Substance Abuse and Mental Health Services Administration (SAMHSA): Reauthorization Issues

Substance Abuse and Mental Health Services Administration (SAMHSA): Reauthorization Issues

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SAMHSA is the federal agency that provides federal funds for community-based substance abuse
and mental health services. SAMHSA awards discretionary funds to substance abuse and mental
health programs through its authorities in Title V of the Public Health Service (PHS) Act. In
addition, SAMHSA provides formula-based Substance Abuse Prevention and Treatment (SAPT)
block grants and Mental Health (MH) block grants through its authorities in Title XIX of the PHS
Act. SAMHSA has had level funding at approximately $3 billion since it was last reauthorized in
2000. Most of SAMHSA’s authorities expired at the end of FY2003.
The 2000 reauthorization (P.L. 106-310) focused on improving mental health and substance abuse
services for children and adolescents, implementing proposals to give states more flexibility in
the use of block grant funds with accountability based on performance, and consolidating
discretionary grant authorities to give the Secretary of the Department of Health and Human
Services (HHS) more flexibility to respond to those who require mental health and substance
abuse services. The legislation provided a waiver from the requirements of the Narcotic Addict
Treatment Act of 1974 to permit qualified physicians to dispense schedule III, IV, or V narcotic
drugs or combinations of such drugs approved by Food and Drug Administration (FDA) for the
treatment of heroin addiction, and provided a comprehensive strategy to combat
methamphetamine use.
SAMHSA has had three new authorizations since 2000. The Sober Truth on Preventing Underage
Drinking Act of 2005 (P.L. 109-422) requires SAMHSA to collaborate with other federal agencies
to prevent alcohol use by minors. The Garrett Lee Smith Memorial Act of 2004 (P.L. 108-355)
enables SAMHSA to support youth suicide prevention activities in states and on college
campuses. The No Child Left Behind Act of 2002 (P.L. 107-110) requires SAMHSA to consult
with the Secretary of the Department of Education on the soliciting and awarding of grants
through this program.
As SAMHSA reauthorization is considered, issues that may be of interest include accountability
for the block grants, flexibility for SAMHSA to issue grants using its general authority, the
Access To Recovery Program, and SAMHSA’s role in disaster response. In addition, there have
been some criticisms of the formula used to distribute SAMHSA’s block grants.
This report describes SAMHSA’s history, organization, authority, and programs, and analyzes the
issues that may be considered if the 110th Congress takes up the agency’s reauthorization. The
Appendixes include a list of relevant websites, the National Outcome Measures, and a table that
shows authority and appropriations for SAMHSA’s various programs since 2004.

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Background and History.................................................................................................................. 1
Organization and Funding ............................................................................................................... 2
Center for Mental Health Services (CMHS) ............................................................................. 2
Center for Substance Abuse Treatment (CSAT)........................................................................ 2
Center for Substance Abuse Prevention (CSAP) ...................................................................... 2
Priorities Matrix ........................................................................................................................ 4
Reauthorization Issues in 2000........................................................................................................ 4
Authorizations Since FY2000 ......................................................................................................... 5
The Sober Truth on Preventing Underage Drinking Act of 2005.............................................. 5
The Garrett Lee Smith Memorial Act of 2004 .......................................................................... 6
The No Child Left Behind Act of 2002..................................................................................... 6
Current Reauthorization Issues........................................................................................................ 6
Accountability for SAMHSA Grants ........................................................................................ 6
Flexible Use of Funds ............................................................................................................... 6
Access To Recovery (ATR)....................................................................................................... 7
Disaster Response ..................................................................................................................... 7
Collaboration with Other Federal Agencies .............................................................................. 7
Focus on Prevention and Early Intervention ............................................................................. 8
Block Grants Formula ............................................................................................................... 8
History ................................................................................................................................ 8
Current Formula.................................................................................................................. 9
Issues Regarding Current Formula ................................................................................... 10

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Figure 1. SAMHSA Funding FY2000-FY2007 .............................................................................. 3

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Table 1. SAMHSA Funding, FY2000-FY2008 ............................................................................... 3

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Appendix A. Program Descriptions for Authorized SAMHSA Sections .......................................11
Appendix B. SAMHSA Authorization and Appropriation Levels (FY2004-FY2008) ................ 14
Appendix C. SAMHSA Matrix of Priorities ................................................................................. 18
Appendix D. SAMHSA National Outcome Measures .................................................................. 19
Appendix E. Useful SAMHSA Resources .................................................................................... 20

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Author Contact Information .......................................................................................................... 20

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The Substance Abuse and Mental Health Services Administration (SAMHSA) is the federal
agency, located within the Department of Health and Human Services (HHS), that funds mental
health and substance abuse treatment and prevention services. SAMHSA provides federal support
for these services by administering two block grants (one for substance abuse prevention and
treatment services, the other for mental health services), two other formula grants, and
discretionary grants to local communities, states, and private entities to address the public health
issues of substance abuse and mental illness. SAMHSA funds a wide range of activities including
strategic planning, education and training, prevention programs, early intervention, and treatment
services. SAMHSA’s Substance Abuse Prevention and Treatment (SAPT) block grant provides an
average of 42% of the expenses of the state agency responsible for substance abuse. By
comparison, SAMHSA’s Community Mental Health Services (CMHS) block grant funds only an
average of 2-3% of the expenses for the state mental health agency.1 The difference reflects the
historical role federal and state governments have played in funding services in these two areas.
In 1946 Congress established the National Institute of Mental Health (NIMH), in growing
recognition of the extraordinary burden that disorders of brain and behavior place on national
health resources. Congress, after determining that a strong program of research and research
training would contribute most directly to improving mental health and to treating mental illness,
alcoholism, and drug abuse, established NIMH as one of the original components of the National
Institutes of Health (NIH). In addition to research, the new institute’s mission included programs
for educating and training clinical personnel and for providing leadership to enhance the quality
of treatment services.
In the early 1970s, increasing awareness of the public health problems of alcohol abuse and
alcoholism led to the founding of the National Institute on Alcohol Abuse and Alcoholism
(NIAAA) from what had been NIMH’s alcohol division; a similar event occurred in the field of
drug abuse with the founding of the National Institute on Drug Abuse (NIDA). In 1974, the
Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) was created as the parent
agency for the three research agencies, NIMH, NIAAA and NIDA, and to provide federal funding
to states for substance abuse and mental health treatment services.
In 1992, the ADAMHA Reorganization Act (P.L. 102-321) moved the three research institutes—
NIMH, NIDA and NIAAA—to NIH. ADAMHA was renamed SAMHSA to reflect its focus on
funding community-based services. SAMHSA is authorized under Title V of the Public Health
Service (PHS) Act, as amended. The SAPT and CMHS block grants are authorized under the PHS
Act Title XIX Part B. In 2000, most of SAMHSA’s authorities were reauthorized through
FY2003.2
This report describes SAMHSA’s history, organization, authority, and programs, and analyzes the
issues that may be considered if the 110th Congress takes up the agency’s reauthorization. This
report will be updated as necessary.

