Transforming

Mental Health Care

in America

·

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

www.samhsa.gov

From Exclusion 

to Belonging:

The Vision

A Life in the Community for Everyone

Dear Colleague: 

It is an honor and a pleasure to share this important document: “From Exclusion to Belonging: 

Transforming Mental Health Care in America.” Americans know all too well the human and fi nancial 

costs and burdens of mental health conditions—to individuals and families as well as to communities 

and States. Now we are thankfully and fi nally at a turning point in America—one where we have come 

to recognize and embrace three fundamental principles at the core of our vision for the Substance Abuse 

and Mental Health Services Administration (SAMHSA), “A Life in the Community for Everyone.”

The fi rst of these principles is that prevention efforts which embrace the natural resiliency of 

Americans are not only possible, but incredibly effective in reducing the incidence and severity 

of mental disorders. Second is that individuals with mental illnesses, substance use disorders, and 

co-occurring disorders can and do recover. When they take that brave step toward seeking help and 

the right services and treatment take hold, the bright promise of recovery can unfold. The third is 

that we are taking bold action on the long-neglected need to design, construct, improve, and sustain 

a humane and effi cient mental health promotion and service delivery infrastructure. The mental 

health care system is today being forever changed through the twin goals of building resiliency and 

promoting recovery and through a strong Federal commitment to partner with allies to lead the way 

toward transformation. 

The transformation of the mental health care system began with President Bush’s vision of hope 

and equality. As a presidential candidate, he pledged to “tear down” barriers to equality that 

exclude many of the 54 million Americans with mental and physical disabilities. Shortly after his 

inauguration, the President established the New Freedom Initiative to eliminate inequality for all 

Americans with disabilities. On April 29, 2002 in Albuquerque, he launched the New Freedom 

Commission on Mental Health, as an essential part of the New Freedom Initiative. Beginning with the 

full support of former Health and Human Services Secretary Tommy Thompson, and continuing 

under the leadership of Secretary Michael Leavitt, I have had both the honor and the privilege of 

working to make the President’s vision a reality through the Federal Action Agenda on Mental Health.

Today recovery from mental illnesses and co-occurring substance use disorders is no longer the 

privilege of a few exceptional people, but a possibility for all. We stand now at what the Tipping 

Point calls that “magic moment” when minds and hearts are changed, when “radical change is more 

than a possibility, it is a certainty.”

With new Federal leadership charting the course, and the vision of mental health care transformation 

lighting the way, more and more Americans with mental illnesses are stepping out of the shadows 

of hopelessness, stigma, and exclusion, and are at long last receiving the care, respect, and belonging 

which they deserve.

 Charles G. Curie, M.A., A.C.S.W. 

 Administrator, SAMHSA

 “People of all ages, 

with, or at risk for 

mental or substance 

use disorders, should 

have the opportunity 

for a fulfi lling life 

that includes a job, a 

home, and meaningful 

relationships with 

family and friends.” 

 —Charles G. Curie, 

Administrator
Through its three Centers and supporting Offi ces, SAMHSA 

engages in activities aligned with the SAMHSA Matrix of 

Priorities to carry out its mission: To build resilience and 

facilitate recovery for people with, or at risk for, substance use 

and mental disorders. Through these activities, SAMHSA 

will realize its vision of “A Life in the Community for 

Everyone.” SAMHSA’s Centers and Offi ces administer and 

fund a rich portfolio of grant programs and contracts that 

support State and community efforts to expand and enhance 

prevention programs and to improve the quality, availability, 

and range of substance abuse and mental health services—in 

local communities—where people can be served most effectively.

Driven by a strategy to improve accountability, capacity, 

and effectiveness, SAMHSA can ensure that its resources are 

not only being used effectively and effi ciently in State and 

community programs, but also that these resources are being 

invested in the best interest of the people SAMHSA serves.

2

The Substance Abuse and 

Mental Health Services Administration

Meeting the Challenge through Federal Leadership

Programs and

 Cross-Cutting Principles
The Centers and Offi ces

3

Center for Mental Health Services 

The Center for Mental Health Services (CMHS) leads 

Federal efforts in expanding the availability and accessibility 

of high-quality, community-based services for adults with 

serious mental illnesses and children with serious emotional 

disturbances. CMHS administers the Mental Health 

Services Block Grant Program—the single largest Federal 

contribution to improving mental health service systems 

across the country. CMHS also administers a portfolio 

of discretionary grant programs to prevent mental health 

problems, promote mentally healthy communities, and 

expand the use of evidence-based practices. 

Center for Substance Abuse Prevention

The Center for Substance Abuse Prevention (CSAP) 

works to improve the quality of substance abuse 

prevention practices in every community. Through its 

discretionary grant programs and 20 percent of the Substance 

Abuse Prevention and Treatment Block Grant Program, 

CSAP provides States, communities, organizations, and 

families with tools to promote protective factors and to 

reduce risk factors for substance abuse. 

Center for Substance Abuse Treatment 

The Center for Substance Abuse Treatment (CSAT) 

promotes the quality and availability of community-based 

substance abuse treatment services for individuals and 

families who need them under their discretionary grant 

programs. CSAT works with States and community-based 

groups to improve and expand existing substance abuse 

treatment services under the Substance Abuse Prevention 

and Treatment Block Grant Program. 

Offi ce of Applied Studies 

The Offi ce of Applied Studies (OAS) collects, analyzes, 

and disseminates national data on behavioral health 

practices and issues and is responsible for the annual 

National Survey on Drug Use and Health, the Drug 

Abuse Warning Network, and the Drug and Alcohol 

Services Information System, among other projects 

including the National Outcome Measures.

“HHS and its partners across the Federal

government are committed to a shared 

goal of collaborating to fundamentally 

change the way the nation’s mental 

health care system currently functions.”

—Michael Leavitt, Secretary

U.S. Department of Health and Human Services

Supporting State and Community Efforts to Address 

Mental Health and Substance Abuse Issues
4

SAMHSA’s Three Strategic Goals: 

Accountability, Capacity, and Effectiveness (ACE)

SAMHSA has streamlined its operations and 

has developed a strategy that allows it to pursue 

its mission as a one-SAMHSA in the most 

deliberate manner possible. The Strategic Plan 

is designed around three “ACE” goals:

Accountability

Capacity

Effectiveness 

The Accountability goal targets results with 

regard to programs, policies, and practices 

that SAMHSA promulgates through grants, 

contracts, and knowledge dissemination. It 

ensures that appropriate data collection is 

established for the purposes of measuring 

performance and managing agency processes. 

The Capacity goal refl ects SAMHSA’s activities 

to build the infrastructure that provides mental 

health and substance abuse services throughout 

the Nation. SAMHSA’s block and formula 

grants are key components of SAMHSA’s 

efforts to achieve its Capacity goal. 

The Effectiveness goal focuses on ensuring that 

the infrastructure that delivers mental health 

and substance abuse services promotes policies, 

programs, and practices that are evidence-based. 

SAMHSA’s science-to-services activities, 

knowledge dissemination, and orientation 

toward best practices help it achieve its 

Effectiveness goal.

