SAMHSA Strategic Plan

Strategic Plan
2023-2026

Strategic Plan
Fiscal Year 2023–2026

Substance Abuse and Mental Health Services Administration
National Mental Health and Substance Use Policy Laboratory

Strategic Plan: Fiscal Year 2023-2026
Acknowledgements
We would like to acknowledge all those who contributed to the development of the
2023-2026 SAMHSA Strategic Plan, especially SAMHSA’s Executive Leadership Team, Priority
and Guiding Principle Leads and staff.
Strategic Plan: Fiscal Year 2023-2026 was prepared for the Substance Abuse and Mental
Health Services Administration (SAMHSA) under contract number
CMS75FCMC18D0047/75S20322F80003 with SAMHSA, U.S. Department of Health and
Human Services (HHS). Donelle Johnson served as contracting officer representative.

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. Nothing in this document
constitutes a direct or indirect endorsement by SAMHSA or HHS of any non-federal entity’s
products, services, or policies.

Public Domain Notice
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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.

Electronic Access
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Recommended Citation
Substance Abuse and Mental Health Services Administration: Strategic Plan: Fiscal Year
2023-2026. Publication No. PEP23-06-00-002 MD: National Mental Health and Substance
Use Laboratory, Substance Abuse and Mental Health Services Administration, 2023.

Originating Office
National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental
Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, SAMHSA Publication
No. PEP23-06-00-002. Released 2023.

Nondiscrimination Notice
The Substance Abuse and Mental Health Services Administration (SAMHSA) complies with
applicable Federal civil rights laws and does not discriminate on the basis of race, color,
national origin, age, disability, religion, or sex (including pregnancy, sexual orientation, and
gender identity). SAMHSA does not exclude people or treat them differently because of race,
color, national origin, age, disability, religion, or sex (including pregnancy, sexual orientation,
and gender identity).

Publication No. PEP23-06-00-002
Released 2023

Message from the Assistant Secretary
for Mental Health and Substance Use,
U.S. Department of Health and Human
Services
As the Assistant Secretary for Mental Health and Substance Use in the United States Department of
Health and Human Services (HHS) and the leader of the Substance Abuse and Mental Health Services
Administration (SAMHSA), I am pleased to present our 2023-2026 Strategic Plan.
This four-year plan emphasizes a more person-centered approach and introduces a new mission and
vision, key guiding principles, and priorities. It will serve as a roadmap to improve and advance public
health and service delivery efforts that promote mental health, prevent substance misuse and overdose,
and provide treatments and supports to foster recovery while also ensuring equitable access and better
outcomes.
In order to achieve our mission, we have identified five priority areas to better meet the behavioral health
care needs of the nation. The priorities include: 1) Preventing Substance Use and Overdose; 2) Enhancing
Access to Suicide Prevention and Mental Health Services; 3) Promoting Resilience and Emotional Health
for Children, Youth, and Families; 4) Integrating Behavioral and Physical Health Care; and 5)
Strengthening the Behavioral Health Workforce. Our work is also guided by four key principles that are
infused throughout the Agency’s programs and policies: Equity; Trauma Informed Approaches;
Recovery; and Commitment to Data and Evidence.
The Strategic Plan is driven by initiatives elevated by the White House, Congress, and HHS, such as the
Unity Agenda, the Bipartisan Safer Communities Act, and the HHS Strategic Plan. It is our intent that our
plan unite these efforts by facilitating actions to help fully integrate behavioral health services and
supports within all health care programs and systems; develop a well-trained, diverse, and culturally
competent workforce; reduce incidence, prevalence, and mortality related to substance use, overdose,
mental illness, and suicide; and provide resources needed to develop, support, promote, and sustain
resilience in children, youth, and families.
In crafting this new Strategic Plan, it was essential to connect with the public to ensure our ideas and
approaches are in line with what people are experiencing in real life as well as in the behavioral health
field. We received numerous comments, and I am pleased to say that public input was influential in
shaping our thinking.
Furthermore, without our federal, state, tribal and local partners, as well as our many other stakeholders,
SAMHSA cannot accomplish our goals and objectives. We hope this Strategic Plan informs and guides
your planning as you work to develop and implement programs and policies that ensure people living
with, affected by, or at risk for mental health and substance use conditions receive care, achieve wellbeing, and thrive.

Miriam E. Delphin-Rittmon, PhD
Assistant Secretary for Mental Health and Substance Use
U.S. Department of Health and Human Services
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2023 - 2026 | SAMHSA Strategic Plan

Table of Contents
Introduction ................................................................................................................ 2
Strategic Framework .................................................................................................. 3
Mission .............................................................................................................. 3
Vision ................................................................................................................. 3
Priorities and Guiding Principles ........................................................................ 3
Purpose ............................................................................................................. 4
Guiding Principles.............................................................................................. 5
Equity ................................................................................................................ 5
Trauma-Informed Approaches ........................................................................... 6
Recovery ........................................................................................................... 7
Commitment to Data and Evidence ................................................................... 8
Priorities ............................................................................................................ 8
Priority 1: Preventing Substance Use and Overdose.............................................. 9
Priority 2: Enhancing Access to Suicide Prevention and Mental Health Services
................................................................................................................................... 18
Priority 3: Promoting Resilience and Emotional Health for Children, Youth, and
Families ..................................................................................................................... 30
Priority 4: Integrating Behavioral and Physical Health Care ................................ 42
Priority 5: Strengthening the Behavioral Health Workforce ................................. 49
Conclusion................................................................................................................ 57
Acronyms.................................................................................................................. 58
Glossary .................................................................................................................... 60
References ................................................................................................................ 67

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Introduction

The United States faces unprecedented mental health and substance use crises among
people of all ages and backgrounds. Two out of five adults have symptoms of anxiety or
depression, and under-served communities are disproportionately impacted. 1 Even before
the COVID-19 pandemic, rates of depression and anxiety were increasing.1 The grief,
trauma, and physical and social isolation related to the COVID-19 pandemic have
exacerbated these issues for many. 2 Among adults aged 18 or older in 2021, nearly 58
million people had any mental illness and 14 million people had a serious mental illness in
the past year. Drug overdose deaths have reached a historic high, devastating individuals,
families, and communities. More than 107,600 people in the United States died due to an
overdose in 2021, and over 46 million people met the diagnostic criteria for a substance
use disorder (SUD) in the past year. 3,4
Despite these tragic numbers, many people are moving toward and achieving recovery.
The most recent National Survey on Drug Use and Health (NSDUH) tells a more
encouraging story: nearly 21 million adults who perceived they ever had a substance use
problem and nearly 39 million who perceived they ever had a problem with their mental
health considered themselves in recovery or recovered.3
Behavioral health issues are challenging and complex and require multifaceted efforts. As
part of a comprehensive and nation-wide approach, in 2022 President Biden announced
the Unity Agenda, which highlights mental health and the overdose crisis as two of four
key pillars.2 The Substance Abuse and Mental Health Services Administration (SAMHSA)
actively works to advance this agenda by strengthening system capacity, connecting more
people to care, and creating a continuum of holistic and equitable behavioral health
supports aimed to transform our health and social services infrastructure, including for
historically under-served communities and populations. With this in mind, SAMHSA
developed a new, four-year strategic plan to reflect these priorities.
The 2023–2026 SAMHSA Strategic Plan presents a new person-centered mission and
vision highlighting key guiding principles and presenting new priorities, goals, and
objectives. This Plan aligns with various initiatives and goals of the Administration,
Congress, and the U.S. Department of Health and Human Services (HHS).

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Strategic Framework
This is a significant time in history. Federal, state, and territory governments; tribes and
tribal organizations; communities; families; providers; and people with lived experience are
coming together to address the mental health and substance use crises. Agency
leadership and staff; traumatic events such as school shootings; natural disasters such as
hurricanes, tornadoes, and wildfires; and the innovative ideas and suggestions
communicated by our many stakeholders informed this Strategic Plan.
Mission
SAMHSA’s mission is to lead public health and service delivery efforts that promote mental
health, prevent substance misuse, and provide treatments and supports to foster recovery
while ensuring equitable access and better outcomes.
Vision
SAMHSA envisions that people with, affected by, or at risk for mental health and
substance use conditions receive care, achieve well-being, and thrive.
Priorities and Guiding Principles
The Strategic Plan keeps the continuum of mental health and substance use services and
supports at its core and emphasizes four overarching guiding principles across all policies
and programs to support SAMHSA in achieving its mission and vision. These include
equity, trauma-informed approaches, a commitment to data and evidence, and recovery.
The priorities and their corresponding goals and objectives focus on five key areas,
described in detail further in this document:

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Figure 1. Strategic Plan Priorities and Guiding Principles

Purpose

The 2023–2026 SAMHSA Strategic Plan supports the numerous initiatives and goals of
the Administration, Congress, and HHS that prioritize behavioral health. Specifically, the
President’s Unity Agenda identifies mental health as essential to overall health, and
executive orders such as Executive Order 13985 highlight the importance of advancing
racial equity and support for under-served communities. 5,6 The 2022 National Drug Control
Strategy underscores the damaging consequences of the drug overdose epidemic and the
urgent need for substance use prevention and early intervention, harm reduction,
treatment, and recovery support for all who need it. 7
In concert, HHS released its 2022–2026 Strategic Plan, which calls for protecting and
strengthening equitable access to high-quality and affordable health care as well as
improving social well-being, equity, and economic resilience. 8 HHS published a Health
Workforce Strategic Plan, which discusses enhancing care quality through professional
development, collaboration, and evidence-based and evidence-informed practices and
encourages the use of data to strengthen the health workforce. 9 The Surgeon General
developed an Advisory on Protecting Youth Mental Health, which emphasizes the role
family, communities, policymakers, media, young people, and others play in increasing
resiliency and supporting children and youth. 10 SAMHSA also advances the National Tribal
Behavioral Health Agenda (TBHA) with tribes and the federal government, to improve
behavioral health and contribute to the well-being of American Indians and Alaska Native
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people. The TBHA is a blueprint to strengthen policies and programs, align disparate
resources, and facilitate collaboration. 11
Further illustrating behavioral health as a top priority for the nation, Congress passed the
Bipartisan Safer Communities Act, which, among other directives, includes meaningful
investments in school-based mental health services and additional support for the 988
Suicide & Crisis Lifeline. 12 SAMHSA received extensive and thoughtful feedback from
stakeholders calling for action to improve well-being by heightening the importance of
behavioral health integration and focusing on trauma-informed, recovery-oriented, and
person-centered care.
SAMHSA received a total of $7.5 billion in the Consolidated Appropriations Act, 2023. 13
This is almost $1 billion over SAMHSA’s Fiscal Year 2022 level. This law reauthorized key
SAMHSA programs at increased funding levels and created new programs to improve
availability of recovery and peer supports. It contains provisions to improve access to
integrated care, increase the behavioral health workforce, and increase access to
medications for opioid use disorder by removing the DATA 2000 waiver.13
These federal efforts share similar themes and objectives. SAMHSA intends for the 2023–
2026 Strategic Plan to unite these undertakings by facilitating actions to help fully integrate
behavioral health services and supports within all healthcare programs and systems;
develop a well-trained, diverse, and culturally competent workforce; reduce incidence,
prevalence, and mortality related to overdose and suicide; and provide the resources
needed to develop, support, promote, and sustain resilience in children, youth, and
families (see Figure 1).

Guiding Principles

The 2023–2026 Strategic Plan integrates four overarching guiding principles across all
policies and programs to support SAMHSA in achieving its mission and vision.
Equity
Under-served/historically marginalized populations: Black, Latino, Hispanic, and
Indigenous and Native American persons; Asian Americans and Pacific Islanders
and other persons of color; members of religious minorities; Lesbian, Gay, Bisexual,
Transgender, Queer, and Intersex (LGBTQI+) persons; persons with disabilities;
persons who live in rural areas; and persons otherwise adversely affected by
persistent poverty or inequality.14
Behavioral health equity is the right to access high-quality and affordable healthcare
services and supports for all populations. Executive Order 13985 defines “equity” as the
consistent and systematic, fair, just, and impartial treatment of all individuals, including
those who belong to under-served communities that have been denied such treatment.6

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As population demographics evolve, behavioral healthcare systems must expand their
ability to effectively meet the growing needs of a diverse population. Improving access to
care, promoting quality programs and practice, and reducing persistent disparities in
mental health and substance use services for under-served and historically marginalized
populations and communities are important first steps to ensuring that all people are
provided with fair opportunities to be as healthy as possible.
For some populations, this is an ongoing challenge. The 2021 NSDUH survey reports that
White people were more likely than Hispanic, Latino, or Asian people to have received
substance use treatment at a specialty facility in the past year. Similarly, White and
Multiracial adults were more likely to receive mental health services in the past year than
Black, Hispanic, Latino, or Asian American adults.3 American Indian/Alaska Native adults
were more likely than White, Black, Hispanic, or Asian adults to have both any mental
illness and a SUD.3 Lesbian, Gay, and Bisexual (LGB) adults were more than twice as
likely than heterosexual individuals (49.7 percent for LGB vs. 20.2 percent for
heterosexual) to have used an illicit substance in the past year.3 This has important
implications for how behavioral health systems effectively outreach, engage, and retain
these diverse groups in care. In conjunction with promoting access to high-quality services,
behavioral health disparities can be mitigated by addressing social determinants of health
(SDOH), such as social injustice and racial exclusion, unemployment, level of education,
lack of access to transportation, food insecurity, housing instability, and exposure to
trauma. 14
Reducing the impact of SDOH in conjunction with promoting adherence to the National
Culturally and Linguistically Appropriate Services Standards are important steps SAMHSA
takes to reduce disparities. 15 Unfortunately, language accessibility and assistance are
often overlooked despite the fact that they are fundamental to engagement in treatment,
quality of care, and the customer experience. 16 For communities and populations where
English is not the primary spoken language, provision of language assistance is not only a
civil right regarding health care, but a necessary component of equitable care.16
Trauma-Informed Approaches
Trauma-informed approaches recognize and intentionally respond to the lasting adverse
effects of traumatic experiences, while promoting linkages to recovery and resilience for
impacted individuals and families. Not only is trauma a widespread and costly public health
problem that may occur from experiencing emotionally harmful events such as violence,
abuse, neglect, or natural disasters, for those with mental health and substance use
conditions trauma is an almost universal experience. 17
Trauma negatively impacts both mental and physical health. These adverse effects may
have both short-term and long-term consequences. 18,19,20,21,22 Many people who
experience trauma may overcome it, becoming stronger and more resilient; but for others,
traumatic experiences can be overwhelming and disruptive to their daily lives.17