1 SAMHSA, Office of Legislative Affairs, May 7, 2007.
2 P.L. 106-310.
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In FY2008, SAMHSA employed 534 full-time employees and had a budget of nearly $3.4 billion.
SAMHSA is composed of three centers of operation, as described below. Each center has a
director who reports to SAMHSA’s Administrator. Each center has general authority to fund states
and communities to address priority substance abuse and mental health needs. This authority,
called Programs of Regional and National Significance (PRNS), authorizes SAMHSA 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. SAMHSA determines its funding priorities in
consultation with states and other stakeholders. For a list of specific programs authorities within
each of SAMHSA’s centers, see Appendix A.
Ž—?Ž›ȱ?˜›ȱŽ—?Š•ȱ ŽŠ•?‘ȱŽ›Ÿ’ŒŽœȱǻ Ǽȱ
CMHS supports mental health services provided by the states and local governments through its
mental health block grant and discretionary grant programs. CMHS is authorized to prevent
mental illness and promote mental health by providing funds to evaluate, improve and implement
effective treatment practices, address violence among children, provide technical assistance to
state and local mental health agencies, and collect data.
Ž—?Ž›ȱ?˜›ȱž‹œ?Š—ŒŽȱ‹žœŽȱ›ŽŠ?–Ž—?ȱǻǼȱ
CSAT administers the SAPT block grant and other programs of regional and national
significance. CSAT is authorized to develop, evaluate and implement effective treatment
programs; and enable improvement of service quality and access.
Ž—?Ž›ȱ?˜›ȱž‹œ?Š—ŒŽȱ‹žœŽȱ›ŽŸŽ—?’˜—ȱǻǼȱ
CSAP supports programs of regional and national significance for substance abuse prevention.
CSAP is authorized to prevent substance abuse through public education, training, technical
assistance, and data collection. This center also provides states with grants to support their
strategic planning activities and maintains a registry of evidence-based practices for substance
abuse prevention.
SAMHSA’s budget has been fairly level since the agency was reauthorized in 2000. As shown in
Table 1, the dollar amounts have been fairly constant since FY2002.
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Table 1. SAMHSA Funding, FY2000-FY2008
(dollars in millions)

FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08
CMHS 631 782 832 856 862 901 883 883 911
CSAP 479 175 198 197 198 198 192 192 194
CSAT 1,814 1,921 2,016 2,071 2,198 2,197 2,156 2,157 2,159
Total 2,651 2,966 3,141 3,137 3,233 3,334 3,322 3,326 3,356
Source: SAMHSA budget justifications.
If SAMHSA’s appropriation levels are adjusted for inflation, there has been a net decrease in
funding available for substance abuse and mental health services. For example, SAMHSA’s
FY2000 budget of $2.651 billion is equivalent to $3.417 billion for FY2007. Actual FY2007
appropriation was only $3.326 billion. This is illustrated in Figure 1, which shows a downward
trend in the real dollar value of SAMHSA’s total appropriations between FY2000 and FY2007.
Appendix B includes the authorization and appropriation levels for major SAMHSA programs.
Figure 1. SAMHSA Funding FY2000-FY2007

Source: Prepared by CRS using SAMHSA budget justifications.
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In April 2006, SAMHSA published a matrix3 that listed the mental health and substance abuse
issues addressed by the agency, along with the cross-cutting principles SAMHSA applies to each
issue area (See Appendix C).
SAMHSA has identified a number of priority areas; typically these are policy issues that cut
across the work of its three centers. The priority issue areas include individual health concerns
like co-occuring mental health and substance abuse disorders, suicide, behavioral health issues for
individuals with hepatitis and HIV/AIDS; societal issues like homelessness, and criminal justice;
and systems-level issues like treatment capacity and workforce development. In addition,
SAMHSA has identified principles to guide program, policy and resource allocation within the
agency. These principles include use of evidence-based practices, evaluation, collaboration,
cultural competence, stigma reduction, and cost-effectiveness. The matrix illustrates, for example,
that SAMHSA aims to address the issue of co-occurring disorders using each of the cross-cutting
principles including evidence-based practices, surveillance, and collaboration.
SAMHSA does not formally require its grantees to apply each of these cross-cutting principles to
their work. Instead, SAMHSA requires grantees to submit data using the indicators identified
through the National Outcome Measures, as described later in this report. There is no crosswalk
between the National Outcome Measures and the cross-cutting principles in this matrix.
ŽŠž?‘˜›’£Š?’˜—ȱ œœžŽœȱ’—ȱŘŖŖŖȱ
SAMHSA was last authorized in 2000, as part of the Children’s Health Act.4 At the time of that
reauthorization, most of the agency’s programs were extended for three years, through FY2003,
and the block grant funding formula was not modified. A discussion of issues surrounding the
block grant formula, which has not changed since 1992, is presented later in this report.
The 2000 reauthorization focused on improving mental health and substance abuse services for
children and adolescents, implementing proposals to give states more flexibility in the use of
block grant funds, and replacing some existing categorical grant programs with general authority
to give the Secretary of HHS more flexibility to respond to those who require mental health and
substance abuse services.
Provisions in the 2000 reauthorization that related to children and adolescents authorized
programs to address emergency response, treatment services, and other comprehensive
community-based services for youth at risk due to violence, substance abuse, or mental illness.
Other provisions addressed the issue of homeless individuals with substance abuse and/or mental
illness. Additionally, SAMHSA was required to issue regulations on use of restraint and seclusion
within residential non-medical facilities.5 These facilities were required to report deaths occurring
as a result of use of restraint (restricting the movement of a person’s limbs, head or body by the
use of mechanical or physical devices for the purpose of preventing injury to self or others) and

