The Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services (HHS), is the lead federal agency for increasing access to behavioral health services. SAMHSA funds community-based mental health and substance abuse treatment and prevention services and collects information on the incidence and prevalence of mental illness and substance abuse at the national and state level. These activities support SAMHSA's mission to improve the lives of people with substance abuse disorders and mental illnesses. SAMHSA funds mental health and substance abuse services through formula and competitive grants. SAMHSA provides formula funding to states, U.S. territories, and the Red Lake Indian tribe, while competitive funding is awarded through numerous grant programs to states, territories, tribal organizations, local communities, and private entities. Under SAMHSA's charitable choice provisions, religious organizations are eligible to receive funding in order to provide substance abuse services without altering their religious character. SAMHSA's two largest programs are the $1.8 billion Substance Abuse Prevention and Treatment (SAPT) block grant and the $421 million Community Mental Health Services (CMHS) block grant, which account for more than 60% of the agency's budget in FY2010. The SAPT block grant provides approximately 40% of the expenses of state agencies responsible for substance abuse prevention and treatment services. By comparison, the CMHS block grant funds on average 2% of the expenses of state mental health agencies. The difference reflects the historical role federal and state governments have played in funding services in these two areas, with states providing a much larger portion of mental health funding than substance abuse funding. SAMHSA also collects data on mental health and substance abuse at the national and state level. These data provide information on the incidence and prevalence of mental illness and substance abuse, the availability and utilization of treatment services, and the outcomes of mental health and substance abuse prevention and treatment services. SAMHSA uses this information to monitor mental health and substance abuse trends and to help determine how resources should be directed. In addition, performance and outcome data are used to measure the impact of programs and interventions. This report provides an overview of SAMHSA's organization and programs and includes some analysis of the agency's funding over the past decade. It also highlights some of the issues that may be addressed by Congress when it next considers legislation to reauthorize SAMHSA and its programs. SAMHSA was last reauthorized in 2000. Authorizations of appropriations for most of SAMHSA's grant programs expired at the end of FY2003, though many of them continue to receive funding. Comprehensive reauthorization of SAMHSA was discussed during the 110 th Congress, and reauthorizing legislation was introduced in the 111 th Congress. Possible reauthorization issues include increased performance measurement and accountability for SAMHSA grants, granting specific authority for the Access to Recovery program, improving the ability of communities to provide behavioral health services during disaster response, requiring collaboration between SAMHSA and other federal agencies, increasing SAMHSA's level of emphasis on primary prevention, increasing SAMHSA's role in expanding the number and diversity of the behavioral health provider workforce, and ensuring fairness of the formula used to distribute SAMHSA's block grants. This report will be updated as warranted by legislative and other developments. SAMHSA and most of its programs and activities are authorized under Title V of the Public Health Service Act (PHSA). The SAPT and CMHS block grants are separately authorized under PHSA Title XIX Part B. SAMHSA has authority to administer several specific formula and competitive grant programs to support mental health and substance abuse prevention and treatment services, as well as general authorities for activities in these areas. Appropriations for the agency were reauthorized in 2000, as part of the Children's Health Act. The act amended SAMHSA's existing authorities under Title V, added several new authorities, and authorized appropriations through FY2003. Congress has not taken up comprehensive reauthorization legislation since 2000, though it has added some new authorities to Title V and otherwise expanded the agency's programs and activities (see " New Authorizations Since 2000 " below). PHSA Title V authorizes SAMHSA programs under three centers: the Center for Mental Health Services (CMHS), the Center for Substance Abuse Treatment (CSAT), and the Center for Substance Abuse Prevention (CSAP). The PHSA also directs SAMHSA to conduct data collection and analysis activities related to mental health and substance abuse. These activities are centrally coordinated in the Center for Behavioral Health Statistics and Quality. SAMHSA funds competitive and formula grant programs. While the majority of SAMHSA programs provide funding through a competitive grant process, together these programs account for only one-third of the agency's budget. The five formula grants—primarily the two block grants—account for the other two-thirds of SAMHSA's budget. This mix of funding provides flexibility at both the federal and state levels. The formula block grants allow states the flexibility to allocate funding to address specific issues