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The Charge

FEDERAL

EXECUTIVE

STEERING

COMMITTEE ON

MENTAL HEALTH

TRANSFORMATION

Disaster Response Grants

HIV/AIDS Education

Homelessness Grants

Minority Fellowship Program

National Registry of Evidence-Based 

Programs & Practices

Suicide Resource Center

Technical Assistance Centers

Workforce Development Initiative

• Department of Agriculture

• Department of Defense

• Department of Education

• Department of Health and 

 Human Services

 Administration on Aging

 Administration for Children

 and Families

 Agency for Healthcare Research

 and Quality

 Assistant Secretary for Planning

 and Evaluation

 Centers for Disease Control

 and Prevention

 Centers for Medicare and 

 Medicaid Services

 Health Resources and Services

 Administration

 Indian Health Service

 National Institutes of Health

 Office for Disability

 Office for Civil Rights

 Office of Public Health and Science

 Substance Abuse and Mental

 Health Services Administration

• Department of Housing and

 Urban Development

• Department of Justice

• Department of Labor

• Department of Transportation

• Department of Veterans Affairs

• Equal Employment Opportunity

 Commission

• Social Security Administration

Track National Trends 

Establish Measurements and Reporting Systems 

Implement National Outcome Measures (NOMs) 

within State and Community Program 

Achieve Excellence in Management Practices 

Science to Services
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Capacity and Services

National Outcome 

Measures (NOMs)

Community Mental Health

Services Block Grant

National Mental Health

Information Clearinghouse

State Data Infrastructure Grants

Annual Client and Mental

Health Organizational Surveys

Children’s Mental Health Services Program

Children’s State Incentive Grants

Chronic Homelessness Initiative

Consumer Network Grants

Co-Occurring State Incentive Grants

Grants to Benefit Homeless Individuals

Jail Diversion Grants

Protection and Advocacy Program

Recovery Community Services Program (RCSP)

Assess Resources and Needs 

Support Service Expansion 

Improve Service Organization and Financing 

Recruit, Educate, and Retain Workforce 

Create Interlocking Systems of Care 

Promote Appropriate Assessment and Referral 

Assess Service Delivery Practices 

Identify and Promote Evidence-Based 

Approaches 

Implement and Evaluate Innovate Services 

Provide Workforce Training and Education 

• Advocates

• Communities

• Consumers

• Educators

• Faith-Based Groups

• Families

• Legislators

• Media

• Providers

• Researchers

• States

• Territories

• Tribes

• Youth

STAKEHOLDER

PARTNERSHIPS

National Suicide Hotline

National Child Traumatic Stress Initiative

Projects for Assistance in Transition 

from Homeless (PATH)

Older Adults Mental Health and Primary Care Grants

Mental Health Treatment Locator

Annual State Spending

Estimates Survey

Safe Schools/Healthy Students

Seclusion and Restraint State Incentive Grants

State Incentive Grants for Transformation

Statewide Family Network Grants

Suicide Prevention Grants

Medicaid and Medicare Analyses

Minority AIDS Initiative

Transforming Mental Health Care in America
6

The President’s New Freedom 

Commission on Mental Health 

The President’s New Freedom Commission on Mental Health 

was established by Executive Order 13263 on April 29, 2002. 

The transformation of the mental health care system began 

with a vision of hope and equality that emerged from a 

campaign promise by then candidate George W. Bush. 

He pledged to “tear down” barriers to equality that face 

many of the 54 million Americans with mental and 

physical disabilities.

The Commission’s work has been an essential part of the 

President’s commitment—embodied in the New Freedom 

Initiative—to eliminate inequality for Americans with 

disabilities. The Commission’s fi nal report, Achieving the 

Promise: Transforming Mental Health Care in America, the 

product of a year of study, fi nds that the Nation’s mental 

health care system is beyond simple repair. Building on 

research, expert testimony, and input from more than 2,300 

consumers, family members, service providers, and others, 

the report concludes that “traditional reform measures 

are not enough....” Instead, it recommends a wholesale 

transformation that involves consumers and providers, 

policymakers at all levels of government, and both the 

public and private sectors. 

Building Resilience, Facilitating Recovery, 

and Transforming Mental Health Care

The New Federal Leadership

 “We must work for a welcoming and 

compassionate society, a society where no American 

is dismissed and no American is forgotten. This is 

the great and hopeful story of our country and 

we can write another chapter. We must give all 

Americans who suffer from mental illness the 

treatment, and the respect, they deserve.” 

 —President George W. Bush
7

The Commission’s six key recommendations are:

Americans must understand that mental health is essential 

to overall health; that mental illnesses must be addressed 

with the same urgency as other medical problems; and that 

the stigma attached to mental illness, which discourages 

people from seeking care, must be eliminated. 

Mental health care must be consumer- and family-driven;

consumers’ needs, not bureaucratic requirements, must 

drive the services they receive; consumers and their families 

must be placed at the center of service decisions.

Disparities in mental health services must be eliminated; 

in particular, members of minority groups and people 

of rural areas have worse access to care; services must be 

designed that are culturally competent and acceptable and 

effective to people of varied backgrounds.

Early mental health screening, assessment, and referral to 

services must be common practice; too often services focus 

on living with disability, not the better outcomes associated 

with early intervention; early detection, assessment, 

and linkage with treatments can prevent mental health 

problems from compounding.

Excellent mental health care must be delivered and 

research accelerated; evidenced-based practices must be the 

bedrock of service delivery and research must be designed 

to promote recovery, and ultimately, to cure and prevent 

mental illnesses.

Technology must be used to access mental health care 

and information; the power of computer technology and 

communications must be harnessed to improve access 

to information and care, and to improve quality and 

accountability.

The Commission’s fi ndings, goals, and recommendations 

are designed to be assessed and carried forward not only 

by Federal agencies and offi ces, but also by States and 

communities, and public and private providers, nationwide. 

The Commission urged all shareholders in mental health 

to work together to make recovery from mental illness the 

expected outcome.

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To achieve this vision, the Commission presented the •

President with six goals and a series of specifi c recommendations

for Federal agencies, States, communities, and providers 

nationwide. Together, working through both the public and 

private sectors, the recommendations will transform systems 

and put limited resources to their best use.

We envision a future when everyone with 

a mental illness will recover, a future when 

mental illnesses can be prevented or cured, 

a future when mental illnesses are detected 

early, and a future when everyone with a 

mental illness at any stage of life has access 

to effective treatment and supports—

essentials for living, working, learning, and 

participating fully in the community.

—The President’s New Freedom Commission 

on Mental Health 

Achieving the Promise: 

Transforming Mental Health Care in America

Vision Statement
8

The reshaping of the Nation’s approach to mental health 

is well underway. No longer does a diagnosis of a mental 

disorder mean automatic institutionalization and exclusion 

from the community. There are four major fronts of progress 

that deserve celebration— 

First, is the new understanding of the power of resiliency 

to thwart mental illnesses. Scientifi c research in the mental 

health fi eld has led to new knowledge that is transforming 

the Nation’s approach to mental health. We know now 

that by developing assets in individuals, families, and 

communities, and by fostering relationships with caring 

adults, children can develop resiliency that acts as an 

antidote to the development of a mental disorder. This 

“strength-based” approach has gained a proven place in 

mental health care and has guaranteed a prevention-oriented 

perspective on the part of mental health researchers, 

providers, and policymakers. 

Second, is the strong Federal commitment to facilitate 

recovery from mental illnesses. Today, mental illnesses 

can be viewed as not only treatable, but recovery is the 

expectation. Recovery is cited within Transforming Mental 

Health Care in America, Federal Action Agenda: First Steps, 

as the “single most important goal” for the mental health 

service delivery system. Even those individuals with serious 

mental illness such as psychosis, who require medical 

monitoring and ongoing medication, can partake in the 

promise of recovery, if only by virtue of the compassion and 

de-stigmatization of mental illness on the part of those who 

care for them. Mental health recovery not only benefi ts 

individuals with mental health disabilities, it also enriches 

the texture of American community life, by focusing on 

their ability to live, work, learn, and fully participate in 

our society.

A third and critical stride forward is the evolution of 

Federal leadership in addressing co-occurring mental illness 

and substance abuse. Transforming systems means breaking 

down the wall between the mental health care and substance 

abuse treatment systems. Ideally, the two systems are fully 

connected so that when a person with either disorder 

initially accesses one system, the person is properly assessed 

and referred to the other as necessary and appropriate. The 

Federal Action Agenda on Mental Health underscores the 

growing consensus that all mental health and substance 

abuse service providers must be able to screen, assess, and 

provide treatment for, or refer individuals with co-occurring 

substance use and mental disorders, without regard to disease 

severity, duration, or symptomatology. Treatment must 

be seamless, comprehensive, coordinated, and involve the 

client’s family when feasible.