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Whole communities can be profoundly shaped by traumatic experiences.17 This can occur
through a significant event such as a mass violence event. For many marginalized
populations, experiences of historical and intergenerational trauma and daily experiences
of interpersonal and structural racism and discrimination can significantly impact individual
and community well-being.17
A trauma-informed approach is defined by six key principles:
1. Safety: participants and staff feel physically and psychologically safe.
2. Peer support: peer support and mutual self-help are vehicles for establishing
safety and hope, building trust, enhancing collaboration, and utilizing lived
experience.
3. Trustworthiness and transparency: decisions are conducted with the goal of
building and maintaining trust.
4. Collaboration and mutuality: importance is placed on partnering and leveling
power differences.
5. Cultural, historical, and gender issues: cultural and gender-responsive services
are offered while moving beyond stereotypes/biases.
6. Empowerment, voice, and choice: organizations foster a belief in the primacy of
the people who are served to heal and promote recovery from trauma.17
Recovery
SAMHSA defines recovery as a process of change through which individuals improve their
health and wellness, live self-directed lives, and strive to reach their full potential. 23 This
definition is realized through four major dimensions:
1. Health: overcoming or managing one’s disease(s) or symptoms, and making
informed, healthy choices that support physical and emotional well-being.
2. Home: having a stable and safe place to live.
3. Purpose: conducting meaningful daily activities, such as a job, school,
volunteerism, family caretaking, or creative endeavors, and the independence,
income, and resources to participate in society.
4. Community: having relationships and social networks that provide support,
friendship, love, and hope.23
Recovery promotes the expectation that all individuals, including those with SUDs and
mental illnesses, can thrive. Recovery is more than abstinence or symptom remission,
rather it is based on the goal and expectation of living well and thriving. SAMHSA not only
envisions individuals achieving recovery, but also supports developing and sustaining
recovery-oriented systems of care and creating recovery-facilitating environments. We
intend that when anyone with a behavioral health condition seeks help, they are met with
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the knowledge and belief that they can recover and/or manage their conditions
successfully. SAMHSA recognizes that recovery considers cultural and community
expectations and is understood and embraced differently across diverse populations.
SAMHSA instrumentally advances recovery support systems to promote partnering with
people in recovery and their family members to guide the behavioral health system. This
includes promoting individual, program, and system-level approaches that foster health
and resilience; increasing housing to support recovery; reducing barriers to employment,
education, and other life goals; and securing necessary social supports in their chosen
community.
Commitment to Data and Evidence
Timely, high-quality data help public health officials, policymakers, community
practitioners, and the public to understand mental health and substance use trends and
how they evolve; inform the development and implementation of targeted evidence-based
interventions; focus resources where needed most; and evaluate programs and policy
success. SAMHSA aims to decrease burden on stakeholders while expanding and
improving data collection, analysis, evaluation, and dissemination. To achieve this
objective, we are streamlining and modernizing data collection efforts and coordinating
cross-agency evaluation to ensure data-driven funding and policies. SAMHSA uses
rigorous evaluation and analytical processes in alignment with the Foundations for
Evidence-Based Policymaking Act of 2018. 24
SAMHSA leverages data and evidence to strengthen activities around our guiding
principles and the five priority areas and inform agency policies and programs. Using
robust methods to collect, analyze, and report valid, reliable, trustworthy, and protected
data is key to improving and impacting behavioral health treatment, prevention, and
recovery for communities most in need. By using rigorous methods and improving the
quality and completeness of program data, data can be disaggregated across different
population groups to assess disparities within the behavioral healthcare system.

Priorities

The following sections describe SAMHSA’s priorities, strategic goals, and related
objectives. Each section discusses the key approaches, mechanisms, and strategies
SAMHSA intends to engage in to deliver measurable results in advancing its mission and
vision.

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Priority 1

Preventing Substance Use and Overdose
The isolation, anxiety, and reduced access to resources experienced by so many during
the COVID-19 pandemic exacerbated the overdose epidemic and contributed to a sharp
rise in related deaths.2 In response, the U.S. Department of Health and Human Services
(HHS) released an Overdose Prevention Strategy (OPS) in October 2021, outlining four
pillars: Primary Prevention, Harm Reduction, Evidence-Based Treatment, and Recovery
Support (see Figure 2).25 The OPS aims to maximize health equity using the best
available data and evidence to inform policy and actions, integrating substance use
disorder (SUD) treatment services into other types of health care and social services, and
reducing stigma.25 The Substance Abuse and Mental Health Services Administration
(SAMHSA) commits to creating communities where individuals, families, schools, faithbased organizations, and workplaces take action to promote emotional health and reduce
the likelihood of mental illness, early substance use initiation, substance misuse, SUDs,
overdose, and suicide.

Figure 2. HHS Overdose Prevention Strategy Substance Use Continuum

Primary prevention focuses on intervening before a disease or condition occurs. Highvalue benefits derived from primary prevention span multiple sectors, including health
care, public safety, the criminal justice system, and beyond—both broadly speaking and
within marginalized communities. Working to prevent higher-risk behaviors and disease
from happening in the first place has many benefits, including financial benefits, prevention
of unnecessary human suffering, and reduced negative societal impacts. 26,27 Estimates
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approximate a tenfold return on investments made in evidence-based substance use
prevention programs and activities.27
People from under-served communities face particularly complex challenges with
substance use and misuse; however, these communities also have strengths and
protective factors such as faith-based organizations, civic associations, community-based
organizations, and other natural supports that can work in conjunction with evidence-based
practices to support people facing substance use issues.23 Addressing substance use,
misuse, and SUDs among under-served racial, ethnic, and Lesbian, Gay, Bisexual,
Transgender, Queer, and Intersex (LGBTQI+) populations includes (1) incorporating
culturally and linguistically effective policies, programs, practices, and engagement
strategies; (2) being community-centered; (3) offering comprehensive services that
address participants’ substance use and misuse, SUD(s), health care, and social needs;
and (4) using culturally appropriate harm reduction and healing-centered approaches to
care and recovery.23
For individuals who may have a SUD or need more intensive services, SAMHSA supports
a range of more targeted mitigation services, including harm reduction approaches such as
distribution of naloxone and fentanyl test strips to those at high risk for overdose.
SAMHSA’s treatment and recovery support programs, such as the State Opioid Response,
Tribal Opioid Response, and Building Communities of Recovery grants, include a range of
evidence-based services. These services link people with SUDs and those who have
experienced an overdose to low-barrier access to medication and non-pharmacologic
treatment options and peer support and recovery services to reduce repeat overdoses.
Together, these efforts meet people wherever they are on the behavioral health
continuum, through targeted services and supports that are culturally appropriate and
driven by public health data.
Goal 1. To reduce and prevent substance use and misuse, SAMHSA will support
efforts to strengthen prevention programs, policies, and practices.
Primary prevention appropriately underscores a need for earlier and broader work to
benefit all of SAMHSA’s priorities. Central to a comprehensive prevention system are (1)
environmental strategies for capacity building via steady economic investments; (2)
strategic focus on increasing protective factors across the lifespan in order to mitigate risks
to individual- and population-level well-being and resilience; (3) support for communication
across the prevention system to raise public awareness about substance use and misuse
and build support for prevention programming; (4) investments in evidence-based and/or
evidence-informed programming and technical assistance (e.g., workforce development
and tool accessibility) to ensure broad implementation of culturally appropriate policies,
programs, and practices; and (5) strong community relationships and engagement that
enable stakeholders to work together to address health-related issues and promote wellbeing to achieve positive health impact and outcomes. SAMHSA’s contributions to these
efforts begin upstream with primary prevention policies, programs, and practices that

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address individual and population health and involve state, territorial, tribal, and community
sectors.
Preventing Substance Use and Overdose
Goal 1 Example Programs
The SAMHSA-funded Prevention Technology Transfer Center (PTTC) Network
develops and strengthens the specialized behavioral healthcare and primary
healthcare workforce that provides prevention services for SUDs and mental illness. It
also improves implementation and delivery of effective substance use prevention
interventions and provides training and technical assistance services to the
prevention field.
The Strategic Prevention Framework-Partnerships for Success Program is
designed to help state, territorial, tribal, and community organizations reduce the
onset and progression of substance misuse and its related problems by supporting
the development and delivery of prevention services. The program extends
established cross-agency and community-level partnerships by connecting prevention
programming to departments of social services and their community service
providers. This includes working with populations disproportionately impacted by the
consequences of substance misuse (e.g., children entering the foster care system
and transitional aged youth) and individuals who support persons with substance
misuse issues (e.g., women, families, parents, caregivers, and young adults).
The Grants for the Benefit of Homeless Individuals program supports the
development and/or expansion of local implementation of a community infrastructure
that integrates treatment and recovery support services for SUDs or co-occurring
disorders, permanent housing, and other critical services for individuals (including
youth) and families experiencing homelessness.

Objective 1.1. Provide support to states, territories, tribes, and communities for
programs and projects that address the prevention and reduction of substance use
and misuse.
The healthcare system lacks enough providers and resources to offer quality treatment to
everyone in need. However, a broader prevention approach has the capacity to strengthen
our nation to reduce treatment demand altogether. Broader and earlier approaches to
primary prevention include strengthening social determinants of health (SDOH), supporting
healthy social and emotional development, reducing and addressing childhood and other
trauma, supporting parents and strengthening families, expanding evidence-based
programs in schools, and improving the safety and livability of community environments.
SAMHSA’s Strategic Prevention Framework (SPF) is a dynamic, data-driven planning
process to support effective primary prevention work starting at the community level. In
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general, programs and practices must operate in a variety of community settings and
influence local risk and protective factors at both the individual and environmental levels.
The Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block
Grant is the cornerstone of the nation’s prevention, treatment, and recovery systems. The
program provides funds to all 50 states, the District of Columbia, Puerto Rico, the U.S.
Virgin Islands, the Northern Mariana Islands, Guam, American Samoa, 3 Pacific
jurisdictions, and 1 tribal entity to prevent substance use and misuse and treat SUDs. The
SUPTRS Block Grant affords grantees the flexibility to tailor their substance use-related
services to meet the needs of their populations. SAMHSA requires that grantees spend no
less than 20 percent of their allotment on substance use primary prevention strategies.
Grantees must also develop a comprehensive primary prevention program that includes
activities and services provided in a variety of settings targeting both the general
population and subgroups at high risk for substance use, misuse, and use disorders.
Additionally, the program must include, but is not limited to, the following strategies:
information dissemination, education, alternatives, and problem identification and referral.
Objective 1.2. Enhance protective factors in preventing or delaying initiation of
substance use.
Risk and protective factors are conditions in environments that can significantly impact
health and overall well-being. 28 Protective and risk factors are behaviors, experiences, or
conditions that either decrease or increase the impact on individual and community health,
wellness, and well-being, including an individual’s likelihood of consuming substances.
Protective factors include social coping and effective problem-solving skills, strong
interpersonal relationships, employment, and community supports. Alternatively, risk
factors include adverse childhood experiences (ACEs), social pressure, living in
communities with negative SDOH, and trauma. ACEs can have lasting, negative effects on
health and well-being, including behavioral health. Creating and sustaining safe, stable,
nurturing relationships and environments for all children and families can prevent ACEs
and help all children reach their full potential. Protective factors can help buffer individuals
from influences that make them more inclined to start using or misusing substances. 29,30
Through grant funding and stakeholder partnerships, SAMHSA will support strengthsbased approaches that enhance protective factors. Approaches include enhancing cultural
connections, bolstering community-based resources, strengthening family relationships,
and offering a variety of afterschool programs.
Objective 1.3. Increase public awareness of negative consequences of substance
use and misuse for individuals, families, and communities.
For the past 30 years, SAMHSA has raised public awareness about the effects and harms
of substance use and misuse and related consequences on the health, wellness, and wellbeing of individuals, families, and communities. To meet the unique needs of diverse
communities across the nation, SAMHSA utilizes various evidence-based and/or evidence-

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informed programs, campaigns, social media platforms, curricula, and trainings to educate
the public and the prevention workforce. As a result, individuals, families, and communities
receive the knowledge and skills to seek help and/or help others access support services.
These public awareness efforts promote community mobilization to improve life trajectories
for youth and adults who may be using or misusing substances or may be at risk for, or
living with, SUDs. Effective communication to raise awareness relies on alignment of
prevention messaging (e.g., "Talk. They Hear You.”®) with public health interventions such
as policies, programs, and practices.
Objective 1.4. Provide technical assistance and training to communities and
organizations interested in establishing and expanding prevention programs
seeking to implement evidence-based and/or evidence-informed practices.
SAMHSA provides a range of technical assistance resources and trainings to enable
community needs assessments, community improvement plans, logic models, and
workplans. The Strategic Prevention Technical Assistance Center assists prevention
providers in developing culturally appropriate and evidence-based and evidence-informed
substance misuse prevention programs in alignment with the SPF. This work focuses on
enhancing data-driven decision making and reducing behavioral health disparities
experienced by historically disenfranchised communities.
Through the Prevention Technology Transfer Center (PTTC) Network, SAMHSA provides
comprehensive training and technical assistance to the nation’s substance use prevention
field. The PTTC Network improves implementation and delivery of effective substance use
prevention interventions by developing and disseminating tools and strategies needed to
improve the quality of substance misuse prevention efforts; providing intensive technical
assistance and learning resources to prevention professionals to improve their
understanding of prevention science, epidemiological data, and their implementation of
evidence-based and promising practices; and developing tools and resources to engage
the next generation of prevention professionals.
Goal 2. To prevent overdose deaths in America, SAMHSA will support efforts to
transform systems and services that increase access to and utilization of harm
reduction approaches and effective treatments.
As the overdose crisis evolves, SAMHSA will engage in an evidence-based approach to
saving lives, reducing risk, and removing barriers to effective interventions. With this
approach, SAMHSA will promote care and services that respect the health and dignity of
people who use drugs. System changes include data-driven performance improvement
informed by impacted individuals, families, and communities to achieve outcomes that
reduce risk, save lives, and provide equitable pathways to recovery. System
transformation will occur within clinical and community-based settings, focusing on priority
populations across the lifespan and throughout the continuum of care.

