Funding and Characteristics of Single State Agencies for Substance Abuse Services and State Mental Health Agencies, 2015

2017·11.4 MB·English

Behavioral Health Is E ssential To Health • Prevention Works • Treatment Is Effective • People Recover

Funding and Characteristics
of Single State Agencies for
Substance Abuse Services
and State Mental Health
Agencies, 2015
Funding and Characteristics of SSAs and SMHAs, 2015 Page i
Acknowledgments
This report was prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA) under SAMHSA IDIQ Prime Contract #HHSS283200700029I/Task Order
HHSS2834002T with SAMHSA, U.S. Department of Health and Human Services (HHS).
Mitchell Berger served as the Government Project Officer.
Disclaimer
The views, opinions, and content of this publication are those of the author and do not
necessarily reflect the views, opinions, or policies of SAMHSA or HHS.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied
without permission from SAMHSA. Citation of the source is appreciated. However, this
publication may not be reproduced or distributed for a fee without the specific, written
authorization of the Office of Communications, SAMHSA, HHS.
Recommended Citation
Substance Abuse and Mental Health Services Administration, Funding and Characteristics of
Single State Agencies for Substance Abuse Services and State Mental Health Agencies, 2015.
HHS Pub. No. (SMA) SMA-17-5029. Rockville, MD: Substance Abuse and Mental Health
Services Administration;2017.
Electronic Access and Copies of Publication
http://store.samhsa.gov/. Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English
and Español).
Originating Office
Office of Policy, Planning, and Innovation, Substance Abuse and Mental Health Services
Administration, 5600 Fishers Lane, Rockville, MD 20857.
HHS Publication No. (SMA) SMA-17-5029. Printed in 2017.
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SAMHSA complies with applicable Federal civil rights laws and does not discriminate on the
basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes
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Funding and Characteristics of SSAs and SMHAs, 2015 Page ii
Contents

Chapter Page
Executive Summary ........................................................................................................................ 1

Chapter 1: Introduction ................................................................................................................ 4

Purpose ....................................................................................................................... 4

Background ................................................................................................................ 4

State Mental Health Agencies .................................................................................... 4

Single State Agencies for Substance Use Services .................................................... 5

Overview of the Remainder of the Report ................................................................. 5

Chapter 2: Information Sources and Limitations........................................................................ 8

2.1 State Mental Health Agency Profiling System .......................................................... 8

2.2 State Mental Health Agency Controlled Revenues and Expenditures Study ............ 9

2.3 The Uniform Reporting System ................................................................................. 9

2.4 Single State Agency Controlled Revenues and Expenditures ................................. 10

2.5 Substance Use Prevalence, Client, and Provider Data ............................................. 10

2.6 Limitations ............................................................................................................... 10

Chapter 3: Organization and Structure of State Mental Health Agencies ................................. 13

3.1 Key Highlights ......................................................................................................... 13

3.2 State Mental Health Agency Location in State Government ................................... 13

3.3 State Mental Health Agency Relationships With Other State Agencies ................. 15

Single State Agency for Substance Abuse Services ................................................ 15

State Intellectual Disability Agency ........................................................................ 15

State Medicaid Agency ............................................................................................ 16

State Housing Authority .......................................................................................... 16

State Public Health Agency ..................................................................................... 16

3.4 State Mental Health Agency Service Responsibilities ............................................. 17

Funding and Characteristics of SSAs and SMHAs, 2015 Page iii
State Psychiatric Hospitals ....................................................................................... 18

Mental Health Services for Children and Adolescents ............................................ 18

Services for Alzheimer’s Disease ............................................................................ 18

Services for Organic Brain Syndrome ..................................................................... 18

Services for Traumatic Brain Injury ........................................................................ 18

Services for Autism.................................................................................................. 18

SMHA Services for Individuals With Criminal Justice System Involvement ......... 20

Forensic Service Responsibilities of the SMHA ..................................................... 20

