1

Navigating the State and 

Local Behavioral Health 

System Terrain

A Guide for Community-Integrated

Community Care Hubs
i 

Table of Contents Introduction.................................................................................................................... 1

Importance of Incorporating BH Services .................................................................. 1

Why Connect with State and Local BH Authorities? ................................................. 2

Structure of State BH Agencies...................................................................................... 4

BH and Housing Supports ..............................................................................................7

The Olmstead Decision .............................................................................................. 8

BH Crisis Services .........................................................................................................10

National 988 Lifeline ................................................................................................10

Person-Centered Crisis Care ..................................................................................... 11

Funding Streams for BH Programs ..............................................................................13

Types and Formats of BH Grant Programs...............................................................13

Protection & Advocacy for Individuals with Mental Illness (PAIMI) Program........15

Community Mental Health Services Block Grant.....................................................16

Substance Abuse Prevention and Treatment Block Grant........................................ 17

Examples of Discretionary Grants with Relevance to CCHs’ Activities .................... 17

Statewide Consumer Network Program................................................................18

National Suicide Prevention Lifeline and Disaster Distress Helpline Program....18

Targeted Capacity Expansion: Special Projects.....................................................18

Building Communities of Recovery.......................................................................19

Mental Health Awareness Training Grants...........................................................19

Grants for the Benefit of Homeless Individuals ....................................................19
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List of Exhibits 

 

Exhibit 1 Organizational Affiliation and Contact Information for State BH Authorities

........................................................................................................................................ 4

Exhibit 2 Organizational Responsibilities for MH, SUD, and IDD Services, 2020-2021

........................................................................................................................................ 5

Exhibit 3 Primary State Strategies for Funding and Operating Community-Based 

Mental Health Programs, 2020-2021............................................................................ 6

Exhibit 4 SAMHSA’s Permanent Supportive Housing Evidence-Based Practices KIT..7

Exhibit 5 Presence of Housing Plans and/or Housing Coordinators to Support People 

with Serious BH Conditions, 2020-2021....................................................................... 8

Exhibit 6 Lists of State and Local Resources for Integrating People with Long-Term 

Service and Support Needs into the Community........................................................... 9

Exhibit 7 Toolkit for Best Practices in Behavioral Health Crisis Care..........................10

Exhibit 8 Messaging Framework for the 988 Lifeline .................................................. 11

Exhibit 9 List of State-Specific Sources of Information on BH Advance Directives ....12

Exhibit 10 Pathways for SAMHSA Funding Streams ...................................................14

Exhibit 11 Guide to Information About SAMHSA Grant Programs and Awardees......15

Exhibit 12 Links to State Protection and Advocacy Agencies with PAIMI Funding ....16

 
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Acronyms and Abbreviations

BH Behavioral Health

BHAD Behavioral Health Advance Directive

CCH Community Care Hub 

COD Co-Occurring Disorder

DHHS Department of Health and Human Services

DC District of Columbia

DDH Disaster Distress Helpline

IDD Intellectual and Developmental Disabilities

MH Mental Health

MHBG Community Mental Health Services Block Grant

P&A Protection and Advocacy

PAD Psychiatric Advance Directive

PAIMI Protection & Advocacy for Individuals with Mental Illness

RCO Recovery Community Organization

SABG Substance Abuse Prevention and Treatment Block Grant

SAMHSA Substance Abuse and Mental Health Services Administration

SCN Statewide Consumer Network (grant program)

SED Serious Emotional Disturbance

SMI Serious Mental Illness

SROI Social Return on Investment

SSA Single State Authority (or Agency)

SUD Substance Use Disorder
PAGE INTENTIONALLY LEFT BLANK
1

Introduction

The organization, funding, and administration of publicly funded mental health and

substance use services vary from state to state; within some states, there are regional

variations as well. This brief guide provides an overview of these different organizational 

structures and suggests ways for CBO networks to make connections with the state and 

local behavioral health (BH) authorities in their area. 

Importance of Incorporating BH Services 

Substance use disorders (SUD) among older Americans have increased over the past two 

decades. In 2020, approximately one in ten people ages 50 or older, that is, a total of 11 

million people in this age group, had an alcohol or drug use disorder.1 Excessive 

substance use at older ages is associated with elevated risk of cognitive decline, 

dehydration, falls, and adverse interactions with prescription medications. SUD also 

leads to complications in liver and pancreas diseases, immune system disorders, 

osteoporosis, diabetes, high blood pressure, stroke, and seizures.

