	Introduction

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'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. 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 Authorization and Organization

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. 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. In real (i.e., inflation-adjusted) dollars, however, the funding increase over that period was only 6%. Substance abuse prevention PRNS grew much less, increasing by 37% from FY2000 to FY2010. The act amended SAMHSA's existing authorities under Title V, added several new authorities, and authorized appropriations through FY2003. The following key provisions were included in the 2000 reauthorization, which
increased flexibility for SAMHSA to direct mental health and substance abuse funding by rewriting and standardizing the general authority (i.e., PRNS) for each center and eliminating several existing categorical grant programs; increased flexibility for states to direct the use of block grant funds to treat mental health and substance abuse disorders; added new categorical grant programs, primarily with a focus on expanding and improving mental health and substance abuse services for children and adolescents; and added "charitable choice" provisions that allow religious organizations to receive funding from SAMHSA for the provision of substance abuse prevention and treatment services (see "Charitable Choice" text box below). The second report, delivered in 2005, discusses SAMHSA's efforts to improve the flexibility and accountability of the block grants. In addition, the Patient Protection and Affordable Care Act of 2010 (PPACA), as amended by the Health Care and Education Reconciliation Act (HCERA), contained new authorizations for SAMHSA, as well as additional provisions related to mental health and substance abuse, which are discussed in the next section of this report. Legislation to reauthorize SAMHSA was introduced in the 111 th Congress, but has not moved out of committee. Issues that may be of interest during reauthorization of SAMHSA include increased performance measurement and accountability for SAMHSA grants and programs, granting specific authority for the Access To Recovery program that provides vouchers for individuals to seek treatment services and that was created under SAMHSA's general authority, 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. 99-319 1988: Anti-Drug Abuse Act, P.L.
The Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services (HHS), provides federal funding to support community-based mental health and substance abuse prevention and treatment services. SAMHSA awards formula and competitive grants under its authorities in Title V of the Public Health Service Act (PHSA). The agency also administers the $1.8 billion Substance Abuse Prevention and Treatment (SAPT) block grant and the $420 million Community Mental Health Services (CMHS) block grant, both of which are authorized in PHSA Title XIX. SAMHSA's funding totaled almost $3.6 billion in FY2010. The agency's budget increased by 34% from FY2000 to FY2010. In real (i.e., inflation-adjusted) dollars, however, the funding increase over that period was only 6%. Funding for SAMHSA's two block grants, which together account for 62% of the agency's budget, has grown at a much slower pace than funding for its competitive grant programs.
SAMHSA was reauthorized in 2000, as part of the Children's Health Act (P.L. 106-310). The act amended SAMHSA's existing authorities to give the agency more flexibility to direct mental health and substance abuse funding; increased state flexibility to direct the use of block grant funds, creating several new competitive grant programs to expand mental health and substance abuse services for children and adolescents; and authorized appropriations through FY2003. It also added charitable choice provisions that allow faith-based organizations to compete for SAMHSA substance abuse funding without impairing their religious character. P.L. 106-310 required SAMHSA to submit two reports to Congress, one on providing coordinated care to individuals with co-occurring mental illness and substance abuse, and the other on efforts to improve the flexibility and accountability of the block grants.
Comprehensive reauthorization has not occurred since 2000. However, several laws have further expanded the agency's programs and activities in suicide prevention, underage drinking, and prescription drug abuse. The Patient Protection and Affordable Care Act of 2010 (P.L. 111-148) contained new authorizations for SAMHSA related to depression and behavioral health services for American Indians and Alaskan Natives, as well as additional provisions related to mental health and substance abuse.
While reauthorization has not moved out of committee, issues that may be of interest during the next reauthorization of SAMHSA include increased performance measurement and accountability for SAMHSA grants and programs, granting specific authority for the Access To Recovery program that provides vouchers for individuals to seek treatment services, 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 describes SAMHSA's history, organization, authority, and programs, and analyzes some of the issues that may be considered by Congress during a reauthorization of the agency. The appendixes include a table describing SAMHSA's authorizations and appropriations, a table with SAMHSA's funding from FY2000-FY2010, a matrix of SAMHSA's National Outcome Measures that aim to evaluate progress on substance abuse and mental health prevention and treatment indicators, and a list of SAMHSA resources.