Fourth, the fi nal report of the President’s New Freedom 

Commission on Mental Health and the Federal Action 

Agenda have established an historic vision and goals for 

transforming the mental health system of care in America. 

These two landmark reports have generated substantial 

momentum for change. Transformative programs and 

activities are taking shape across the Nation. Transformation 

is happening. SAMHSA, and its many partners across 

government and the private sector, are making real strides 

toward realizing the vision and creating a recovery-focused 

mental health care system that can transform lives. With 

the Federal Action Agenda, the Federal partners commit 

themselves to action and accountability in pursuit of the vision.

The Challenge

Promoting An Understanding That 

Mental Health Is Part of Overall Health
The Federal Action Agenda on 

Mental Health 

Building on the work of the President’s New Freedom 

Commission on Mental Health, SAMHSA/CMHS has led 

an unprecedented partnership among Federal departments, 

agencies, and offi ces to take the initiative to formally collaborate

to transform the mental health system. 

Transforming Mental Health Care in America—The Federal 

Action Agenda: First Steps is the collaborative product of the 

U.S. Department of Health and Human Services agencies 

and offi ces, including SAMHSA, along with the Departments 

of Agriculture, Defense, Education, Housing, Justice, Labor, 

Transportation, and Veterans Affairs; the Equal Employment 

Opportunity Commission; and the Social Security Administration.

Together, these agencies and departments comprise the Federal

Executive Steering Committee on Mental Health Transformation. 

(See page 4 for a complete list of partners.)

In developing the Action Agenda, each participating Federal 

department and agency created an inventory of its current 

mental health activities. An additional list was created by each 

Federal partner outlining proposals for transforming programs 

and practices. From these inventories and lists of transforming 

activities, this fi rst Federal Action Agenda on Mental Health was 

developed. The Action Agenda is organized around the fi ve 

principles contained in the Executive Order that created the 

New Freedom Commission on Mental Health. 

Specifi cally, the President directed us to:

1. Improve the outcomes of mental health care

2. Promote collaborative, community-level models of care

3. Maximize existing resources and reduce regulatory barriers

4. Use mental health research fi ndings to infl uence 

service delivery

5. Follow the principles of Federalism, and promote 

innovation, fl exibility, and accountability at all levels 

of government.

The Action Agenda outlines 70 specifi c action steps that 

the Federal Government is committed to taking. It is not a 

quick fi x for the problems that have ailed the mental health 

care system for decades, but rather, it is a living document 

that begins to chart the course for the long-term goal of 

transforming mental health care in America. 

However, the Federal Government cannot and should not go 

it alone. Transformation is a shared responsibility. Federal 

agencies must act as leaders, partners, and as facilitators, 

promoting shared responsibility for change and for fi nding the 

common ground in areas such as public education, research, 

service system capacity, and technology development. 

States are the center of gravity for system transformation. 

Most states have already begun this critical work. State 

leadership in planning, fi nancing, service delivery, and 

evaluation of consumer and family-driven services is 

advancing the transformation agenda. 

Consumers and family members must also play a meaningful 

role. Consumers and families deserve real and meaningful 

choices about treatment options and providers. Care must 

focus on increasing an individual’s ability to cope successfully 

with life’s challenges—on building resilience and on 

facilitating recovery.

 The proud record of improvement and accomplishment 

comes as a result of the President’s leadership and vision that 

was passionately embraced by the Secretary of Health and 

Human Services, the Administrator of SAMHSA, and its 

three center Directors. Together, we will continue to make 

progress through an unwavering commitment to develop 

resilient communities and embrace the promise of recovery 

that offers a life in the community for everyone.

9
Highlights of the 

Federal Action Agenda:

10

Highlighted Action Steps to Transform the Mental Health System 

Principle A Focus on the Outcomes of Mental Health Care, Including Employment, Self-Care, Interpersonal 

Relationships, and Community Participation

Action Steps Initiate a National Public Education Campaign. 

Launch the National Action Alliance for Suicide Prevention. 

Educate the Public about Men and Depression. 

Respond to refugees’ mental health needs. 

Develop prototype individualized plans of care that promote resilience and recovery. 

Provide technical assistance on resilience and recovery. 

Promote the use of customized employment strategies. 

Promote the transition of youth with serious emotional disturbances from school to post-secondary opportunities and/or employment. 

Develop an employer initiative to increase the recruitment, employment, advancement, and retention of people with psychiatric disabilities. 

Assist youth with serious emotional disturbances involved with the juvenile justice system to transition into employment. 

Promote the employment of people with mental illnesses who are chronically homeless. 

Establish a DOL Work Group to promote quality employment of adults with serious mental illnesses and youth with serious 

emotional disturbances. 

Provide treatment and vocational rehabilitation that supports employment for people with mental disorders. 

Conduct outreach to homeless individuals with mental disorders. 

Initiate a national effort focused on meeting the mental health needs of young children as part of overall health care. 

Create a comprehensive action agenda for implementing throughout the Veterans Health Administration all relevant recommendations

of the President’s New Freedom Commission on Mental Health. 

Launch a user-friendly, consumer-oriented Web site. 

Promote ADA compliance, support and work to eliminate unnecessary institutionalization, and help eliminate discrimination. 

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Principle B Focus on Community-Level Models of Care that Coordinate Multiple Mental Health and Human 

Service Providers and Private and Public Payers

Action Steps Include issues critical to mental health in health care reform. 

Launch the Federal Executive Steering Committee on Mental Health. 

Build on and expand criminal and juvenile justice and mental health collaborations. 

Support the Interagency Autism Coordinating Committee. 

Review standards and set guidelines for culturally competent care. 

Create a National Strategic Workforce Development Plan to reduce mental health disparities. 

Initiate a project to examine cultural competence in behavioral health care education and training programs. 

Advance efforts to integrate mental health and primary care services for racial and ethnic minorities. 

Participate in HHS “Close the Gap Initiative.” 

Develop a National Rural Mental Health Plan. 

Promote strategies to appropriately serve children at risk for mental health problems in high-risk service systems. 

Develop a demonstration project for children in foster care. 

Foster joint responsibility and implementation strategies for children, youth, adults, and older adults with co-occurring disorders. 

Focus on children in the juvenile justice and child welfare settings. 

Include mental health in Community Health Center consumer assessment tools. 

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Highlighted Action Steps to Transform the Mental Health System 

Principle C Maximize Existing Resources by Increasing Cost Effectiveness and Reducing Unnecessary and 

Burdensome Regulatory Barriers

Action Steps Educate employers and benefi ts managers on the practicability of paying for mental health care. 

Evaluate and report the impact of mental health parity. 

Initiate Medicaid Demonstration Projects. 

Convene Directors of State Mental Health, State Medicaid, and Regional Medicare Programs. 

Help parents avoid relinquishing custody and obtain mental health services for their children. 

Support the Ticket to Work Program. 

Address reimbursement in primary care. 

Develop a strategy to implement innovative technology in the mental health fi eld. 

Explore creation of a Capital Investment Fund for Technology.

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Principle D Use Mental Health Research Findings to Infl uence the Delivery of Services

Action Steps Accelerate research to reduce the burden of mental illnesses. 

Foster a research partnership. 

Expand the “Science-to-Services” agenda. 

Conduct research to understand co-occurring disorders. 

Harness research to improve care. 

Support research to develop new medications. 

Expand the National Registry of Evidence-based Programs and Practices to include mental health. 

Develop new toolkits on specifi c evidence-based mental health practices. 

Develop the knowledge base in understudied areas. 

Conduct research to reduce mental health disparities. 

Review the literature and develop new studies on mental illness/general health. 