2 Older people are 

also at high risk of mood disorders. For example, a recent household survey indicated 

that approximately 40% of the population ages 60 and older felt “nervous, anxious, or on 

edge” for longer than a day during the past two weeks and about 19% of them had these 

feelings “nearly every day.”3 

One of the challenges of providing appropriate BH services and supports to older people 

is the difficulty of differentiating between dementia and BH issues, frequently resulting 

in a misdiagnosis.

4 Evidence-based BH screening, referral to appropriate treatment, and 

effective interventions are therefore critical for any organization providing routine 

services to older adults.5 Currently, services for older adults in the U.S. are split among 

sectors and organizations without sufficient linkages or communication pathways, 

constituting a barrier to effective diagnosis and consistent treatment of BH disorders. 

Homebound older adults are especially vulnerable to co-occurring physical and mental 

health conditions and are less likely to receive appropriate diagnosis and treatment.

6

 

1 Center for Behavioral Health Statistics and Quality. 2021. 2020 National Survey on Drug Use and 

Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services 

Administration.

2 Kuerbis, A., Sacco, P., Blazer, D.G., & Moore, A.A. (2014). Substance abuse among older adults. 

Clinics in Geriatric Medicine, 30(3), 629-654. 

3 U.S. Census Bureau, Household Pulse Survey, April 2022. 4 Bottino, C.M.C., de Pádua, A.C, Smid, J., Areza-Fegyveres, R., Novaretti, T., & Bahia, V.S. (2011). 

Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and 

supplementary exams. Dementia & Neuropsychologia, 5(4), 288-296.

5 SAMHSA—Get Connected: Linking Older Adults with Resources on Medication, Alcohol, and 

Mental Health. HHS Pub. No. (SMA) 03-3824. Rockville, MD: Center for Substance Abuse 

Prevention, Substance Abuse and Mental Health Services Administration, 2019.

6 Qiu, W.Q., Dean, M., Liu, T., George, L., Gann, M., Cohen, J., & Bruce, M.L. (2010). Physical 

and mental health of homebound older adults: an overlooked population. Journal of the 
2 

Another unmet service need for older populations is specialized BH care after hospital 

discharge. Older adults discharged after inpatient psychiatric care have higher rates of rehospitalization within five years compared to younger adults.7 Notably, older adults 

hospitalized for physical conditions are also more likely to be re-hospitalized if they have 

a co-morbid psychiatric condition. One study found up to 1.4 additional hospital days 

attributable to psychiatric co-morbidity in adults discharged after a heart condition.8

The fragmented nature of BH services for older adults and shortage of providers trained 

in addressing the needs of this population have consequences for racial health disparities 

as well. Not only are older adults less likely to seek BH care compared to younger 

populations, but there is also evidence to suggest that older African Americans tend to be

more reluctant than others in the same age group to report a BH condition.9 BH providers 

with cultural competence in addition to specialized training in older adult care are needed 

to address this disparity. 

An effective strategy for addressing these unmet needs for BH care is for key elder care 

organizations, such as Area Agencies on Aging, to establish close partnerships with 

providers in their communities.10 

The Value of Connecting with State and Local BH 

Authorities 

Although insurance coverage for BH screening and treatment services has expanded 

in recent years, reimbursement gaps continue to be a barrier for certain services, most 

notably prevention and recovery supports. Crucial yet non-reimbursable BH services 

are often funded through federal grants administered by state and local BH 

authorities who are the best sources of information about these funding streams and

mechanisms for accessing them.

As the previous section briefly summarizes, including BH care in services and 

supports provided to older adults has multiple benefits. Returns for investments in 

these services include shorter hospital stays and fewer re-hospitalizations after 

discharge. Additionally, the social returns on investment (SROI) of well-integrated, 

American Geriatrics Society, 58(12),2423-8. doi: 10.1111/j.1532-5415.2010.03161.x. Epub 

2010 Nov 10. PMID: 21070195; PMCID: PMC3044592.

7 Yu, C., Sylvestre, J.D., Segal, M., Looper, K.J., & Rej, S. (2015) Predictors of psychiatric rehospitalization in older adults with severe mental illness. International Journal of Geriatric 

Psychiatry, 30(11), 1114-1119. doi: 10.1002/gps.4361. Epub 2015 Sep 21. PMID: 26388437.

