Substance Abuse and Mental Health Services Administration (SAMHSA): Agency Overview
Released: 2016-05-27T00:00:00

Background

In recent years, Members of both chambers have introduced legislation that would reauthorize, amend, add, or eliminate programs and activities undertaken by the Substance Abuse and Mental Health Services Administration (SAMHSA). This report briefly summarizes SAMHSA's major programs and activities and describes the agency's organizational structure. This report does not address specific legislation that would amend SAMHSA's statutory authorities; however, it points to the sections of statute relevant to each of SAMHSA's programs and activities, which may be helpful as Congress considers potential changes.

The Appendix provides an overview of SAMHSA's budget, excerpted from CRS Report R44375, SAMHSA FY2017 Budget Request and Funding History: A Fact Sheet . More detailed descriptions and funding levels for SAMHSA's programs and activities are available in SAMHSA's annual budget request.

SAMHSA's Major Programs and Activities

SAMHSA's major programs and activities include two block grants, numerous discretionary grants and other activities known as Programs of Regional and National Significance (PRNS), several other grant programs, and data collection and related activities.

Block Grants

SAMHSA's two biggest programs are block grants—one supports mental health services and the other supports substance abuse prevention and treatment services.

Community Mental Health Services Block Grant (MHBG)

The Community Mental Health Services Block Grant (MHBG) supports community mental health services for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED). SAMHSA distributes MHBG funds to states (including the District of Columbia and specified territories) according to a formula.

Each state may distribute MHBG funds to local government entities and non-governmental organizations in accordance with the state's plan for providing comprehensive community mental health services for adults with SMI and children with SED. States have flexibility in the use of MHBG funds within the framework of the state plan and federal requirements.

Each MHBG grantee must support a mental health planning council, which provides input on the state's plan for providing comprehensive community mental health services. A majority of members of the mental health planning council must be mental health service consumers or family members (of children with SED); other members represent relevant state agencies (e.g., mental health, education, and social services). States may opt to have behavioral health planning councils, which are responsible for both mental health and substance abuse services.

For each of the 50 states and the District of Columbia, the MHBG allotment formula is based on the population at risk (weighted), cost of services, and available resources. The MHBG allotment for each territory is proportional to the civilian population of the territory. All states (including the District of Columbia) and territories have minimum allotments.

Public Health Service Act (PHSA) Title XIX, Part B, Subpart I authorizes the MHBG program. Provisions in PHSA Title XIX, Part B, Subpart III also apply to the MHBG. PHSA Section 1920 explicitly authorizes appropriations for the MHBG through FY2003. Since that time, the program has continued to operate under its general authorities and has continued to receive funding through the annual appropriations process.

Substance Abuse Prevention and Treatment Block Grant (SABG)

The Substance Abuse Prevention and Treatment Block Grant (SABG) supports services to prevent and treat substance use disorders. SAMHSA distributes SABG funds to states (including the District of Columbia and specified territories) and one tribal entity according to a formula.

Each state may distribute SABG funds to local government entities, administrative service organizations, and prevention and treatment service providers (among others) in accordance with the state's plan for expending SABG funds. States have flexibility in the use of SABG funds within the framework of the state plan and federal requirements.

Each SABG grantee must expend at least 20% of its SABG allotment on primary prevention strategies. In addition, each SABG grantee must enact laws that prohibit the sale or distribution of tobacco products to minors; enforce such laws; inspect tobacco outlets; and report annually to the HHS Secretary on past-year enforcement activities (and the extent of success achieved), as well as enforcement strategies for the coming grant year.

For each of the 50 states and the District of Columbia, the SABG allotment formula is based on the MHBG formula and takes into account the population at risk (unweighted), cost of services, and available resources. The SABG allotment for each territory is proportional to the civilian population of the territory. All states (including the District of Columbia) and territories have minimum allotments. For Indian tribes and tribal organizations that request SABG funds directly (and that the HHS Secretary determines would be better served by means of direct grants), the grant amount is reserved from the state's SABG allotment based on the ratio of the state's allotment expended for the tribal entity in FY1991.