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2023 - 2026 | SAMHSA Strategic Plan

Telehealth is an important modality to expand services and increase equitable access to
services. SAMHSA will promote telehealth options through educational offerings, technical
assistance, and collaboration with other federal partners such as the Drug Enforcement
Administration (DEA) to support and advance telehealth service expansion under their
respective authorities. SAMHSA will support revisions to opioid treatment program
regulations to lower barriers to accessing and engaging with treatment services.

Preventing Substance Use and Overdose
Goal 2 Example Programs
The Substance Use Prevention, Treatment, and Recovery Services Block Grant
provides funds to states, territories, and tribes to help plan, implement, and evaluate
activities that support prevention, treatment, and recovery from SUDs. SAMHSA
strongly encourages grantees to use a portion of their funding for recovery support
services.
State/Tribal Opioid Response Programs prevent overdose deaths from opioids and
stimulants, reduce unmet treatment need, and support recovery for people with, or at
risk for, opioid use disorder and/or stimulant use disorders and related conditions. The
programs also include a robust technical assistance center.
The Harm Reduction Program Grant supports community-based overdose
prevention programs, including naloxone distribution, syringe services programs,
health and harm reduction education, and linkages to care, including for infectious
diseases.

Objective 2.1. Increase utilization of medications for opioid use disorder.
The Food and Drug Administration (FDA) has approved three medications for the
treatment of opioid use disorder (MOUD): buprenorphine, methadone, and naltrexone.
Available in different formulations, significant evidence supports the effectiveness of these
medications in improving outcomes for people with opioid use disorder (OUD). 31 Studies
show that methadone and buprenorphine reduce opioid-related mortality by over 50
percent. Treatment that includes MOUD is also associated with significant reductions in
human immunodeficiency virus and viral hepatitis disease transmission, and with
improvements in recovery-related outcomes such as employment, educational attainment,
and quality of life. 32 Despite policy changes seeking to expand access to MOUD, these
medications continue to be vastly underutilized. 33,34
To foster the utilization of MOUD, SAMHSA will partner with other entities in the federal
government and externally. This includes implementing policy changes that remove the
DATA 2000 waiver (X-waiver) for prescribing buprenorphine for the treatment of OUD and
revised regulations for the provision of methadone. Removal of the X-waiver seeks to

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2023 - 2026 | SAMHSA Strategic Plan

reduce barriers to treatment availability by allowing more practitioners to prescribe
buprenorphine for OUD. 35 To increase treatment capacity and decrease stigma, SUD
management education will be a requirement of all DEA-registered providers as part of
usual healthcare practitioner curricula.35 SAMHSA partners with other stakeholders to
expand access to and use of methadone and buprenorphine in correctional settings,
addressing stigma of MOUD, and addressing other factors impacting equitable uptake and
continued treatment, particularly among populations most affected by the overdose crisis.
SAMHSA will require the provision of MOUD wherever possible, including in the Certified
Community Behavioral Health Clinics program, which now has nearly 500 sites across 46
states. 36
Objective 2.2. Increase uptake of evidence-based interventions.
To combat morbidity and mortality related to SUDs, SAMHSA supports several evidencebased interventions like opioid education and naloxone distribution to reverse overdose,
and syringe services programs to reduce infectious disease spread.31 In the absence of
pharmacological treatments, behavioral interventions are often employed as mainstays.
For example, the lack of effective, FDA-approved pharmacological treatments for stimulant
use disorder elevates contingency management as a lifesaving option. Contingency
management is an evidence-based intervention to support SUD recovery efforts among
adults, in which individuals receive incentives to reinforce desired behaviors. 37 Decades of
research demonstrates the effectiveness of contingency management for recovery from
various SUDs across racially and socioeconomically diverse populations by producing
higher abstinence rates and higher retention in treatment compared to other
interventions.37
Through grant funded training, technical assistance, and strategic partnerships, SAMHSA
promotes non-pharmacological evidence-based interventions, such as overdose
education, and contingency management, that are proven to save and improve lives.
SAMHSA also supports permissible expenditures in service delivery grants.
Objective 2.3. Achieve universal access to overdose prevention strategies and
education competencies.
SAMHSA will support federal, state, territorial, tribal, and community partnerships by
promoting universal and focused public education campaigns. These campaigns raise
awareness of overdose mitigation strategies such as naloxone and fentanyl test strip
distribution/drug checking, stigma reduction, overdose prevention training, and low-barrier
treatment.
To address populations at heightened risk for overdose fatality, SAMHSA supports
targeted and data-driven public health strategies including pre-arrest diversion and referral
to harm reduction programs, naloxone upon release programs, programs that are culturally
appropriate for under-served and marginalized populations, post-overdose response
programs, and naloxone distribution at treatment programs.

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2023 - 2026 | SAMHSA Strategic Plan

Additionally, SAMHSA collaborates with states, territories, tribes, and communities to
achieve naloxone saturation, which is typically considered the amount of naloxone needed
to ensure its availability for immediate use in 80 percent of witnessed overdoses. 38 We
support harm reduction organizations’ access to naloxone and support public health
interventions to increase knowledge and capabilities in naloxone distribution. SAMHSA
prioritizes training and education that facilitates low-barrier services by promoting
partnerships between harm reduction and treatment organizations.
Goal 3. To advance recovery, SAMHSA will support strengths-based approaches to
reduce barriers and create more opportunities to thrive.
This goal will impact those at risk for a SUD and/or for an overdose as well as help
individuals, families, and communities facilitate greater opportunities for recovery. Primary
prevention includes strategies and interventions mainly focused on the general population
that aim to delay or prevent substance use, and strategies and interventions that prioritize
subgroups at higher risk for substance misuse and overdose to prevent the likelihood of
developing a SUD or experiencing an overdose. A strengths-based recovery approach
recognizes and cultivates the unique strengths and abilities individuals possess to better
cope with and overcome behavioral health challenges.23 Recovery support services are
designed to leverage the assets of individuals, families, and community resources to
improve health and well-being.23

Preventing Substance Use and Overdose
Goal 3 Example Programs
The Substance Use Prevention, Treatment, and Recovery Services Block Grant
requires that grantees spend no less than 20 percent of their allotment on primary
prevention strategies. While a similar set-aside has yet to be included for recovery
support, SAMHSA strongly encourages states to use a portion of their funding for
recovery support services.
The Peer Recovery Center of Excellence is a peer-led national center that provides
training and technical assistance related to SUD recovery.

Objective 3.1. Establish recovery-oriented systems of care as the framework for
promoting individual, family, and community health.
A recovery-oriented system of care is a network of community-based services and
supports that is person- and family-centered, is culturally appropriate, and builds on the
strengths and resiliencies of individuals, families, and communities to achieve improved
health, wellness, and quality of life for those with or at risk for behavioral health
problems.23 Community-based services and supports draw on the resources within the

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community, including clinical and non-clinical services. This ensures ongoing and
seamless connections to individuals for as long as needed. Services are designed to
support individuals across the lifespan, understanding that needs and resources change
and shift over the course of recovery and time.
To further this objective, SAMHSA will adapt or adopt policies and practices that are
informed by the most recent data and reflect scientific advances. This approach directs
resources and technical assistance to advance community-based systems and services
oriented to recovery, resiliency, wellness, and social inclusion. SAMHSA engages people
with lived experience and federal, state, territorial, tribal, and community partners to
advance health equity and address SDOH so that people in every community can thrive
and reach their fullest potential.
Objective 3.2. Expand resources for families and caregivers impacted by overdose.
Families and caregivers impacted by overdose need access to resources to support the
well-being of a person at risk of or who has experienced an overdose. Resources can
include programs, activities, or services that help promote the well-being of families and
caregivers to help prevent substance use among other family members. SAMHSA will
partner with other federal agencies to develop informational materials and programs that
are consistent with the 2022 National Strategy to Support Family Caregivers. 39
SAMHSA will direct resources to ensure the inclusion and participation of family members
and informal caregivers in program development, implementation, and evaluation of
funded services and technical assistance. Families and caregivers from diverse and underserved communities will be a population of special focus for culturally appropriate
outreach, education, and mitigation tools in partnership with local entities.

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Priority 2
2023 - 2026 | SAMHSA Strategic Plan

Enhancing Access to Suicide Prevention
and Mental Health Services

The continuum of mental health services includes mental health promotion and early
intervention, crisis care, suicide prevention, treatment, and recovery support services.
Individuals with any mental health condition, including serious mental illness (SMI), too
often lack timely access to care. Additionally, mental health services are often fragmented
such that transitions from one level of care to another are challenging. Many communities
experience service gaps across the continuum such that persons are not able to receive
what they need, when they need it.
The Substance Abuse and Mental Health Services Administration (SAMHSA) aims to lead
our nation in increasing access to a full continuum of care that provides timely and highquality services to anyone who needs them. In part, this priority aims to enhance access to
suicide prevention and crisis care as crucial elements of the mental health continuum of
care, so that people experiencing suicidal ideation and other behavioral health crises can
receive the care they need and want in order to thrive and achieve well-being (see Figure
3).

Figure 3. The Mental Health Continuum

Mental Health Promotion & Early Intervention
Multiple risk factors increase the risk for developing a mental health condition. Example
risk factors include early childhood exposure to adverse experiences like abuse or neglect;
adverse social and environmental determinants of health, such as low education
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2023 - 2026 | SAMHSA Strategic Plan

opportunity, housing instability, unemployment, high crime, neighborhood violence, and
others; and experiencing bullying or other violent acts at any age. Effectively recognizing
and addressing these risk factors through structures and services can prevent the
development of a disorder or lessen the impact or severity of a mental disorder. SAMHSA
works through several grants and technical assistance programs to promote access to
effective prevention and early intervention services and supports.
SAMHSA’s Community Mental Health Services Block Grant (MHBG) set-aside for early
SMI/first episode psychosis (FEP) is an effective early intervention approach, increasing
the number of FEP coordination specialty care programs to over 350 since its start in
2014. Project Advancing Wellness and Resiliency in Education (Project AWARE) provides
training for school personnel and other adults who interact with school-aged youth to
detect and respond to mental health challenges and connects school-aged youth who may
present with behavioral health challenges, and their families, to needed services.
SAMHSA’s Project Linking Actions for Unmet Needs in Children’s Health (Project
LAUNCH) promotes the wellness of children from birth to age 8 by disseminating effective
and innovative early childhood mental health practices and services, ultimately leading to
better outcomes for young children and their families. Project LAUNCH builds the
capacities of adult caregivers of young children to promote healthy social and emotional
development; prevents mental, emotional, and behavioral disorders; and identifies and
addresses behavioral concerns before they develop into serious emotional disturbances
(SEDs).
SAMHSA supports Mental Health Awareness Training (MHAT), which prepares individuals
and communities to respond appropriately and safely to persons with SMI and/or SED.
Through MHAT, individuals receive the knowledge, skills, confidence, and resources to
engage with someone experiencing mental health and/or substance use challenges.
Trained individuals use these skills and resources to help others access needed mental
health care or other services from within their own families, places of employment,
communities, or places of worship.
Mental Health Crisis Care & Suicide Prevention
Suicide is a leading, and preventable, cause of death for adults and youth. During the
COVID-19 pandemic, suicidal behaviors among young people significantly increased. 40 In
2021, suicide was the second leading cause of death for youth ages 10–14 and the third
leading cause among youth ages 15–24 in the United States. 41 Data from the 2021
National Survey on Drug Use and Health (NSDUH) estimated that the number of adults
with serious thoughts of suicide was 12.3 million, those with plans for suicide was 3.5
million, and those who attempted suicide was about 1.7 million.3 Fully addressing suicide
involves preventive interventions and includes mental health workforce improvements. All
providers should identify and provide basic care and support to those at risk for suicidal
ideation and behaviors, and family members of these individuals.

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2023 - 2026 | SAMHSA Strategic Plan

As SAMHSA’s 2020 National Guidelines for Behavioral Health Crisis Care indicate,
comprehensive crisis care systems include core services, such as crisis contact centers,
mobile crisis teams, and crisis receiving and stabilizing facilities. 42 In 2022, SAMHSA
provided guidance on crisis care for youth in the National Guidelines for Child and Youth
Behavioral Health Crisis Care, which supports a developmentally tailored approach to
crisis care for young people. It emphasizes appropriate home- and community-based
stabilization supports, and “a safe place to be” while prioritizing safety. 43 These services
address the acute behavioral health needs of people in crisis. Additionally, these services
are consistent with goals to prevent suicide, overdose, and other adverse crisis-related
outcomes and are linked to subacute and outpatient services with a goal of ongoing
engagement toward harm reduction, treatment, and recovery. Robust, culturally
appropriate, and responsive systems will be essential to meeting crisis care needs across
the nation. Crisis services must be trauma-informed and avoid re-traumatizing individuals
seeking help by avoiding use of restraint and seclusion practices. Together these
components, when person-centered and coordinated with other services, can address the
goal of serving anyone, at any time, from anywhere across the country.
To help achieve this goal, on July 16, 2022, the National Suicide Prevention Lifeline
transitioned to the 988 Suicide & Crisis Lifeline. 44 Persons who use this number are put in
direct contact with a trained counselor and referred to services. Counselor training includes
work across the lifespan; approaches for individuals with disabilities; attention to historical
trauma, stigma, and discrimination in marginalized communities; and knowledge of
population-specific factors that may influence engagement with crisis workers. For
imminent risk situations or if a crisis is ongoing, a responder such as a mobile crisis
response unit can go where the caller is and/or identify a place the caller can go for help.
SAMHSA continues to invest in key suicide prevention efforts such as the Garrett Lee
Smith (GLS) Youth Suicide Prevention and Zero Suicide programs, as well as to provide
needed technical assistance to the field through the Suicide Prevention Resource Center
(SPRC).
Recovery & Treatment
Recovery and improved health and well-being are the goals of mental health care for
individuals with a mental health condition. Individuals often take different pathways to
engage with behavioral health services and initiate and sustain recovery. Because a
mental and/or substance use disorder (SUD) crisis often results from environmental
challenges and events, such as trauma, job loss, or financial or interpersonal stressors,
addressing these issues is crucial to sustaining recovery. The recovery process is highly
personalized, with individuals engaging in a variety of services and supports that may
include treatment as well as recovery support services.
Goal 1. To improve health and well-being of all Americans, SAMHSA will support
mental health promotion and early intervention programs and services for
individuals at risk for or living with mental health conditions.

