State and Local Government Partnerships

Overview

States, territories, counties, and localities play an important role in the financing, organization, and delivery of behavioral health prevention, treatment services, and recovery supports. Individual state laws define and dictate which services are eligible and offered. In most states, behavioral health treatment and service funds flow from the state mental health authority or single state agency for substance use services (combined in one agency in some states), to counties or regions within the state. These funds are then awarded to various service providers to deliver care. In other instances, funds flow directly from the state to regionally or locally based provider organizations. Of SAMHSA’s two block grants, the Substance Abuse Prevention and Treatment Block Grant is awarded to single state agencies for substance abuse services in states, territories, and the District of Columbia, and the Community Mental Health Services Block Grant funds mental health authorities in the same jurisdictions.

State and local governments also establish statewide policies and issue rules and regulations that govern the delivery of behavioral health services in accordance with federal and other state laws and regulations. SAMHSA values and supports state and local governments as they work collaboratively to reduce the impact of mental illness and substance use mental illness and substance use on America’s communities and to design and oversee effective treatment service delivery systems. The societal cost of mental health and substance use disorders is significant:

• The Economy—Worldwide, by the year 2030, mental illnesses and substance use disorders will account for $6 trillion in direct and indirect costs and 35% of lost economic output. In the United States, the economic impact of behavioral health conditions, including lost earnings/productivity and health and treatment expenses, is estimated by a 2011 Department of Justice study (PDF | 4.9 MB) to be nearly $500 billion per year.
• Health Care—By 2020, behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide. In the United States, SAMHSA estimates that nearly 43.7 million adults ages 18 and up have a mental illness, and that more than 20 million people ages 12 and up have a substance use disorder.
• Schools—13% to 20% of children in the United States (up to 1 out of 5 children) experience a mental disorder each year. Also, 2.2 million youth, ages 12 to 17, had a major depressive episode during the past year.

Estimates and projections of national spending on health care services offer state and local governments a valuable tool for planning and developing policies and budgets. According to a recent Health Affairs report – 2014, national spending on mental health and substance use treatment services is projected to reach $210 billion in 2014 and $281 billion in 2020. The report indicates that mental health spending currently accounts for roughly 85% of all behavioral health spending (roughly $180 billion out of $210 billion) and is anticipated to account for 85% ($238 billion) of all mental health and substance use treatment spending in 2020. Substance use treatment spending, which comprises a significantly smaller share of mental health and substance use treatment spending and overall health spending, is currently $31 billion and projected to increase to $42 billion in 2020. Further, while expenditures have increased from previous years, mental health and substance use treatment services represent only a small share of overall health spending, about 7% in 2014, and will fall to about 6.5% in 2020. Moreover, the rate of growth for behavioral health spending will be about 4.6% per year between 2009 and 2020, compared to 5.8% for overall health spending.

Public programs pay for most treatment costs for mental illness, primarily through Medicaid, Medicare, and other state and local funding. Public funding accounts for roughly $110 billion of $180 billion in mental health spending (60%) and will represent a similar proportion of spending in 2020. Public payers also continue to pay for most substance use treatment services; these include Medicaid, Medicare, other state and local funding sources, and other federal funding sources (including SAMHSA’s Substance Abuse Prevention and Treatment Block Grant). As of 2014, public payers account for 70% of total substance use disorder spending (roughly $21.9 billion of $31.3 billion total spending). In 2020, public payers are projected to spend roughly $29.9 billion, roughly 70% of substance use disorder spending.

Learn about SAMHSA’s state and local program initiatives and partnerships with national and local organizations that represent various jurisdictions:

• SAMHSA’s Partnerships with State, Territory, County, and Other Governmental Organizations
• SAMHSA in Your State and Community
• SAMHSA Grants to States
• Publications and Resources on State and Local Government Partnerships

SAMHSA Block Grants to States

Learn about SAMHSA’s two block grants administered to state and local jurisdictions to fund behavioral health treatment and prevention programs, and their purpose, allotment methodology, and application submission deadlines:

• The Substance Abuse Prevention and Treatment Block Grant (SABG) provides funds and technical assistance for programs to plan, implement, and evaluate activities that prevent and treat substance use and promote public health. The SABG is provided to states, territories, the District of Columbia, and the Red Lake Band of the Chippewa.
• The Community Mental Health Services Block Grant (MHBG) provides funds and technical assistance for programs with comprehensive, community-based mental health services to adults with serious mental illnesses and to children with serious emotional disturbances, and to monitor progress in implementing a comprehensive, community-based mental health system. The MHBG is provided to states, territories, and the District of Columbia.

Data and Statistics

SAMHSA’s first edition of Behavioral Health Barometer: United States, 2013, gives a snapshot of the nation’s behavioral health. Individual Behavioral Health Barometer reports are also available on a state-by-state basis. The reports present substance use and mental health indicators from population and treatment facility-based data sets, and provides point-in-time and trend data reflecting the status and progress in improving key behavioral health indicators.

SAMHSA administers a number of national surveys and data sets that contain valuable information about state behavioral health conditions prevalence and trends. Visit the Data, Outcomes, and Quality topic to see publications using our data and statistics or to create your own customized reports.

Faith-Based and Community Initiatives (FBCI)

SAMHSA’s FBCI supports several programs in mental health services, substance use prevention, and addiction treatment at the national, state, and local levels. Learn more about receiving training and technical assistance to help deliver effective behavioral health and community-based social services.

Laws and Regulations

Learn about the federal laws, regulations, and guidelines that specifically relate to SAMHSA, SAMHSA-funded state and local activities, the behavioral health field, and criminal justice systems.