8 Sayers, S.L., Hanrahan, N., Kutney, A., Clarke, S.P., Reis, B.F. and Riegel, B. (2007). 

Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher 

hospitalization costs in older adults with heart failure. Journal of the American Geriatrics 

Society, 55(10), 1585-1591. https://doi.org/10.1111/j.1532-5415.2007.01368.x

9 Conner, K.O., Copeland, V.C., Grote, N.K., Koeske, G., Rosen, D., Reynolds, C.F. 3rd, & 

Brown, C. (2010). Mental health treatment seeking among older adults with depression: the 

impact of stigma and race. American Journal of Geriatric Psychiatry, 18(6), 531-43. doi: 

10.1097/JGP.0b013e3181cc0366. PMID: 20220602; PMCID: PMC2875324.

10 Horvitz-Lennon, M., Kilbourne, A. M., & Pincus, H. A. (2006). From silos to bridges: Meeting 

the general health care needs of adults with severe mental illnesses. Health Affairs, 25(3), 659-

669. https://doi.org/10.1377/hlthaff.25.3.659
3 

high-quality BH services to older adults deserve serious consideration. SROI

calculations go beyond a narrow focus on the fiscal benefits of investments in health

and human services to take a broader view of their social value to a wide range of

stakeholders and to communities at large. In addition to recent developments in 

quantitative methods for calculating SROI, organizations increasingly utilize a

combination of quantitative, qualitative, and narrative descriptions of the social value

of their investments to make a business case.11 One implication of the SROI approach

for the services under consideration here is their contribution to health equity and

overall improvements in quality of life for older populations. Although these factors 

are challenging to reduce to financial returns, their social value is indisputable. 

Partnerships with state and local BH authorities can provide CBO networks and 

their lead entities with information about and access to available BH services and 

other resources in the community, enhancing the SROI of the services and supports 

they already provide. 

11 American Public Human Services Association (APHSA). (2013). Social return on investment 

[online]. APHSA Innovation Center Issue Brief. Accessed in September 2022 from 

https://33igt8427g0w69zms33dqm48-wpengine.netdna-ssl.com/wpcontent/uploads/2014/06/Social-Return-on-Investment-Brief.pdf 
4 

Structure of State BH 

Agencies 

All states and jurisdictions have one or two federally designated units within their

executive branch responsible for managing mental health (MH) and substance use 

disorder (SUD) services and programs, generally referred to as Single State Agencies

(SSA) for their respective areas. In some states, one SSA is responsible for both MH 

and SUD programs while in others, these two functions are managed by separate 

agencies. SSAs oversee strategic planning and implementation of the state’s 

behavioral health programs and policies. They manage federal BH funds allocated to 

their state, including federally mandated performance data collection and reporting. 

Each SSA has a designated person officially recognized as the authority for the 

agency’s functions. 

SSAs are typically located within larger umbrella agencies, such as Departments of 

Human Services, Health Departments, or combined Health and Human Services 

Departments. Some states have independent Departments of Mental Health or 

Behavioral Health. 

Exhibit 1 Organizational Affiliation and Contact Information for State BH Authorities

The Substance Abuse and Mental Health Services Administration (SAMHSA) 

maintains directories for contact information and organizational affiliations of 

Single State Authorities: 

Directory of State Mental Health Authorities

Single State Substance Abuse Agencies Directory

Responsibility for intellectual and developmental disability (IDD) services is also 

located within the MH and/or SUD SSA in some states. Exhibit 2 maps the 

organizational structure of behavioral health SSAs across the nation. 
5 

Exhibit 2 Organizational Responsibilities for MH, SUD, and IDD Services, 2020-2021 

Source: Reproduced from National Association of State Mental Health Program Directors Research Institute (NRI). 2021. 

State Mental Health Agency Organization. Data for Alaska and Hawaii were not available in the source report but were 

added based on SSA directories published by SAMHSA.

State mental health authorities use different strategies for distributing the federal 

funds under their management to community-based mental health programs. 

 In the majority of states, the SSA’s primary method is to contract with 

community mental health service providers (typically non-profit 

organizations) but not directly operate the programs. 

 In 13 states, the primary strategy is for the SSA to distribute the funds to local 

mental health authorities (typically, county or city MH departments) who, in 

turn, fund and operate community-based programs, either through contract 

arrangements or by directly operating the programs. This strategy is more 

common among larger states with more complex health service systems. 