PHSA Title XIX, Part B, Subpart II authorizes the SABG. Provisions in PHSA Title XIX, Part B, Subpart III also apply to the SABG. PHSA Section 1935 explicitly authorizes appropriations for the SABG through FY2003. Since that time, the program has continued to operate under its general authorities and has continued to receive funding through the annual appropriations process.

Programs of Regional and National Significance (PRNS)

SAMHSA's Programs of Regional and National Significance (PRNS) encompass numerous grants and activities within each of three areas: (1) mental health, (2) substance abuse treatment, and (3) substance abuse prevention. PRNS activities may include competitive grants, contracts, and cooperative agreements. Eligible entities vary from one PRNS program to another. PRNS programs themselves may vary from year to year as existing programs are terminated or new programs are created, either at SAMHSA's recommendation or at the direction of Congress.

PRNS grants and activities within each area fall into two categories, called "Capacity" and "Science and Service." Most PRNS programs are in the Capacity category. Those in the Science and Service category tend to focus on training and technical assistance. For example, within mental health PRNS, primary and behavioral health integration appears under both categories: grants to community mental health centers appear under Capacity, and a competitive cooperative agreement for a training and technical assistance center appears under Science and Service.

PHSA Title V Part B requires the HHS Secretary to "address priority ... needs of regional and national significance" (in mental health, substance abuse treatment, and substance abuse prevention) and allows the HHS Secretary to do so "directly or through grants or cooperative agreements with States, political subdivisions of States, Indian tribes and tribal organizations, other public or private nonprofit entities." Some of the grants and activities currently operating under PRNS have (or had) separate, explicit authorizations of appropriations; others never had explicit authorizations of appropriations and operate solely under the PRNS authority for mental health, substance abuse treatment, or substance abuse prevention.

Mental Health PRNS

PHSA Section 520A authorizes the mental health PRNS. Both the authorization of appropriations in PHSA Section 520A and most of the explicit authorizations of appropriations for specific grants and activities categorized as mental health PRNS have expired. Since that time, some mental health PRNS programs have continued to operate under their general authorities and have continued to receive funding through the annual appropriations process. Table 1 lists current (FY2016) grants and activities categorized as mental health PRNS; additional details (e.g., program descriptions and funding) are available in SAMHSA's FY2017 budget request.

Example: Suicide Prevention

SAMHSA's suicide prevention activities provide an illustrative example of mental health PRNS activities that are currently active (i.e., received funding in FY2016 through the annual appropriations process) and operate under either the mental health PRNS authority or their separate authorities. Six suicide prevention programs operate within the mental health PRNS (as shown in Table 1 ). Three of the programs (GLS—Youth Suicide Prevention—States, GLS—Youth Suicide Prevention—Campus, and GLS—Suicide Prevention Resource Center) are separately authorized under PHSA sections amended or added by the Garrett Lee Smith (GLS) Memorial Act ( P.L. 108-355 ). The other three suicide prevention programs (National Strategy for Suicide Prevention, Suicide Lifeline, and AI/AN Suicide Prevention Initiative) do not have explicit authorizations of appropriations; they operate under the mental health PRNS authority (PHSA Section 520). In addition, the PHSA sections amended or added by the GLS Act (as summarized in Table 2 ) authorize some programs that have never been funded.

Substance Abuse Treatment PRNS

PHSA Section 509 authorizes the substance abuse treatment PRNS. Both the authorization of appropriations in PHSA Section 509 and the explicit authorizations of appropriations for specific grants and activities categorized as substance abuse treatment PRNS have expired. Since that time, some substance abuse treatment PRNS programs have continued to operate under their general authorities and have continued to receive funding through the annual appropriations process. Table 3 lists current (FY2016) grants and activities categorized as substance abuse treatment PRNS; additional details (e.g., program descriptions and funding levels) are available in SAMHSA's FY2017 budget request.

Example: Pregnant and Postpartum Women

The Pregnant and Postpartum Women program supports residential substance use disorder treatment services for pregnant and postpartum women. The program takes a family-centered approach that includes services for the women's children and other family members. In addition to grants and contracts supporting prevention, treatment, and recovery support services, the program also supports the development and dissemination of curriculum materials to expand the use of the family-centered model beyond the program. SAMHSA funds an ongoing evaluation of the program.

