On June 25, 2022, President Biden signed into law the Bipartisan Safer Communities Act (BSCA), providing an unprecedented investment in mental health funding for children and families across the country. The historic legislation included: supplemental funding for the Community Mental Health Services Block Grant; funding to support new child and family serving mental health grantees; supplemental funding for states and territories to expand and enhance the 988 Suicide & Crisis Lifeline services; and funding to expand the Certified Community Behavioral Health Clinics (CCBHC) program. As we mark the one-year anniversary since BSCA was signed into law, I am excited to share some of the life-changing work the Substance Abuse and Mental Health Services Administration (SAMHSA) and its grantees have implemented thus far.
Mental Health Block Grant
The Community Mental Health Services Block Grant (MHBG) is a formula grant distributed annually to all 50 states, DC, Puerto Rico, U.S. Virgin Islands, and six Pacific jurisdictions to support State Mental Health Authorities in the development and expansion of a comprehensive, community-based, mental health service system for adults with serious mental illness (SMI) and children with serious emotional disturbances (SED).
As part of BSCA, states and territories will be awarded supplemental MHBG funding each fiscal year (FY), from FY 2022-2025. SAMHSA awarded $59.4 million for the first of-four increments to the states and territories in October 2022, with the recommendation (PDF | 228 KB) that the funding be spent to address mental health emergency preparedness and crisis response efforts.
The states and territories have been using the additional funds to:
- Add mobile crisis teams to their community mental health centers that previously did not have teams;
- Increase training for crisis response and de-escalation trainings;
- Develop Trauma Response Teams, with skills used in the teams specific to trauma, gun violence, and addressing children and families in crisis as well as a special focus on identifying and referring children and young adults with an SED to appropriate services;
- Support expansion of 988 system for responding to behavioral health crises;
- Ensure youth, families, teachers and staff, and other members of the community receive specific, evidence-based services in the event of a mass shooting/school violence; and
- Implement policies and procedures to provide appropriate post-trauma treatment services for first responders to preserve their mental health and mitigate vicarious trauma.
States and territories will receive their second increment of funding by September 2023.
Child and Family Serving Grants
BSCA provided vital resources to support the mental health of children and families across the country. On December 31, 2022, SAMHSA awarded $185.7 million in funding for 299 child and family-serving grants: Mental Health Awareness Training (MHAT), Resiliency in Communities After Stress and Trauma (ReCAST), Trauma-Informed Services in Schools, National Child Traumatic Stress Initiative (NCTSI), and Project Advancing Wellness and Resiliency in Education (Project AWARE). These grantees will support mental health efforts across 231 cities in 47 states, DC, and three territories. Grants were awarded for four years, and grantees will complete their projects no later than December 2026.
While our grantees are still in the early stages of implementation, I am excited to share what they have planned thus far:
- MHAT grants increase mental health literacy by preparing and training individuals and communities to respond appropriately, and safely, to persons with mental health conditions to enable early intervention. The 236 BSCA-funded MHAT grantees are located across 45 states, DC, and three territories. They are beginning to train mental health and related workforce, school/higher education systems, first responders, law enforcement, diverse human service organizations, and other community members, with the goal of training approximately 72,000 individuals by the end of 2023.
- ReCAST grants promote resilience, trauma-informed approaches, and equity in communities that have recently faced civil unrest, community violence, and/or collective trauma. The 10 BSCA-funded ReCAST grantees are implementing evidence-based violence prevention and community youth engagement programs across six cities, four Tribal nations, three counties, and one public school system in seven states. The grantees plan to collectively provide 1,400 individuals with evidence-based mental health–related services by the end of 2023.
- Trauma-Informed Services in School grants increase student access to evidence-based and culturally relevant trauma support services and mental health care. The eight BSCA-funded Trauma-Informed Services in School grantees anticipate screening nearly 1,000 students in six states by the end of 2023.
- SAMHSA’s NCTSI is improving the quality of trauma treatment and services in communities for children, adolescents, and their families across the country who experience or witness traumatic events. Through BSCA, seven new NCTSI Treatment and Service Adaptation Center grantees are focusing on specific areas of trauma and population groups, including rural communities, marginalized communities, juvenile justice settings, and school settings. The grantees are planning to train more than 5,000 individuals in trauma-informed approaches by the end of 2023. BSCA is supporting 14 new NCTSI Community Treatment and Services Center grantees who are screening and providing treatment services to children who have experienced or witnessed traumatic events, including abuse, violent crime, substance use, domestic violence, natural disasters, parent incarceration, interpersonal or community violence, and targeted harassment. By the end of the 2023, the grantees expect to screen more than 2,800 individuals for trauma and anticipate providing evidence-based mental-health-related services to approximately 1,000 individuals.