Conduct mental health services research in diverse populations and settings. 

Test new treatments for co-occurring disorders in community settings. 

Disseminate fi ndings of the Juvenile Justice and Mental Health Project. 

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Principle E Ensure Innovation, Flexibility, and Accountability at All Levels of Government and Respect the 

Constitutional Role of the States and Indian Tribes

Action Steps Award State Mental Health Transformation Grants. 

Provide technical assistance to help develop comprehensive State Mental Health Plans. 

Award Child and Adolescent State Infrastructure Grants. 

Track State mental health system transformation activities. 

Establish a foundation for the Samaritan Initiative. 

Establish the Re-Entry Initiative for ex-prisoners with psychiatric disabilities. 

Award Seclusion and Restraint State Incentive Grants. 

Develop statewide systems of care for children with mental disorders. 

Provide technical assistance to States on systems of care for children with serious emotional disturbances and their 

parents and other family members. 

Convene State leadership to develop statewide plans to serve children with serious emotional disturbances. 

Expand the Partnerships for Youth Transition Grant Program. 

Provide technical assistance on Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). 

Facilitate linkages between DOL/SSA’s joint Disability Program Navigator Initiative, SAMHSA, and related State and 

local mental health systems. 

Disseminate information on mental health issues through DOL grant and program initiatives. 

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12

Components of Recovery

Individualized

and

Person-Centered

Self-Direction

Hope

Responsibility

E

m

p

o

w

e

mr e

nt

R

esp

ect

Peer Support

Strengths-Based Non-Linear

Holistic

Components

of Recovery

Recovery is cited, within Transforming Mental Health Care 

in America, Federal Action Agenda: First Steps, as the “single 

most important goal” for the mental health service delivery 

system. We know that many children, adults, and older 

adults can and do recover from mental illnesses. For those 

individuals who cannot reach the full alleviation of the 

signs and symptoms of mental illness, recovery can entail 

the process they go through to achieve their highest level of 

functioning and community participation.

To clearly defi ne recovery, SAMHSA, within the 

U.S. Department of Health and Human Services, and 

the Interagency Committee on Disability Research in 

partnership with six other Federal agencies convened the 

National Consensus Conference on Mental Health 

Recovery and Mental Health Systems Transformation 

on December 16-17, 2004.

More than 110 expert panelists participated, including 

mental health consumers, family members, providers, 

advocates, researchers, academicians, managed care 

representatives, accreditation organization representatives, 

State and local public offi cials, and others. A series of 

technical papers and reports were commissioned that 

examined topics such as recovery across the lifespan, 

defi nitions of recovery, recovery in cultural contexts, the 

intersection of mental health and addictions recovery, and 

the application of recovery at individual, family, community, 

provider, organizational, and systems levels. 

Mental health 

recovery is a journey 

of healing and 

transformation 

enabling a person 

with a mental health 

problem to live a 

meaningful life in a 

community of his or 

her choice, while 

striving to achieve his 

or her full potential.
13

National Consensus Statement on Mental Health Recovery

The 10 Fundamental Components of Recovery

Self-Direction: Consumers lead, control, exercise choice over, 

and determine their own path of recovery by optimizing 

autonomy, independence, and control of resources to achieve 

a self-determined life. By defi nition, the recovery process 

must be self-directed by the individual, who defi nes his or her 

own life goals and designs a unique path toward those goals.

Individualized and Person-Centered: There are multiple 

pathways to recovery based on an individual’s unique 

strengths and resiliencies as well as his or her needs, 

preferences, experiences (including past trauma), and cultural 

background in all of its diverse representations. Individuals 

also identify recovery as being an ongoing journey and 

an end result as well as an overall paradigm for achieving 

wellness and optimal mental health.

Empowerment: Consumers have the authority to choose 

from a range of options and to participate in all decisions—

including the allocation of resources—that will affect their 

lives, and are educated and supported in so doing. They have 

the ability to join with other consumers to collectively and 

effectively speak for themselves about their needs, wants, 

desires, and aspirations. Through empowerment, an individual

gains control of his or her own destiny and infl uences the 

organizational and societal structures in his or her life.

Holistic: Recovery encompasses an individual’s whole life, 

including mind, body, spirit, and community. Recovery 

embraces all aspects of life, including housing, employment, 

education, mental health and health care treatment and 

services, complementary and naturalistic services, addictions 

treatment, spirituality, creativity, social networks, community 

participation, and family supports as determined by 

the person. Families, providers, organizations, systems, 

communities, and society play crucial roles in creating and 

maintaining meaningful opportunities for consumer access to 

these supports.

Non-Linear: Recovery is not a step-by-step process but one 

based on continual growth, occasional setbacks, and learning 

from experience. Recovery begins with an initial stage of 

awareness in which a person recognizes that positive change 

is possible. This awareness enables the consumer to move on 

to fully engage in the work of recovery.

Strengths-Based: Recovery focuses on valuing and building 

on the multiple capacities, resiliencies, talents, coping 

abilities, and inherent worth of individuals. By building on 

these strengths, consumers leave stymied life roles behind 

and engage in new life roles (e.g., partner, caregiver, friend, 

student, employee). The process of recovery moves forward 

through interaction with others in supportive, trust-based 

relationships. 

Peer Support: Mutual support—including the sharing of 

experiential knowledge and skills and social learning—plays 

an invaluable role in recovery. Consumers encourage and 

engage other consumers in recovery and provide each other 

with a sense of belonging, supportive relationships, valued 

roles, and community.

Respect: Community, systems, and societal acceptance and 

appreciation of consumers—including protecting their rights 

and eliminating discrimination and stigma—are crucial in 

achieving recovery. Self-acceptance and regaining belief in 

one’s self are particularly vital. Respect ensures the inclusion 

and full participation of consumers in all aspects of their lives.

Responsibility: Consumers have a personal responsibility 

for their own self-care and journeys of recovery. Taking steps 

toward their goals may require great courage. Consumers 

must strive to understand and give meaning to their 

experiences and identify coping strategies and healing 

processes to promote their own wellness. 

Hope: Recovery provides the essential and motivating 

message of a better future—that people can and do overcome 

the barriers and obstacles that confront them. Hope is 

internalized, but can be fostered by peers, families, friends, 

providers, and others. Hope is the catalyst of the recovery 

process. Mental health recovery not only benefi ts individuals 

with mental health disabilities by focusing on their abilities 

to live, work, learn, and fully participate in our society, 

but also enriches the texture of American community life. 

America reaps the benefi ts of the contributions individuals 

with mental disabilities can make, ultimately becoming a 

stronger and healthier Nation.
In addition to its leadership role, the programs described 

in the following pages illustrate SAMHSA’s ongoing 

contributions to achieve the steps to transformation 

highlighted in the Federal Action Agenda on Mental Health.

Reducing Stigma and Discrimination

Many Americans view mental illness through a lens of stigma 

and discrimination. This limited perspective lies at the 

center of why thousands of individuals across the Nation fail 

to access the mental health services that are available. Year 

after year, adults and children continue to suffer in silence 

from depression and other debilitating mental conditions. 

Where most of us would not hesitate to seek treatment 

for a physical illness, many of us remain paralyzed when it 

comes to seeking support for a mental health problem. A 

broad spectrum of CMHS programs, including a National 

Anti-Stigma Campaign, has been designed to establish a 

“new norm” in which individuals, without hesitation, seek 

out the mental health services they need and deserve. The 

Elimination of Barriers Initiative is paving the way in eight 

States—California, Florida, Massachusetts, North Carolina, 

Ohio, Pennsylvania, Texas, and Wisconsin—with pilot efforts 

to reduce stigma, including strategic marketing plans and 

trained teams of public speakers. Training teleconferences, a 

Web site, and other technical assistance is available through 

the CMHS Resource Center to Address Discrimination and 

Stigma. Additionally, CMHS is in the process of developing 

a national anti-stigma campaign in partnership with the 

Ad Council designed to increase caring and compassion for 

individuals with mental illnesses. 

