From Exclusion to Belonging:

Transforming Mental Health Care in America

The Vision: A Life in the Community for Everyone

The Substance Abuse and Mental Health Services Administration

The Centers and Offices
Transforming Mental Health Care in America
The New Federal Leadership
The Challenge
Highlights of the Federal Action Agenda
Components of Recovery
National Consensus Statement on Mental Health Recovery
Programs of Transformation
Making It Count






Making It Count

Ensuring Accountability Through Data-Driven Decisionmaking

Mental Health Data and Analysis

With the ultimate goal of improving the quality of mental health programs and services delivery, CMHS collects, analyzes, and reports national statistical information on mental health services and the people served. These activities include primary and secondary data collection and analysis, cost estimation, services evaluation, and policy assessment. CMHS data collection activities date back to 1840, and represent one of the longest continuous data collections in American public health. Program activities include the following:

  • Surveys of the organization and financing of all specialty mental health organizations in the United States;
  • Special surveys and analyses of mental health services provided outside of specialty mental health settings, such as in schools, prisons and jails, juvenile justice settings, nursing homes, and mental health self-help activities;
  • Client sample surveys of persons served by specialty mental health organizations;
  • Development of benchmark information on mental health spending by both public and private payors;
  • Analyses of Medicaid data to highlight trends and characteristics of public financing of mental health services; and
  • Development of standards that make national mental health data collection uniform and comparable.

CMHS data are recognized as the authoritative source of information on mental health organizations and their staff, finances, and clients. The results of data and analysis activities are showcased in a widely disseminated biennial publication on major mental health policy and statistical issues, Mental Health, United States, in peer-reviewed journals, and government reports and monographs. In addition, two widely used Web-based tools are available: a comprehensive electronic services locater, and a searchable database of behavioral health headlines from newspapers and periodicals for all 50 States—these tools can be found on SAMHSA’s National Mental Health Information Center Web site at

The SAMHSA Annual National Survey

 The National Survey on Drug Use and Health (NSDUH) is the Nation’s most comprehensive source of substance abuse and mental health related data. NSDUH is a SAMHSA-sponsored annual survey of the U.S. population ages 12 and older, excluding persons residing in institutions. The Survey presents national and State-level estimates on rates of use, numbers of users, and other measures related to illegal drugs, alcohol, tobacco, as well as measures related to mental health problems, including co-occurrence of substance use and mental health problems, and new data on depression among youth and adults.

Because it is an annual survey, NSDUH reveals important trends in substance use and mental health that can be used to plan effective evidence-based treatment and services and to judge the success of current activities. Mental health focused data show that in 2004—

  • There were 35.1 million (14.7 percent) persons aged 12 or older who had at least one major depressive episode in their lifetime.
  • There were 21.4 million adults aged 18 or older with serious psychological distress, representing 9.9 percent of all adults, a rate that increased from 2002 when it was 8.3 percent.
  • There were 5.7 million youths aged 12 to 17 (22.5 percent) who received treatment or counseling for emotional or behavior problems in the year proceding to the interview; a rate higher than the estimates for 2002 (19.3 percent) and 2003 (20.6 percent).

Unfortunately, the survey also indicated that those who need mental health care do not receive it. Less than half of all Americans with serious mental illnesses seek treatment. SAMHSA is committed to supporting both mental health prevention and treatment programming that builds resiliency and promotes recovery. Of paramount importance is the need to expand the capacity of treatment systems to meet the needs of youth and adults with mental illnesses and substance use disorders.

Using Data to TRAC Performance

CMHS directs a diverse portfolio of grants, contracts, and other activities aimed at improving the lives of people with, or at risk for mental illnesses. To assist with managing and monitoring functions, CMHS is developing a new Web-based database system know as the TRAC (referring to TRansformation ACcountability). This new tool will serve as a centralized portal for data from across CMHS’s wide discretionary portfolio that includes approximately 28 distinct programs. The TRAC will capture performance measures generated by key foci of CMHS programs: client services and infrastructure development. It will also capture requests for and delivery of technical assistance. The TRAC will allow SAMHSA to obtain a snapshot of the performance of individual grantees against target performance goals. Data analysis and output reports will allow CMHS to monitor and work with grantees to ensure quality implementation of programs, and to inform the agency about future program needs and directions.

Streamlining Reporting Requirements

SAMHSA has responded to the public's demand that government agencies demonstrate accountability to the taxpayer by wisely investing resources into treatments and services that produce positive outcomes. To enhance the effectiveness of SAMHSA-funded programs and to streamline reporting requirements, SAMHSA and the States have created a simple, performance-based, outcome-driven measurement system for SAMHSA’s two Block Grant programs and other funded programs. These National Outcome Measures (NOMs) represent meaningful, real life outcomes for people who are striving to attain and sustain recovery, build resilience, and work, learn, live, and participate fully in their communities.

National Outcome Measures (NOMs)

In alignment with SAMHSA's three strategic goals, NOMs also reduce State reporting burdens and provides uniform, consistent reporting of information focusing on 10 domains:

  • Reduced symptomatology from mental illnesses or Abstinence from drug use and alcohol abuse
  • Resilience and sustaining recovery, including:
    __Getting and keeping a job or enrolling and staying in school
    __Decreasing involvement with the criminal justice system
  • Finding safe and stable housing
  • Improving social connectedness to others in the community
  • Increased access to services
  • Retention in substance abuse treatment or decreased inpatient hospitalizations for mental health treatment
  • Quality of services provided
  • Client perception of care
  • Cost-effectiveness
  • Use of evidence-based treatment practices.

Data for reporting on the NOMs will come primarily from the States. SAMHSA will support States in their efforts with infrastructure and technical assistance through a new State Outcomes Measurement and Management System (SOMMS), an umbrella activity in SAMHSA to implement NOMs. After receiving data from each State, SAMHSA and State officials collaborate on data analysis and performance management to improve services. Currently, each State is at a different stage of readiness and some of the measures themselves are still in development. However, we will be able to report State-level, consistent, cross-year data, which will ultimately allow us to examine the impact of programs and changes over time.

SAMHSA is realigning its entire grant and contract data collection programs—both internal and external—using these NOMs, while expanding and focusing its technical assistance resources to help States and providers develop NOMs reporting capacity.