Substance Abuse Prevention PRNS

PHSA Section 516 authorizes the substance abuse prevention PRNS. Both the authorization of appropriations in PHSA Section 516 and the explicit authorizations of appropriations for specific grants and activities categorized as substance abuse prevention PRNS have expired. Since that time, some substance abuse prevention PRNS programs have continued to operate under their general authorities and have continued to receive funding through the annual appropriations process. Table 4 lists current (FY2016) grants and activities categorized as substance abuse prevention PRNS; additional details (e.g., program descriptions and funding) are available in SAMHSA's FY2017 budget request.

Example: Drug-Free Workplace and National Laboratory Certification

As an example of substance abuse prevention PRNS, SAMHSA provides oversight of the Federal Drug-Free Workplace Program and the related National Laboratory Certification Program. The Federal Drug-Free Workplace Program aims to eliminate illegal drug use (and prescription drug misuse) in executive branch agencies and federally regulated industries by ensuring that employees are tested. The National Laboratory Certification Program inspects and certifies the laboratories that conduct drug tests for executive branch agencies and federally regulated industries. Federally regulated industries include organizations receiving federal grants and organizations with federal contracts of $100,000 or more.

Other Grant Programs

In addition to its block grants and numerous discretionary grants under the PRNS authorities, SAMHSA has three other grant programs: Children's Mental Health Services, Projects for Assistance in Transition from Homelessness (PATH), and Protection and Advocacy for Individuals with Mental Illness (PAIMI).

Children's Mental Health Services

The Children's Mental Health Services program supports services for children and youth with serious emotional disturbance (SED). In recent years, SAMHSA has awarded competitive grants to help states, local governments, tribes, and territories develop and implement systems of care; cooperative agreements to sustain and expand systems of care; and contracts to provide technical assistance and conduct evaluations. The systems of care approach focuses on delivering evidence-based interventions in the least restrictive setting.

PHSA Title V, Part E authorizes the Children's Mental Health Services program. PHSA Section 565 explicitly authorizes appropriations for the program through FY2003. Since that time, the program has continued to operate under its general authorities and has continued to receive funding through the annual appropriations process.

Projects for Assistance in Transition from Homelessness (PATH)

The Projects for Assistance in Transition from Homelessness (PATH) program supports services for people with serious mental illness (including those with co-occurring substance use disorders) who are homeless or at imminent risk of becoming homeless. The PATH program distributes funds to states (including the District of Columbia and specified territories) according to a formula. The states, in turn, make grants to local governments and private non-profit organizations to support mental health and substance abuse treatment, case management, and other services. Up to 20% of the federal payments may be used for housing-related assistance. All services provided using PATH funding must be consistent with (and included in) the state's comprehensive mental health services plan (as required for participation in the mental health block grant).

Each state's allotment is based on its population living in urbanized areas (as a percentage of the total U.S. population living in urbanized areas). A minimum allotment for each state is prescribed in statute (with exceptions for specified territories). States must provide matching funds of at least $1 for every $3 of federal funds.

PHSA Title V, Part C authorizes the Projects for Assistance in Transition from Homelessness (PATH) program . PHSA Section 535 explicitly authorizes appropriations for the PATH program through FY2003. Since that time, the program has continued to operate under its general authorities and has continued to receive funding through the annual appropriations process.

Protection and Advocacy for Individuals with Mental Illness (PAIMI)

The Protection and Advocacy for Individuals with Mental Illness (PAIMI) program supports state-designated protection and advocacy (P&A) systems mandated to protect individuals with mental illness residing in care or treatment facilities from abuse, neglect, and violations of their civil rights. The PAIMI program distributes funds to P&A systems in the states (including the District of Columbia and specified territories) and the American Indian Consortium according to a formula.