Preventing Suicide

Transformation of mental health service systems includes 

taking a public health approach to preventing suicide. 

Building resilience to face life’s challenges is central to 

this approach. As part of the National Strategy for Suicide 

Prevention and to promote the idea that suicide prevention is 

a shared responsibility on all levels—Federal, State, community,

and individual—CMHS is collaborating with several Federal 

agencies to build a public-private partnership called the 

National Action Alliance for Suicide Prevention. 

Programs of Transformation

Changing Forever Mental Health Care in America

Recently, the WB Television Network contacted 

SAMHSA’s National Suicide Prevention Lifeline 

(Lifeline) about an episode of One Tree Hill, a 

prime time television show set to air depicting an 

adolescent who held his school hostage before killing 

himself. In the spirit of responsible programming, 

WB also produced a Public Service Announcement 

(PSA) with Lifeline’s toll-free number. The PSA, which 

aired immediately after the One Tree Hill episode, 

generated more than 750 calls to Lifeline within 

5 minutes of its airing. One of the calls was from a 

Colorado high school sophomore with a history of 

suicide attempts. The distressed student disclosed that 

he was planning an assault on his school. Through 

Lifeline’s coordinated efforts, a school crisis counselor 

facilitated an emergency intervention and escorted 

the young man to a hospital for evaluation. The young 

man is currently receiving mental health treatment.

Offering a lifeline to 

prevent suicide

14

Principle A 

Focus on the Outcomes of Mental Health Care, 

Including Employment, Self-Care, Interpersonal 

Relationships, and Community Participation
15

The Garrett Lee Smith Memorial Act, a congressional action 

authorizing support to States, tribes, colleges, and universities 

to develop youth suicide prevention and intervention 

programs has also emboldened CMHS’s ongoing suicide 

prevention activities. SAMHSA’s National Suicide Prevention 

Lifeline provides immediate assistance to individuals in suicidal 

crisis by connecting them to the nearest available suicide 

prevention and mental health service provider through a 

toll-free telephone number: 1-800-273-TALK (8255). It 

is the only national suicide prevention and intervention 

telephone resource funded by the Federal Government. 

The National Suicide Prevention Hotline Network connects 

certifi ed crisis centers to this single nationwide toll-free 

telephone number. The Suicide Prevention Resource Center is 

facilitating the development of suicide prevention plans in 

all 50 States, as well as disseminating articles, research, and 

other suicide prevention resources. CMHS is also funding the 

development of school-based suicide prevention guidelines 

for use nationwide. To support the American Indian/Alaskan 

Native community, the SAMHSA-funded One Sky Center is 

providing suicide prevention consultation and an interagency

agreement with the Indian Heath Service is helping to 

develop a culturally competent community suicide prevention 

toolkit. The transformation of the mental health care system 

is happening every day as States and communities use their 

Federal grants to implement programs that embody the best 

evidenced-based suicide prevention practices.

Promoting Self-Directed Mental Health Care

Involving consumers in planning, evaluating, and providing 

services is central to creating a transformed mental health 

care system that focuses on recovery. Consumer participation 

is ongoing at CMHS through the Consumer-Operated Services 

Program, which provides support through seven consumer/

peer-operated programs as well as a coordinating center to 

evaluate effectiveness at improving outcomes and quality of 

life for people with mental illnesses. 

Programs of Transformation

Consumers are also providing services to peers with the 

support of fi ve national technical assistance centers and a 

manual for States on implementing peer-support services. 

Finally, self-direction impacts nearly every aspect of the 

mental health care delivery system, including planning, 

fi nancing, workforce training, provider networks, and 

oversight and quality improvement.

Disseminating Knowledge to the Public: 

The National Mental Health Information 

Center 

SAMHSA’s National Mental Health Information Center 

(NMHIC) is a one-stop, national clearinghouse for free 

information about mental health, including publications, 

references, and referrals to local and national resources 

and organizations.

The Information Center was developed for users of mental 

health services and their families, the general public, policy 

makers, providers, and the media. Staff members are skilled 

at listening and responding to questions from the public 

and professionals. The staff quickly directs callers to Federal, 

State, and local organizations dedicated to treating and 

preventing mental illness. The Information Center also has 

information on Federal grants, conferences, and other events. 

For more information, visit www.mentalhealth.samhsa.gov/ 

or call 1-800-789-2647 (English and Español) or 

1-866-889-2647.
16

Programs of Transformation

Principle B 

Focus on Community-Level Models of Care that 

Coordinate Multiple Mental Health and Human 

Service Providers and Private and Public Payers

Focusing on Children, Youth, and Families 

The CMHS Systems of Care grants are based on the premise 

that the mental health care needs of children, adolescents, and 

their families can best be met within their home, school, and 

community environments. CMHS continues to fund Systems 

of Care grants and other activities to develop coordinated 

and integrated systems of care in counties across the Nation, 

including the Systems of Care Research Conference and a series 

of State policy academies to help States design and implement 

new child mental health policies.The Caring for Every Child’s 

Mental Health campaign is also providing information and 

technical assistance to system of care communities. For those 

youth who have serious emotional disturbances, CMHS 

provides support through Partnerships for Youth in Transition, 

a series of cooperative agreements to States, to help youths 

ages 14-25 who so often need individualized treatment plans 

as they transition to adulthood. 

Elevating Prevention Approaches

Armed with the knowledge gained from research and motivated

by the need to prevent senseless death and disability caused 

by suicide, violence, or mental health problems, mental 

health researchers and policymakers are bringing prevention 

to the forefront of their approach to public health. The 

Federal Action Agenda on Mental Health recognizes that a 

comprehensive system of mental health care requires both 

treatment and prevention. CMHS embraces the National 

Institute of Mental Health defi nition as not just prevention 

of the onset of a disorder, but also the prevention of comorbidity, relapse, and disability. Some examples of how 

CMHS is promoting prevention-based activities are the 

Youth Violence Prevention grants, the CMHS Anti-bullying 

Campaign, and targeted capacity expansion Prevention and 

Early Intervention grants.

The Safe Schools/Healthy Students (SS/HS) Initiative is an 

unprecedented collaborative grant program supported by 

three Federal agencies—the U.S. Departments of Health and 

Human Services, Education, and Justice. 

People who recover from mental illness often act as vectors for leading others into appropriate mental health 

services. Many of these ”helping hands” are young people. During this past year, the CMHS-funded National 

Youth Development Board (NYDB), composed of 15 young people across the United States who themselves 

are consumers of mental health services, has emerged as a national youth leadership force. The NYBD has 

provided leadership trainings, created youth-guided principles and policies, and developed training tools, 

guides, and other documents. Most recently, the NYDB changed its name to Youth Move (Youth Motivating 

Others through Voices of Experience) and is seeking to establish its own national organization. More 

information about this Board and their activities can be found at: www.systemsofcare.samhsa.gov.

Promoting peer-driven recovery among youth
17

Programs of Transformation

The grant program is designed to develop real-world 

knowledge about what works best to promote safe and 

healthy environments in which America’s children can 

learn and develop. This issue is critical to effective system 

transformation. A SAMHSA study confi rms that one-fi fth 

of elementary, middle, and high school students receive 

some type of school-supported mental health services during 

the school year. School districts are using these funds to 

help communities design and implement comprehensive 

educational, mental health, social service, law enforcement, 

and juvenile justice services in an effort to strengthen healthy 

child development. 