Reorganization of SMHAs ....................................................................................... 20

3.5 Eligibility for State Operated or Funded Mental Health Services ........................... 21

Chapter 4: Organization, Types, and Numbers of Mental and Substance Use Disorder

Service Providers .............................................................................................................. 24

4.1 Key Highlights ......................................................................................................... 24

4.2 Organization of Mental Health Services and Provider System ............................... 24

4.3 Community Mental Health Services ........................................................................ 25

Mechanisms Used to Fund and Administer Community-Based Mental

Health Services ........................................................................................................ 25

Initiatives to Restructure Community-Based Mental Health Services .................... 26

Controlling Entry to State Hospitals ........................................................................ 27

Privatization of Community Mental Health Services .............................................. 27

4.4 State Psychiatric Hospitals ....................................................................................... 27

Reorganization of State Psychiatric Hospitals ......................................................... 27

Psychiatric Inpatient Bed Availability ..................................................................... 28

Privatization of State Psychiatric Hospitals ............................................................. 29

4.5 Forensic Mental Health Services ............................................................................. 29

4.6 Public Substance Use Disorder Prevention and Treatment Systems ....................... 29

Funding and Characteristics of SSAs and SMHAs, 2015 Page iv
Chapter 5: Characteristics of Individuals the State Mental Health Agency and Single

State Agency Systems Serve ............................................................................................. 33

5.1 Key Highlights ......................................................................................................... 33

5.2 Individuals State Mental Health Agencies Served, FY 2014 .................................. 33

Demographic Characteristics of Individuals Served................................................ 33

Utilization Rates of Individuals Served, by Race and Ethnicity and by Sex ........... 35

Individuals Served, by Service Setting .................................................................... 36

Individuals Served Through Medicaid and Other Funding Sources ........................ 36

Employment Status of Individuals Served ............................................................... 37

Residential Settings of Individuals Served .............................................................. 37

5.3 Individuals for Whom Single State Agencies Provided Substance Use

Disorder Services, FY 2013–2014 ........................................................................... 38

Characteristics of Individuals Admitted to Publicly Supported Treatment for

Substance Use Disorders.......................................................................................... 42

Prevention: Population Served and Services Provided ............................................ 45

Chapter 6: State Mental Health Agency Efforts to Address Health-Mental Health

Integration ......................................................................................................................... 52

6.1 Key Highlights ......................................................................................................... 52

6.2 Integration, Colocation, and Other Initiatives to Integrate Physical and

Behavioral Health .................................................................................................... 52

Integration of Mental Health and Primary Care ...................................................... 52

Colocation of Mental Health and Primary Care ...................................................... 53

Physical Health Screening ....................................................................................... 54

Substance Use Treatment and Trauma Initiatives ................................................... 54

6.3 Implementation of Electronic Health Records and Sharing Electronic Health

Information .............................................................................................................. 55

Organization and Funding of Information Management Functions ........................ 55

Electronic Health Records ....................................................................................... 58

Personal Health Records .......................................................................................... 62

Funding and Characteristics of SSAs and SMHAs, 2015 Page v
Chapter 7: Major Policies of State Mental Health Agencies and Single State Agencies .......... 64

7.1 Key Highlights ......................................................................................................... 64

7.2 Evidence-Based Practices ........................................................................................ 65

Evidence-Based Practices for Mental Health .......................................................... 65

Implementation of Evidence-Based Practices ......................................................... 67

7.3 Involuntary Mental Health Treatment ..................................................................... 69

Involuntary Patient Treatment ................................................................................. 70

SMHA Access to Information About Involuntary Commitments ........................... 70

Delivery Settings for Forensic Clients and Sex Offenders ...................................... 71

Forensic Bed Availability ........................................................................................ 71

Sex Offenders........................................................................................................... 72

Legal Status of Patients in State Psychiatric Hospitals ............................................ 72

Outpatient Commitment........................................................................................... 73