and populations within their jurisdictions, but they do not allow funding levels to be easily adjusted based on changing levels of need due to fixed statutory funding formulas (see " Block Grant Formula " below). By comparison, competitive grant programs are generally issue-specific. These grants allow SAMHSA to allocate funding for a particular issue, such as suicide prevention, to areas and populations with the greatest need. Title V authorizes numerous competitive grant programs, some, but not all, of which receive funding through the annual appropriations process. For instance, Early Intervention Services for Children and Adolescents and Grants for Emergency Mental Health Centers have never received funds. In addition to the grant programs with specific statutory authority, which are often referred to as categorical grants, each center also has general authority, called Programs of Regional and National Significance (PRNS), to fund states and communities to address priority substance abuse and mental health needs. PRNS authorizes the center to fund projects that (1) translate promising new research findings to community-based prevention and treatment services; (2) provide training and technical assistance; and (3) target resources to increase service capacity where it is most needed. Each center funds several grant programs that were created under its general (i.e., PRNS) authority. Examples of such PRNS programs include the Access to Recovery program and the Strategic Prevention Framework, described below. Most SAMHSA programs are administered by one of the three centers and focus on mental health, substance abuse prevention, or substance abuse treatment. This structure encourages the development of programs that fit within a center, and can make it more difficult to implement programs that focus on both mental health and substance abuse. Several cross-cutting programs receive support separately from all three centers, including the National Registry of Evidence-based Programs and Practices, the SAMHSA Health Information Network, the Minority AIDS Program, and the Minority Fellowship Program. To better address cross-cutting issues, SAMHSA has also created connections between centers for programs with both mental health and substance abuse components. For instance, the co-occurring state incentive grant, which supports improvements to infrastructure and capacity for treating individuals with both mental health and substance abuse conditions, is administered by both CMHS and CSAT. A brief description of each center follows, including a list of significant programs. As noted above, some programs are specifically authorized, and others are created and funded under the general PRNS authority. Table A -1 in Appendix A at the end of the report includes a description of SAMHSA's program authorities—including current funding and appropriations history—within each of SAMHSA's centers. In addition, Appendix C includes links to SAMHSA websites with additional information on the agency's centers, programs, and grants. CSAT is authorized to develop, evaluate, and implement effective substance abuse treatment programs, and to improve the quality of services and access to services. CSAT administers the formula-based SAPT block grant, as well as a much smaller formula grant for prescription drug monitoring. The center also administers several competitive grant programs that focus on treatment and recovery support services, homeless individuals, early detection, and criminal justice populations. Included below are brief descriptions of significant programs within CSAT that account for most of the center's funding. See Table A -1 for a full list of authorized programs and funding within CSAT. Substance Abuse Prevention and Treatment Block Grant : Formula grants to states to plan, carry out, and evaluate activities to prevent and treat substance abuse. Access to Recovery (ATR) : Grants to states and tribal organizations to evaluate individuals with substance abuse issues and provide vouchers for treatment and recovery support services that can be redeemed with approved providers. This program is discussed below in the " Access to Recovery " section. Screening, Brief Intervention, and Referral to Treatment (SBIRT) : Grants to states and tribal organizations to integrate substance abuse screening, brief intervention, referral, and treatment services within general medical and primary care settings in order to identify individuals with or at risk for a substance abuse disorder. Treatment Drug Courts : Grants to adult, juvenile, and family drug courts and providers to fund substance abuse treatment, assessment, case management, and program coordination for those referred by the drug courts. Grants for the Benefit of Homeless Individuals: Grants to organizations to provide services for homeless individuals with a substance use disorder or who have co-occurring substance abuse and mental health disorders. Minority AIDS: Grants to community-based organizations to provide substance abuse treatment and related HIV/AIDS services targeting high-risk substance abusing populations. Targeted Capacity Expansion : Grants to states, local governments, and tribal entities to expand or enhance a community's ability to respond to a specific, well-documented substance abuse capacity problem. CSAP is authorized to support efforts to prevent substance abuse through public education, training, technical assistance, and data collection.