Serving Older Adults

Many older adults who need treatment do not receive it 

because of their own and others’ ingrained attitudes about 

mental illnesses. Yet by 2030, the population of Americans 

over 65 is expected to double. Late-life depression is just 

one reason that the Federal Action Agenda on Mental Health

addresses mental health needs across a life span. Nine 

CMHS-funded Targeted Capacity Expansion Grants are 

implementing evidenced-based programs and responding 

to the needs of older adults. CMHS’s Positive Aging Resource 

Center (PARC) is assisting the sites in selecting screening 

instruments and models of care that are effective for older 

adults. CMHS’s PRISM-E, the acronym for Primary Care 

Research in Substance Abuse and Mental Health Services for the 

Elderly, is a multi-site study, which concluded that integrated 

primary care settings were preferable to enhanced referral 

care for older adults with severe psychiatric disturbances and 

substance abuse problems. In addition, several State teams 

to promote healthy aging are working on State-specifi c 

plans to enhance community care systems for older adults. 

Finally, SAMHSA and the Administration on Aging (AoA) 

are working collaboratively to support States in their efforts 

to improve access, coordination, and integration among 

health and social support services and to shift resources from 

institutions to home- and community-based long-term 

care options.

HILLSBORO, Oregon—Aggressive and defi ant, with 

poor social skills, preschooler Bill S. was clearly at 

risk for severe diffi culties. His “First Step” Coach 

at Washington County’s “Enhanced First Step to 

Success,” a local effort funded under the Federal Safe 

Schools/Healthy Students program, worked with both 

his Kindergarten teacher and his parents, who were 

both recovering from addiction; his mother was also 

suffering from depression. The Coach helped Bill’s 

mother to re-enter mental health treatment and to 

complete the HomeBase parent training program. 

Eventually Bill’s mother returned to school and work 

and Bill joined a sports team. After careful fi rst grade 

placement and support from both his mother and 

father, Bill has built a record of success in school 

and at home.

Fostering student success 

in school and at home
18

Programs of Transformation

Reducing the Effects of Trauma and Disaster

New research is revealing that traumatic experiences—

physical abuse, sexual abuse, severe neglect, loss, or the 

witnessing of violence or disaster—can affect anyone at 

any time, and that the effects of trauma are not always 

recognized. One effect can be posttraumatic stress disorder or 

PTSD. Other effects can include anxiety and depression. We 

are just beginning to understand the full effects of terrorist 

activities, natural disasters, and an array of other violent 

“assaults” on million of adults and children. 

In response to national disasters, SAMHSA works closely with 

the Federal Emergency Management Agency to administer its 

crisis counseling program. SAMHSA also funds the Disaster 

Technical Assistance Center (DTAC), which helps prepare 

States, Territories, and local entities to deliver an effective 

behavioral health response during disasters. 

CMHS funds the National Center for Post Traumatic Stress 

Disorder to develop disaster mental health intervention models,

evaluation methods, and data collection tools to build effective

evidenced-based mental health disaster response capabilities. 

CMHS also works with the National Child Traumatic Stress 

Network (NCTSN) to raise the standard of care and improve 

access to services for traumatized children, adolescents, and 

their families. The Network consists of three components: a 

National Coordinating Center, Intervention Development and 

Evaluation Centers, and Community Treatment Service Centers in 

the majority of States and the District of Columbia.

Every month, thousands of victims of trauma, all children 

and adolescents, are treated within the NCTSN with the 

most up-to-date methods and the latest scientifi c knowledge. 

Reinventing the Workforce

The Federal Action Agenda on Mental Health warned of a 

national crisis in the mental health care workforce, not just 

because of a shortage of professionals, but also because of 

a lack of diversity, cultural competence, skills essential to 

practice in contemporary health systems, and knowledge of 

evidence-based and emerging best practices. 

CMHS is currently coordinating SAMHSA’s national 

behavioral health workforce development strategy. Through 

a public-private partnership with the Annapolis Coalition 

on Behavioral Health Workforce Education, SAMHSA is 

working to build new competencies among providers and 

educators, among health care organizations and academic 

institutions, and among Federal and State agencies, 

accrediting bodies, health care insurers, and professional 

organizations. 

Through Workforce Training Grants to Reduce Racial and 

Ethnic Disparities in Mental Health Services, CMHS is also 

identifying effective training models to improve the capacity 

of the mental health care workforce to engage, treat, and support

racial and ethnic minority persons with mental illnesses. 
19

Programs of Transformation

Principle C 

Maximize Existing Resources by Increasing Cost 

Effectiveness and Reducing Unnecessary and 

Burdensome Regulatory Barriers

Leveraging Resources: The Community 

Mental Health Services Block Grant

The Community Mental Health Services Block Grant is the 

single largest Federal contribution dedicated to improving 

mental health service systems across the country. Based on a 

congressionally mandated formula, CMHS awards grants to 

States, Territories, and the District of Columbia to provide 

mental health services to adults with serious mental illnesses 

and to children with serious emotional disturbances. CMHS 

works in close collaboration with each State to develop and 

implement its own State Mental Health Plan for improving 

community-based services and reducing reliance on 

hospitalization. The program stipulates that case management 

be provided to individuals with the most serious mental 

disorders and encourages appropriate partnerships among 

a wide range of health, dental, mental health, vocational, 

housing, and educational services. The program also promotes 

partnerships among Federal, State, and local government 

agencies. SAMHSA continues to work toward linking Block 

Grant resources with transformation activities.

Working to End Homelessness

Approximately 200,000 individuals annually are chronically 

homeless. Research shows that integrated mental health 

services, substance abuse services, and supportive housing 

work together to end chronic homelessness. CMHS has a 

rich history of efforts to reduce homelessness, most recently 

through a Federal partnership between the U.S Departments 

of Health and Human Services, Housing and Urban 

Development (HUD), and Veterans Affairs (VA). 

Contrary to the widely held notion that chronically 

homeless individuals are beyond help and destined 

to never-ending dependency, SAMHSA’s collaboration 

with HRSA, HUD, VA, and the Interagency Council 

on Homelessness is setting the record straight. The 

3-year, $55 million joint initiative to help end chronic 

homelessness is effectively linking and coordinating 

mental health and substance abuse services, primary 

health care, permanent housing, and veterans 

services. A designated planning and operations 

“lead” agency also networks with other community 

service agencies as needed. The stunning results 

from the 11 communities participating in the groundbreaking SAMHSA initiative are forever changing the 

face of homelessness: Of the 493 persons served 

during one year, 456 (92%) were in their own 

housing, 71 (14%) were in salaried jobs, and 383 

(78%) were receiving appropriate services.

Assisting individuals on the journey

from chronic homelessness to 

housing and recovery
20

Programs of Transformation

The Collaborative Initiative to Help End Chronic 

Homelessness funded projects in 11 communities to develop 

comprehensive systems of services linked to permanent 

housing. Individuals participating in one of these programs 

can enter the system through any door to gain access to all 

the services they require, whether it’s primary health care, 

mental health care, substance abuse treatment, housing, or 

veterans services. Even more recently, CMHS, under the 

Projects for Assistance in Transition from Homelessness (PATH), 

a formula grant program to States, conducted site visits, 

provided technical assistance, initiated a PATH outcome and 

evaluation study, and held panels to explore ways to ensure 

cultural competencies in homeless service systems. 

Finally, SAMHSA’s second national training conference, 

HOPE: The Key to Ending Homelessness for People with Mental 

Illnesses and/or Substance Abuse Disorders, brought together 

participants and faculty from across the country to focus 

on evidenced-based and promising practices for providing 

support to homeless individuals. 

Principle D 

Use Mental Health Research Findings to Infl uence 

the Delivery of Services

Moving Science to Services: Evidence-Based 

Practices

SAMHSA’s Science-to-Services Agenda was born from 

SAMHSA’s ongoing commitment to build on the effectiveness 

of programs, practices, and policies delivered in communities, 

and to reduce the time lag between the development of 

scientifi c interventions and their application in service settings.

Evidenced-based practices are practices that have been proven 

by research to be effective. They are vital to the mental 

health and substance abuse professions in an age of increased 

accountability and tightened budgets. 