3 SAMHSA, Matrix of Priorities, April 2006 at http://www.samhsa.gov/Matrix/ Matrix_Brochure_2006.pdf.
4 P.L. 106-310, Titles XXXI - XXXIV.
5 42 CFR 483 Subpart G (2003).
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seclusion (isolation and containment of residents who pose an imminent threat of physical harm
to themselves or others) to the Secretary of HHS within 24 hours of the death. Finally, provisions
relating to methamphetamine abuse included criminal penalties, enhanced law enforcement, and
programs for abuse prevention and treatment.
The 2000 reauthorization legislation also included two additional titles.6 The first title permitted
qualified physicians to treat heroin addicts in the doctor’s offices using drugs approved by the
Food and Drug Administration (FDA), and the second title provided a comprehensive strategy to
combat methamphetamine abuse.
As part of the 2000 reauthorization, SAMHSA was required to produce two reports to Congress.
The first report was on the efforts of the agency and the states to provide coordinated services to
individuals who have co-occuring substance abuse and mental health problems. In this report,
which was produced in 2002, SAMHSA summarized the prevention and treatment practices for
people with co-occurring disorders, and provided a plan for improving services for these people.7
The second report discusses the flexibility and performance of its block grants and accountability
measures. This report, which SAMHSA delivered in 2005, detailed the flexibility given to states,
defined the common performance measures to be used for state accountability, outlined an
implementation strategy, and discussed possible obstacles to implementing the performance
measures.8 A discussion of the performance measures is included in this report under the section
on current reauthorization issues.
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There have been few modifications of SAMHSA’s authority since the 2000 reauthorization. The
three major laws passed since then that involve SAMHSA are described below.
‘Žȱ˜‹Ž›ȱ›ž?‘ȱ˜—ȱ›ŽŸŽ—?’—?ȱ—?Ž›Š?Žȱ›’—”’—?ȱŒ?ȱ˜?ȱŘŖŖśşȱ
SAMHSA is required to participate in the Interagency Coordinating Committee on the Prevention
of Underage Drinking. The committee is intended to guide policy and program development
across the federal government, with respect to underage drinking. SAMHSA has been providing
leadership for this committee.10

6 P.L. 106-310, Titles XXXV - XXXVI.
7 SAMHSA, “Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and
Mental Disorders,” Nov 2002, at http://www.samhsa.gov/reports/congress2002/index.html.
8 SAMHSA, A Report Required by Congress on Performance Partnerships: A Discussion of SAMHSA’s Efforts to
Increase Accountability Based on Performance in Its Block Grant Programs by Instituting National Outcome
Measures, September 2005 at http://www.nationaloutcomemeasures.samhsa.gov/./PDF/performance_partnership.pdf.
9 P.L. 109-422.
10 For a discussion of SAMHSA’s role in the prevention of underage drinking, see CRS Report RS22636, Alcohol Use
Among Youth, by Andrew Sommers and Ramya Sundararaman.
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This act authorizes SAMHSA to support the planning, implementation, and evaluation of
organized activities involving statewide youth suicide early intervention and prevention
strategies; to provide grants to institutions of higher education to reduce student mental and
behavioral health problems; to support a national suicide prevention hotline; and to fund a
national technical assistance center for suicide prevention.
‘Žȱ˜ȱ‘’•?ȱŽ??ȱŽ‘’—?ȱŒ?ȱ˜?ȱŘŖŖŘŗŘȱ
This act requires SAMHSA to provide consultation to the Secretary of Education in awarding
grants to local educational agencies for reducing alcohol abuse in secondary schools.
ž››Ž—?ȱŽŠž?‘˜›’£Š?’˜—ȱ œœžŽœȱ
As SAMHSA reauthorization is considered, issues that may be of interest include accountability
for SAMHSA grants, the consequences of increased flexibility for SAMHSA to issue grants using
general authority (PRNS), the Access To Recovery Program, and SAMHSA’s role in disaster
response.
ŒŒ˜ž—?Š‹’•’?¢ȱ?˜›ȱ ȱ ›Š—?œȱ
In order to increase accountability, SAMHSA has identified 10 domains as National Outcome
Measures (NOMs) in collaboration with the states. The indicators for these domains (see
Appendix D) are intended to measure the effectiveness of SAMHSA’s mental health and
substance abuse grants in enabling individuals in need to attain and sustain recovery; build
resilience; and work, learn, and participate fully in their communities. SAMHSA’s 2006 annual
report indicates that between 43 and 47 states report on the different mental health outcomes, and
between 27 and 38 states report on the different substance abuse outcomes.13
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Most of SAMHSA’s substance abuse funding is provided under general authority (PRNS), rather
than being directed toward specific substances of abuse, whether for prevention or treatment. This
gives the agency, in consultation with states, the flexibility to determine the specific problem the
funds will be used to address, such as unique or emerging substance abuse issues in a particular
state. This practice may also make it easier to provide coordinated care for those in need of
multiple substance abuse treatment services. On the other hand, SAMHSA’s use its block grant
funding and PRNS authority to provide grants makes it difficult for Congress to determine how
much funding is used to address specific issues of interest. For example, while there was a line