Unlike SAMHSA's other formula grants, for which formulae are prescribed in statute, PAIMI's formula is prescribed by the HHS Secretary, subject to statutory requirements. Specifically, it must be based equally on (1) each state's population and (2) each state's population weighted by per capita income relative to the United States. A minimum allotment for each state is prescribed in statute. Exceptions to components of the formula and minimum allotment calculation are made for specified territories and the American Indian Consortium.

State P&A systems were established under the Developmental Disabilities Assistance Act of 1975. The PAIMI Act of 1986 (as amended) authorizes the formula grant to support P&A systems in serving the mentally ill. Section 10827 of the PAIMI Act explicitly authorizes appropriations for the PAIMI program through FY2003. Since that time, the program has continued to operate under its general authorities and has continued to receive funding through the annual appropriations process.

Data Collection and Related Activities

In addition to the activities described above, SAMHSA collects data and conducts related activities, such as the following:

S urveillance and data collection : for example, the National Survey of Drug Use and Health (NSDUH), an annual household survey of drug use and other health information among the U.S. population aged 12 or older. S tatistical and analytic support : for example, the Substance Abuse and Mental Health Data Archive (SAMHDA), a repository for public access data files that provides public access and online analysis. P erformance and quality information systems activities : for example, the National Registry of Evidence-based Programs and Practices (NREPP), a searchable database of mental health and substance abuse programs supported by research findings. A gency-wide initiatives : for example, SAMHSA's collaboration with the Health Resources and Services Administration (HRSA) to develop consistent methods of identifying and tracking behavioral health workforce needs.

PHSA Section 505 requires the HHS Secretary, acting through the SAMHSA Administrator, to collect data on various topics; specific requirements include conducting annual surveys and making summaries and analyses available to the public. PHSA Title V includes numerous other references to collecting and disseminating data, embedded within larger programs. Under PHSA Title XIX, both block grant programs also require some data collection and evaluation activities.

SAMHSA's Organizational Structure

SAMHSA is organized in four centers supported by headquarters offices, regional administrators, and advisory councils and committees. SAMHSA estimates that it will support 665 full-time employee equivalents in FY2016 and FY2017. Most FTEs (more than 500) are attributed to a category in SAMHSA's budget that does not correspond to a specific center or office.

Centers

SAMHSA carries out most of its programs and activities through three statutorily established centers focusing on mental health services, substance abuse treatment, and substance abuse prevention. SAMHSA's fourth center—which is not explicitly established in statute—focuses on activities such as collecting data and providing analytic support.

Center for Mental Health Services (CMHS)

The Center for Mental Health Services (CMHS) has primary responsibility for promoting prevention and treatment of serious mental illness (SMI) among adults and serious emotional disturbance (SED) among children. CMHS is responsible for leading efforts to increase access to mental health services and improve their quality.

PHSA Title V, Part B, Subpart 3 establishes CMHS, lists the Director's duties, and authorizes various programs. The CSAT Director's duties include administering the Community Mental Health Services Block Grant (MHBG), the Projects for Assistance in Transition from Homelessness (PATH) program, and the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program. PHSA Section 561 requires the HHS Secretary, acting through the CMHS Director, to award grants under the Children's Mental Health Services program. Currently all other CMHS programs fall under the category of mental health PRNS.

Center for Substance Abuse Treatment (CSAT)

The Center for Substance Abuse Treatment (CSAT) has primary responsibility for promoting community-based treatment and recovery services for individuals with substance use disorders. CSAT is responsible for leading efforts to increase access and decrease barriers to effective treatment; closing the gap between demand and capacity for treatment; promoting evidence-based practices; and strengthening treatment systems (among other responsibilities).

PHSA Title V, Part B, Subpart 1 establishes CSAT, lists the Director's duties, and authorizes various programs. The CSAT Director's duties include administering the Substance Abuse Prevention and Treatment Block Grant. Currently all of CSAT's other programs and activities fall under the category of substance abuse treatment PRNS.

Center for Substance Abuse Prevention (CSAP)

The Center for Substance Abuse Prevention (CSAP) has primary responsibility for preventing misuse (and underage use) of alcohol, tobacco, prescription drugs, and illegal drugs. CSAP is responsible for leading the development of effective prevention policies, programs, and services, and enabling states, local communities, and organizations to adopt such policies, programs, and services (among other responsibilities).