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2023 - 2026 | SAMHSA Strategic Plan

Mental health promotion and early intervention programs and services for individuals at
risk for or living with mental health conditions is an important focus for SAMHSA. This is
guided by many factors, such as national negative trends in mental health. Efforts include
optimizing positive mental health before mental health problems have been identified, or
soon after, with the goal of improving mental health for the population. 45 Recent research
shows the positive effects of mental health promotion and early interventions through a
public health approach. 46

Enhancing Access to Suicide Prevention and Mental Health Services
Goal 1 Example Programs
Mental Health Awareness Training (MHAT) trains individuals (e.g., school
personnel, fire department and law enforcement staff, and veterans, military members,
and their families) to recognize the signs and symptoms of mental disorders and how
to safely de-escalate crisis situations involving individuals with a mental illness. MHAT
also provides education on local mental illness resources and other tools, such as how
to establish links with school- or community-based mental health agencies.
Community Programs for Outreach and Intervention with Youth and Young
Adults at Clinical High Risk for Psychosis provide evidence-based interventions to
youth and young adults who are at clinical high risk for psychosis by improving
symptoms and behavioral functioning, enabling youth and young adults to resume
age-appropriate activities, delaying or preventing the onset of psychosis, and
minimizing the duration of untreated psychosis for those who develop psychotic
symptoms.

Objective 1.1. Expand mental health literacy through outreach, training, and
technical assistance.
In alignment with SAMHSA’s mental health promotion initiatives, SAMHSA programs
implement outreach activities with communities, schools, and individuals; implement
training activities on mental health symptoms and evidence-based practices; and provide
technical assistance on service provision and program implementation. All these activities,
implemented and adapted through a culturally appropriate lens, are important components
of mental health literacy expansion as the programs reach people with various mental
health needs and numerous backgrounds.
Continuing to implement these initiatives will expand mental health literacy in areas such
as increasing awareness of mental health symptoms in general, culturally specific
experiences of mental health symptoms, and understanding and implementation of
evidence-based and evidence-informed practices, and will ultimately increase the number
of individuals trained on how to respond to individuals with mental disorders appropriately
and safely.

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For example, the Project AWARE program has increased mental health literacy in schools
and communities, removed barriers to finding care, and ensured cultural relevance for
school programs. With SAMHSA’s support, Project AWARE will focus on improving the
school environment and trauma-informed programming to improve care for school-aged
youth. Additionally, through the MHAT grant program, SAMHSA reinforces positive
partnerships between law enforcement and communities, which increases public trust and
enhances public safety. SAMHSA’s advisory promotes MHAT implementation by broadly
targeting the workplace, from traditional work settings to places in the community that
people frequent.
SAMHSA recognizes the need for technical assistance in many areas of mental health
promotion, including early childhood and social media. SAMHSA addresses these through
Centers of Excellence, such as the National Center of Excellence for Infant and Early
Childhood Mental Health Consultation and the Center of Excellence on Social Media and
Mental Wellbeing. These Centers of Excellence develop and disseminate information,
guidance, and training for mental health practitioners addressing the spectrum of mental
health needs and applicable services and interventions, including prevention and
promotion. SAMHSA supports and expands mental health literacy with these initiatives.
Objective 1.2. Encourage states and tribes to focus resources on mental health
promotion and early intervention services.
SAMHSA encourages states and tribes to focus resources on mental health promotion and
early intervention through infrastructure and services grants, and through technical
assistance.
Infrastructure-focused grants allow SAMHSA to partner with tribal communities and state
agencies to develop culturally appropriate service delivery systems. Some of these
programs include Planning and Developing Infrastructure to Promote the Mental Health of
Children, Youth and Families in American Indian/Alaska Native (AI/AN) Communities
(Circles of Care); Project AWARE, including state-level educational systems; and Grants
for Expansion and Sustainability of the Comprehensive Community Mental Health Services
for Children with Serious Emotional Disturbance (the Children’s Mental Health Initiative or
CMHI), funded in tribal communities and with state-level agencies. SAMHSA’s grant
programs also support direct mental health services in tribal communities, as funded
through Linking Actions for Unmet Needs in Children’s Health in AI/AN Communities, U.S.
Territories, and Pacific Jurisdictions Cooperative Agreements (Indigenous – Project
LAUNCH) and in state-level agencies as funded through CMHI.
SAMHSA prioritizes specific support for tribes through various initiatives that promote
mental health and early intervention. The Tribal Training and Technical Assistance Center
offers training and technical assistance on mental and SUDs, suicide prevention, and
mental health promotion. SAMHSA’s efforts reflect a commitment to upholding the federal
government’s historical and unique legal relationship with Federally Recognized Tribes

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2023 - 2026 | SAMHSA Strategic Plan

through consultation, outreach, education, and engagement when developing initiatives
specific to AI/AN.
Goal 2. To save lives and improve well-being, SAMHSA will lead public health efforts
to reduce suicidal ideation and behavior.
This goal aligns with the Surgeon General’s 2021 Call to Action to Implement the National
Strategy for Suicide Prevention. Through grant funding, coordination, dissemination of
practice and policy recommendations, data collection, and evaluation, SAMHSA is key to
strengthening service development to promote access to quality suicide prevention care, to
improve engagement of service recipients and providers, and to ensure that resources are
aligned with practices that are more impactful.
The nexus between substance use and suicide requires a public health approach.
Because risk and protective factors for the two overlap, SAMHSA supports collaboration
across the continuum to ensure all parts of the system can implement appropriate
programming. Building and strengthening connections among suicide prevention,
substance use prevention, treatment for mental illness, and SUD treatment—along with
recovery support services—are necessary to reduce suicidal behavior and suicide rates.

Enhancing Access to Suicide Prevention and Mental Health Services
Goal 2 Example Programs
The Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early
Intervention Program supports states and tribes with implementing youth suicide
prevention and early intervention strategies in schools, the juvenile justice system,
substance use and mental health programs, foster care systems, pediatric health
programs, and other child and youth-serving organizations. The program reduces
suicides and suicide attempts among youth.
The Suicide Prevention Resource Center advances suicide prevention infrastructure
and capacity building through consultation, training, and resources to states, tribes,
communities, colleges and universities, health systems and other settings, and
organizations that serve populations at risk for suicide.
The National Strategy for Suicide Prevention grant program supports efforts to
implement suicide prevention and intervention programs. The grant program raises
awareness of resources available to prevent suicide, promotes help-seeking behavior,
establishes referral processes, and improves outcomes for individuals at risk for
suicide.

Objective 2.1. Improve access to suicide prevention services.
Reducing barriers and enhancing equitable, culturally appropriate, trauma-informed, and
linguistically responsive access to the 988 Suicide & Crisis Lifeline and other core
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2023 - 2026 | SAMHSA Strategic Plan

components of the crisis services continuum will offer immediate support to those in
distress and can decrease the development of future crisis situations. Suicide prevention
services must also be embedded through the broader public health and healthcare
systems. To reinforce these programmatic attributes, states and territories are required to
report on their systemic suicide prevention activities in the Community MHBG application.
An example of this work can be seen in the Zero Suicide grant program, which supports
the implementation of the Zero Suicide intervention and prevention model for adults
throughout a health system or systems.
Building suicide prevention services does not guarantee that all populations will be aware
of or use them. For populations with deep-seated mistrust of healthcare systems,
engagement strategies with the community and community gatekeepers will be essential
to facilitating trust and use of these services. Offering in-language services also builds trust
and is essential in crisis situations for communities where English is not the preferred or
primary language.
SAMHSA will support the expansion of community health and healthcare-based wellness,
recovery, and suicide prevention programs that work to prevent future crisis encounters.
Efforts include preventing suicide attempts and the emergence of suicidality, increasing
primary care providers’ skills in identifying suicidality, assessing safety and talking about
lethal means restrictions, implementing safety planning, and increasing behavioral health
providers’ knowledge and implementation of evidence-based practices to treat suicidality
and deliver behavioral health crisis care. To support these efforts, programs like the GLS
program use strategies such as working with a range of youth-serving systems (e.g.,
schools and child welfare, juvenile justice, and pediatric services). Other SAMHSA efforts
include engaging systems serving military personnel, veterans, and older adults;
workplaces; faith-based communities; and tribal communities.
Considerations regarding equity are also critical to these efforts. For example, the
SAMHSA Native Connections Grant Program supports grantees in reducing suicidal
behavior and substance use among Native youth up to age 24; easing the impacts of
substance use, mental illness, and trauma in tribal communities; and supporting youth as
they transition into adulthood. Furthermore, the National Action Alliance for Suicide
Prevention, with SAMHSA’s SPRC, is conducting a formative audience evaluation to
ensure 988 Suicide & Crisis Lifeline efforts are informed by populations at high risk for, or
disproportionately impacted by, mental health conditions or suicide-related behaviors. This
will include qualitative and quantitative data collection from groups such as African
American youth and adults; AI/AN; older rural adults; Lesbian, Gay, Bisexual,
Transgender, Queer, and Intersex (LGBTQI+) individuals; and Latino and Hispanic youth
and adults.
Objective 2.2. Improve the quality and effectiveness of suicide prevention services.
SAMHSA will enhance suicide prevention services by supporting training standards and
promoting the adoption of practices that are evidence-based, evidence informed, or

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2023 - 2026 | SAMHSA Strategic Plan

promoted through expert consensus. This includes, but is not limited to, ensuring 988
Suicide & Crisis Lifeline staff are well trained and responsive to the needs of all individuals
who call, text, or chat, including those from under-served communities. Training will be
supported through implementation of core curriculum modules with subsequent evaluation
of worker skill.
An example of an evidence-based practice is strengthening follow-up protocols for
individuals who have experienced a behavioral health crisis, including but not limited to
emergency department visits, inpatient psychiatric admissions, and other behavioral health
crisis care encounters. Collecting, analyzing, and reporting data (e.g., training and policy
changes, screening, model fidelity, practice adoption) must accompany practice
implementation to inform quality improvement efforts. This type of work is supported
through the Zero Suicide grant program that supports the implementation of the Zero
Suicide intervention and prevention model for adults throughout a health system or
systems.
Goal 3. To deliver crisis care across all communities, SAMHSA will improve the
quality and accessibility of the crisis care system.
An adequately resourced, responsive behavioral health crisis system provides personcentered, trauma-informed responses that decrease reliance on law enforcement and
hospital emergency department use. Often, people with mental health and SUD treatment
needs cannot access the care they need when they need and want it, or they get lost in
transition across a highly fragmented and inadequately funded system. Under-served and
marginalized populations, such as those from racial, ethnic, sexual, and gender minority
groups and rural communities, often face additional barriers with respect to access and
outcomes.42
The growth of a robust behavioral health crisis response system will require leadership at
multiple levels throughout mental health and substance use services systems. This
includes a role for federal partners as well as state, territory, tribal, and community leaders,
and people with lived experience. In a highly fragmented and disjointed system, there is a
clear role for SAMHSA. Through the 988 and Behavioral Health Crisis Coordinating Office,
in conjunction with the agency’s Centers and Offices, SAMHSA will work with partners to
convene, coordinate, and disseminate information, including updated evidence and best
practices; provide ongoing learning and technical assistance; facilitate awareness and
behavior change campaigns; and support the measurement and evaluation of system
performance across the crisis continuum. In this role, SAMHSA can identify strategies and
resources to address policy issues including regulatory, governance, and funding or
obstacles faced by jurisdictions. Through SAMHSA’s State Program Improvement
Technical Assistance contract, the agency supports states’ use of the Crisis Services Setaside of the Community MHBG to implement evidence-based crisis services.
SAMHSA’s crisis care system is centered on three elements—“someone to talk to,”
“someone to respond,” and “a place to go.”42 Mobile crisis services play a key role in crisis

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2023 - 2026 | SAMHSA Strategic Plan

response as the second element of the crisis continuum—“someone to respond.” A
fundamental tenet of mobile crisis is to serve anyone, anytime, anywhere. This means that
any individual experiencing a behavioral health crisis can be supported where they are,
regardless of age, language, diagnosis, ability to pay, or location. Mobile crisis services
allow individuals to receive care in their communities, and limit unnecessary involuntary
transportation, hospitalization, incarceration, and detention.
In some communities specialized teams serve youth, veterans in crisis, individuals with
intellectual and developmental disabilities, and individuals experiencing homelessness.
This specialized attention is important, but mobile crisis teams should be equipped to
skillfully support all populations. Well-designed mobile crisis services include coordination
with law enforcement so that first responders to behavioral health crises can be mobile
crisis staff.
SAMHSA envisions that mobile crisis services will be universally available in every
community and will be able to meet the needs of all individuals. SAMHSA supports efforts
to make that vision a reality.

Enhancing Access to Suicide Prevention and Mental Health Services
Goal 3 Example Programs
The 988 State and Territory Grant Program improves state and territory response
to 988 Suicide & Crisis Lifeline contacts by recruiting, hiring, and training the
behavioral health workforce to staff local 988/Lifeline centers to respond, intervene,
and provide follow-up to individuals experiencing a behavioral health crisis; engaging
Lifeline crisis centers to unify 988 Suicide & Crisis Lifeline response across
states/territories; and expanding the crisis center staffing and response structure
needed to successfully implement the 988 Suicide & Crisis Lifeline.
The Community Mental Health Services Block Grant (MHBG) program provides
state/territory formula grants that offer optimal flexibility to enable states to meet the
unique needs of individuals with SMI or SED. Grantees are required to set aside 5
percent of their MHBG allocation to support evidence-based crisis system
components. States and territories use this funding to support transitions from their
previous call center networks to a more centralized response paired with new
capabilities to coordinate with additional crisis services such as mobile crisis
outreach and crisis stabilization units.
The Community Crisis Partnerships Program enhances existing mobile crisis
response teams to divert adults, children, and youth experiencing a mental health
crisis from law enforcement in high-need communities. The program recognizes
high-need communities as a community in which mobile crises are responded to by
first responders and/or where first responders are not adequately trained or
equipped to diffuse mental health crises.