 In three states and D.C., the central mental health authority both funds and 

directly operates community-based programs. In these four cases, 

community-based providers are employees of the state (or district). 

In some states, a combination of the above three strategies is used. Exhibit 3 shows 

the dominant (primary) strategy in each state.
6 

Exhibit 3 Primary State Strategies for Funding and Operating Community-Based

Mental Health Programs, 2020-2021 

Source: Reproduced from National Association of State Mental Health Program Directors Research Institute (NRI). 

2021. State Mental Health Agency Organization. 

Further detail on funding sources for community-based services and BH authorities’ 

responsibilities in managing funding streams is provided in a later section of this 

document. 
7 

BH and Housing 

Supports

The links between behavioral health and housing stability go both ways. Housing 

instability exacerbates mental health and substance use challenges and presents a 

barrier to healthy recovery and wellness maintenance. Likewise, risks of unstable 

housing are higher for people with BH disorders and such disorders often pose 

challenges to obtaining permanent housing after an episode of homelessness. This 

two-way association has led to multiple collaboration efforts between housing and BH 

agencies. 

SAMHSA supports homelessness prevention and permanent supported housing 

initiatives undertaken by BH agencies and community-based BH providers and 

provides guidance for states and communities to address housing instability among 

people with serious BH conditions (see, for example, Exhibit 4). 

Exhibit 4 SAMHSA’s Permanent Supportive Housing Evidence-Based Practices KIT 

Permanent Supportive Housing Evidence-Based Practices Resource Kit

consists of nine downloadable files with step-by-step guidance for state 

authorities and community organizations to set up housing support programs, 

train their staff, establish partnerships, obtain funding, and monitor program 

performance. The kit also includes a review of the research literature and 

annotated bibliography on this topic and tools for engaging stakeholders in the 

program. 

In response to SAMHSA’s recommendation to state BH authorities to develop 

strategies and action plans for addressing housing instability among people with 

serious BH conditions, the majority of state BH authorities now have housing plans 

incorporated into their strategic plans. Most states have a plan to ensure adequate 

housing for people with serious BH conditions, or a housing coordinator responsible 

for increasing affordable housing opportunities for this population, or both (Exhibit 5). 
8 

Exhibit 5 Presence of Housing Plans and/or Housing Coordinators to Support People 

with Serious BH Conditions, 2020-2021 

Source: Reproduced from National Association of State Mental Health Program Directors Research Institute (NRI). 

2022. Initiatives to Support Housing Services for Individuals with SMI and SED. 

The Olmstead Decision 

The landmark Supreme Court decision, Olmstead v. L.C. (1999) and subsequent legal 

actions that interpreted and broadened the scope of the original decision have had an 

impact on the housing support needs of people with BH conditions, older adults, and 

people with disabilities. The original decision ruled that unnecessary segregation of 

people with mental health conditions constitutes discrimination under the Americans 

with Disabilities Act, mandating that states provide services to people with long-term 

support needs in the most integrated settings appropriate to their needs. That is, 

anyone who can safely receive home and community-based services cannot be forced 

to live in segregated congregate settings. The Supreme Court, as part of its decision, 

encouraged states to develop comprehensive plans to increase community 

integration, commonly referred to as Olmstead Plans. Although most states have 

housing supports as part of their BH strategic plans, less than half currently have an 

Olmstead Plan. Bringing states into full compliance with Olmstead is an ongoing 

effort involving negotiations and consent rulings between the U.S. Department of 

Justice and state BH authorities. 

There is increasing evidence that housing alone does not guarantee full community 

integration. Some states have started combining education and employment supports 

with housing supports to better facilitate independent living in the community. 

Exhibit 6 provides links to state and local resources for full community integration of 

people with long-term support needs. 
9 

Exhibit 6 Lists of State and Local Resources for Integrating People with Long-Term 

Service and Support Needs into the Community

Alabama Alaska Arizona Arkansas California

Colorado Connecticut Delaware Florida Georgia

Hawaii Idaho Illinois Indiana Iowa

Kansas Kentucky Louisiana Maine Maryland

Massachusetts Michigan Minnesota Mississippi Missouri

Montana Nebraska Nevada New Hampshire New Jersey

New Mexico New York North Carolina North Dakota Ohio

Oklahoma Oregon Pennsylvania Rhode Island South 

Carolina

South Dakota Tennessee Texas Utah Vermont

Virginia Washington West Virginia Wisconsin Wyoming

District of 

Columbia

Source: Disability Integration Project at the Atlanta Legal Aid Society, Olmstead Rights. 
10

BH Crisis Services

One consequence of the siloed nature of long-term services and supports is the 

inconsistency in responding to older adults experiencing BH crises. In many 

situations, first responders lack skills and experience in geriatric care, resulting in 

inappropriate crisis response, often exacerbating, rather than stabilizing, the episode. 