PHSA Title V, Part B, Subpart 2 establishes CSAP, lists the Director's duties, and authorizes various programs. Currently all of CSAP's programs and activities fall under the category of substance abuse prevention PRNS. CSAP works with CSAT to administer the Substance Abuse Prevention and Treatment Block Grant (SABG), which includes a 20% set-aside for prevention.

Center for Behavioral Health Statistics and Quality (CBHSQ)

The Center for Behavioral Health Statistics and Quality (CBHSQ) has primary responsibility for collecting and analyzing behavioral health statistics. It is one of three units within executive agencies that have statistical work as their principal mission. CBHSQ is responsible for designing and implementing data collection and analysis projects, advising the SAMHSA Administrator and the HHS Secretary on behavioral health statistics, and working with other agencies to develop federal health statistics policy (among other responsibilities).

Unlike SAMHSA's other centers, CBHSQ is not explicitly established in statute; however, some of its activities are explicitly authorized (albeit without explicit authorizations of appropriations). For example, PHSA Section 505 requires the HHS Secretary, acting through the SAMHSA Administrator, to collect specified data relevant to mental illness and substance abuse.

CBHSQ's data collection programs include the National Survey on Drug Use and Health (NSDUH) and the Behavioral Health Services Information System (BHSIS), among others. CBHSQ maintains a data archive and conducts research on behavioral health access, cost, quality, outcomes, policy, and practices. CBHSQ also maintains the National Registry of Evidence-based Programs and Practices (NREPP). CBHSQ is responsible for agency-wide initiatives such as efforts to develop the behavioral health workforce.

Headquarters Offices

Key offices within SAMHSA's headquarters are described briefly below.

The Office of the Administrator is responsible for managing and directing the agency, leading policy and program development, and working with the Office of the Secretary in HHS (among other responsibilities).

The Office of Policy, Planning, and Innovation is responsible for determining the approach to identify and adopt policies and practices that improve outcomes of behavioral health services; collaborating with other agencies to facilitate adoption of data-driven policies and practices; and responding to requests under the Freedom of Information Act (among other responsibilities).

The Office of Behavioral Health Equity is responsible for coordinating SAMHSA's efforts to ensure equitable access to high-quality behavioral health care and to reduce disparities in health outcomes; strategically focusing investments in underserved populations; and supporting behavioral health workforce development (among other responsibilities).

The Office of Tribal Affairs and Policy is responsible for supporting agency efforts to implement the Tribal Law and Order Act of 2010 (Title II of P.L. 111-211 ) and working on behavioral health issues affecting tribal communities in collaboration with tribal governments, tribal organizations, other SAMHSA offices and centers, and other federal agencies (among other responsibilities).

The Office of Communications is responsible for guiding the agency's strategic communications plan, managing its online presence, interacting with the media, and consulting with other centers and offices on outreach and engagement strategies (among other responsibilities).

The Office of Financial Resources is responsible for all functions of the Chief Financial Officer, including advising the SAMHSA Administrator on alignment between legislation, agency policies, and the agency's budget, financial management, and program priorities; providing the financial, cost, and performance information necessary to manage programs; reducing waste, fraud, and abuse; and improving asset management (among other responsibilities).

The Office of Management, Technology, and Operations is responsible for administrative services, human resources management, and information technology (among other responsibilities).

Regional Administrators

HHS has 10 regional offices to ensure that "the Department maintains close contact with state, local, and tribal partners and addresses the needs of communities and individuals served through HHS programs and policies." SAMHSA's regional administrators represent SAMHSA within their regions; promote behavioral health initiatives; collaborate with other federal agencies; provide support (e.g., technical assistance) to stakeholders; and periodically report on relevant trends, issues, and policies.