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2023 - 2026 | SAMHSA Strategic Plan

Objective 3.1. Improve the experience for people in crisis and for crisis care
providers.
SAMHSA will lead the nation in promoting the development of crisis and related services
so the needs and experience of people in crisis are prioritized. The foundation SAMHSA
relies on in the design of crisis services starts with the individual. First one must ask, “what
does a person in crisis need?” As noted earlier, the person needs three broad categories
of services: “someone to talk to,” “someone to respond,” and a safe “place to go.” Using a
whole-population approach, SAMHSA asks states and other stakeholders to start their
planning by thinking about the needs, circumstances, and situation of a person in crisis.
Through this whole-population approach, SAMHSA aims to continuously increase support
through the development of technical assistance documents, reports, and meetings and by
monitoring evolving research on best practices in crisis services. SAMHSA will promote
and enhance genuine engagement with persons who have experienced crisis and are
living with or are in recovery from mental illnesses or SUDs by developing several
initiatives that will improve and serve as a model for state and community systems on
consumer engagement in services design and delivery. SAMHSA also aims to lead efforts
to reduce barriers and enhance equitable, culturally and linguistically appropriate access to
the 988 Suicide & Crisis Lifeline; strengthen coordination between 988 and 911 Public
Safety Answering Points, including the support of programs that divert calls from 911 to
988 to decrease unnecessary law enforcement response to crisis encounters; promote the
improvement of law enforcement interactions; and increase the influence of those with
lived experience in planning, implementation, delivery, and evaluation of the behavioral
health crisis continuum. The incorporation of person-centered, trauma-informed principles
will promote engagement and improvements in quality crisis service delivery. Through
these efforts as well as collaborations with national partners, SAMHSA will lead the nation
in the development and dissemination of best practices in crisis care.
It is important to recognize that individuals remain at elevated risk of suicide following crisis
encounters. This includes time after crisis calls, emergency department discharges, and
inpatient psychiatric hospitalizations. Research found that 43 percent of callers
experiencing a suicidal crisis who completed evaluation follow-up assessments
experienced some recurrence of suicidality (ideation, plan, or attempt) in the weeks after
their crisis call, and only 22.5 percent of those callers had been seen by someone in the
mental healthcare system to which they had been referred. 47 Recent national approaches
to follow-up care have included safety planning interventions followed by a follow-up phone
contact—a model that has been shown to be effective in patients discharging from
emergency department settings. Outcomes include improved treatment engagement,
decreased risk of hospitalization, and reduced suicidal behaviors.47,48,49,50 The Crisis
Center Follow-Up Program aims to significantly enhance continuity of care with
engagement of hospitals, behavioral health organizations and services, as well as
911/Public Safety Answering Points, mobile crisis outreach, and police, to improve the
well-being of individuals who are at risk of suicide through continual engagement after
initial contact through 988.
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Objective 3.2. Improve allocation of resources across the crisis care ecosystem.
There are significant variations in crisis service definitions and gaps in the evidence base
supporting specific model implementation. The crisis system must adapt to emerging
needs and evidence, and resources need to be aligned and scaled to respond to this
growth and evolution. A multi-faceted financing strategy will create flexibility in allowing
partners to construct sustainable funding approaches for crisis services. SAMHSA will
support alignment of policy and program incentives to drive effective, safe, high-quality
community-based care. SAMHSA will focus on promoting opportunities for sustaining crisis
services through grant opportunities, and public and commercial payors. Resource
allocation must be consistent with equity goals to overcome historical barriers and address
inequities in access and outcomes.
Goal 4. To improve the quality and accessibility of care, SAMHSA will strengthen
treatment and recovery services for individuals at risk for or living with mental
health conditions.
SAMHSA’s NSDUH survey consistently demonstrates that many individuals with mental
illness do not receive treatment, including those with SMI. Among the many reasons for
this are an insufficient number of mental health professionals and long wait lists for
outpatient appointments. Additionally, there is tremendous variability in the level and
quality of services individuals receive once they are in care. SAMHSA works to increase
access to effective evidence-based programs through several efforts like services grants
and technical assistance.

Enhancing Access to Suicide Prevention and Mental Health Services
Goal 4 Example Programs
The Transforming Lives through Supported Employment grant program
enhances state and community capacity to provide evidence-based supported
employment programs for adults and youth with SMI or SED with the goal for
individuals to achieve competitive employment and build paths to self-sufficiency
and recovery.
Certified Community Behavioral Health Clinics (CCBHCs) are designed to
ensure access to coordinated comprehensive behavioral health care. CCBHCs
serve anyone who requests care for mental health or substance use, regardless of
their ability to pay, place of residence, or age—including developmentally
appropriate care for children and youth.
Behavioral Health Partnerships for Early Diversion grants establish or expand
programs that divert adults and youth with a mental illness or a co-occurring
disorder from the criminal or juvenile justice system to community-based mental
health and substance use disorder services and other supports.

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Objective 4.1. Expand community efforts to provide a continuum of treatment and
recovery supports for individuals living with SMI or SED, and their families and
caregivers.
Persons living with mental illness should have access to treatment and services that
enhance and support their ability to receive care, achieve well-being, and thrive. Over the
past 60 years, community services have developed in fragmented and divergent ways. To
offer states and territories optimal flexibility in meeting the unique needs of adults with SMI
or children with SED, SAMHSA funds the Community MHBG program which is designed
to provide comprehensive community mental health services.
The Certified Community Behavioral Health Clinic (CCBHC) model incorporates nine
treatment and recovery support services including crisis services and SUD treatment for
children and adults. SAMHSA will continue to expand this model through both its CCBHC
Expansion Grants and work with the Centers for Medicare & Medicaid Services on the
Medicaid Demonstration Programs for CCBHCs. For example, in 2023 SAMHSA provided
15 new planning grants for states to prepare to potentially join the CCBHC Medicaid
demonstration that was expanded by the Bipartisan Safer Communities Act.
SAMHSA will continue to support recovery services so that individuals live well and thrive
through programs such as the Statewide Consumer Network Grant Program. This program
aims to enhance the ability of statewide mental health consumer-run organizations to
promote mental health, and to improve related service system capacity and infrastructure
development to be consumer-centered and targeted toward recovery and resiliency. The
program supports consumer-driven improvements by promoting the use of consumers as
agents of transformation. The Mental Health Technology Transfer Center supports efforts
to ensure that high-quality, evidence-based, and effective mental health condition
treatment and recovery support services are available for all individuals with mental
disorders including, in particular, those with SMI. Additionally, the Recovery Community
Services Program provides peer recovery support services via recovery community
organizations to individuals with SUDs or co-occurring substance use and mental
disorders, or those in recovery from these disorders. The program’s foundation is the value
of peers’ lived experience to assist others in achieving and maintaining recovery. These
services, with clinical treatment services, are an integral component of the recovery
process.

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Priority 3

Promoting Resilience and Emotional Health
for Children, Youth, and Families
Most individuals with mental health and substance use conditions first manifest signs in
childhood, adolescence, and young adulthood. 51 In fact, half of all mental illnesses emerge
by the time a youth turns age 14, and nearly 75 percent by the time a person is 24 years
old.51 There is a significant correlation between adverse childhood experiences and
aspects of the child’s environment that can undermine their sense of safety, stability, and
bonding and contribute to poor physical and behavioral health outcomes in adulthood. 52
Even before the COVID-19 pandemic, the nation’s youth were experiencing significant
mental health and substance use challenges. Nearly 1 in 5 youth had a diagnosable
mental health condition, and 1 in 10 had a serious emotional disturbance (SED) that
negatively impacted their ability to function at home, in school, or in the community. 53,54
Additionally, more than 1 in 10 youth ages 12–20 had a substance use disorder (SUD),
inclusive of alcohol or illicit drugs. 55 The pandemic made this situation worse, with
depression and anxiety doubling in youth, especially youth of color, compared to prepandemic levels;53 moreover, more than 215,000 children in the United States have
experienced the death of a primary or secondary caregiver due to COVID-19, with children
of Black, Indigenous, and other people of color disproportionately impacted. 56,57,58 The
Centers for Disease Control and Prevention (CDC) also released data indicating that 1 in 3
high school students experienced poor mental health during the pandemic and nearly half
of students felt persistently sad or hopeless. 59,60
Unfortunately, many young people do not receive the treatment supports they need.
According to the 2021 National Survey on Drug Use and Health, over half of children and
youth with mental health needs did not receive services, and over 98 percent of young
adults with a SUD did not receive appropriate treatment.3,61 Furthermore, those seeking
treatment experienced longer delays, including days-long stays in the emergency
department for those needing an inpatient hospital bed. 62
The Substance Abuse and Mental Health Services Administration (SAMHSA)’s vision for
youth behavioral health is that all children, youth, and their families thrive in their homes
and communities. SAMHSA will achieve this through a tiered public health approach that
matches each child, youth, young adult, and their families with the right intervention at the
right time. This can be achieved by working upstream and acting early in the risk trajectory
through a continuum of care. This approach uses mental health promotion, primary
prevention measures, early identification, and effective interventions, when indicated; it
also applies implementation science to maximize broad strategy application in the context
of community engagement so that youth and their families will achieve and sustain good
health and well-being. It is also important to provide specialized evidence-informed and
evidence-based treatment for those at risk of and who have SED, serious mental illness
(SMI), and SUDs.

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Children, youth, and families is inclusive of those under 26 years of age (including
young adults) and their families. Families can include biological parents and their
partners, adoptive parents and their partners, foster parents and their partners,
grandparents and their partners, siblings and their partners, caregivers, friends, and
others as defined by the family.63

Goal 1. To ensure the wellness and resilience of children and youth, SAMHSA will
support mental health promotion and primary prevention of substance use.
There are many risk and protective factors that can contribute to either the mitigation or
exacerbation of mental health and substance use conditions that manifest in childhood,
adolescence, and young adulthood. Thus, it is critical that we start early—“upstream”—to
foster positive development, build coping skills, and equip young people and their parents/
caregivers with the tools they need to navigate life’s challenges. By doing this, we will help
enhance wellness and build resilience so that our nation’s youth thrive. Promoting
wellness and resilience is cost-effective. There is strong evidence demonstrating that
prevention programs provide significant returns on investment. 64
SAMHSA supports a wide range of mental health promotion and substance use
prevention services that include screening, identification, and referral; warm hand-offs
(e.g., mental health promotion, suicide prevention); parent training; school-based
prevention; student assistance; community awareness; community-based education; and
community linkages. In addition, SAMHSA focuses efforts on young children through the
Infant and Early Childhood Mental Health Grant Program and Linking Actions for Unmet
Needs in Children’s Health, which both aim to reduce the number of children and youth
experiencing mental health or substance use issues.

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2023 - 2026 | SAMHSA Strategic Plan

Promoting Resilience and Emotional Health for Children, Youth, and Families
Goal 1 Example Programs
The “Talk. They Hear You.”® campaign helps parents and caregivers, educators,
and community members get informed, be prepared, and take action to prevent
underage drinking and other substance use.
The Enhancement and Expansion of Treatment and Recovery Services for
Adolescents, Transitional Aged Youth, and their Families program enhances and
expands comprehensive outpatient-based treatment, early intervention, and recovery
support services for adolescents (ages 12–18) and transitional aged youth (ages 16–
25) with SUDs and/or co-occurring substance use and mental disorders, and their
families/primary caregivers. The services include screening, assessment, treatment,
and wraparound services in ambulatory settings.
The Sober Truth on Preventing Underage Drinking Act (STOP Act) Grant
Program enables organizations to strengthen collaboration and coordination among
stakeholders to achieve a reduction in underage drinking in their communities. The
STOP Act Program aims to (1) address norms regarding alcohol use by youth; (2)
reduce opportunities for underage drinking; (3) create changes in underage drinking
enforcement efforts; (4) address penalties for underage use; and/or (5) reduce
negative consequences associated with underage drinking.

Objective 1.1. Expand mental health promotion and primary prevention of substance
use through outreach, training, and technical assistance.
Mental health promotion and primary prevention of substance use programs strive to
increase the protective factors and healthy behaviors that promote positive mental,
emotional, and behavioral development at home, in school, and in the community. These
programs also seek to mitigate the risk factors that can lead to the development of
substance misuse and mental illness. These risk factors can be at the individual, family, or
community level, such as family history of substance use, favorable parental attitudes
toward substance use, lack of school connectedness, and childhood trauma. Primary
prevention of substance also focuses on providing the information and skills necessary to
avoid substance use and misuse. Collectively, these strategies are often referred to as the
“universal” approach because the interventions address an entire population, and all
children and youth can benefit from the programs and services.
Training, technical assistance, and evidence-based interventions are essential
components of mental health promotion and primary prevention of substance use.
Examples of training programs include mental health first aid, suicide prevention, traumainformed care, and cultural competency. Providing these trainings to diverse groups of
individuals (e.g., youth and families, educators, healthcare providers, first responders, and
community leaders) will create a network of people who can promote wellness, identify
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early signs of concerns, offer appropriate support, and refer individuals to necessary
services.
Evidence-based programs and interventions that support social-emotional development,
self-management, and resiliency and improvement of parental, school, and community
connections have shown evidence of reducing the development of problem substance use
behaviors. 65
Tailoring initiatives to reach multiple settings (e.g., home, school, employment, community,
faith organizations) is also important to raise awareness about behavioral health, reduce
prejudice and discrimination, and promote healthy lifestyles. Such efforts can include
organizing behavioral health awareness campaigns, hosting workshops and seminars,
disseminating educational materials, and using digital platforms and social media to reach
a broad audience. Providing accurate information, resources, and support empowers
individuals, organizations, and policymakers to prioritize behavioral health, recognize the
signs of distress, and seek support when needed. SAMHSA provides technical assistance
in various programs that also provide guidance and resources to individuals and
organizations to implement evidence-based prevention programs, evaluate their
effectiveness, and make data-driven improvements.
Objective 1.2. Lead efforts with federal partners to reduce substance use by those
under the age of 21.
Establishing and enhancing key partnerships assists in reducing substance use rates
among children and youth. SAMHSA leads the federal Interagency Coordinating
Committee on the Prevention of Underage Drinking, which includes 23 federal agencies
and focuses on a multi-faceted approach to lower the prevalence and negative
consequences of underage drinking.
SAMHSA also partners with other federal efforts to improve substance use prevention
efforts, including the Community Preventive Services Task Force (CPSTF) that is
managed by the CDC. The CPSTF works to improve the health of communities by issuing
evidence-based findings and recommendations on public health interventions used in realworld settings. Together, the CPSTF and SAMHSA developed recommendations for
CDC’s Community Guide related to family-focused and community-based interventions to
prevent substance use.
SAMHSA also partners with the National Institute on Drug Abuse and the National Institute
on Alcohol Abuse and Alcoholism. These institutes conduct research related to substance
use and misuse and play critical roles in informing prevention and treatment efforts. In
addition, SAMHSA engages with local governments, organizations, and tribal and
community leaders to create a comprehensive and integrated system of care that
advances collective impact and fosters healthier and safer environments for all children,
youth, and families. Together, these programs and activities constitute a complementary
and coordinated federal approach that has helped reduce underage substance use.

