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DEPARTMENT of HEALTH and HUMAN SERVICES 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 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 and substance use disorder. Unfortunately, the majority of those who need treatment do not receive it. Only 43 percent of adults with diagnosable mental health problems received treatment. The unmet treatment need for those with substance use disorders is even greater with only 8 percent of individuals receiving specialty treatment. 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 misuse and mental illness on America’s communities. SAMHSA accomplishes this through providing leadership and resources – programs, policies, information and data, funding, and personnel – to advance mental and substance use disorder prevention, treatment, and recovery services in order to improve individual, community, and public health. 1 Overview of Budget Request The FY 2020 Budget Request is $5.68 billion, a decrease of $65.0 million from the FY 2019 Enacted budget. The budget request aims to address critical national priorities including: combating the nation’s opioid crisis, addressing serious mental illness, developing and implementing strategies to prevent suicide, and expanding school-based mental health services. Key Budget Highlights: Substance Abuse Prevention and Treatment Block Grant The FY 2020 Budget Request is $1.9 billion. This funding serves as a critical safety net for substance misuse prevention and substance use disorder treatment services. The states and jurisdictions have the flexibility to plan, carry out, and evaluate prevention, treatment, and recovery services that address the needs of individuals, families, and communities. Recognizing that prevention is an integral component to reduce the effects of substance misuse on America’s communities, the statute requires that twenty percent of the SABG state allocation must be spent on primary prevention services. Medication Assisted Treatment for Prescription Drug and Opioid Addiction (MAT-PDOA) The FY 2020 Budget Request is $89.0 million. MAT refers to the use of the Food and Drug Administration-approved pharmacotherapies (i.e., buprenorphine products, methadone, and naltrexone products) in combination with evidence-based psychosocial interventions for treatment of opioid addiction. MAT is a safe and effective strategy for decreasing the frequency and quantity of opioid abuse and reducing the risk of overdose and death. MAT PDOA addresses treatment needs of individuals who have an opioid addiction by expanding/enhancing treatment system capacity to provide accessible, effective, comprehensive, coordinated/integrated, and evidence-based MAT and recovery support services. Recovery support services include linking patients and families to social, legal, housing, and other supports to improve the probability of positive outcomes. State Opioid Response Grants The FY 2020 Budget Request is $1.5 billion. This program aims to address the opioid crisis by increasing access to medication-assisted treatment using the three FDA-approved medications for the treatment of opioid use disorder, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder (OUD) (including prescription opioids, heroin and illicit fentanyl and fentanyl analogs). Funding was established
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