11 P.L. 108-355.
12 P.L. 107-110, Sec. 4129.
13 SAMHSA, A Message from the Administrator, 2007, at http://www.nationaloutcomemeasures.samhsa.gov/
welcome.asp. The 2006 SAMHSA report highlighting the compiled results of the data submitted by the states is at
http://www.nationaloutcomemeasures.samhsa.gov/./PDF/overview2006.pdf.
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item in SAMHSA’s FY2006 budget providing $3.9 million to address methamphetamine abuse,
no funding was provided specifically for methamphetamine treatment. However, states used some
of their block grant funds, Access To Recovery funds and other grant funds for methamphetamine
treatment. For a list of SAMHSA authorizations and their funding levels, see Appendix B.
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The Access to Recovery (ATR)14 program is an initiative, proposed by President Bush in FY2003,
which provides vouchers to clients for the purchase of substance abuse clinical treatment and
recovery support services. The program has been funded at about $98 million per year since
FY2004. ATR is different from other grant programs funded by SAMHSA in that the state uses
program funds to evaluate the consumer and provide a voucher for the consumer to obtain
treatment services from an approved provider of his or her choice. The first ATR grants were
funded through CSAT in FY2004. SAMHSA expects to evaluate the program with FY2007 funds,
by which time all 15 grantees will have been funded for more than two years. The evaluation is
expected to take three years to complete.
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SAMHSA played a significant role in providing mental health and substance abuse services after
Hurricanes Katrina and Rita. However, experts believe that the current evidence base for effective
treatment and prevention strategies targeting disaster survivors is weak. One approach to
addressing this concern might be requiring a collaborative effort on this issue by SAMHSA and
the National Institute of Mental Health (NIMH).15
˜••Š‹˜›Š?’˜—ȱ ’?‘ȱ?‘Ž›ȱŽ?Ž›Š•ȱ?Ž—Œ’Žœȱ
SAMHSA works closely with the three behavioral health research institutes at NIH (NIDA,
NIMH and NIAAA) to enable promising research findings to be translated into services. While
SAMHSA has expertise in and funds programs in the fields of substance abuse and mental health,
other federal agencies have expertise on and access to populations that are affected by these
problems. The Departments of Education and Justice serve youth, with substance abuse and
mental health problems, who are also the focus of many SAMHSA programs. The Centers for
Disease Control and Prevention’s (CDC) Injury Prevention and Control Program works on
prevention and surveillance in the fields of violence, suicide and mental health. The Indian Health
Service (IHS) serves a population that has significant substance abuse problems, along with
issues of access to mental health care. However, there are few statutory requirements by which
these agencies are required to work closely with SAMHSA. Improved collaboration between
these agencies may be required in order to improve the quality and cost-effectiveness of services
provided by the federal government.

14 Program details available at http://atr.samhsa.gov.
15 For a detailed description of the services provided by SAMHSA and analysis of issues, see CRS Report RL33738,
Gulf Coast Hurricanes: Addressing Survivors’ Mental Health and Substance Abuse Treatment Needs, by Ramya
Sundararaman, Sarah A. Lister, and Erin D. Williams.
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The 1999 Surgeon General’s Report on Mental Health and the 2002 President’s New Freedom
Commission Report framed mental health as a public health issue. The reports advised applying a
public health approach, which would emphasize prevention and early intervention, rather than
focusing on individuals who have become severely ill and expensive to treat. The Commission
recommended a wholesale transformation of the nation’s approach to mental health care
involving consumers and providers, policymakers at all levels of government, and both the public
and private sectors. SAMHSA has funded states to develop plans to reduce system fragmentation
and increase services and support available to people living with mental illness.
•˜Œ”ȱ ›Š—?œȱ˜›–ž•Šȱ
’œ?˜›¢ȱ
The Alcohol, Drug, and Mental Health Services (ADMS) block grant was one of seven block
grants established by the Omnibus Budget Reconciliation Act of 1981 (OBRA).16 This block
grant consolidated several existing categorical grants for substance abuse and community mental
health services in order to provide state and local governments with more flexibility and control
over funding to enhance their ability to meet localized needs, to end duplication of effort in
delivering services, and to enable better coordination. OBRA authorized ADMS block grant funds
for FY1982 through FY1984 in proportion to the historical funding patterns of the original
categorical grants. Due to the resulting inequities among states in per capita funding for substance
abuse and mental health services, OBRA directed HHS to conduct a study that would produce a
formula, considering population and state fiscal capacity, to more equitably distribute funds
among states.
The 1984 ADAMHA Amendments renewed the block grants for three years with a “minor equity
adjustment” that would hold harmless states that would have otherwise received decreased
funding under the new calculation.17 Funds above the FY1984 hold-harmless level18 were to be
allocated using a formula based equally on state population and relative per capita income. The
Amendments also required a non governmental entity to provide recommendations on the
formula proposed by HHS. The resulting recommendations, from the Institute for Health and
Aging (IHA),19 included phasing out the hold-harmless provisions, allocating funds based on
populations at risk, and incorporating a state fiscal capacity measure.
The 1988 Anti-Drug Abuse Act20 revised the formula, based on the IHA recommendations, to
phase out the hold-harmless provision, use total taxable resources as the measure of state fiscal

16 P.L. 97-35.
17 P.L. 98-509.
18 This hold-harmless provision assured that each state’s block grant funding would not be less than the amount it
received in FY1984. Currently, the hold-harmless provision is set at the level received by the state in FY1998 for the
mental health block grant, and the previous fiscal year for the substance abuse block grant. If there is a decrease in
appropriation for the substance abuse block grant, states can get a proportionate decrease in their block grant amount.
There is no similar provision for the mental health block grant.
19 IHA is an institute within the University of California, San Francisco.
20 P.L. 100-690, Comprehensive Alcohol Abuse, Drug Abuse and Mental Health Amendments Act.
˜—?›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ
Şȱ

ž‹œ?Š—ŒŽȱ‹žœŽȱŠ—?ȱŽ—?Š•ȱ ŽŠ•?‘ȱŽ›Ÿ’ŒŽœȱ?–’—’œ?›Š?’˜—ȱǻ Ǽȱ
ȱ
capacity, and incorporate weighted age cohorts as a measure of population at risk. The high-risk
age cohorts, determined using an IHA study, were 25-64 years for alcohol abuse, 18-24 years for
other drug abuse, and 25-44 for selected mental disorders. Later studies indicated that inequities
in the block grants persisted even after the recommendations were implemented.21
The 1992 ADAMHA Reorganization Act split the ADMS block grant into two separate block
grants, one for mental health services (CMHS block grant) and another for substance abuse
services (SAPT block grant). The formula for the two block grants was adjusted to reflect the
differences in the population in need of mental health and substance abuse services.22
ž››Ž—?ȱ˜›–ž•Šȱ
The formula for calculating the grant amounts, which is in Sec. 1918 and Sec. 1933 of the PHS
Act, takes into account three measures: (1) the population in need of services, (2) costs of services
in the state, and (3) fiscal capacity of the state. The first factor is intended to be a proxy for the
extent of need for services in a state. Adjustments were made to the weights assigned to each age-
cohort in this factor to address the inequities caused by the original weights used. The second
factor, which is the cost of services, is derived from the 1990 report of Health and Economics
Research, Inc., and ranges from 0.9 to 1.1.23 The third factor, which is the fiscal capacity of the
state, is intended to adjust for differences in state capacity to pay for these services. This factor
uses the three-year mean of the total taxable revenue of the state.
The three factors mentioned above are multiplied to produce a score for the state. To calculate the
grant amount for a given state, that state’s score is mutiplied by the total available grant amount
and divided by the sum of all the states’ (and District of Columbia’s) scores. The formula can be
written as:
Gi = A ( Xi / ∑Xi)
where
Gi = grant amount for the ith state
A = total funds appropriated for distribution among the states
Xi = score for the ith state
There is a hold-harmless provision (no less than previous year’s amount) as well as a state
minimum provision ($50,000 + 30.65% of the percentage increase in the total block grant
amount).