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Goal 2. To ensure that all children, youth, and families have opportunities to thrive,
SAMHSA will increase access to a comprehensive array of equity-driven behavioral
health programs by increasing program integration and expanding pediatric
behavioral health capacity.
SAMHSA will emphasize the importance of promotion, prevention, early intervention,
treatment, and recovery by engaging with multiple child- and youth-serving sectors,
especially schools and primary care; create a specialized focus for children, youth, and
families as part of the crisis continuum; and strengthen workforce capacity and skills.
Promoting Resilience and Emotional Health for Children, Youth, and Families
Goal 2 Example Programs
The Children’s Mental Health Initiative provides resources to improve the mental
health outcomes for children and youth (birth through age 21) at risk for or with SED
and their families. This program supports the implementation, expansion, and
integration of the System of Care approach by creating sustainable infrastructure and
services that are required as part of the Comprehensive Community Mental Health
Services for Children and their Families Program (also known as the Children’s Mental
Health Initiative or CMHI). With this program, SAMHSA aims to prepare children and
youth with or at risk of SED for successful transition to adulthood and assumption of
adult roles and responsibilities.
Circles of Care provide tribes and tribal organizations with the tools and resources to
plan and design a family-driven, community-based, and culturally and linguistically
competent system of care. With this program, SAMHSA aims to increase resilience and
improve emotional health for American Indian and Alaska Native children, youth, and
families.
The Project for Advancing Wellness and Resiliency in Education (Project
AWARE) program develops a sustainable infrastructure for school-based mental
health programs and services. Recipients build collaborative partnerships with the
state education agencies, local education agencies, and tribal education agencies or
expand the capacity of state education agencies, in partnership with state mental
health agencies, community-based providers of behavioral healthcare services, school
personnel, community organizations, families, and school-aged youth. Project AWARE
leverages mental health-related promotion, awareness, prevention, and resilience
activities for school-based youth. By building or expanding capacity, the program
advances wellness and resiliency in education by increasing mental health awareness
in schools across states, territories, and tribal communities.
The Protection & Advocacy for Individuals with Mental Illness Program is
intended to protect and advocate for the rights of children or adults with serious
emotional disturbances with significant (serious) mental illness through activities to
ensure the enforcement of the Constitution and federal and state statutes.

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2023 - 2026 | SAMHSA Strategic Plan

Objective 2.1. Strengthen the nation’s youth behavioral health system by integrating
behavioral health services across youth-serving systems, including child welfare
and juvenile justice, with a particular emphasis on education and pediatric primary
care.
SAMHSA will expand the use of the “System of Care” framework, which seeks to organize
services and supports into a coordinated network, build meaningful partnerships with youth
and families, and address their cultural and linguistic needs. 66 Services and supports are
coordinated across systems, individualized, and delivered in the most appropriate, least
restrictive setting to help young people reach their full potential and thrive. The foundation
of this work has been created through the Expansion and Sustainability of the
Comprehensive Community Mental Health Services for Children with Serious Emotional
Disturbances program (also known as the Children’s Mental Health Initiative or CMHI).
Additionally, Community Mental Health Services Block Grant funds are contingent on
states submitting a plan for an evidence-based system of care for children and families
and reporting on all aspects of the work in the public mental health system for children.
States and territories actively work with community mental health agencies, other
community mental health providers, and school systems to provide comprehensive
services for children with mental health support needs.
Schools
To address students’ behavioral health needs and ensure that schools are secure and
safe, SAMHSA will emphasize the Advancing Comprehensive School Mental Health
Systems (CSMHS) framework and the use of a multi-tiered system of supports (MTSS). 67
The CSMHS framework and MTSS approach are designed to provide a continuum of
instructional and behavioral supports that can positively impact an entire school and create
a supportive school culture, as well as offer specific interventions to meet the individual
needs of each student. The Project Advancing Wellness and Resiliency in Education
(Project AWARE) program provides training for school personnel and other adults who
interact with school-aged youth to detect and respond to mental health challenges, and
connects school-aged youth, who may present with behavioral health challenges, and their
families to needed services. Additionally, SAMHSA funds the School-Based TraumaInformed Support Services program to further enhance and improve trauma-informed
support and mental health services for children and youth. 68
Although some schools can provide direct services (i.e., school-based interventions), many
others do not have such capabilities and therefore must link with services in the community
(i.e., school-linked services). These linkages with community-based organizations help
school staff identify and address the unique needs of students, which can allow for more
comprehensive assessments, reduce service gaps, and lead to better outcomes. These
programs focus on emotional and behavioral wellness and resilience, substance use
prevention, and services and supports for youth who have SED, SMI, or SUDs.

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In addition to school staff, it is important to train and collaborate with other community
professionals and paraprofessionals, including members of a family’s social support
network, youth peer specialists, coaches and mentors, and others who serve as providers
of care or extensions of the behavioral health workforce. These individuals have direct and
frequent interactions with children and youth, allowing them to observe behavioral
changes, promote healthy coping and resilience, provide early intervention, and create a
supportive and nurturing environment. Establishing partnerships among schools,
healthcare providers, and other community supports creates a more seamless and
coordinated system of care, and improves outcomes for children, youth, and families.
Pediatric Primary Care
SAMHSA seeks to improve the integration of youth behavioral health and pediatric primary
care. Pediatric primary care is the point of initial care delivery for 75 percent of children
and youth and can be the key to early identification of complex needs, effective referral,
and coordination of care. 69 Best practice related to integrating behavioral health and
primary care requires an infrastructure of evidence-based primary prevention, mental
health promotion, screening, measurement-based care (MBC), psychiatric and medicine
consultation, and collaboration among service providers.
The Consolidated Appropriations Act, 2023 included provisions that prioritized integrating
primary and behavioral health care.13 Section 1301 of the law reauthorized and augmented
SAMHSA’s Primary and Behavioral Health Care Integration program.13 This provision
requires 10 percent of appropriated program funds be allocated to implement the
psychiatric collaborative care model by primary care practices.13
Objective 2.2. Ensure that plans to develop the crisis continuum, in conjunction with
the transition to the 988 Suicide & Crisis Lifeline, incorporate a specialized focus for
children, youth, and their families.
The nation’s crisis system is in a state of major growth and development. Crisis services
do not adequately meet the specialized needs of youth, nor do they function as a
coordinated system. This prevents children and youth from getting the services they need
when and where they need them. Ideally children and youth in crisis receive services in
their communities, but emergency departments and law enforcement are often the first
point of entry into the behavioral health system. Therefore, in 2022, SAMHSA released
The National Guidelines for Child and Youth Behavioral Health Crisis Care, offering best
practices, implementation strategies, and practical guidance for the design and
development of services that meet the needs of children, youth, and their families
experiencing a behavioral health crisis.43
Crisis and mobile response teams can de-escalate behavioral health emergencies and are
an important part of the array of available services.43 These teams often serve as a
diversion from hospital-level care and involvement in the juvenile justice and child welfare
systems.43 Mobile response and stabilization teams focused on children and youth are

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2023 - 2026 | SAMHSA Strategic Plan

necessary to ensure that services are provided by the right people with the appropriate
expertise.43 Some youth may need more than mobile crisis response and may also need a
“safe place to be.”43 Efforts should prioritize stabilization with the youth and their family
such that the youth can remain at home, while prioritizing safety. For youth, home-based
and/or community-based stabilization services can be delivered over a period of several
weeks. When situations cannot be resolved in home or when the home is unsafe, youth
may need more intensive services such as a crisis stabilization unit, emergency
department, or inpatient treatment.
SAMHSA recognizes that when a child or youth is in crisis, the family is in crisis. As a
result, it is important to expand opportunities for parents, caregivers, and family members
to engage in their child’s treatment and receive support from individuals who understand
them. SAMHSA will create strategies for youth and families with lived experience to
provide support to their peers facing similar behavioral health challenges.
Objective 2.3. Increase opportunities across multiple settings for screening, early
identification, and early and brief intervention.
By increasing opportunities to integrate screening and early intervention for mental health
and substance use concerns across multiple settings, SAMHSA will create a more
comprehensive and accessible system of care that encourages early identification and
early intervention and creates support for young people experiencing behavioral health
challenges. These services and supports can be expanded or incorporated into schools,
pediatric primary care settings, and community organizations and settings as these are
well positioned to identify early signs of behavioral health concerns. Digital technology,
such as online screening tools or mobile apps, can also be leveraged. By using
standardized screening tools, providing training to help identify symptoms, establishing
clear referral pathways, and implementing integrative care models, appropriate and timely
interventions can be provided to those in need.
Objective 2.4. Work collaboratively with other federal agencies and external
stakeholders to develop strategies to increase capacity to deliver behavioral health
services for children, youth, and their families.
The pediatric behavioral health workforce shortage will ultimately lead to long-term
negative outcomes across countless dimensions, particularly in under-served
communities, with more pronounced inequities across communities of color. 70,71 In
addition, low reimbursement rates for youth behavioral health services and limited
behavioral health benefit packages have contributed to ongoing challenges related to
obtaining and paying for services and supports.69 To ensure quality care is available to
children, youth, and families, it is of paramount importance to address funding
mechanisms and the need to expand access. To respond to this need, a responsive and
culturally, racially, and ethnically diverse workforce comprising youth and family peers,
paraprofessionals, allied professionals, and clinicians must be mobilized. One specific area

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2023 - 2026 | SAMHSA Strategic Plan

of focus will be to provide guidance regarding how to implement services and obtain
reimbursement to integrate pediatric primary care and youth behavioral health.
To expand the workforce, SAMHSA has a long history of collaborating with federal
partners. Similarly, non-federal partnerships can drive the state, territorial, tribal, and
community dissemination of resources. SAMHSA will continue collaborative efforts to
expand the youth behavioral health workforce, address behavioral health issues related to
child welfare and juvenile justice, and identify strategies to fund quality behavioral health
services for youth.
Despite Medicaid and/or the Children’s Health Insurance Programs insuring 36 percent of
American children, significant challenges remain for children and youth accessing innetwork providers. SAMHSA will commission a study to evaluate the barriers to behavioral
health provider participation in public insurance programs. 72 Although SAMHSA
encourages care in the least restrictive environment, there is the growing issue of a lack of
available inpatient and residential treatment beds for children who require them. This
situation has significant downstream effects, like increased emergency department
boarding times for children in behavioral health crisis. SAMHSA will evaluate the reasons
behind bed closures and engage partners in discussing opportunities to develop funding
mechanisms for youth crisis services to prevent the unnecessary utilization of inpatient and
residential levels of care.
Goal 3. To meet the specific needs of children, youth, and their families, SAMHSA
will support the dissemination and implementation of evidence-based and culturally
appropriate services.
SAMHSA will encourage the use of evidence-informed and evidence-based services that
promote well-being by developing positive attributes (promotive) and that prevent
substance use, misuse, and harm (preventive). Points of access for these services occur
at the youth and family level; within schools; within primary and other healthcare settings;
and as part of national, state, territory, tribal, and community efforts to improve population
health.
Studies demonstrate that the use of evidence-based practices to address child and youth
behavioral health conditions improves outcomes. 73 These treatments consistently
outperform control conditions for the most common youth disorders, including anxiety,
depression, and disruptive behavior.
Evidence-based interventions are needed and should demonstrate improved outcomes,
relevance, and effectiveness for culturally diverse populations.73 Although SAMHSA is not
a research entity, the agency often supports necessary adaptations to evidence-based
services to align with cultural and linguistic needs of populations served. SAMHSA will
encourage the use of an MBC approach. MBC is an evidence-based strategy to improve
service outcomes that involves the systematic administration of symptom rating scales and
use of the results to drive clinical decision making. Research demonstrates routine data

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collection, as part of MBC processes that inform treatment planning, improves treatment
outcomes.

Promoting Resilience and Emotional Health for Children, Youth, and Families
Goal 3 Example Programs
The Enhancement and Expansion of Treatment and Recovery Services for
Adolescents, Transitional Aged Youth, and their Families (Youth and Family
TREE) grantees provide a comprehensive, family-centered, trauma-informed,
culturally appropriate, and evidence-based integrated outpatient system of care,
which includes early intervention and recovery support services to meet the complex
needs of the population of focus. The benefits include screening, assessment,
treatment, and wraparound care, and they must be provided in outpatient, intensive
outpatient, or day treatment settings.
The National Child Traumatic Stress Initiative program increases access to
effective trauma- and grief-focused treatment and service systems for children,
adolescents, and their families who experience traumatic events. With this program,
SAMHSA aims to raise the standard of care and improve access to evidence-based
services for children experiencing trauma across the nation.

Objective 3.1. Reduce health disparities and ensure effectiveness of SAMHSA
programs by establishing an equity-informed approach to data, evaluation, technical
assistance, and service delivery that is specific to young people and their families.
Increasing timely data collection and analysis is needed to more immediately respond to
youth behavioral health needs.73 Data are also needed to develop, implement, and
evaluate interventions to determine if they meet requirements to be identified as evidencebased practices and to ensure the inclusion of marginalized groups in the interventions
that are provided. Relevant and timely data analysis is critical to evaluating the
effectiveness of SAMHSA’s programs and services and to understanding the needs of
diverse populations. Data can help inform the implementation of high-quality programs,
practices, and policies that are responsive, upstream-focused, recovery-oriented, traumainformed, and equity-driven (culturally and linguistically appropriate). This objective
focuses on creating data strategies that understand the unique needs of children and
youth and support programs that reduce and eliminate behavioral health inequities.
Population-inclusive data can help identify specific needs and can be used to develop
focused interventions. Significant inequities exist across a range of behavioral health areas
for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+); Black; and
Indigenous children and children of color.10 These range from rates of diagnosis of
attention-deficit/hyperactivity disorder to disparate treatment with antipsychotics for
impulsivity, to the startling morbidity and mortality among Black youth by suicide.10 Given
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this, there is an explicit need to address the social and structural determinants of mental
illness and SUD—paying particular attention to behavioral health equity.
Objective 3.2. Promote and coordinate technical assistance for youth behavioral
health that provides guidance and expertise to professionals, organizations, and the
public.
SAMHSA provides technical assistance to support professionals, organizations, and the
public as they develop and implement plans to address youth behavioral health
challenges. SAMHSA’s current efforts in this area are limited. Building on existing efforts,
SAMHSA will create a robust specialized national technical assistance center for youth
behavioral health to assist individuals, organizations, and communities in improving and
reforming youth behavioral health services and systems. This comprehensive center will
use a public health approach to provide technical assistance related to wellness and health
promotion, primary prevention, early identification and intervention, and treatment and
recovery approaches across the developmental spectrum. Technical assistance will focus
on improving clinical services and programs, addressing specialized topics such as
reducing health disparities and financing service delivery, expanding capacity and access
to youth and family peer support, and providing interventions that are trauma- and griefinformed and recovery/resilience-oriented.
Objective 3.3. Increase the inclusion of young people and family members with lived
and living experience in the development, implementation, and evaluation of
programs and services.
An increasing body of evidence shows that outcomes improve when young people and
their families are engaged in their own treatment decisions and in the development of
policies and procedures governing care. 74,75,76 Youth and family members with lived and
living experience provide a perspective and descriptive information that contextualizes and
complements the interventions delivered, and highlights areas for system improvement
and reform.
SAMHSA incorporates the child, youth, young adult, and family lived experience
perspective through programs such as the Statewide Family Network Program,
implemented by family-driven organizations; the Healthy Transitions program serving
youth and young adults ages 16–26 with or at risk for serious mental health conditions;
and other programs requiring key personnel positions or advisory groups including young
people and family members with lived experience. In addition to this, SAMHSA will obtain
feedback from people receiving services for continuous quality improvement and to
promote opportunities for leadership and positive development. This includes engaging
young people and their family members on SAMHSA National Advisory Council and
educational activities, and in the development and implementation of training and technical
assistance to grantees and the public.