Advisory Councils and Committees

To help draw advice from mental health and substance abuse professionals and members of the public, SAMHSA has several advisory councils and committees:

SAMHSA National Advisory Council CMHS National Advisory Council CSAT National Advisory Council CSAP National Advisory Council Drug Testing Advisory Board Advisory Committee for Women's Services Tribal Technical Advisory Committee

PHSA Sections 501 and 222 (respectively) require the SAMHSA Administrator to "establish such peer review groups and program advisory committees as are needed" and allow the HHS Secretary to "appoint such advisory councils or committees ... as [she] deems desirable ... for the purpose of advising [her] in connection with any of [her] functions."

Some of the advisory councils and committees are explicitly required in statute. PHSA Section 502 requires the HHS Secretary to appoint an advisory council for SAMHSA and each of its three statutorily established centers (CMHS, CSAT, and CSAP). PHSA Section 501 requires the SAMHSA Administrator to appoint an Associate Administrator for Women's Services, who must establish an Advisory Committee for Women's Services.

HHS has a Tribal Consultation Policy, under which each division within HHS (including SAMHSA) must have "an accountable consultation process to ensure meaningful and timely input by Tribal officials in the development of policies that have Tribal implications" (among other requirements). SAMHSA's Tribal Technical Advisory Committee is also consistent with a 2000 executive order and a 2004 presidential memorandum.

Appendix. Budget Overview

SAMHSA's budget and appropriations fall under four categories: (1) mental health, (2) substance abuse treatment, (3) substance abuse prevention, and (4) health surveillance and program support. The first three of these categories correspond to SAMHSA's three statutorily established centers; however, the fourth category does not correspond to the remaining center. CBHSQ ($120 million in FY2016) does not appear as a line item in SAMHSA's budget; it is funded by a set-aside in the SABG, a portion of the appropriation for health surveillance and program support, transfers from the PHS Evaluation Tap (described below), and transfers from the Prevention and Public Health Fund (described below).

The following is excerpted from CRS Report R44375, SAMHSA FY2017 Budget Request and Funding History: A Fact Sheet .

Funding Sources

The total amount of funding available to SAMHSA (i.e., total program level) traditionally includes discretionary budget authority provided in annual appropriations acts, Public Health Service (PHS) Program Evaluation Set-Aside funds, Prevention and Public Health Fund (PPHF) transfers, and data request and publications user fees. Also, SAMHSA's FY2017 budget request proposes new mandatory spending that, if enacted, would be in addition to the budgetary resources described below.

Discretionary Budget Authority . The main source of funding for SAMHSA is the discretionary budget authority it receives through the annual appropriations process. SAMHSA is funded through the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor-HHS-ED) appropriations act.

PHS Program Evaluation Set-Aside Funds . The PHS Evaluation Tap allows the HHS Secretary to redistribute a portion of eligible PHS agency appropriations for program evaluation across HHS. In the annual Labor-HHS-ED appropriations acts, Congress specifies the maximum percentage for the set-aside and directs specific amounts of funding from the tap to a number of HHS programs.

Prevention and Public Health Fund (PPHF) Transfers . The Patient Protection and Affordable Care Act (ACA) established the Prevention and Public Health Fund (PPHF) and provided it with a permanent annual mandatory appropriation. PPHF funds are to be transferred by the HHS Secretary for prevention, wellness, and public health activities. PPHF funds are available to the HHS Secretary on October 1 of each year, when the new fiscal year begins. The Administration's annual budget proposal for the PPHF reflects its intended distribution and use of the funds.

Data Request and Publications User Fees . The Consolidated Appropriations Act, 2014 ( P.L. 113-76 ), authorized SAMHSA to collect fees "for the costs of publications, data, data tabulations, and data analysis completed under [PHSA Title V] and provided to a public or private entity upon request, which shall be credited to this appropriation and shall remain available until expended for such purposes."

FY2017 Budget Request and Funding History

Table A-1 presents SAMHSA's FY2017 budget request in the context of SAMHSA's funding history since FY2014. Program-level funding is shown in bold for each major budget account. PHS evaluation funds, PPHF transfers, and one of the proposed new mandatory spending programs are shown as "non-adds" in parentheses. All three proposed new mandatory spending programs, PHS evaluation funds, PPHF transfers, and user fees are subtracted from program-level funding to show discretionary budget authority.