; members of religious minorities; Lesbian, 

Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+) persons; 

persons with disabilities; persons who live in rural areas; and persons 

otherwise adversely affected by persistent poverty or inequality. 
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Term Definition

Behavioral health 

provider

A professional who helps individuals to address mental health and 

substance use disorders. Professionals include psychologists, 

psychiatrists, nurses, peers, patient navigators, therapists, substance 

use disorder treatment and mental health counselors, recovery 

coaches, case workers, social workers, psychiatric aides and 

technicians, psychiatrists, and paraprofessionals working in psychiatric 

rehabilitation and substance use recovery fields, as well as other 

medical and non-medical professionals who manage and support 

behavioral health issues. 

Burnout An occupational condition resulting from chronic workplace stress that 

has not been successfully managed and is typically characterized by 

three dimensions: sustained feelings of exhaustion, depersonalization, 

and professional inefficacy. 

Crisis care A range of services for individuals experiencing an acute mental and/or 

substance use disorder crisis. 

Culturally and 

linguistically 

appropriate

Services that are respectful of and responsive to the health beliefs, 

practices, and needs of diverse consumers. 

Data and Evidence A guiding principle. The Substance Abuse and Mental Health Services 

Administration (SAMHSA)’s commitment to data and evidence includes 

ensuring timely, high-quality, ongoing, and specific data, which helps 

public health officials, policymakers, community practitioners, and the 

public to understand mental health and substance use trends and how 

they are evolving; informs the development and implementation of 

targeted evidence-based and evidence-informed interventions; focuses 

resources where they are needed most; and evaluates the success of 

response efforts. 

Equity A guiding principle. Behavioral health equity is the right to access highquality and affordable healthcare services and supports for all 

populations, including Black, Latino, and Indigenous and Native 

American persons; Asian Americans and Pacific Islanders and other 

persons of color; members of religious minorities; veterans and military 

service members; older adults; LGBTQI+ persons; persons with 

disabilities; persons who live in rural areas; and persons otherwise 

adversely affected by persistent poverty or inequality. 
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Term Definition

Evidence-based and 

evidence-informed 

practice(s)

Interventions that are guided by the best research evidence with 

practice-based expertise, cultural competence, and the values of the 

persons receiving the services, which promote individual-level or 

population-level outcomes. 

Family Families can be organized in a wide variety of configurations regardless 

of social or economic status. Families can include biological parents 

and their partners, adoptive parents and their partners, foster parents 

and their partners, grandparents and their partners, siblings and their 

partners, caregivers, friends, and others as defined by the family. 

Fit How well a program matches, or is appropriate for, the community, 

organization, stakeholders, and potential participants. 

Health disparities A particular type of health difference that is closely linked with social, 

economic, and/or environmental disadvantage. 

Health inequities Differences in health status or in the distribution of health resources 

among different population groups, arising from the social conditions in 

which people are born, grow, live, work, and age.

Implementation 

science 

The scientific study of the methods to promote the systematic uptake of 

clinical research findings and other evidence-based practices into 

routine practice and hence improve the quality and effectiveness of 

health care. 

Integrated care The care that results from a practice team of primary care and 

behavioral health clinicians, working together with patients and families, 

using a systematic and cost-effective approach to provide patientcentered care for a defined population. This care may address mental 

health and substance use conditions, health behaviors (including their 

contribution to chronic medical illnesses), life stressors and crises, 

stress-related physical symptoms, and ineffective patterns of 

healthcare utilization.

Lived experience Personal knowledge gained through direct, first-hand involvement.

Mental health The state of well-being in which every individual realizes their own 

potential, can cope with the normal stresses of life, can work 

productively and fruitfully, and is able to make a contribution to her or 

his community.
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Term Definition

Mental health 

conditions 

Involve changes in thinking, mood, and/or behavior. These disorders 

can make daily activities difficult and impair a person’s ability to work, 

interact with family, and fulfill other major life functions. Reaching a 

level that can be formally diagnosed often depends on a reduction in a 

person’s ability to function as a result of the disorder. 

Mental illnesses Conditions involving changes in emotion, thinking, or behavior (or a 

combination of these). Mental illnesses are associated with distress 

and/or problems functioning in social, work, or family activities.

Natural supports Personal associations and relationships typically developed in the 

community that enhance the quality and security of life for people, 

including, but not limited to, family relationships; friendships reflecting 

the diversity of the neighborhood and the community; association with 

fellow students or employees in regular classrooms and workplaces; 

and associations developed though participation in clubs, 

organizations, and other civic activities.

Paraprofessional Individuals in psychiatric rehabilitation and substance use recovery 

fields including case managers, homeless outreach specialists, or 

parent aides.

Peer Support Someone with the lived experience of recovery from a mental health 

condition, substance use disorder, or both. They provide support to 

others experiencing similar challenges. They provide non-clinical, 

strengths-based support and are “experientially credentialed” by their 

own recovery journey. 

