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SAMHSA/HHS FY 2020 Justification of Estimates for Appropriations

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SAMHSA/HHS FY 2020 Justification of Estimates for Appropriations DEPARTMENT of HEALTH and HUMAN SERVICES Fiscal Year 2020 Substance Abuse and Mental Health Services Administration Justification of Estimates for Appropriations Committees Page intentionally left blank ii 5600 Fishers Lane • Rockville, MD 20857 www.samhsa.gov • 1-877-SAMHSA-7 (1-877-726-4727) Letter from the Assistant Secretary I am pleased to present the Substance Abuse and Mental Health Services Administration (SAMHSA) fiscal year (FY) 2020 Budget Request. SAMHSA is requesting a total of $5.6 billion. As the primary federal agency responsible for addressing the mental and substance use disorders that affect millions of Americans, SAMHSA takes seriously its responsibility to ensure that the best, most evidence-based care is reaching all communities in our nation. Now, more than ever, we must ensure individuals living with these conditions gain access to high quality prevention, treatment, and recovery services. Consistent with the goals of the 21st Century Cures Act, SAMHSA's budget demonstrates a commitment to addressing pressing public health challenges, including the opioids crisis and serious mental illness (SMI). This budget aligns with the Administration’s priorities to address mental and substance use issues for children, adults, families, and communities. Through a sustained focus on implementing evidence-based practices, SAMHSA's budget aims to improve the lives of people across the country. SAMHSA’s FY 2020 budget request includes investments to: • Expand access to care for opioid use disorders (OUD) through continued investment in FDA-approved pharmacotherapies for OUD, also known as Medication-Assisted Treatment (MAT) in conjunction with psychosocial supports, expanded community supports, and strategies to prevent opioid abuse through evidence-based prevention approaches, including the use of the life-saving opioid overdose antidote, naloxone • Prioritize ensuring that individuals with SMI gain access to care over incarceration through increased investments in evidence-based programs, such as Assertive Community Treatment (ACT) and Assisted Outpatient Treatment (AOT), jail diversion programs, and a focus on addressing the needs of high utilizers of services through the Community Mental Health Services Block Grant • Expand Certified Community Behavioral Health Clinic (CCBHC) services that provide integrated mental health, substance use, and physical healthcare to those living with SMI, offer 24/7 crisis intervention services and provide access to wrap-around, evidence-based interventions that will support community living for those affected by mental and substance use disorders • Make critical investments in children's mental health programs, including essential school-based supports, to ensure our nation's schools provide a positive and safe learning environment for America’s youth • Improve access to suicide prevention services and strategies for youth, transition-aged youth, and adults at risk for suicide In FY 2020, SAMHSA maintains a strong commitment to enhancing the delivery of clinically sound, evidence-based, effective services. SAMHSA continues to streamline its business operations, including the provision of technical assistance and training, to ensure an optimization of service provision across America's communities. The work SAMHSA does is vital to the heath of this country. I am confident this budget supports SAMHSA's mission to reduce the impact of substance abuse and mental illness on America's comm unities. Elinore F. McCance-Katz, M.D., Ph.D. Assistant Secretary for Mental Health and Substance Abuse Behavioral Health is Essential to Health • Prevention Works • Treatment Is Effective • People Recover iii Page intentionally left blank iv DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION Table of Contents Fiscal Year 2020 Budget Page Letter from Assistant Secretary..................................................................................................... iv Table of Contents........................................................................................................................... vi Organization Chart ........................................................................................................................ vii A. Performance Budget Overview 1. Introduction and Mission ....................................................................................................1 2. Overview of Budget Request .............................................................................................2 3. Overview of Performance ..................................................................................................7 4. All Purpose Table (APT) ....................................................................................................8 B. Budget Exhibits 1. Appropriations Language .................................................................................................10 2. Language Analysis ...........................................................................................................13 3. Amounts Available for Obligation ...................................................................................17 4. Summary of Changes .......................................................................................................18 5. Budget Authority by Activity ...........................................................................................19 6. Authorizing Legislation ....................................................................................................21 7. Appropriations History .....................................................................................................25 8. Appropriations Not Authorized by Law ...........................................................................28 C. Mental Health 1. Mental Health Programs of Regional and National Significance ....................................31 2. Children’s Mental Health Services .................................................................................115 3. Project for Assistance in Transition from Homelessness ...............................................121 4. Protection and Advocacy for Individuals with Mental Illness .......................................127 5. Certified Community Behavioral Health Clinic .............................................................132 6. Community Mental Health Services Block Grant ..........................................................136 D. Substance Abuse Prevention 1. Substance Abuse Prevention Programs of Regional and National Significance............151 E. Substance Abuse Treatment 1. Substance Abuse Treatment Programs of Regional and National Significance ............189 2. State Targeted Response to the Opioid Crisis Grants ....................................................252 3. State Opioid Response Grants ........................................................................................255 4. Substance Abuse Prevention and Treatment Block Grant .............................................259 v F. Health Surveillance and Program Support 1. Health Surveillance ........................................................................................................271 2. Drug Abuse Warning Network (DAWN) ......................................................................278 3. Performance and Quality Information Systems .............................................................280 4. Program Support .............................................................................................................285 5. Public Awareness and Support .......................................................................................287 G. Nonrecurring Expenses Fund.............................................................................................292 H. Drug Control Budget...........................................................................................................294 I. Supplementary Tables 1. Budget Authority by Object Class .................................................................................318 2. Salaries and Expenses ......................................................................................................327 3. Detail of Full-Time Equivalent Employee (FTE) ..............................................................329 4. Detail of Positions ...........................................................................................................330 5. Programs Proposed for Elimination ..................................................................................331 6. Physician’s Comparability Allowance Worksheet ............................................................333 J. Significant Items….............................................................................................................. 334 vi Organizational Structure: Substance Abuse and Mental Health Services Administration (SAMHSA) Page intentionally left blank Introduction 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. Individuals and families across the nation are struggling with the consequences of living with mental and substance use disorders. In 2017, approximately 18.7 million adults and 46.6 million adults had a substance use or mental disorder respectively. Of these, 8.5 million adults had a co-occurring mental
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