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DEPARTMENT of HEALTH and HUMAN SERVICES DEPARTMENT of HEALTH and HUMAN SERVICES Fiscal Year 2019 Substance Abuse and Mental Health Services Administration Justification of Estimates for Appropriations Committees Page intentionally left blank ii iii Page intentionally left blank iv DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION Table of Contents Fiscal Year 2019 Budget Page Letter from Assistant Secretary..................................................................................................... iii Table of Contents.............................................................................................................................v Organization Chart........................................................................................................................ vii A. Executive Summary 1. Introduction and Mission ....................................................................................................1 2. Overview of Budget Request .............................................................................................2 3. Overview of Performance ..................................................................................................5 4. All Purpose Table (APT) ....................................................................................................7 B. Budget Exhibits 1. Appropriations Language .................................................................................................11 2. Language Analysis ...........................................................................................................13 3. Amounts Available for Obligation ...................................................................................17 4. Summary of Changes .......................................................................................................18 5. Budget Authority by Activity ...........................................................................................19 6. Authorizing Legislation ....................................................................................................20 7. Appropriations History .....................................................................................................21 C. Mental Health 1. Mental Health Programs of Regional and National Significance ....................................26 2. Children’s Mental Health Services ...................................................................................95 3. Project for Assistance in Transition from Homelessness ...............................................101 4. Protection and Advocacy for Individuals with Mental Illness .......................................107 5. Community Mental Health Services Block Grant ..........................................................113 D. Substance Abuse Prevention 1. Substance Abuse Prevention Programs of Regional and National Significance............128 2. Drug Free Communities .................................................................................................157 E. Substance Abuse Treatment 1. Substance Abuse Treatment Programs of Regional and National Significance ............168 2. State Targeted Response to the Opioid Crisis Grants ....................................................217 3. Substance Abuse Prevention and Treatment Block Grant .............................................219 v F. Health Surveillance and Program Support 1. Health Surveillance ........................................................................................................233 2. Performance and Quality Information Systems .............................................................243 3. Program Support .............................................................................................................251 4. Public Awareness and Support .......................................................................................253 G. Additional Opioids Allocation............................................................................................259 H. Drug Control Budget.......................................................................................................... 261 I. Supplementary Tables 1. Budget Authority by Object Class .................................................................................281 2. Salaries and Expenses ......................................................................................................290 3. Detail of Full-Time Equivalent Employee (FTE) ..............................................................292 4. Detail of Positions ...........................................................................................................293 5. Programs Proposed for Elimination ..................................................................................294 6. Physician’s Comparability Allowance Worksheet ............................................................297 J. Significant Items….............................................................................................................. 298 vi IMMEDIATE OFFICE OF THE ASSISTANT SECRETARY Elinore McCance-Katz, M.D., Ph.D. Assistant Secretary Vacant Deputy Assistant Secretary (MA) OFFICE OF COMMUNICATIONS Marla Hendriksson, M.P.M. Director (MAB) OFFICE OF BEHAVIORAL HEALTH OFFICE OF FINANCIAL RESOURCES EQUITY OFFICE OF MANAGEMENT, TECHNOLOGY AND OPERATIONS Deepa Avula, M.P.H. Larke Huang Ph.D Director Director Michael Etzinger Director Vacant (MD-1) Deputy Director CAPT Danny Nguyen Deputy Director (MG) (MB) CENTER FOR SUBSTANCE ABUSE CENTER FOR MENTAL HEALTH CENTER FOR SUBSTANCE ABUSE CENTER FOR BEHAVIORAL HEALTH PREVENTION SERVICES TREATMENT STATISTICS AND QUALITY Frances M. Harding Paolo del Vecchio, M.S.W. Kimberly Johnson, Ph.D. Daryl Kade, M.A. Director Director Director Director Gregory Goldstein, M.P.H. Priscilla Clark, Ph.D. Elizabeth Lopez, Ph.D. Michael Corriere, Ph.D., PMP Deputy Director Deputy Director Deputy Director Deputy Director (MP) (MS) (MT) (MC) Page intentionally left blank viii Performance Budget Overview Introduction The need to face mental health and substance abuse is critical to the nation’s future. Prevention, treatment, and support to help people recover from mental and/or substance use disorders are essential strategies for the health and prosperity of individuals, families, communities, and the country. Unfortunately, the majority of those who need treatment do not receive it. Only 43.1 percent of the 44.7 million adults with diagnosable mental health problems received treatment in the past year. The unmet treatment need for those who needed substance use treatment (19.9 million adults) is even greater with only 1 in 9 individuals receiving specialty treatment in the past year. The nation can do better. SAMHSA has a unique responsibility to focus on these preventable and treatable problems, which, if unaddressed, lead to significant individual, societal, and economic consequences. Mission SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. SAMHSA accomplishes this mission through providing leadership and devoting its resources, including programs, policies, information and data, contracts, and grants to help demonstrate that: Behavioral Health is essential to health Prevention works Treatment is effective People recover from mental and substance use disorders 1 Overview of Budget Request The Fiscal Year (FY) 2019 President's Budget provides a program level of $3.5 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA), which is a reduction of $688.4 million below the FY 2018 Continuing Resolution. In addition, the Budget provides $1.2 billion to SAMHSA for a variety of new and expanded efforts to fight the opioid crisis. When accounting for these resources, the total for SAMHSA is $4.8 billion, which is an increase of $551.6 million above the FY 2018 Continuing Resolution. This budget request seeks to advance SAMHSA’s mission to reduce the impact of substance abuse and mental illness on America’s communities. The budget request aims to address critical national priorities including combating the nation’s opioid crisis, addressing serious mental illness, and developing and implementing strategies to prevent suicide. Key Budget Highlights: Additional Opioids Allocation The FY 2019 President’s Budget Request includes $10.0 billion in new resources to combat the opioid epidemic and address serious mental illness. In FY 2019, an initial allocation provides $1.2 billion in SAMHSA for a variety of new and expanded efforts to fight the opioid crisis. Of that amount, $1.0 billion is included to expand the State Targeted Response to the Opioid Crisis important program that addresses the opioid crisis by increasing access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment, and recovery activities for opioid addiction. The SAMHSA allocation also includes $150.0 million to reduce opioid-related injection drug use and related HIV/AIDS and Hepatitis C infection rates. In addition, also within SAMHSA, $90.0 million will be used to expand access to the overdose-reversing drug naloxone for first responders, expand the use of drug courts, and expand services to pregnant and postpartum women. Substance Abuse Prevention and Treatment Block Grant The FY 2019 President’s Budget Request is $1.9 billion. This funding serves as a safety net for substance abuse prevention and
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