In addition to training first responders in age-appropriate crisis response, 

familiarizing older adult-serving organizations with their state and local crisis 

response system would go a long way in ensuring effective communication and 

appropriate care across the entire crisis response process. 

Best practices in crisis response minimally require three core components: 

 Crisis call center that receives the initial call and coordinates the crisis 

response process in real time

 Centralized 24/7 mobile crisis response capability

 Round-the clock crisis receiving and stabilization programs

Further, it is desirable for the system to have a well-formulated set of principles and 

standard practices shared by all of its crisis response components. State BH 

authorities are the key actors in developing and managing BH crisis response in their 

states, although multiple and varied stakeholders typically collaborate in developing 

and running the system, such as other health and human service agencies, advocacy 

organizations, and contracted community-based providers. States vary in their crisis 

response infrastructure and their compliance with best practices. A link to national 

guidelines for best practices is provided in Exhibit 7. 

Exhibit 7 Toolkit for Best Practices in Behavioral Health Crisis Care

National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit

describes the core elements of evidence-based crisis care, addresses challenges 

posed by rural and frontier communities, and provides suggestions for 

funding, training, and community outreach. Success stories and interviews 

with stakeholders are also included in the toolkit.

Source: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services 

Administration. 

National 988 Lifeline 

Beginning in the summer of 2022, the 988 Suicide and Crisis Lifeline now provides a 

nationwide crisis call center designed to respond to calls or texts from people across 

the nation experiencing a behavioral health crisis. The center also provides online real 

time chat capability through 988lifeline.org. The center is staffed with counselors

trained in crisis response. Callers can select to speak in English or Spanish, with 

translation services available in 150 additional languages. Incorporating this service 
11

into existing state and local crisis systems is an ongoing process with variation across 

states in the speed with which local systems seamlessly align with the national center. 

State BH authorities are the best sources of information for the status of local 

alignment efforts.

Community-based organizations are encouraged to inform the people they serve and 

their broader community about the 988 call center. Exhibit 8 provides a link to the 

recommended messaging framework for this outreach.

Exhibit 8 Messaging Framework for the 988 Lifeline

The 988 Messaging Framework is intended to provide guidance for state 

agencies, crisis centers, nonprofit organizations, businesses, foundations, and 

advocacy groups to spread the word about the 988 Lifeline. It provides 

detailed information about what 988 is (and isn’t) and recommends strategies 

for developing and disseminating this information with special emphasis on 

tailoring the message to audiences from diverse community types and

cultural/experiential backgrounds. 

Source: National Action Alliance for Suicide Prevention. 

Person-Centered Crisis Care 

Person-centered care – meaning an individualized response that maximizes a 

person’s autonomy and preferences – is often unfeasible during the crisis episode, 

both due to the urgent need for action and the distress of the person in crisis. This, 

however, does not necessarily mean that it is impossible to provide person-centered 

crisis care. People can provide advance instructions about their treatment preferences 

and appoint a representative who is legally authorized to make decisions on their 

behalf in case they are incapacitated due to a behavioral health crisis. These directives 

may include where the person prefers to receive care, preferences about certain 

medication, and even visitors allowed while in a care facility. Legal requirements

governing Behavioral Health Advance Directives (sometimes called Psychiatric 

Advance Directives or PADs) vary from state to state. Exhibit 9 provides links to 

sources of information about BH Advance Directives across the country.
12

Exhibit 9 List of State-Specific Sources of Information on BH Advance Directives

Alabama Alaska Arizona Arkansas California

Colorado Connecticut Delaware Florida Georgia

Hawaii Idaho Illinois Indiana Iowa

Kansas Kentucky Louisiana Maine Maryland

Massachusetts Michigan Minnesota Mississippi Missouri

Montana Nebraska Nevada New 

Hampshire New Jersey

New Mexico New York North Carolina North Dakota Ohio

Oklahoma Oregon Pennsylvania Rhode Island South Carolina

South Dakota Tennessee Texas Utah Vermont

Virginia Washington West Virginia Wisconsin Wyoming

District of 

Columbia Veteran Affairs

Source: National Resource Center on Psychiatric Advance Directives.
13

Funding Streams for BH 

Programs

Medicaid is the largest public funder of behavioral health services in the United 

States. For example, 60% of the 45.9 billion dollars controlled by state mental health 

authorities in 2020 was provided by Medicaid (federal and state match combined).12

The rest of the revenues came exclusively from state general funds and grants. 