CMHS is funding three aspects of a National EvidencedBased Practices (EPB) Project, a public-private partnership 

focused on developing the capacity for evidenced-based 

practices within the public mental health system. The three 

aspects of the project are a series of comprehensive EPB 

implementation resource tool kits, a national demonstration 

project, and a National Center for Evidenced-Based Practices. 

Numerous Evidence-Based Practice grants are also in place to 

initiate state-of-the-art training and continuing education for 

State mental health care providers and other stakeholders. 

Through its partnership with the National Institutes of 

Health—including the National Institute on Mental Health, 

the National Institute on Drug Abuse, and the National 

Institute on Alcohol Abuse and Alcoholism—SAMHSA 

developed and implemented the National Registry of 

Evidence-Based Programs and Practices (NREPP). NREPP is 

a comprehensive system to screen, select, and disseminate 

evidence-based prevention and treatment programs, policies, 

and practices.

Treating People with Co-occurring Mental 

and Substance Use Disorders

According to SAMHSA’s 2004 National Survey on Drug Use 

and Health, an estimated 4.6 million people experienced 

co-occurring mental and substance use disorders during the 

year. Nearly half of the adults with co-occurring disorders 

received no treatment for either problem, and only 6 percent 

received treatment for both. The resulting human and 

societal costs are high. People with co-occurring disorders 

are at greater risk for HIV/AIDS, homelessness, contact with 

the criminal justice system, violence, and suicide. To better 

serve individuals in need, States and communities must 

strengthen their systems to address both substance abuse and 

mental health disorders.
21

In a landmark 2002 Report to Congress, SAMHSA recognized

that people with co-occurring disorders are the expectation, 

not the exception, in substance abuse and mental health 

treatment systems. In this report, SAMHSA outlined its 

commitment to ensure that States and communities have 

the incentives, technical assistance, and training they need 

to effectively serve people with co-occurring disorders. To 

this end, SAMHSA has awarded Co-occurring State Incentive 

Grants to help States develop or enhance their infrastructure 

to provide accessible, comprehensive, and evidence-based 

treatment services to people with co-occurring substance 

use and mental disorders. SAMHSA has also established the 

National Co-occurring Center for Excellence, published a new 

Co-occurring Treatment Improvement Protocol (TIP 42), and 

held policy academies to encourage the development of State 

action plans. 

Co-occurring Center for Excellence

SAMHSA created the Co-occurring Center for Excellence 

(COCE) as a vital link between the agency and States, 

communities, and providers. COCE provides the technical, 

informational, and training resources needed for the 

dissemination of knowledge and the adoption of evidencebased practices in systems and programs that serve persons 

with co-occurring disorders.

COCE’s mission is to:

 Receive, generate, and transmit advances in substance 

abuse and mental health treatment that address mental 

health and substance use disorders at all levels of severity 

that can be adapted to the unique needs of each client

 Guide enhancements in the infrastructure and clinical 

capacities of the mental health and substance abuse 

service systems 

 Foster the infusion and adoption of evidence- and 

consensus-based treatment and program innovation into 

clinical and organizational practice.

•

•

•

Partnering with the Criminal Justice 

Community

SAMHSA shares common goals with the criminal justice 

community and is committed to improving both public 

health and public safety. To address the inescapable link 

between mental illness, substance abuse, and crime, 

SAMHSA is focused on leveraging partnerships and building 

infrastructure. SAMHSA had developed a Criminal Justice 

and Juvenile Justice Framework that focuses squarely on 

the needs of consumers who are involved or are at risk of 

becoming involved in the criminal and juvenile justice 

systems. Through the Framework, SAMHSA is determined 

to develop effective reentry efforts, reduce recidivism, and 

increase the coordination of treatment between providers in 

prisons and in communities. In addition to its collaborations 

with the Department of Justice, SAMHSA continues to 

strengthen partnerships with criminal justice organizations 

such as the Association of State Corrections Administrators, 

the American Correctional Association, and the National 

District Attorney’s Association. 

CMHS also supports a jail diversion grant program to develop 

model diversion programs in more than two dozen sites 

across the country. Preliminary results from a SAMHSA study 

of nonviolent offenders indicate reduced rates of re-arrest, 

decreased incidence of psychiatric symptoms and substance 

abuse, and increased quality of life among people who are 

diverted from the justice system. SAMHSA also supports 

Family, Juvenile, and Adult Treatment Drug Courts, as well as 

the Youth Offender Reentry Program, which funds community

partnerships that plan, develop, and provide services in the 

community to promote recovery, and prevent recidivism.

Programs of Transformation
Principle E 

Ensure Innovation, Flexibility, and Accountability 

at All Levels of Government and Respect the 

Constitutional Role of the States and Indian Tribes

Transforming State Systems

SAMHSA is working with States to develop comprehensive 

statewide mental health plans by releasing an unprecedented 

grant program known as the Mental Health Transformation 

State Incentive Grants Program. Eligible to States and Tribes, 

these grants are made to Governors’ offi ces and are fi nancing 

the costs of planning and infrastructure development needed 

to achieve systems improvements across programs, agencies, 

and departments. 

The goal of these grants is to achieve a fundamental shift in 

how we view and provide mental health care. This shift will 

require changes of great magnitude to policies and programs, 

to planning and partnerships, and to the traditional 

boundaries and beliefs maintained by different stakeholders. 

Consequently, the State transformation grants focus on 

broad-based systemic change—what a grantee must do to 

unite multiple systems behind a single vision of a consumerdriven, recovery-oriented system. 

The expected payoffs will be better cross-agency 

coordination, more effective blending and use of available 

resources, and incredible improvements in the infrastructure 

for delivering services to adults and children in need. 

Offering these grants reinforces that transformation 

can occur only through collaboration and an ongoing 

commitment to change by all the systems that deliver, 

fund, or administer services and supports used or needed 

by individuals with a mental illness and their families. This 

is what is meant by transformation: profound change that 

occurs at the very core of the larger mental health system and 

other relevant systems and not through piecemeal reform 

around the margins. 

Eliminating Seclusion and Restraint 

For many years, coercion, seclusion, and restraint have 

been used in a wide range of psychiatric settings. Recently, 

CMHS has published materials to educate mental health 

care providers about the need to obviate these practices 

and to recognize their use for what it is: treatment systems 

failures when not involving issues of safety. Furthermore, 

State Incentive Grants to Build Capacity for Alternatives to 

Restraint and Seclusion are enhancing State efforts to adopt 

best practices to reduce and ultimate eliminate their use in 

institutional and community-based settings that provide 

mental health service. These grants are collecting data to 

document systems and services changes in the specifi c grantee 

States including Hawaii, Massachusetts, Illinois, Kentucky, 

Louisiana, Maryland, Missouri, and Washington. 

Enhancing Protection and Advocacy

In 1986, Congress passed the Protection and Advocacy for 

Individuals with Mental Illness (PAIMI), currently serving 

nearly 22,000 individuals. CMHS funds and oversees 

PAIMI, which is administered through State Protection and 

Advocacy (P&A) systems. P&A’s advocate for individuals with 

mental illnesses who reside in public or private facilities or 

in the community who may be abused, neglected, or whose 

rights are violated. State P&A systems carryout investigations 

and class litigation, and respond to thousands of requests 

for information and referrals. They are empowered to 

use legal, legislative, systemic, and other remedies for 

correcting violations. P&A’s monitor and act upon reported 

allegations of inappropriate use of seclusion and restraint, 

thus supporting the goal of the New Freedom Commission on 

Mental Health to protect and enhance the rights of people 

with mental illnesses.