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Objective 3.4. Guide the optimal use of technology to support the behavioral health
of children, youth, young adults, and families.
Technology use significantly impacts the nation’s children, youth, and families.10 The use
of telehealth services in particular greatly expanded as a result of the COVID-19 pandemic
and has improved access to mental and substance use disorder services.10 Technology
also has the potential to provide robust social support. For example, social media provides
youth who identify as LGBTQI+ with an environment that fosters peer connections and
supports emotional well-being. 77 Additionally, youth use of crisis supports through text and
chats has risen exponentially since the transition to the 988 Suicide & Crisis Lifeline. 78 An
emerging area of work is to better understand the role of digital technologies to assist in
the treatment of behavioral health conditions, from apps to wearables, which show promise
for the future of behavioral health service delivery.
Unfortunately, social media can also be harmful to child, youth, young adult, and family
mental health. According to a 2022 Pew Research Survey, nearly half of U.S. teens ages
13 to 17 experienced bullying and harassment online, and 53 percent identify it as a “major
problem.” 79 Such negative influences can create or exacerbate conditions like anxiety and
depression, and excessive use of social media has been linked to impulsive behavior and
loneliness. Nearly all adolescents and young adults use social media and digital
communications, and they are uniquely vulnerable to the negative effects of social media
and highly susceptible to peer influences. 80 Understanding the influences of increased
technology use and new digital platforms on the initial use and progression of potentially
harmful drug use, behaviors, and the mental health of young people is key to adapting
policy and practices. SAMHSA’s Center of Excellence on Social Media and Mental
Wellbeing develops and disseminates information, guidance, and trainings on the impact
of youth social media and technology use, particularly the potential benefits and risks that
these platforms may pose to mental wellness and resilience.

41

Priority 4

Integrating Behavioral and Physical Health
Care

2023 - 2026 | SAMHSA Strategic Plan

People with behavioral health conditions often experience challenges getting the care they
need. Forty-four million people ages 12 and older in the United States needed substance
use treatment in the past year; however, only 6.3 percent reported receiving any. Close to
58 million adults ages 18 or older had any mental illness during the same time period, but
less than half (47.2 percent or 26.5 million) reported receiving mental health services in the
past year.3 Systemic factors, such as lack of stable housing and transportation, food
insecurity, condition-related stigma and discrimination, and high rates of past trauma,
racism, and homophobia, may pose significant barriers for people and families to trust and
effectively engage with behavioral and other healthcare services. These factors apply no
matter the age of the individual as they have impacts across the lifespan.
Although mortality can be directly related to mental and substance use disorders (SUDs),
people living with these conditions are also at higher risk for poor health outcomes
associated with preventable chronic physical health problems. Healthcare services
systems, including primary care, are often ill equipped to meet the myriad of complex
needs of people with mental health and substance use disorders, especially when the
support and attention that would be most helpful is beyond what is available or feasible
within these setting. 81 This may complicate efforts for people with serious mental illness
(SMI) and SUDs to access or effectively engage with different types of health care from
which they could benefit. This is a contributing factor to the shorter life expectancies
among people with SMI and SUDs compared to their peers without these conditions.81
Integrating behavioral health and physical health care is particularly important for older
adults, who often prefer to seek behavioral health care in primary care settings for several
reasons.79 Nineteen percent of adults over age 65 reported they could not function at all or
had a lot of difficulty with at least 1 of 6 functioning domains: vision, hearing, mobility,
communicating, cognition, and self-care. 82 Older age groups had the highest (85+) or
among the highest (75–84) suicide rates for any age group. 83 Additionally, approximately 3
million adults 50 or over reported having any SMI; 17.7 million reported any mental illness;
11.4 percent reported binge drinking in the past month; and 11.3 percent reported having a
SUD.±
Improving health more holistically can be accomplished through the integration of
behavioral and physical health care by using systematic, evidence-based, cost-effective
approaches to improve person-centered comprehensive care in all settings. Recognizing
the multidimensional elements to health, a whole-person approach considers the individual
at the center of care regardless of treatment setting, integrates their goals and priorities
into a person-centered care plan, is culturally appropriate, and aims for the creation of
health and well-being—not just the absence of disease.

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2023 - 2026 | SAMHSA Strategic Plan

A key to achieving a whole-person care approach is advancing the bi-directional
integration of behavioral health with all other healthcare services and systems. The
Substance Abuse and Mental Health Services Administration (SAMHSA)’s integration
efforts provide support in areas integral to its mission, including grant programs, technical
assistance, training resources, and policy activities. These efforts include the education
and training of primary care providers to better promote prevention, screening, and early
behavioral health interventions; self-management approaches including shared decision
making so individuals and families can fully participate in care; as well as investing in
models that connect individuals with behavioral health issues to needed physical health
screening and associated care.
SAMHSA funds the National Center of Excellence for Integrated Health Solutions (CIHS),
which houses some of the newest evidence-based resources, tools, and support for
organizations working to integrate primary and behavioral health care. This team of
experts in organizational readiness, integrated care models, workforce and clinical
practice, health and wellness, and financing and sustainability partner with providers to
create a customized approach to advance integrated care and health outcomes. SAMHSA
also works with federal, state, territorial, tribal, and community partners to eliminate the
barriers that providers encounter when trying to deliver whole-person health care and
supports. These barriers are especially profound when serving communities
disproportionately affected with co-morbid infectious disease conditions.
Goal 1. To promote whole-person care and improve health outcomes, SAMHSA will
advance bi-directional integration of healthcare services across systems for people
with behavioral health conditions.
Bi-directional care integration focuses on improving access to and delivering whole-person
care. It also includes addressing physical and behavioral health in an integrated system
where providers work together to deliver and coordinate care. 84 SAMHSA acknowledges
that bi-directional care integration is not a “one-size-fits-all” endeavor. Specialty behavioral
health and primary care settings differ in significant ways, including patient populations,
provider expertise and background, resource needs, financing and information technology
systems, and primary drivers of care.84 These differences need to be factored into any
integration activities.
Despite these differences, consistently applying a whole-person care approach equitably,
no matter the setting, can improve health outcomes for people with behavioral health
conditions. 85 Non-specialty healthcare settings, whether emergency departments,
hospitals, or primary care, may be the first place for an encounter with an individual in
need of behavioral health services. These encounters represent significant opportunities
for screening, diagnosis, and engagement in effective services and supports, not only for
physical and behavioral health conditions but also for supports that pay attention to social
determinants of health (SDOH).81 Providing treatment for behavioral health conditions in
primary care not only expands access to these services but allows for attention to other
acute and chronic health conditions.81 Interventions for behavioral health conditions in
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2023 - 2026 | SAMHSA Strategic Plan

primary care especially reach the large population of individuals with less complex or
stable mental and SUD.85
To be successful, this goal will require partnerships and educational efforts among all
stakeholders. That includes actively and closely engaging, building on, and working with
federal partners prominent in this area, including the Health Resources and Services
Administration (HRSA), the Centers for Disease Control and Prevention, the Office of the
Assistant Secretary, the Veterans Administration (VA), and others. For example, the
SAMHSA-HRSA CIHS assists providers in integrating primary and behavioral health
services to better address the needs of individuals with mental health and substance use
conditions, whether seen in specialty behavioral health or primary care provider settings.
Integrating Behavioral and Physical Health
Care Goal 1 Example Programs
The Promoting the Integration of Primary and Behavioral Health Care program
promotes full integration and collaboration in clinical practice between primary and
behavioral health care and promotes integrated care services related to screening,
diagnosis, prevention, and treatment of mental and SUDs, and co-occurring physical
health conditions and chronic diseases.
Screening, Brief Intervention, and Referral to Treatment grants implement
screening, brief intervention, and referral to treatment services for children,
adolescents, and/or adults in primary care and community health settings with a focus
on screening for underage drinking, opioid use, and other substance use.

Objective 1.1. Increase resources and service capacity through grants, educational
materials, and technical assistance for mental health and substance use disorder
education, screening, prevention, treatment, and recovery in physical healthcare
settings.
Historically there has always been an unmet need for behavioral healthcare services, with
many people living with behavioral health conditions not receiving treatment.3 The COVID19 pandemic resulted in increased symptoms of anxiety and substance use that call for
additional investments to address these concerns across more integrated treatment
settings.3 Physical healthcare settings play important roles in preventing, identifying,
mitigating, treating, and supporting the recovery of people with, or at risk for, behavioral
health conditions.85 Meeting these functions presumes that practitioners have the requisite
education, support, and resources to adequately deliver these services. An example can
be found in the Consolidated Appropriations Act, 2023, which amended the Public Health
Service Act to reauthorize and augment the Primary and Behavioral Health Care
Integration program by requiring a 10 percent allocation of appropriated funds to
implementing the psychiatric collaborative care model by primary care practices.13
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2023 - 2026 | SAMHSA Strategic Plan

SAMHSA will continue to support training and technical assistance using a whole-person
care framework for all practitioners, health systems, and other organizations that seek to
provide behavioral health care. These efforts align with and complement a range of
SAMHSA’s programs supporting the continuum of prevention, treatment, recovery support,
and mental health promotion services across primary care, emergency departments and
hospital settings, infectious disease clinics, and criminal justice-related healthcare services
such as grants to expand SUD treatment in drug courts and technical assistance through
the CIHS.
Objective 1.2. Increase resources and service capacity through grants, educational
materials, and technical assistance for physical health condition education,
screening, prevention, treatment, and recovery in behavioral healthcare settings.
Specialty behavioral healthcare settings may be the primary and only places where people
with mental and substance use conditions encounter and engage with health professionals
on a longer-term basis. To improve health outcomes for their clients, behavioral health
organizations must be prepared to address physical health conditions and integrate
services for the people they serve.
Several of SAMHSA’s programs, including the Certified Community Behavioral Health
Clinics, the Minority Acquired Immunodeficiency Syndrome (AIDS) Initiative, and the
Promoting the Integration of Primary and Behavioral Health Care grants, incorporate
aspects of wellness-focused and whole-person care requirements such as primary
healthcare screenings and referrals. SAMHSA will expand these activities to all relevant
grant programs.
Objective 1.3. Increase availability and improve uptake of training, education, and
technical assistance on evidence-based, trauma-informed, integrated whole-person
care.
SAMHSA has a long history of providing training, education, and technical assistance to a
range of healthcare audiences to advance the behavioral health needs of the nation. With
a growing emphasis on wellness-focused, whole-person care, SAMHSA will focus on
these activities to ensure inclusion of trauma-informed, integrated care approaches. Work
from various stakeholders and partner federal agencies such as the VA and the National
Institutes of Health on whole-person care models will also inform efforts.85,86 SAMHSA will
employ its strategic data collection revisions in measuring acceptance and uptake of these
training and technical assistance efforts, including the Whole Health Action Management
model that SAMHSA plans to review and revise.
Goal 2. To promote whole-person care and improved health outcomes, SAMHSA will
advance policies and programs to address social determinants of health.
SAMHSA recognizes the importance of addressing SDOH as key levers to achieving
improved outcomes for people with behavioral health conditions. SAMHSA addresses
various SDOH through our service delivery grants, training, and technical assistance
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2023 - 2026 | SAMHSA Strategic Plan

programs. Wraparound services for transportation assistance, case management, and
supportive and recovery housing are a few examples of allowable activities that can be
supported with SAMHSA grant funds. In addition, SAMHSA collaborates with other federal
partners to support the Homeless and Housing Resource Center, a technical assistance
program.
Many individuals with behavioral health conditions encounter the criminal justice system at
different points. Recognizing this intersection, SAMHSA also supports programs, such as
diversion, drug court, and reentry, that aim to interrupt the cascade of negative events from
this involvement.

Integrating Behavioral and Physical Health
Care Goal 2 Example Programs
The Treatment for Individuals Experiencing Homelessness program
supports the development and/or expansion of local implementation of an
infrastructure that integrates behavioral health treatment and recovery support
services for individuals, youth, and families with an SMI, serious emotional
disturbance, or co-occurring disorder who are experiencing homelessness.
Adult Treatment Drug Court programs support a variety of services including
direct treatment services for diverse populations, wraparound and recovery
support services such as recovery housing and peer recovery support services
designed to improve access to and retention in care, drug test monitoring for
illicit substances, educational support, relapse prevention and long-term
disease management skills development, and human immunodeficiency virus
and viral hepatitis B and C testing and/or referral, conducted in accordance
with state and local requirements.
Adult Reentry Program grants provide screening, assessment,
comprehensive treatment, and recovery support services for diverse
populations reentering the community from incarceration. Other supported
services include providing drug testing as required for supervision, treatment
adherence, and therapeutic intervention; provision of case management and
person-centered case management planning; and screening for infectious
diseases.

Objective 2.1. Strengthen factors to improve health, home, purpose, and community
to address social determinants of health.
Improving socioeconomic factors (such as environmental conditions, economic factors,
and interpersonal relationships) is essential to strengthening SDOH, which reduces the
risk of substance misuse, promotes equity, and improves overall health and well-being.