Although reimbursement for behavioral health services has expanded in recent years, 

substantial gaps remain. For example, roughly a quarter of all adults with mental 

illness report that they did not receive the treatment they needed, the most often cited

reason being insufficient insurance coverage.13 Furthermore, crucial BH services such 

as evidence-based interventions for people at high risk of developing disorders and 

services to support recovery from disorders, such as peer supports, are the least likely 

to be covered by insurance plans. Grants are the main sources of funding for nonreimbursable BH services such as these. 

Types and Formats of BH Grant Programs 

SAMHSA is the main federal agency responsible for BH grant programs. These 

programs fund services and practices aimed at preventing and treating behavioral 

health disorders, maintaining wellbeing, and addressing social determinants of 

health. Most SAMHSA programs are structured in one of two formats: 

 Formula grants are allocated to all states and other qualifying jurisdictions

based on a pre-determined formula that considers factors such as the state’s

population, level of need for the service, and cost of living. These revenues are

managed by state BH authorities and are relatively stable across years;

however, states are required to apply annually and account for their funded

activities during the previous year.

 Discretionary grants are funding streams created in response to emerging

service needs and are renewable for a limited period—typically three to five

years. Depending on the type of program, grantees may be states, territories,

tribes, local agencies, community based organizations, and/or non-profit

organizations. These are competitive grants for which qualifying entities

submit proposals.

Exhibit 10 summarizes the pathways through which SAMHSA grant funding reaches 

community based BH programs and services. For Community Care Hubs,

12 U.S. Department of Health and Human Services, Substance Abuse and Mental Health 

Services Administration, Unified Reporting System. 13 Reinert, M., Nguyen, T., & Fritze, D. (2021). The State of Mental Health in America. 

Alexandria, VA: Mental Health America Inc.
14

information about these funding streams and entities in their state receiving funding 

can serve two related purposes: 

 Their organization or others in their network may directly qualify for a federal

discretionary grant.

 Their state’s BH authorities may seek sub-grantees at the community level for

a federal funding stream they are managing, and their organization or others

in their network may qualify.

 An organization or provider funded through one of these streams may offer

free or subsidized services needed by the CCH’s clients.

Exhibit 11 provides links to information about current BH grant programs and funded 

entities, including their funding levels.

Exhibit 10 Pathways for SAMHSA Funding Streams

Source: Congressional Research Service. (2020). Substance Abuse and Mental Health Services 

Administration (SAMHSA): Overview of the Agency and Major Programs. Document # R46426 Prepared for 

Members and Committees of Congress.
15

Exhibit 11 Guide to Information About SAMHSA Grant Programs and Awardees

Information about currently available BH grant programs can be found at 

SAMHSA’s Grants Page. 

SAMHSA also provides a List of Grant Recipients by State, including their 

current level of funding.

The rest of this document reviews the major BH grants and their potential relevance 

for Community Care Hubs. 

Protection & Advocacy for Individuals with Mental 

Illness (PAIMI) Program 

The PAIMI Grants are authorized by the Protection and Advocacy for Mentally Ill

Individuals Act of 1986 which requires states to:

“... establish and operate a protection and advocacy system for mentally ill individuals

which will— 

(A) protect and advocate the rights of such individuals through activities to

ensure the enforcement of the Constitution and Federal and State statutes;

and

(B) investigate incidents of abuse and neglect of mentally ill individuals if the

incidents are reported to the system or if there is probable cause to believe

that the incidents occurred.”

To support the mandated Protection and Advocacy (P&A) Systems, funds are annually 

allotted to the 50 states, D.C., five territories, and the American Indian Consortium 

for Native Americans. These 57 systems provide legal-based services to protect and 

advocate for the Constitutional rights of adults with serious mental illness (SMI) and 

children with serious emotional disturbance (SED) and to investigate allegations of 

abuse, neglect, and rights violations within this population. 

