1.) CMHS’s Criteria for Awarding Grants to Grantees Varied by Program, but CMHS Did Not Document Its Application of Criteria for About a Third of the Grantees We Reviewed

The criteria CMHS established for awarding grants to grantees for the  MHBG, PAIMI, and selected discretionary grant programs varied by  program. For example, one of the five programs that  awarded grants to grantees we reviewed—Project LAUNCH—required its  grantees to state that they will use evidence-based practices to treat  individuals with mental illness in their applications when such practices  are available, while the others did not. CMHS Did Not Document Its Application of Criteria for About a Third of the Grantees We Reviewed and CMHS Lacked Program-Specific Guidance for How to Document This Information

During the 2-year period covered by our review, CMHS did not document  its application of the criteria it used to award grants to 6 of the 16  grantees we reviewed. For fiscal year 2012, CMHS officials did not clearly document  the application of most criteria for any of the four MHBG grantees we  reviewed; however, officials did document how they applied most of  the criteria for fiscal year 2013. We found that there were a variety of reasons why CMHS did not  adequately document the application of criteria when awarding grants to  grantees. CMHS Stated That It Uses Various Types of Information for Oversight, but the Documentation of This Information Was Often Missing or Not Readily Available

CMHS officials said they use various types of information to oversee  grantees awarded grants through the MHBG, PAIMI, and selected  discretionary grant programs. Documentation of Some Information CMHS Officials Said They Used to Oversee Grantees Was Either Missing or Not Readily Available for Each of the Grantees We Reviewed and CMHS Lacked Program-Specific Guidance

For each of the 16 grantees we reviewed, we found at least one instance  during the period covered by our review in which the documentation  CMHS officials said they used to oversee grantees was missing or not  readily available—meaning it was either missing entirely, stored outside  of the systems CMHS designated for storing the information, or was not  readily available to all officials involved in the oversight of grant  documentation. The grants manual states that CMHS must  create and maintain files that allow a third party, such as an auditor, to  “follow the paper trail” beginning with program initiation through closeout  of individual awards, including decisions made and actions taken in  between. CMHS officials  said that they follow the grants manual. CMHS could not produce documentation of its review of the  required annual program performance reports covering fiscal year  2012 data for any of the four PAIMI grantees we reviewed. Without proper documentation of information  used to oversee grantees that is readily available, CMHS runs the risk  that it does not have complete and accurate information needed to  provide sufficient oversight of its grant programs. CMHS Takes A Variety of Steps When Reviewing Performance Measure Data to Demonstrate How Its Grant Programs Further the Achievement of SAMHSA’s Goals

CMHS officials told us that they take a variety of steps when reviewing  grantees’ performance measure data to demonstrate how CMHS’s grant  programs furthered the achievement of SAMHSA’s goals, which are  identified through the strategic initiatives contained within SAMHSA’s  strategic plan. Specifically, CMHS produces summaries by grant  program that are included as part of its budget justification. Second, some grant programs produced  additional reports that demonstrated how these grant programs furthered  the achievement of SAMHSA’s goals. According to SAMHSA, analyzing performance measure data  across SAMHSA’s centers can assist the agency in evaluating the overall  effectiveness of its grant programs and in ensuring that each program  furthers the achievement of SAMHSA’s goals. Conclusions

CMHS’s grant programs support services for individuals with mental  illness, which is widespread in the United States. Recommendation for Executive Action

To assure the consistent documentation of the application of criteria to  award grants to grantees and of the information used for oversight, the  Administrator of SAMHSA should direct CMHS to take steps, such as  developing additional program-specific guidance, to ensure that it  consistently and completely documents both the application of criteria  when awarding grants to grantees, and its ongoing oversight of grantees  once grants are awarded.
Why GAO Did This Study

In 2013, SAMHSA estimated 43.8 million—or 18.5 percent—of adults in the United States suffered from a mental illness. SAMHSA, an agency within HHS, has various programs that aim to reduce the impact of mental illness through CMHS grants awarded to grantees that include states, territories, and nonprofit organizations.
GAO was asked to provide information on CMHS's oversight of mental health grant programs. This report identifies (1) CMHS's criteria for awarding grants to grantees, and how CMHS documents the application of these criteria; (2) the types of information CMHS uses to oversee its grantees; and (3) the steps CMHS takes to demonstrate how its grant programs further the achievement of SAMHSA's goals. GAO reviewed information related to CMHS grants management; reviewed grant documentation from fiscal years 2012 and 2013 for a nongeneralizable selection of 16 grantees within 5 grant programs: the MHBG, PAIMI, and 3 selected discretionary grant programs that GAO selected based on factors such as size of award and type of grantee; and interviewed SAMHSA officials.

What GAO Found

The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) established criteria for the five grant programs covered by GAO's review that varied by program, but GAO found that CMHS did not document its application of criteria for about a third of the 16 grantees GAO reviewed. An example of how criteria varied by program is that one of the five grant programs required its grantees to state that they will use evidence-based practices to treat individuals with mental illness while the others did not. In addition, CMHS did not document its application of the criteria it used to award grants to 6 of the 16 grantees GAO reviewed. For example, for fiscal year 2012, CMHS did not clearly document the application of most criteria for any of the four Community Mental Health Services Block Grant (MHBG) grantees GAO reviewed. The Department of Health and Human Services' (HHS) grants manual, which CMHS officials told GAO they follow, states that CMHS must maintain appropriate documentation to support funding decisions. GAO found a variety of reasons why CMHS did not adequately document the application of criteria, including a lack of program-specific guidance.
CMHS officials said they use various types of information to oversee grantees, but the documentation of this information was often missing or not readily available during the period GAO reviewed. For each grantee GAO reviewed, there was at least one instance in which the documentation used to oversee grantees was either missing or not readily available—meaning it was either missing entirely, stored outside of the systems designated for storing the information, or was not readily available to all officials involved in the oversight of grant documentation. For example, GAO found that CMHS could not produce documentation of its review of required annual program performance reports covering fiscal year 2012 data for any of the four Protection and Advocacy for Individuals with Mental Illness (PAIMI) grantees GAO reviewed. The grants manual states that CMHS must create and maintain files that allow a third party, such as an auditor, to “follow the paper trail” from program initiation through closeout of individual awards. GAO found a variety of reasons why grant documentation was missing or not readily available, including a lack of program-specific guidance. Without proper documentation of information used to oversee grantees that is readily available, CMHS runs the risk that it does not have complete and accurate information needed to provide sufficient oversight of its grant programs.
CMHS officials told GAO that they take a variety of steps when reviewing grantees' performance measure data to demonstrate how CMHS's grant programs furthered the achievement of SAMHSA's goals. For example, CMHS produces summaries by grant program that are included as part of its budget justification. In addition, CMHS is working to ensure that the performance measure data it collects can be analyzed with performance measure data collected from other grantees awarded through programs across SAMHSA. According to SAMHSA, this analysis can be helpful when demonstrating how CMHS's grant programs further the achievement of SAMHSA's goals.

What GAO Recommends

GAO recommends that the Administrator of SAMHSA direct CMHS to take steps, such as developing additional program-specific guidance, to ensure that it consistently and completely documents both the application of criteria when awarding grants to grantees, and its ongoing oversight of grantees once grants are awarded. HHS concurred with this recommendation.