- Project AWARE grants support the development of a sustainable infrastructure for school-based mental health programs and services. BSCA funded 23 new Project AWARE grantees in 18 states, who are working to support mental health efforts in more than 125 Local Education Agencies, with the goal of serving more than 1,000 elementary, middle, and high schools. By the end of 2023, the grantees anticipate training more than 17,000 people in prevention and mental health promotion.
988 Suicide & Crisis Lifeline
BSCA provided significant additional funding to expand the 988 Lifeline and help strengthen the crisis care system across the country. The 988 Suicide & Crisis Lifeline provides 24/7 support for people who may be struggling or in crisis. Anyone, regardless of location in the U.S., can get support by calling or texting 988, or chatting 988lifeline.org.
The investment in 988 included:
- $47 million awarded to states and U.S. territories to advance local response and the Lifeline, as well as 988-911 coordination, across the country;
- $17.2 million awarded to help 23 Tribal entities build crisis capacity for tribal citizens, who face unique challenges with access to technology and crisis services;
- $64.8 million awarded to the 988 Lifeline administrator, Vibrant Emotional Health, to manage and expand access to local and national 988 Lifeline crisis centers, maintain and enhance language-based services, ensure effective system routing, training, evaluation, network operational outcomes, and improve access to specialized care for populations known to be at higher risk for suicide;
- $12.8 million is supporting 988 Lifeline-national education efforts, so that people across the country are aware of the life-saving services available to them through 988; and
- $5.5 million is being used to support webinars, grantee technical assistance, listening sessions, and toolkit development specifically focused on Tribal crisis response.
We know that this investment in the 988 Lifeline is helping save lives. Studies have shown that after speaking with a trained crisis counselor, most 988 Lifeline callers are significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful. Importantly, since the transition to 988 (from the 1-800 number) there has been an increase in overall calls, texts and chats from the year prior – all while answer rates are significantly improving.
Certified Community Behavioral Health Clinics
CCBHCs provide coordinated, comprehensive whole-person behavioral health care for anyone who requests mental health or substance use services, regardless of their ability to pay, place of residence, or age. CCBHCs were first authorized under section 223 of the Protecting Access to Medicare Act (PAMA) of 2014, as a part of a Medicaid demonstration program in eight states. Two additional states were added to the program through the CARES Act in 2020. Because of the BSCA, there will be significant growth in the program over the next decade.
Starting in July 2024, up to 10 states will be added to the Medicaid demonstration program every two years. In addition, the BSCA extends the program through September 30, 2025 for the original 8 states, allows the two new states to be awarded six years of funding, and any new state added to the program under the BSCA will receive funding for four years. This is important, as the Medicaid demonstration provides cost-based reimbursement to demonstration states at an enhanced Federal matching rate for a comprehensive package of behavioral health services, creating a fundamental solution to the problem of fragmented financing that has faced public behavioral health systems for more than a half century.
BSCA also provided funding for two rounds of state planning grants to enable states to join the demonstration. The first round of 15 grants was awarded this past March. The states currently are working to develop and implement certification systems for CCBHCs, establish prospective payment systems to reimburse CCBHC states for the expected cost of care associated with delivering the nine statutory services outlined in the PAMA, and prepare an application to participate in a four-year CCBHC demonstration program. These states will compete to be one of the 10 states joining the demonstration in 2024. Another round of 15 planning grants will be awarded in 2025. BSCA funding also supports technical assistance to states around the CCBHC model.
The CCBHC provisions of the PAMA, as extended and expanded under the BSCA, are transformative for our nation’s public mental health and substance use disorder service systems. The CCBHC demonstration creates guaranteed access to services and has been shown to increase the availability of a range of services. As a result of BSCA, the demonstration is expected to exist in most states by 2026.
SAMHSA remains steadfast in its commitment to provide treatment and supports to foster recovery while ensuring access and better outcomes. We will continue to monitor our grantees efforts and share their successes and impact on the behavioral health of our nation over the next several years and beyond.