21 General Accounting Office (now Government Accountability Office), T-HRD-91-38, Substance Abuse Funding: Not
Justified by Urban-Rural Differences in Need, 1991.
22 General Accounting Office (now Government Accountability Office), T-HRD-91-32, Mental Health Grants:
Funding Not Distributed in Accordance with State Needs, 1991.
23 Burnam et al., Review and Evaluation of Substance Abuse and Mental Health Services Block Grant Allotment
Formula, RAND Corporation, 1997.
˜—?›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ
şȱ

ž‹œ?Š—ŒŽȱ‹žœŽȱŠ—?ȱŽ—?Š•ȱ ŽŠ•?‘ȱŽ›Ÿ’ŒŽœȱ?–’—’œ?›Š?’˜—ȱǻ Ǽȱ
ȱ
œœžŽœȱŽ?Š›?’—?ȱž››Ž—?ȱ˜›–ž•Šȱ
A number of issues has been raised regarding the current formula. First, the formula does not
consider variations in numbers of uninsured individuals across the states, and other federal
funding (e.g., Medicare and Medicaid) that a state may also receive for mental health and
substance abuse services. Second, experts recommend using data from major national
epidemiological datasets to determine the population in need of services. These datasets are from
the National Comorbidity Survey-Replication24 for mental health needs, and the National Survey
on Drug Use and Health (NSDUH)25 for substance abuse needs. Third, research indicates that the
currently used cost-of-services measure does not adequately represent interstate wage variations
in occupations related to substance abuse and mental health.26

24 SAMHSA, The National Comorbidity Survey (NCS-1) studied the prevalence and correlates of mental disorders
from 1990 to 1992. The NCS Replication (NCS-R) was carried out with a new national sample from 2001 to 2003 to
study trends in a wide range of variables assessed in the baseline NCS-1.
25 SAMHSA, NSDUH, which was formerly known as the National Household Survey on Drug Abuse (NHSDA), is
designed to produce drug and alcohol use incidence and prevalence estimates and report the consequences and patterns
of use and abuse in the general U.S. civilian population aged 12 and older.
26 Burnam et al., Review and Evaluation of Substance Abuse and Mental Health Services Block Grant Allotment
Formula, RAND Corporation, 1997.
˜—?›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ
ŗŖȱ

ȱ
™™Ž—?’¡ȱǯ ›˜?›Š–ȱŽœŒ›’™?’˜—œȱ?˜›ȱž?‘˜›’£Ž?ȱ ȱŽŒ?’˜—œȱ
Section
PHS Act
Title Program
Description
(42 U.S.C. Citation)
Center for Substance Abuse Treatment (CSAT)
Priority Substance Abuse Treatment Needs
General authority to provide grants and fund activities intended to increase knowledge on best
Sec. 509 (290bb-2)
of Regional and National Significance
practices, provide training and technical assistance, and increase capacity of states and local entities to
provide for necessary substance abuse treatment services.
Grants to expand the availability of comprehensive, high quality residential treatment services for
Sec. 508 (290bb-1)
Residential Treatment Programs for Pregnant
and Postpartum Women
pregnant and postpartum women who suffer from alcohol and other drug use problems, and for their
minor children impacted by perinatal and environmental effects of maternal substance use and abuse.
Grants, contracts or cooperative agreement for providing substance abuse treatment services, early
intervention, programs to prevent the use of methamphetamine and inhalants, and for creating
Sec. 514 (290bb-7)
Substance Abuse Treatment Services for
Children and Adolescents
centers of excellence to assist States and local jurisdictions in providing appropriate care for
adolescents who are involved with the juvenile justice system and have a serious emotional
disturbance.
Sec. 514A (290bb-8)
Early Intervention Services For Children and Grants to provide early intervention substance abuse services for children and adolescents. (Not
Adolescents
funded)
Sec. 514(d) (290bb-
Methamphetamine and Amphetamine
To expand methamphetamine treatment services in areas with high prevalence of methamphetamine
9(d))
Treatment Initiative
abuse. (Not funded)
Sec. 1935 (a) (200x-35) Substance Abuse Prevention and Treatment Provides funding to States by formula to plan, carry out, and evaluate activities to prevent and treat
Performance Partnership Block Grants
substance abuse.
Center for Substance Abuse Prevention (CSAP)
General authority to provide grants and fund activities intended to increase knowledge on best
Sec. 516 (290bb-22)
Priority of Substance Abuse Prevention and
Needs of Regional and National Significance
practices, provide training and technical assistance, and increase capacity of states and local entities to
provide for necessary substance abuse prevention efforts.
Sec. 519 (290-bb25)
Services for Children of Substance Abusers
Grants to provide evaluations, treatment and referrals to children of substance abusers. (Not funded)
Sec. 519A (290bb-25a) Grants for Strengthening Families
Grants to provide early intervention and substance abuse prevention services for individuals of hig-
risk families and their communities. (Not funded)
Sec. 519B (290bb-25b) Programs to Reduce Underage Drinking
Grants to develop plans and carry out programs to prevent underage alcohol use. (Not funded)
Sec. 519C(290bb-25c) Services for Individuals with Fetal Alcohol
To provide services to individuals diagnosed with fetal alcohol syndrome or alcohol-related birth
Syndrome
defects. (Not funded)
Ȭŗŗȱ