7.4 Other Major SMHA Policy Initiatives ..................................................................... 73

Prevention Initiatives ............................................................................................... 73

Recovery Support..................................................................................................... 74

Crisis Intervention .................................................................................................... 74

7.5 State Initiatives to Address the Opioid Epidemic .................................................... 75

Overview .................................................................................................................. 75

State Prioritization of the Current Opioid Problem ................................................. 76

State Task Forces ..................................................................................................... 77

Trends in State Data on Prescription Drugs and Heroin Abuse ............................... 80

Preventing Prescription Drug and Heroin Abuse..................................................... 81

Medication Prescribing Guidelines .......................................................................... 86

Addressing the Discrimination Associated With Drug Abuse ................................ 87

Medication-Assisted Treatment and Naloxone ........................................................ 89

Treatment Outcomes and Data Reporting................................................................ 93

Funding and Characteristics of SSAs and SMHAs, 2015 Page vi
Prescription Drug Monitoring Program ................................................................... 95

Other Information and Resources ............................................................................ 97

Conclusion ............................................................................................................... 98

Chapter 8: Financing Mental and Substance Use Disorder Services ........................................ 99

8.1 Key Highlights ......................................................................................................... 99

8.2 SSA and SMHA Expenditures ................................................................................. 99

SSA and SMHA Funding Sources ......................................................................... 102

SSA and SMHA Funding Over Time .................................................................... 108

8.3 Financing State Mental Health Agency Services ................................................... 109

State Mental Health Agency Revenues and Expenditures for Mental Health

Services, FY 2014 .................................................................................................. 112

SMHA Expenditures per Individuals Served ......................................................... 114

SMHA Expenditures by Type of Mental Health Program..................................... 118

SMHA-Controlled Expenditures by Age of Individuals Served ........................... 121

Expenditures by Type of Mental Health Service ................................................... 124

Funding Sources for SMHA Mental Health Services ............................................ 126

Financing Community Mental Health Services ..................................................... 130

State Mental Health Agency Funding Sources for Community Mental

Health Services, FY 2014 ...................................................................................... 132

Financing State Psychiatric Hospitals, FY 2014.................................................... 133

State Psychiatric Hospital Expenditures per Patient Day by Type of Patient ........ 135

Trends in State Mental Health Agency Revenues and Expenditures .................... 139

SMHA Expenditures for Forensic Expenditures Over Time ................................. 141

Trends in SMHA Funding Sources Over Time ..................................................... 142

8.4 Financing of Single State Agency Substance Use Disorder Services.................... 144

Single State Agency Expenditures for Substance Use Disorder Services ............. 144

Funding Sources for Substance Use Disorder Services ......................................... 147

Medicaid Spending for Substance Use Disorder Services ..................................... 149

Funding and Characteristics of SSAs and SMHAs, 2015 Page vii
Trends in Single State Agency Expenditures and Funding Sources ...................... 150

Glossary ...................................................................................................................................... 154

Appendixes
A: Profiles of State Mental Health Agencies ........................................................................ A-1

B: Profiles of Single State Agencies for Substance Abuse Services .................................... B-1

Funding and Characteristics of SSAs and SMHAs, 2015 Page viii
Tables

Table Page
Table 1. Organization of State Mental Health Agencies Within State Governments, FY
2015....................................................................................................................................14

Table 2. State Mental Health Agency Relationships With Other State Government

Agencies, FY 2015.............................................................................................................16

Table 3. State Mental Health Agency Service Responsibilities, FY 2015 ...................................19

Table 4. State Mental Health Agency Responsibilities for Providing Mental Health

Services to Individuals With Criminal Justice Involvement, FY 2015 .............................20

Table 5. Eligibility Criteria for State Mental Health Agency Operated or Funded Mental

Health Services, FY 2015 ..................................................................................................21

Table 6. Number of Facilities State Mental Health Agencies Operate and Fund, FY 2015 .........25

Table 7. Target Population of State Psychiatric Hospitals for Acute, Intermediate, and

