SAMHSA logo Report to Congress - Nov 2002

 

 

 

 

REPORT TO CONGRESS ON THE PREVENTION AND TREATMENT OF CO-OCCURRING SUBSTANCE ABUSE DISORDERS AND MENTAL DISORDERS

 

 


Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

Chapter 2 - The States Respond: The Impact of Federal Block Grants - Background

 

 

On the front lines of treatment, Ray Daw, Executive Director of the Na'nizhoozhi Center Inc.(NCI) in Gallup, New Mexico, sees a common pattern of co-occurring substance abuse disorders and mental disorders.

"Most persons who are chronic abusers have mental disorders of some kind," Mr. Daw says. "Primarily, it's memory and cognitive dysfunction or head injuries or, to a lesser degree, personality disorders such as anti-social personality or aggressive disorders. Generally we see more affective than psychotic disorders, and depression is number one."

NCI primarily helps people with chronic substance abuse who are homeless and, in most cases, American Indians. With a 150-bed facility, and short stays, it has 20,000 admissions a year, making it one of the busiest substance abuse providers in the Nation, according to SAMHSA admission data for the year 2000. NCI has 75 workers, most of them American Indian, including eight traditional healers. The center also holds sweat lodges.

Mr. Daw and his staff integrate care by consulting with psychiatric workers and by trying to disentangle one problem from the other. "Substance abuse, a lot of the time, masks the co-occurring disorder, so the difficulty is getting people to abstain long enough to get a diagnosis," Mr. Daw says. They also work with clients on employment skills.

The facility can treat clients for up to 5 days, long enough to begin treatment but often too short for much. "We do the best that can be done," says Mr. Daw. "We tell them if there's a problem, they can always come back." The Na'nizhoozhi Center is supported by a wide range of Federal, State, and private resources, including the SAMHSA Substance Abuse Prevention and Treatment Block Grant program.

 

Background

The Substance Abuse Prevention and Treatment (SAPT) and the Community Mental Health Services (CMHS) Block Grants are important mechanisms available to the Federal government to support substance abuse prevention and treatment programs, and mental health services programs, in the States and Territories. A key feature of both Block Grant programs is the flexibility given to each State to target funds based on State and community need.

In 2000, Congress reauthorized SAMHSA and its statutory programs under the Children's Health Act of 2000 (P.L. 106-310). The statute requires SAMHSA to realign the regulations governing the Block Grant programs consistent with the concept of Performance Partnerships that provide States even greater flexibility in the use of Block Grant funds. Performance Partnerships also establish State accountability through the use of performance measures with clearly defined outcomes, encouraging not only continuous quality improvement, but also a high level of responsiveness to the consumers of substance abuse and mental health services. As a result, SAMHSA will be better able to document changes in each of the States and Territories in critical areas such as access to services, service effectiveness, and the level of success in meeting the needs of vulnerable populations, including individuals with co-occurring substance abuse disorders and mental disorders.

As described later in this chapter, many States have used funds from both the SAPT and CMHS Block Grants to provide services to individuals with co-occurring disorders. The information provided to SAMHSA by the States does not necessarily represent all of the activities supported by the Block Grants for individuals with co-occurring disorder nor does it reflect changes in the Block Grant related to the development of Performance Partnerships.

Services for Individuals with Co-Occurring Disorders

Section 1956 of the U.S. Public Health Service Act, as amended by Public Law 106-310, clarifies that States may use both SAPT and CMHS Block Grant funds for services to individuals with co-occurring substance abuse disorders and mental disorders. They may do so as long as all funds are used in accordance with the specific regulatory and statutory requirements that govern the relevant funding source, including the purposes for which the funds are authorized and the reporting and auditing requirements.

In other words, SAPT and CMHS Block Grant funds may only be aggregated in ways that maintain the integrity of the separate funds for the purposes of reporting and auditing. Thus, SAPT and CMHS Block Grant funds may be provided by the States to providers of treatment services for individuals with co-occurring disorders as long as the funds are allocated based on the purposes for which the funds are authorized. This means that:

SAPT Block Grant funds must be used for planning, carrying out, and evaluating activities to prevent and treat substance abuse. SAPT Block Grant funds may also be used for substance abuse prevention activities for individuals at risk of developing co-occurring substance abuse disorders and mental disorders. To the extent that States use the SAPT Block Grant's 20 percent primary prevention set-aside for such activities, they must use such funds in accordance with the statutory and regulatory requirements that govern this set-aside.

CMHS Block Grant funds must be used to carry out the State plan for comprehensive community mental health services for adults with serious mental illnesses and children with serious emotional disturbances; to evaluate programs and services carried out under the plan; and to plan, administer, and educate regarding service provision under the plan.

However, nothing in the reporting or accounting requirements precludes programs from using Block Grant funds to provide integrated treatment for co-occurring substance abuse disorders and mental disorders. The Agency provides technical assistance and promotes peer assistance to States and providers to ensure that the reporting requirements associated with Block Grant funds do not present an undue barrier to providing a full array of services, including integrated treatment, for people who have co-occurring disorders.

Differences between the SAPT and CMHS Block Grants

While similar in some respects, the differences between the SAPT and CMHS Block Grants are important to acknowledge particularly since they influence how each of the grant programs responds to the needs of individuals with co-occurring disorders. Differences include:

The fiscal year 2002 SAPT Block Grant appropriation was $1.725 billion, accounting for 40 percent of State expenditures for substance abuse prevention and treatment services (NASADAD, 2002). The CMHS Block Grant funds in the same fiscal year totaled $433 million, accounting for between 3 and 4 percent of State expenditures for community-based mental health care. Regarding the larger picture of national spending on mental and substance abuse disorders, the total expenditure for mental health and substance abuse for 1997 (latest available data) was $82.2 billion. Of this amount, spending for mental health was $70.8 billion (representing 86 percent) and spending for substance abuse accounted for $11.4 billion (or 14 percent) (SAMHSA, 2000a).

Medicaid expends approximately $20 billion per year for mental health services and approximately $1 billion per year for drug and alcohol treatment services.

The SAPT Block Grant does not require that services be provided or reported for individuals with co-occurring disorders. In contrast, in order to be approved to receive CMHS Block Grant funds, State mental health plans must include information about the ways in which the issue of co-occurring substance abuse disorders and mental disorders will be addressed both for adults with serious mental illnesses and children with serious emotional disturbances.

SAPT Block Grant funds can be used without regard to the severity of an individual's substance abuse disorder while the CMHS Block Grant funds may only be used to meet the needs of adults with serious mental illnesses and children with serious emotional disturbances.

Both Block Grant programs have served as a catalyst for the development and implementation of programs for individuals with co-occurring disorders. States have aggregated Block Grant funds with other Federal, State and local resources, to support innovative approaches to mental health services and substance abuse prevention and treatment.