ȱ
Section
PHS Act
Title Program
Description
(42 U.S.C. Citation)
Center of Excellence on Services for
Individuals with Fetal Alcohol Syndrome and To establish centers of excellence to study prevention and treatment strategies for fetal alcohol
Sec. 519D (290bb-25d) Alcohol-Related Birth Defects and Treatment
for Individuals with Such Conditions and
syndrome and alcohol-related birth defects.
their families
Grants to support expansion of methamphetamine prevention interventions and/or infrastructure
Sec. 519E (290bb-25e) Prevention of Methamphetamine Abuse and development. This program assists localities to expand prevention interventions that are effective and
Addiction
evidence-based and/or to increase capacity through infrastructure development. The goal is to
intervene effectively to prevent, reduce or delay the use and/or spread of methamphetamine abuse.
Center for Mental Health Services (CMHS)
Priority of Mental Health Needs of Regional General authority to provide grants and fund activities intended to increase knowledge on best
Sec. 520A (290bb-32)
and National Significance
practices, provide training and technical assistance, and increase capacity of states and local entities to
provide for necessary substance abuse prevention efforts.
Sec. 520D (290bb-35) Services for Youth Offenders
Grants to provide aftercare services to youth offenders who have been discharged from the justice
system and have serious emotional disturbances. (Not funded)
To build on the foundation of prior suicide prevention efforts in order to support States and Tribes
in developing and implementing statewide or tribal youth suicide prevention and early intervention
Sec.520E (290bb-36) Youth Suicide Early Intervention and
strategies, grounded in public/private collaboration. Such efforts must involve public/private
Prevention Strategies (State Grants)
collaboration among youth-serving institutions and agencies and should include schools, educational
institutions, juvenile justice systems, foster care systems, substance abuse and mental health
programs, and other child and youth supporting organizations.
Sec.520-E1 (290bb-36a) Suicide Prevention For Children and
Grants to complement suicide prevention and early intervention strategies developed in Sec. 520 E.
Adolescents
(Not funded)
Sec. 520-E2 (290bb-
Mental and Behavioral Health Services on
To provide funding to support grants to institutions of higher education to enhance services for
36b)
Campus
students with mental and behavioral health problems, such as depression, substance abuse, and
suicide attempts, which can lead to school failure.
Sec. 520F (290bb-37) Centers for Emergency Mental Health
Grants to support designation of hospitals and health centers as Emergency Mental Health Centers.
(Not funded)
To promote the transformation of systems to improve services for justice-involved adults with
Sec. 520G (290bb-38) Grants for Jail Diversion Programs
mental illness. Grantees are expected to act through agreements with other public and nonprofit
entities to develop and implement programs to divert individuals with a mental illness from the
criminal justice system to community-based services.
Sec. 520I (290bb-40) Grants for the Integrated Treatment of
Grants to provide integrated treatment services for individuals with a serious mental illness and co-
Serious Mental Illness and Co-occuring
occuring substance abuse disorder. (Not funded)
ȬŗŘȱ

ȱ
Section
PHS Act
Title Program
Description
(42 U.S.C. Citation) Substance Abuse
Sec. 520J (290bb-40) Mental Health Training Grants
Grants for training on mental illness awareness, and training for emergency services personnel. (Not
funded)
Sec. 521 (290cc-21) & Projects for Assistance in Transition from
Grants to States to provide outreach, mental health and other support services to homeless people
Sec. 535(a) (290cc-35) Homelessness; PATH Grants to States
with serious mental illness. Outreach is focused on homeless individuals who are not pursuing
needed mental health treatment on their own.
Sec. 561(290ff) &
Comprehensive Community Mental Health
Six-year grants to implement, improve and expand systems of care to meet the needs of children
Sec. 565(f) (290ff-4)
Services for Children with Serious Emotional with serious emotional disturbances and their families. This approach emphasizes culturally
Disturbances
competent care, family driven and youth guided practice, and multi-agency collaboration.
Sec.1920 (a) (300x-35) Community Mental Health Services
Formula grants to States to support community mental health services for adults with serious mental
Performance Partnership Block Grants
illness and children with serious emotional disturbance.
Other Authorities
Sec. 506 (290aa-5)
Grants for the Benefit of Homeless
Funds the development of comprehensive drug/alcohol and mental health treatment systems for the
Individuals
homeless
Sec 506A (290aa-5a) Alcohol and Drug Prevention or Treatment
Providing alcohol and drag prevention or treatment services for Indians and Native Alaskans. (Not
Services for Indians and Native Alaskans
funded)
SEC. 506B (290aa-5b) Grants for Ecstasy and Other Club Drugs
To carry out education and other community-based programs to prevent abuse of “club drugs” by
Abuse Prevention
youth. (Not funded)
Sec. 581 (290hh)
Children and Violence
To fund local communities to assist children in dealing with violence. (Funds awarded under the
Department of Education’s Safe Schools Healthy Students program)
Grants to Address the Problems of Persons Improve treatment and services for all children and adolescents in the United States who have
Sec. 582 (290hh-1)
Who Experience Violence and Related
experienced traumatic events. Addresses child trauma issues by creating a national network of
Stress. (Child Traumatic Stress Initiative)
grantees that work collaboratively to develop and promote effective community practices for
children and adolescents exposed to a wide array of traumatic events.
P.L. 99-319, (Sec. 117) Protection and Advocacy for Individuals with Protects individuals with mental illness from abuse, neglect, and violations of their civil rights. The
42USC10827
Mental Illness Act
program provides grants to independent protection and advocacy agencies which investigate and use
legal and other remedies to correct verified incidents.