During fiscal year 2021, 36 million dollars were allocated to fund states’ P&A Systems. 

During that year, close to 9,000 eligible people were served and resolution of these 

allegations resulted in positive outcomes including “receipt of appropriate medical 

and mental disorder treatment; safer, cleaner facility environment; discharge into an 

appropriate community-based setting; and discharge from a nursing facility.”14 

Of the cases brought to P&A Systems in 2021, 619 involved someone ages 65 or older. 

One common issue encountered in caring for older adults is widespread comorbidity 

of dementia with mental illness, often resulting in misdiagnosis, inappropriate 

hospitalization, or other forms of avoidable seclusion. States’ P&A Agencies can help 

14 SAMHSA, Congressional Justification of Estimates for Appropriations Committees, Fiscal 

Year 2023, p. 139.
16

resolve these issues and ensure appropriate and safe care for older adults in need of 

BH supports. 

Exhibit 12 Links to State Protection and Advocacy Agencies with PAIMI Funding

Alabama Alaska Arizona Arkansas California

Colorado Connecticut Delaware Florida Georgia

Hawaii Idaho Illinois Indiana Iowa

Kansas Kentucky Louisiana Maine Maryland

Massachusetts Michigan Minnesota Mississippi Missouri

Montana Nebraska Nevada New 

Hampshire New Jersey

New Mexico New York North Carolina North Dakota Ohio

Oklahoma Oregon Pennsylvania Rhode Island South Carolina

South Dakota Tennessee Texas Utah Vermont

Virginia Washington West Virginia Wisconsin Wyoming

District of 

Columbia

Source: U.S. Department of Health and Human Services, Tracking Accountability in Government Grants 

System (TAGGS).

Community Mental Health Services Block Grant 

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

states’ BH authorities in developing and implementing plans for providing 

comprehensive community mental health services. The main target population for 

programs funded by MHBGs are adults with SMI and children with SED. In this 

context, SMI is defined as a mental health condition that limits at least one major life 

activity (e.g., basic or instrumental activities of daily living, participation in family life, 

school, or workplace). 

The state (or territory) BH authority is responsible for managing these funds. They

are required to distribute MHBG funds to local governments and non-governmental 

organizations that provide MH treatment and recovery support services and must 

ensure that community mental health centers provide screening, outpatient 

treatment, emergency mental health services, and day treatment programs. 
17

Substance Abuse Prevention and Treatment Block 

Grant 

The Substance Abuse Prevention and Treatment Block Grant (SABG) program funds 

prevention and treatment services to the state’s population impacted by SUD. 

Community- and faith-based non-governmental organizations can apply to become 

sub-recipients of SABG funds to provide: 

 Prevention services to communities and individuals at high risk of SUD

 Treatment and recovery support services to individuals and families impacted

by SUD

States must use at least 20% of their SABG funds for primary prevention programs, 

defined as strategies directed at at-risk individuals not identified to need SUD 

treatment. Primary prevention strategies include: 

 Community education to increase awareness of the extent and consequences

of substance use and resources available to impacted people in the community

 Skill building to improve people’s ability to cope with risk factors such as

stress, trauma, peer pressure, and to make healthy decisions

 Alcohol and drug free social activities and community events aimed at

disassociating socializing and entertainment from substance use

 Networking activities and technical assistance to community organizations to

strengthen collaborative grassroots efforts to address alcohol and drug

problems



States’ single-state authorities are the best source of information about the MHBGand SABG-funded programs in the state. See Exhibit 1 for accessing the directory of 

agencies in charge of these funds in each state.

Another source of detailed information about the state’s BH program structure is the

annual Block Grant application documents submitted to SAMHSA. These publicly

available documents describe the state’s BH programs, budgets, and plans for the

future. They can be located on the internet with search terms that include the state’s

name followed by MHBG or SABG and the word “Application.”

Examples of Discretionary Grants with Relevance to 

CCHs’ Activities 

As described earlier in this document (see Exhibit 10), community-based

organizations can access SAMHSA grant funds either directly or as the sub-recipient

of a grant awarded to their state. The following are examples of SAMHSA

discretionary grants for which community-based or non-profit organizations are
18

directly eligible. Program descriptions are direct quotes from the funding opportunity 

announcements.