Programs of Transformation

22
Making It Count

Ensuring Accountability Through 

 Data-Driven Decisionmaking

Mental Health Data and Analysis

With the ultimate goal of improving the quality of mental 

health programs and services delivery, CMHS collects, 

analyzes, and reports national statistical information on 

mental health services and the people served. These activities 

include primary and secondary data collection and analysis, 

cost estimation, services evaluation, 

and policy assessment. CMHS 

data collection activities date back 

to 1840, and represent one of the 

longest continuous data collections 

in American public health. Program 

activities include the following: 

 Surveys of the organization and 

fi nancing of all specialty mental 

health organizations in the 

United States; 

 Special surveys and analyses of 

mental health services provided 

outside of specialty mental health 

settings, such as in schools, prisons 

and jails, juvenile justice settings, 

nursing homes, and mental health 

self-help activities; 

 Client sample surveys of persons served by specialty mental 

health organizations; 

 Development of benchmark information on mental health 

spending by both public and private payors; 

 Analyses of Medicaid data to highlight trends and 

characteristics of public fi nancing of mental health 

services; and 

 Development of standards that make national mental 

health data collection uniform and comparable. 

•

•

•

•

•

•

CMHS data are recognized as the authoritative source 

of information on mental health organizations and their 

staff, fi nances, and clients. The results of data and analysis 

activities are showcased in a widely disseminated biennial 

publication on major mental health policy and statistical 

issues, Mental Health, United States, in peer-reviewed 

journals, and government reports and monographs. In 

addition, two widely used Web-based tools are available: a 

comprehensive electronic services locater, and a searchable 

database of behavioral health headlines from newspapers 

and periodicals for all 50 States—these tools can be found 

on SAMHSA’s National Mental Health Information Center 

Web site at http://www.mentalhealth.samhsa.gov/.

It’s no longer 

enough to show 

evidence of a need; 

we must be able 

to demonstrate 

results in order 

to assure funding 

for the services 

that we know 

work. That’s public 

accountability.

23
24

The SAMHSA Annual National Survey

The National Survey on Drug Use and Health (NSDUH) is 

the Nation’s most comprehensive source of substance abuse 

and mental health related data. NSDUH is a SAMHSAsponsored annual survey of the U.S. population ages 12 and 

older, excluding persons residing in institutions. The Survey 

presents national and State-level estimates on rates of use, 

numbers of users, and other measures related to illegal drugs, 

alcohol, tobacco, as well as measures related to mental health 

problems, including co-occurrence of substance use and 

mental health problems, and new data on depression among 

youth and adults.

Because it is an annual survey, NSDUH reveals important 

trends in substance use and mental health that can be used to 

plan effective evidence-based treatment and services and to 

judge the success of current activities. Mental health focused 

data show that in 2004—

 There were 35.1 million (14.7 percent) persons aged 12 

or older who had at least one major depressive episode in 

their lifetime. 

 There were 21.4 million adults aged 18 or older with serious

psychological distress, representing 9.9 percent of all adults,

a rate that increased from 2002 when it was 8.3 percent.

There were 5.7 million youths aged 12 to 17 (22.5 percent)

who received treatment or counseling for emotional or 

behavior problems in the year proceding to the interview; 

a rate higher than the estimates for 2002 (19.3 percent) 

and 2003 (20.6 percent). 

Unfortunately, the survey also indicated that those who need 

mental health care do not receive it. Less than half of all 

Americans with serious mental illnesses seek treatment. 

SAMHSA is committed to supporting both mental health 

prevention and treatment programming that builds resiliency 

and promotes recovery. Of paramount importance is the 

need to expand the capacity of treatment systems to meet the 

needs of youth and adults with mental illnesses and substance 

use disorders. 

•

•

•
 

National Outcome Measures (NOMs)

In alignment with SAMHSA’s three strategic goals, NOMs also 

reduce State reporting burdens and provides uniform, consistent 

reporting of information focusing on 10 domains:

 Reduced symptomatology from mental illnesses or 

Abstinence from drug use and alcohol abuse

 Resilience and sustaining recovery, including: 

 Getting and keeping a job or enrolling and staying in school

 Decreasing involvement with the criminal justice system

Finding safe and stable housing

 Improving social connectedness to others in the 

community

Increased access to services

 Retention in substance abuse treatment or decreased 

inpatient hospitalizations for mental health treatment 

Quality of services provided

Client perception of care

Cost-effectiveness

 Use of evidence-based treatment practices.

Data for reporting on the NOMs will come primarily from 

the States. SAMHSA will support States in their efforts with 

infrastructure and technical assistance through a new State 

Outcomes Measurement and Management System (SOMMS), 

an umbrella activity in SAMHSA to implement NOMs. After 

receiving data from each State, SAMHSA and State offi cials 

collaborate on data analysis and performance management to 

improve services. Currently, each State is at a different stage 

of readiness and some of the measures themselves are still in 

development. However, we will be able to report State-level, 

consistent, cross-year data, which will ultimately allow us to 

examine the impact of programs and changes over time.

SAMHSA is realigning its entire grant and contract data collection

programs—both internal and external—using these NOMs, 

while expanding and focusing its technical assistance resources 

to help States and providers develop NOMs reporting capacity.

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25

Using Data to TRAC Performance

CMHS directs a diverse portfolio of grants, contracts, and 

other activities aimed at improving the lives of people with, 

or at risk for mental illnesses. To assist with managing and 

monitoring functions, CMHS is developing a new Webbased database system know as the TRAC (referring to 

TRansformation ACcountability). This new tool will serve 

as a centralized portal for data from across CMHS’s wide 

discretionary portfolio that includes approximately 28 distinct

programs. The TRAC will capture performance measures 

generated by CMHS programs including client services and 

infrastructure development. It will also capture requests 

for and delivery of technical assistance. The TRAC will 

allow SAMHSA to obtain a snapshot of the performance of 

individual grantees against target performance goals and align 

grantee goals with SAMHSA’s National Outcome Measures 

(NOMs). Data analysis and output reports will allow 

CMHS to monitor and work with grantees to ensure quality 

implementation of programs, and to inform the agency 

about future program needs and directions.

Streamlining Reporting Requirements

SAMHSA has responded to the public’s demand that 

government agencies demonstrate accountability to the 

taxpayer by wisely investing resources into treatments 

and services that produce positive outcomes. To enhance 

the effectiveness of SAMHSA-funded programs and to 

streamline reporting requirements, SAMHSA and the States 

have created a simple, performance-based, outcome-driven 

measurement system for SAMHSA’s two Block Grant 

programs and other funded programs. These National 

Outcome Measures (NOMs) represent meaningful, real 

life outcomes for people who are striving to attain and 

sustain recovery, build resilience, and work, learn, live, and 

participate fully in their communities.
Contact

Substance Abuse and Mental 

Health Services Administration

1 Choke Cherry Road

Rockville, MD 20857

(240) 276-2000

ADMINISTRATOR 

Charles G. Curie, M.A., A.C.S.W.

Mental Health Resources

SAMHSA’S NATIONAL MENTAL HEALTH

INFORMATION CENTER NMHIC

1 (800) 789-2647 or 

1 (866) 889-2647 (TTY)

http://www.mentalhealth.samhsa.gov

Substance Abuse Resources

SAMHSA’S NATIONAL CLEARINGHOUSE 

FOR ALCOHOL AND DRUG 

INFORMATION (NCADI)

1 (800) 729-6686 (English and Español) 

or 1 (800) 487-4889 (TDD)

http://www.ncadi.samhsa.gov

The Substance Abuse and Mental Health Services 

Administration (SAMHSA), part of the U.S. Department 

of Health and Human Services (HHS), focuses attention, 

programs and funding on promoting a life in the community 

with jobs, homes and meaningful relationships with 

family and friends for people with, or at risk for, mental or 

substance use disorders. The Agency is achieving that vision 

through an action-oriented, measurable mission of building 

resilience and facilitating recovery.

For detailed information about current grant opportunities, 

browse the SAMHSA Web site at www.samhsa.gov and click 

on “Grants.” Visit regularly for updates.

May 2006