Long-Term Inpatient Care, by Age, FY 2015....................................................................27

Table 8. Single State Agency Supported Providers of Primary Prevention and Treatment,

by State, FY 2013 ..............................................................................................................30

Table 9. Number of Individuals Receiving Single State Agency-Supported Substance

Use Disorder Treatment or Support Services, by Nation and State, FY 2013–2014 .........40

Table 10. Number of Individuals/Person Exposures Served by Single State Agency

Sponsored Substance Abuse Prevention Strategies in FY 2013–2014, by State ..............46

Table 11. Budget for Information Management for Each State, FY 2015 ...................................57

Table 12. Number of States Implementing Electronic Health Record Functions in State

Psychiatric Hospitals, by Function, FY 2015 ....................................................................60

Table 13. Number of State Mental Health Agencies Implementing or Planning to

Implement Evidence-Based Practices, FY 2015 ................................................................65

Table 14. Number of Evidence-Based Practice Programs in States and Number of

Individuals Receiving These Programs, FY 2015 .............................................................66

Table 15. Number of States Reporting Funding Sources of Evidence-Based Practices, FY

2015....................................................................................................................................68

Table 16. Number of States Assessing or Monitoring Fidelity of Evidence-Based

Practices, FY 2015 .............................................................................................................69

Funding and Characteristics of SSAs and SMHAs, 2015 Page ix
Table 17. Number of State Mental Health Agencies Able to Access Information About
Involuntary Treatment (N=43 States), FY 2015 ................................................................70

Table 18. Total and per Capita SSA and SMHA Expenditures for M/SUD Services, FY

2014..................................................................................................................................100

Table 19. SSA and SMHA Funding by Major Payment Source, FY 2014 ................................104

Table 20. Percentage of SSA and SMHA Funds from Major Payment Sources, FY 2014 ........106

Table 21. SSA and SMHA Major Funding Sources, FY 2008 to FY 2014 ................................108

Table 22. Types of Medicaid Waivers Used to Pay for Mental Health Services, FY 2015 .......110

Table 23. SMHA-Controlled Expenditures, per Capita Expenditures, and Under 138% of

FPL per Capita Expenditures for Mental Health Services, FY 2014 ...............................113

Table 24. SMHA Expenditures per Individual Served, FY 2014 ...............................................116

Table 25. State Mental Health Agency Controlled Expenditures and Per Capita

Expenditures by Type of Mental Health Program and State, FY 2014 ...........................119

Table 26. State Mental Health Agency Controlled Total and per Capita Expenditures, by

Age Group, FY 2014 (in Millions) ..................................................................................122

Table 27. State Mental Health Agency Controlled Mental Health Revenues by Revenue

Source, FY 2014 ..............................................................................................................128

Table 28. Number of States Using Funding Sources to Finance Community Mental

Health Services, by Type of Service, 2015 (N=46 States) ..............................................130

Table 29. Number of SMHAs Using Funding Sources for Mental Health Services in

State Psychiatric Hospitals, by Hospital Patient Group and Type of Service, 2015

(N=45 States) ...................................................................................................................134

Table 30. State Psychiatric Hospital Inpatient Expenditures per Patient Day for Civil

Status Patients, by State, FY 2014 ...................................................................................136

Table 31. State Psychiatric Hospital Inpatient Expenditures Per Patient Day for Forensic

Status Patients and Sex Offenders by State, FY 2014 .....................................................138

Table 32. Annual Percentage Change in State Mental Health Agency Controlled

Expenditures for Mental Health in Current and Population and Inflation Adjusted

Dollars, FY 2001–2014 ....................................................................................................141

Table 33. Expenditures of Single State Agencies, by Service Provided, FY 2014

(Expenditures in Millions) ...............................................................................................145

Table 34. Single State Agency Funding Sources, FY 2014 ........................................................147

Funding and Characteristics of SSAs and SMHAs, 2015 Page x