Statewide Consumer Network Program15

Description: The purpose of this program is to enhance statewide mental health 

consumer-run organizations’ to promote mental health and related service system 

capacity and infrastructure development to be consumer-centered and targeted 

toward recovery and resiliency, and consumer-driven by promoting the use of 

consumers as agents of transformation. The SCN grant program also seeks to address 

the needs of underserved and under-represented consumers, including those from 

ethnic, racial, or cultural minority groups; sexual orientation and gender minority 

individuals; those with histories of chronic homelessness or involvement with the 

criminal justice system; and those with mental health and co-occurring disorders. 

Eligible Applicants: Domestic public and private non-profit entities.

National Suicide Prevention Lifeline and Disaster Distress Helpline

Program16

Description: The purpose of this program is to: (1) manage, enhance, and 

strengthen the Lifeline that routes individuals in the United States to a network of 

certified crisis centers that links to local emergency, mental health, and social services 

resources; and (2) support the Disaster Distress Helpline (DDH) to assist residents in 

the United States and its territories who are experiencing emotional distress resulting 

from disasters and traumatic events. It is expected that this program will increase 

service capacity and improve behavioral health outcomes by preventing death or 

injury as a result of suicide and suicide attempts and helping individuals and 

communities recover from disasters and traumatic events by providing communitybased behavioral health outreach, referral to and engagement with treatment as 

necessary, and psycho-educational services.

Eligible Applicants: Domestic public and private non-profit entities

Targeted Capacity Expansion: Special Projects17

Description: The purpose of the program is to implement targeted strategies for the 

provision of SUD or co-occurring disorder (COD) harm reduction, treatment, and/or 

recovery support services to support an under-resourced population or unmet need 

identified by the community. The applicant will identify the specific need or 

population it seeks to support through the provision of evidence-based SUD or COD 

harm reduction, treatment, and/or recovery support services. Diversity, equity, and 

inclusion must be integrated in the provision of services and activities throughout the 

project, for example, when conducting eligibility assessments, outreach, and 

engagement or developing policies.

15 https://www.samhsa.gov/grants/grant-announcements/sm-22-009

16 https://www.samhsa.gov/grants/grant-announcements/sm-21-005 17 https://www.samhsa.gov/grants/grant-announcements/ti-22-002 
19

Eligible Applicants: Domestic public and private non-profit entities

Building Communities of Recovery18

Description: The purpose of this program is to mobilize and connect a broad base of 

community-based resources to increase the prevalence and quality of long-term 

recovery support for persons with SUD and COD. These grants are intended to 

support the development, enhancement, expansion, and delivery of recovery support 

services (RSS) as well as the promotion of and education about recovery. It is 

expected that these grant activities will be administered and implemented by 

individuals with lived experience who are in recovery from SUD and COD and reflect 

the needs and population of the community being served.

Eligible Applicants: Recovery Community Organizations (RCOs) that are domestic 

private nonprofit entities in states, territories, or tribes

Mental Health Awareness Training Grants19

Description: The purpose of this program is to: (1) train individuals (e.g., school 

personnel, emergency first responders, law enforcement, veterans, armed services 

members and their families) to recognize the signs and symptoms of mental 

disorders, particularly SMI and/or serious emotional disturbances (SED); (2) 

establish linkages with school- and/or community-based mental health agencies to 

refer individuals with the signs or symptoms of mental illness to appropriate services; 

(3) train emergency services personnel, law enforcement, fire department personnel, 

veterans, and others to identify persons with a mental disorder and employ crisis deescalation techniques; and (4) educate individuals about resources that are available 

in the community for individuals with a mental disorder. It is expected that this 

program will prepare and train others on how to appropriately and safely respond to 

individuals with mental disorders, particularly individuals with SMI and/or SED.

Eligible Applicants: Domestic public and private non-profit entities

Grants for the Benefit of Homeless Individuals20

Description: The purpose of this program is to support the development and/or 

expansion of local implementation of a community infrastructure that integrates 

substance use disorder treatment, housing services and other critical services for 

individuals (including youth) and families experiencing homelessness.

Eligible Applicants: Domestic public and private non-profit entities

18 https://www.samhsa.gov/grants/grant-announcements/ti-22-014 19 https://www.samhsa.gov/grants/grant-announcements/SM-21-007 20 https://www.samhsa.gov/grants/grant-announcements/ti-20-001 
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