Ȭŗřȱ

ȱ
™™Ž—?’¡ȱǯ  ȱž?‘˜›’£Š?’˜—ȱŠ—?ȱ™™›˜™›’Š?’˜—ȱŽŸŽ•œȱȱ
ǻŘŖŖŚȬŘŖŖŞǼȱ
Section
PHS Act
Name of Program
Year
FY2006
FY2007
FY2008
Ever Funded
(42USC
Created
Authorization
FY2005
Appropriation Appropriation Appropriation Appropriation
(since 2000)
Code)
Center for Substance Abuse Treatment (CSAT)
Sec. 509
Priority Substance Abuse
1992 FY2001-$300,000,000; FY 05 -
$324,107,000
$398,949,000
$316,976,000
Yes - 2002
(290bb-2)
Treatment Needs of Regional and
FY2002 - FY2003 SSN
$348,213,000
National Significance
Sec. 508
Residential Treatment Programs
1992
FY2001-FY2003 SSN
$9,852,000
$10,890,000
$10,390,000
$11,790,000
Yes - 2004
(290bb-1)
for Pregnant and Postpartum
Women
Sec. 514
Substance Abuse Treatment
2000 FY2001-$40,000,000; $33,957,000 $29,597,000 $29,275,000 $24,278,000 Yes
-
2002
(290bb-7)
Services for Children and
FY2002-FY2003 SSN
Adolescents
Sec. 514A
Early Intervention Services For
2000 FY2001-
$20,000,000;
NF NF NF NF No
(290bb-8)
Children and Adolescents
FY2002-FY2003 SSN
Sec. 514(d) Methamphetamine and
2000 FY2000-
$10,000,000;
NF NF NF NF No
(290bb-9(d)) Amphetamine Treatment
FY2001-FY2002 SSN
Initiative
Sec. 1935
Substance Abuse Prevention and
1992 FY2001
- $1,775,555,000 $1,758,591,000 $1,679,391,000 $1,679,528,000 Yes
-
2000
((a) 200x-35) Treatment Performance
$2,000,000,000;
Partnership Block Grants
FY2002-FY2003 SSN
Center for Substance Abuse Prevention (CSAP)
Sec. 516
Priority of Substance Abuse
1986 FY2001- $179,213,000 $179,160,000 $178,591,000 $175,928,000 Yes
-
2002
(290bb-22) Prevention and Needs of Regional
$300,000,000;
and National Significance
FY2002-FY2003 SSN
Sec. 519
Services for Children of
1992 FY2001
-
NF NF NF NF No
(290-bb25) Substance Abusers
$50,000,000;
FY2002-FY2003 SSN
Sec. 519A
Grants for Strengthening Families
2000
FY2001- 3,000,000;
NF NF NF NF No
(290bb-25a)
FY2002-FY2003 SSN
ȬŗŚȱ

ȱ
Section
PHS Act
FY2006
FY2007
FY2008
Ever Funded
(42USC
Name of Program
Year
Created
Authorization
FY2005
Appropriation Appropriation Appropriation Appropriation
(since 2000)
Code)
Sec. 519B
Programs to Reduce Underage
2000 FY2001-
$25,000,000;

NF NF NF
$5,404,000
Yes
-
2008
(290bb-25b) Drinking
FY2002-FY2003 SSN
Sec. 519C Services for Individuals with Fetal
2000 FY2001
-
NF NF NF NF
Yes
-
2002
(290bb-25c) Alcohol Syndrome
$25,000,000;
FY2002-FY2003 SSN
Sec. 519D
Center of Excellence on Services
2000 FY2001-
$5,000,000;
$10,000,000 $9,821,000 $9,821,000 $9,821,000 Yes
-
2002
(290bb-25d) for Individuals with Fetal Alcohol
FY2002-FY2003 SSN
Syndrome and Alcohol-Related
Birth Defects and Treatment for
Individuals with such Conditions
and Their families
Sec. 519E
Prevention of Methamphetamine
2000 FY2001-
$10,000,000;
$5,127,000 $3,960,000 $3,960,000 $2,967,000 Yes
-
2002
(290bb-25e) Abuse and Addiction
FY2002-FY2003 SSN
Center for Mental Health Services (CMHS)
Priority of Mental Health Needs
FY2001-
Sec. 520A
of Regional and National
1988
$300,000,000;
$131,602,000 $108,434,000 $263,263,000 $116,100,000 Yes
-
2002
(290bb-32)
Significance
FY2002-FY2003 SSN
Sec. 520D
(290bb-35) Services for Youth Offenders
2000
FY2001- $40,000,000;
FY2002-FY2003 SSN
NF NF NF NF No
Sec. 520E
Youth Suicide Early Intervention
FY2005 - $7,000,000
(290bb-36) and Prevention Strategies (State
2004
FY2006 - $18,000,000
$6,924,000 $17,820,000 $17,820,000 $29,476,000 Yes
-
2005
Grants)
FY2007 - $30,000,000
Sec.520-E1
Suicide Prevention For Children
(290bb-36a) and Adolescents
2000
2001- $75,00,000
2002-2003 SSN
NF NF NF NF No
Sec.520-E2
Mental and Behavioral Health
FY2005- $5,000,000;
(290bb-36b) Services on Campus
2004
FY2006- 5,000,000;
$1,500,000 $4,950,000 $4,950,000 $4,913,000 Yes
-
2005
FY2007- $5,000,000
Sec. 520F
Centers for Emergency Mental
(290bb-37) Health
2000
FY2001- $25,000,000;
FY2002-FY2003 SSN
NF NF NF NF No
Sec. 520G
Grants for Jail Diversion
(290bb-38) Programs
2000
FY2001- $10,000,000
FY2002-FY2003 SSN
$6,944,000 $6,875,000 $6,863,000 $6,684,000 Yes
-
2002
Ȭŗśȱ