Physical healthcare 

setting

A broad array of services and places where health care occurs, 

including acute care hospitals, urgent care centers, rehabilitation 

centers, nursing homes and other long-term care facilities, specialized 

outpatient services (e.g., hemodialysis, dentistry, podiatry, 

chemotherapy, endoscopy, and pain management clinics), and 

outpatient surgery centers.

Practitioner or 

Provider

Refers to individuals providing services. Any individual (practitioner) or 

entity (provider) engaged in the delivery of healthcare services and who 

is legally authorized to do so by the state in which the individual or 

entity delivers the services. 
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Term Definition

Public health 

approach

A focus on the health, safety, and well-being of entire populations. A 

unique aspect of the field is that it strives to provide the maximum 

benefit for the largest number of people. It is defined by multiple steps, 

including (1) define the problem, (2) identify risk and protective factors, 

(3) develop and test prevention strategies, and (4) ensure widespread 

adoption. 

Recovery A guiding principle. A process of change through which individuals 

improve their health and wellness, live self-directed lives, and strive to 

reach their full potential. Four major dimensions of recovery include (1) 

health: overcoming or managing one’s disease(s) or symptoms, and 

making informed, healthy choices that support physical and emotional 

well-being; (2) home: having a stable and safe place to live; (3) 

purpose: conducting meaningful daily activities, such as a job, school, 

volunteerism, family caretaking, or creative endeavors, and the 

independence, income, and resources to participate in society; and (4) 

community: having relationships and social networks that provide 

support, friendship, love, and hope.

Resilience An individual’s ability to cope with change and adversity. Resilience 

develops over time and gives an individual the capacity not only to 

cope with life’s challenges but also to be better prepared for the next 

stressful situation.

Service provider See “Practitioner or Provider.” 

Social determinants 

of health

Social determinants of health (SDOH) are the conditions in the 

environments where people are born, live, learn, work, play, worship, 

and age that affect a wide range of health, functioning, and quality-oflife outcomes and risks.

Stakeholders Individuals, organizations, or communities that have a direct interest in 

the process and outcomes of a project, research, or policy endeavor.

Stigma Discrimination against an identifiable group of people, a place, or a 

nation. Stigma about people with substance use disorder might include 

inaccurate or unfounded thoughts like they are dangerous, incapable of 

managing treatment, or at fault for their condition.

Substance misuse Use of illegal drugs and the inappropriate use of legal substances, such 

as alcohol and tobacco. 

Substance use Encompasses all forms and frequencies of using harmful substances.
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Term Definition

Substance use 

disorder

A health condition characterized by a cluster of cognitive, behavioral, 

and physiological symptoms that describe an individual’s compulsive 

use of a substance despite significant adverse problems associated 

with the use.

Suicidal ideation Refers to thinking about or planning suicide. The thoughts lie on a 

continuum of severity from a wish to die with no method, plan, intent, or 

behavior, to active suicidal ideation with a specific plan and intent.

Systems of care A comprehensive spectrum of effective services and supports for 

children, youth, and young adults with or at risk for mental health or 

other challenges and their families that is organized into a coordinated 

network of care, builds meaningful partnerships with families and youth, 

and is culturally and linguistically responsive in order to help them to 

thrive at home, in school, in the community, and throughout life. A 

system of care incorporates mental health promotion, prevention, early 

identification, and early intervention in addition to treatment to address 

the needs of all children, youth, and young adults.

Trauma-informed 

approaches 

A guiding principle. Trauma-informed approaches recognize and 

intentionally respond to the lasting adverse effects of experiencing 

traumatic events, defined through six key principles: (1) safety: 

participants and staff feel physically and psychologically safe; (2) peer 

support: peer support and mutual self-help as vehicles for establishing 

safety and hope, building trust, enhancing collaboration, and utilizing 

their lived experience; (3) trustworthiness and transparency: decisions 

are conducted with the goal of building and maintaining trust; (4) 

collaboration and mutuality: importance is placed on partnering and 

leveling power differences; (5) cultural, historical, and gender issues: 

culture- and gender-responsive services are offered while moving 

beyond stereotypes/biases; and (6) empowerment, voice, and choice: 

organizations foster a belief in the primacy of the people who are 

served to heal and promote recovery from trauma. 

Under-served 

communities

Population groups that experience greater obstacles to health, based 

on characteristics such as, but not limited to, race, ethnicity, religion, 

income, geography, gender identity, sexual orientation, and disability.

Upstream 

prevention

Like wellness promotion, this is also delivered prior to the onset of a 

disorder. These prevention interventions are intended to prevent or 

reduce the risks of developing a behavioral health problem, such as 

underage alcohol use and prescription drug and illicit drug misuse.

Whole-person care See “Whole-person health.” 
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Term Definition

Whole-person 

health

A person-centered, integrated approach to health care that focuses on 

health creation and well-being by incorporating patients’ goals into their 

health care.
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Publication No. PEP23-06-00-002

Released 2023
SAMHSA’s mission is to lead public health and service delivery efforts that promote mental 

health, prevent substance misuse, and provide treatments and supports to foster recovery 

while ensuring equitable access and better outcomes. 

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