ȱ
Section
PHS Act
FY2006
FY2007
FY2008
Ever Funded
(42USC
Name of Program
Year
Created
Authorization
FY2005
Appropriation Appropriation Appropriation Appropriation
(since 2000)
Code)
Grants for the Integrated
Sec. 520I
Treatment of Serious Mental
2000
FY2001- $40,000,000
(290bb-40)
Illness and Co-occuring Substance
FY2002-FY2003 SSN
NF NF NF NF No
Abuse
Sec. 520J
(290bb-40) Mental Health Training Grants
2000
FY2001 - 25,000,000;
FY2002-FY2003 SSN
NF NF NF NF No
Sec. 521
(290cc-21) & Projects for Assistance in
Formula;
Sec. 535(a)
Transition from Homelessness;
1990
FY2001-FY2003 -
$54,809,000 $54,261,000 $54,261,000 $53,313,000 Yes
-
2002
(290cc-35)
PATH Grants to States
$75,000,000 each year
Sec. 561
Comprehensive Community
(290ff) &
Mental Health Services for
FY2001-
Sec. 565(f) Children with Serious Emotional
1992
$100,000,000;
$105,112,000 $104,078,000 $104,078,000 $102,260,000 Yes
-
2000
(290ff-4)
Disturbances
FY2002-FY2003 SSN
Sec.1920 (a) Community Mental Health
FY2001 -
300x-35
Services Performance Partnership
1992
$450,000,000;
$432,756,000 $428,646,000 $428,256,000 $399,735,000 Yes
-
2000
Block Grants
FY2002-FY2003 SSN
Other Authorities
Sec. 506
Grants for the Benefit of
FY2001 -
(290aa-5)
Homeless Individuals
1984
$50,000,000;
$35,973,000 $43,915,000 $34,517,000 $32,600,000 Yes
-
2002
FY2002-FY2003 SSN
Sec 506A
Alcohol and Drug Prevention or
FY2001 -
(290aa-5a)
Treatment Services for Indians
2000
$15,000,000; FY2002-
NF NF NF NF No
and Native Alaskans
FY2003 SSN
SEC. 506B
Grants for Ecstasy and Other
FY2001 -
(290aa-5b)
Club Drugs Abuse Prevention
2000
$10,000,000;
$4,385,000 NF NF NF No
Subsequent -SSN
Sec. 581
(290hh)
Children and Violence
2000
FY2001-$100,000,000;
FY2002-FY2003 SSN
$78,738,000 $82,202,000 $93,156,000 $93,002,000 Yes
-
2002
Grants to Address the Problems
Sec. 582
of Persons Who Experience
(290hh-1)
Violence and Related Stress.
2000
FY2001-$50,000,000;
FY2002-FY2006 SSN
$29,760,000.00 $29,462,000 $28,068,000 $33,092,000 Yes
-
2002
(Child Traumatic Stress Initiative)
ȬŗŜȱ

ȱ
Section
PHS Act
FY2006
FY2007
FY2008
Ever Funded
(42USC
Name of Program
Year
Created
Authorization
FY2005
Appropriation Appropriation Appropriation Appropriation
(since 2000)
Code)
P.L. 99-319,
Protection and Advocacy for
FY1992 -
Sec. 117
$19,500,000;
$34,343,000 $34,000,000 $34,000,000 $34,880,000 Yes
-
2000
42USC10827 Individuals with Mental Illness Act
1986
FY1993-FY2003 SSN
Sec. 301;P.L.
1984
98-621
Program Management
(P.L. 98-
Not
applicable $75,806,000 $76,049,000 $76,042,000 $74,098,000 Yes
-
2000
42USC241
621)
Source: SAMHSA Budget Justifications FY2004 - FY2009.
Notes: NF means “No Funding”; SSN means “Such Sums as may be Necessary.”
Ȭŗŝȱ

ž‹œ?Š—ŒŽȱ‹žœŽȱŠ—?ȱŽ—?Š•ȱ ŽŠ•?‘ȱŽ›Ÿ’ŒŽœȱ?–’—’œ?›Š?’˜—ȱǻ Ǽȱ
ȱ
™™Ž—?’¡ȱǯ  ȱŠ?›’¡ȱ˜?ȱ›’˜›’?’Žœȱ

Source: SAMHSA.
˜—?›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ
ŗŞȱ

ž‹œ?Š—ŒŽȱ‹žœŽȱŠ—?ȱŽ—?Š•ȱ ŽŠ•?‘ȱŽ›Ÿ’ŒŽœȱ?–’—’œ?›Š?’˜—ȱǻ Ǽȱ
ȱ
™™Ž—?’¡ȱǯ  ȱŠ?’˜—Š•ȱž?Œ˜–Žȱ
ŽŠœž›Žœȱ

Source: SAMHSA.
Notes: 1. For ATR, “Social Support of Recovery” is measured by client participation in voluntary recovery or
self-help groups, as well as interaction with family and/or friends supportive of recovery.
2. Required by 2003 Office of Management and Budget’s Program Assessment Rating Tool Review.
˜—?›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ
ŗşȱ

ž‹œ?Š—ŒŽȱ‹žœŽȱŠ—?ȱŽ—?Š•ȱ ŽŠ•?‘ȱŽ›Ÿ’ŒŽœȱ?–’—’œ?›Š?’˜—ȱǻ Ǽȱ
ȱ
™™Ž—?’¡ȱǯ œŽ?ž•ȱ ȱŽœ˜ž›ŒŽœȱ
SAMHSA Website: http://www.samhsa.gov.
SAMHSA grant awards by state: http://www.samhsa.gov/statesummaries/index.aspx.
FY2008 Budget justification: http://www.samhsa.gov/Budget/FY2008/
SAMHSA08CongrJust.pdf.
National Outcome Measures: http://www.nationaloutcomemeasures.samhsa.gov/.
FY2000 Reauthorization Language: http://www.samhsa.gov/legislate/Sept01/
childhealth_toc.htm.
Center for Mental Health Services: http://mentalhealth.samhsa.gov/cmhs/.
Center for Substance Abuse Prevention: http://prevention.samhsa.gov/.
Center for Substance Abuse Treatment: http://csat.samhsa.gov/.
Office on Applied Statistics: http://oas.samhsa.gov/.
SAMHSA Report on Co-occuring Disorders: http://www.oas.samhsa.gov/CoD/CoD.pdf.
SAMHSA report on Performance Partnerships:
http://www.nationaloutcomemeasures.samhsa.gov/./PDF/performance_partnership.pdf.
National Outcome Measures: http://nationaloutcomemeasures.samhsa.gov/./outcome/
index_2007.asp.
SAMHSA grant awards to states: http://www.samhsa.gov/grants/.
Garrett Lee Smith grantee activities: http://www.sprc.org/grantees/show AllStateTribe.asp
(state grantees) and http://www.sprc.org/grantees/C_Udescriptions.asp (campus grantees).

ž?‘˜›ȱ˜—?ŠŒ?ȱ —?˜›–Š?’˜—ȱ

Ramya Sundararaman

Analyst in Public Health
rsundararaman@crs.loc.gov, 7-7285

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