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To help strengthen these linkages, SAMHSA will provide funding to eligible entities for
screening, intervention, referral, linkage to care, and warm hand-off support services
focused on substance misuse prevention and/or cessation, infectious disease prevention
and treatment, mental health, primary care, pre-arrest diversion/deflection, housing,
employment, education, peer support, and other psychosocial needs. SAMHSA works with
federal partners and other stakeholders, such as through the Interdepartmental Substance
Use Disorders Coordinating Committee (ISUDCC), and will support policies and practices
that address individual, family, and community needs associated with SDOH (including
through efforts such as peer specialists, community health workers, community coalition
volunteers, faith-based leaders, person-centered planning, case management, and
others). The ISUDCC focuses on coordination across federal agencies and on strategies
to improve federal programs and outcomes related to substance use prevention,
treatment, and recovery. Specific activities include expanding access to services,
assessing the alignment of federal and state prevention and treatment strategies,
recommending strategies for public engagement regarding policy and program
development, and recommending strategies to minimize duplicative programming.
Objective 2.2. Adapt community-based services and supports to meet the needs of
specific populations such as people experiencing homelessness.
Far too many individuals with behavioral health conditions become homeless. Engagement
with treatment that restores a person’s dignity, humanity, and mental health can help these
individuals remain well and enable them in working with housing professionals to obtain
and sustain successful housing. Often this treatment includes medication for those with
SUD as well as medications that treat mental illnesses such as depression, bipolar
disorder, or schizophrenia.
SAMHSA leads many programs that provide identification of mental illnesses in individuals
that are unhoused and promotes referral to treatment. These include the Projects for
Assistance in Transitioning from Homelessness program as well as the Treatment for
Individuals Experiencing Homelessness program. Additionally, SAMHSA provides
technical assistance to shelters and other entities that are engaged with assisting our
nation’s homeless individuals and developed a guide on Expanding Access to and Use of
Behavioral Health Services for People Experiencing Homelessness. This guide highlights
strategies for behavioral health and housing providers to conduct outreach and engage
with individuals experiencing homelessness, initiate use of behavioral health treatment as
they wait to receive stable housing, and retain them in their recovery efforts once housed.
SAMHSA intends to continue investments in programs and training opportunities that
support linkage to and engagement with a range of recovery support services for persons
with mental illness and SUDs, improving access to and retention in services, and reducing
homelessness by partnering with and supporting homeless service organizations, housingrelated entities, and training and technical assistance resources that work to identify and
provide sustainable housing options for persons with mental illness and SUDs. This
includes Assertive Community Treatment Grants, Grants for the Benefit of Homeless
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2023 - 2026 | SAMHSA Strategic Plan

Individuals, and others. SAMHSA actively participates in the U.S. Interagency Council on
Homelessness and will leverage its existing relationships to help advance the integration of
behavioral health into local U.S. Department of Housing and Urban Development
Continuum of Care Program and associated Coordinated Entry Systems.
Objective 2.3. Increase and improve care for people involved with the criminal
justice system from all points of diversion to reentry.
Too often Americans with behavioral health conditions are arrested and incarcerated
rather than provided with opportunities to participate in effective treatment and recovery
support services. With adequate crisis response and timely access to treatment and
recovery supports, individuals with behavioral health conditions can receive treatment
rather than face arrest and incarceration.
To help individuals remain well in the community of their choice, SAMHSA will continue
investments in programs that aim to divert individuals with behavioral health conditions
from the criminal justice system, establish and expand drug courts, and assist offenders
with behavioral health conditions with reentry. These programs all aim to move people with
behavioral health conditions away from the criminal justice system and into community
care. Programs include diversion programs such as support for mental health courts and
SAMHSA’s long-standing Gather, Assess, Integrate, Network and Stimulate Center, which
is a nationally recognized technical assistance center that provides resources on diversion
from criminal justice as well as information on treatment of incarcerated individuals with
mental illnesses and SUDs and best practices in release planning for those individuals.
Individuals entering carceral settings still require treatments that they were receiving in the
community. SAMHSA will continue educating and supporting medical staff across federal,
state, tribal, and other systems on best practices for working with people with behavioral
conditions in the criminal justice system. SAMHSA intends to conduct a series of activities,
including listening sessions, policy academies, and training events, to advance service
implementation.
Recognizing that the overdose risk for people with a SUD leaving incarceration is far
higher than that of the general population, SAMHSA will work with partners including the
Drug Enforcement Agency, the Federal Bureau of Prisons, and other stakeholders to
ensure increased access to medications for opioid use disorder and other services for
individuals being released from prisons or jails.

48

Priority 5

Strengthening the Behavioral Health
Workforce
The nation’s mental health and substance use workforce is critical to providing individuals
with access to essential healthcare services. Prior to the COVID-19 pandemic, there was a
projected shortage of behavioral healthcare providers, with acute shortages predicted for
psychiatrists and substance use disorder (SUD) treatment counselors through 2030. 87 The
provider shortage is likely further exacerbated by the negative impact of COVID-19 and
burnout. 88 Simultaneously, higher demands in services are predicted due to an increased
prevalence of depression and anxiety disorders and substance use related to the COVID19 pandemic. 89,90 The Substance Abuse and Mental Health Services Administration
(SAMHSA) works closely with the Health Resources and Services Administration (HRSA)
through the Behavioral Health Workforce Research Center to define and more clearly
describe these needs.
Recognizing that a strong behavioral health workforce must meet people’s needs where
they are, the 21st Century Cures Act directed SAMHSA to work with states and other
stakeholders to develop and support recruitment and retention efforts specific to
addressing mental health conditions and SUDs across the lifespan. 91 To assist with
recruitment and retention efforts, SAMHSA engages with the field through numerous
pathways, such as provision of training and technical assistance, encouraging the
expansion of the use of paraprofessionals, and increasing the diversity and cultural
competency of the workforce. Peer providers and paraprofessionals have been shown to
play a crucial role in enhancing and extending care to communities. 92 This expansion of
workers from within the community served is important considering that lack of diversity in
the workforce is a systemic issue that contributes to poor health outcomes for racial,
ethnic, sexual, and gender minorities. 93 The use of telehealth and other technologies
among behavioral health providers is also a promising strategy that can help increase
access to mental illness and SUD treatment by addressing workforce shortages, which are
often more pervasive in certain geographic areas. 94
Goal 1. To meet the behavioral health needs of the nation, SAMHSA will support the
active recruitment, training, and retention of diverse, qualified individuals into the
behavioral health workforce.
Research shows positive impact on client outcomes when the clinicians providing care are
of similar racial, ethnic, sexual orientation, and gender identity backgrounds as those
receiving services.93 Further, behavioral health service accessibility, availability,
affordability, and acceptability are enhanced when the workforce is accessible to all
individuals, including those with disabilities, and is stable and established in a community.
Through grants, contracts, and technical assistance resources, SAMHSA will use bestand promising practices in recruitment and retention and will expand the reach of training

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2023 - 2026 | SAMHSA Strategic Plan

and skill development to ensure the workforce reflects those receiving care (including
racial, ethnic, sexual, and gender minority individuals; individuals with disabilities; and
other under-served communities) and is qualified to provide the services offered.

Strengthening the Behavioral Health Workforce
Goal 1 Example Programs
Minority Fellowship Program (MFP) fellowships are open to people pursuing master’s
or doctoral degrees in various fields of behavioral health. SAMHSA-sponsored, and
administered by 8 national behavioral health organizations, the MFP annually provides
approximately 200 master’s level and Ph.D. students with educational scholarships and
training. MFP fellows commit to working with under-served communities for a specified
period after they complete their education.
The Historically Black Colleges and Universities Center of Excellence (HBCU-CFE)
recruits students to careers in behavioral health fields that address mental and SUD,
provides training that can lead to careers in the behavioral health field, and prepares
students for obtaining advanced degrees in the behavioral healthcare field. HBCU-CFE
activities emphasize education, awareness, and preparation for careers in mental and
SUD treatment including addressing opioid use disorders, serious mental illness (SMI)
(including First Episode Psychosis), and suicide prevention.

Objective 1.1. Expand the number of Minority Fellowship Program fellows and
enhance the reach of the Historically Black Colleges and Universities Center of
Excellence.
SAMHSA operates the Minority Fellowship Program (MFP) and Historically Black Colleges
and Universities Center of Excellence (HBCU-CFE) in Behavioral Health program that aim
to increase the number of behavioral health practitioners serving minority populations.
While both the MFP and HBCU-CFE programs successfully expand the number of
behavioral health providers that serve racial and ethnic minority populations, they are not
meeting increased demand to provide culturally appropriate behavioral health care.
Working with grantees and stakeholders, SAMHSA will reassess the MFP and HBCU-CFE
to expand and enhance their impact. By expanding the reach of these two programs,
SAMHSA can support increasing the total number of behavioral health practitioners that
treat and serve people of different cultural and ethnic backgrounds.
Objective 1.2. Develop new pipeline programs by engaging high school, community
college, and four-year university students.
While the MFP, HBCU-CFE, and Prevention Fellowship programs have experienced
success in bolstering the behavioral health workforce, they are insufficient to meet the

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2023 - 2026 | SAMHSA Strategic Plan

increasing demand. SAMHSA launched the Prevention Fellow Program to (1) develop and
sustain a well-trained and knowledgeable cadre of prevention professionals who
understand and exemplify the principles and best practices of substance misuse
prevention, and (2) prepare fellows to achieve certification. Nationally, there is a need to
attract quality candidates into the behavioral health prevention, intervention, treatment, and
recovery support fields. Programs that build awareness and educate people about these
career fields establish a “pipeline” of new talent that eventually adds to the national
behavioral health workforce.
To build a sustainable workforce, it is necessary to attract candidates by educating them
about the behavioral health field as early as possible. Targeted outreach efforts are
needed to support those exploring entry-level careers and those who are completing their
degrees and deciding with which populations they want to specialize. This is long-term
work that will grow the pool of viable candidates for behavioral healthcare positions around
the country.
Objective 1.3. Expand the availability of paraprofessionals and peer support
providers.
Peer support providers offer encouragement, practical assistance, guidance, and
understanding to support recovery. Peer support providers walk alongside people in
recovery, offering individualized supports and demonstrating that recovery is possible.
They share their own experience including strategies for self-empowerment and achieving
a self-determined life that can complement or, in some cases, replace clinical supports.
They support people in recovery in connecting with their own inner strength, motivation,
and desire to move forward in life, even when experiencing challenges. Peer support
providers and recovery coaches are critical in engaging people into recovery; navigating
complex service systems; providing support and hope; and modeling that people can
manage or overcome their conditions and live full, healthy lives. Leveraging
paraprofessionals and peer support providers can help licensed clinicians to serve a
greater number of people. SAMHSA supports the Peer Recovery Center of Excellence to
further the peer workforce and released the National Model Standards for Peer Support
Certification to expand and improve the quality of the nation’s growing peer workforce.
Recognizing their value, SAMHSA will work with stakeholders to educate them on what
peer support providers and paraprofessionals are doing across the nation to help address
the acute need for behavioral health care. This includes developing a model national peer
specialist standard, conducting training and technical assistance to further the peer
workforce, and working with federal, state, territorial, tribal, and community partners on
issues such as financing, recruitment, and continuing education.
Objective 1.4. Increase the supply and capacity of the behavioral health workforce to
provide new, innovative, and evidence-based treatment in community-based
primary care settings.

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2023 - 2026 | SAMHSA Strategic Plan

SAMHSA recognizes that the overall supply of the behavioral health workforce does not
meet the current demand for behavioral health services.87 In addition to increasing the
overall supply of behavioral health practitioners, there are other ways, such as greater
utilization of telehealth, to expand capacity.94 More behavioral health care can be provided
in primary care settings. However, these settings often do not have behavioral health
providers embedded in the practice, requiring additional steps to access behavioral health
care. Overburdened primary care providers may not have the resources to stay abreast of
new, innovative, and evidence-based behavioral health treatments. 95 Recent additional
funding has been provided through both SAMHSA and HRSA for primary health providers
to offer behavioral health care, but primary health providers will need supports to
understand what new, innovative, and evidence-based interventions are most effective and
how to access them.
SAMHSA will increase resources for education and training programs that enhance
providers’ use of recovery-oriented, evidence-based strategies and tailor prevention and
clinical interventions to be responsive to communities’ linguistic and cultural needs.
SAMHSA will maintain and expand its Evidence-Based Practices Resource Center with
easily searchable references to make information and tools that incorporate evidencebased practices available to practitioners for use in communities or clinical settings. The
agency supports states, territories, tribes, and communities to ensure that credentialed
prevention staff can deliver services with a comprehensive understanding of prevention
and the latest evidence-based practices addressing substance use prevention. The design
of the Targeted Capacity Expansion grant will highlight innovations to provide pathways to
and knowledge about certification or licensing for prevention specialists.
Goal 2. To improve the quality of behavioral health care, SAMHSA will promote and
support professional development initiatives to improve the competencies of
service providers.
A wide variety of professionals and paraprofessionals deliver mental health and SUD
prevention, treatment, and recovery services in greatly varied settings. Regardless of the
setting, behavioral health care should be delivered using evidence-based and culturally
appropriate practices. Working with professional organizations, licensing and credentialing
boards, and SAMHSA’s Technical Assistance Centers (TACs) and Centers of Excellence,
SAMHSA will work to improve behavioral health provider competencies. SAMHSA has
seen improvement through our funded programs like the Providers Clinical Support
System, which provides both training and clinical mentoring to providers treating SUDs.

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Strengthening the Behavioral Health Workforce
Goal 2 Example Programs
The Technology Transfer Centers (TTC) Program develops and strengthens the
specialized behavioral healthcare and primary healthcare workforce that provides
prevention, treatment, and recovery support services for SUD and mental illness. The
TTC program comprises three networks: the Addiction Technology Transfer Centers,
the Mental Health Technology Transfer Centers, and the Prevention Technology
Transfer Centers. Each network comprises a National Coordinator Center and 10
Regional Centers.
The Clinical Support System for Serious Mental Illness initiative, called Serious
Mental Illness (SMI) SMI Adviser, supports the use and implementation of evidencebased screening and treatment for SMI through education and consultation. The
technical assistance provider engages and leads more than 30 national mental health
organizations that help guide this interprofessional project. SMI Advisor supports realworld clinical practice with education, data, and consultations.

Objective 2.1. Increase the use of equity-oriented and trauma-informed approaches
in SAMHSA’s training and technical assistance efforts for providers of behavioral
health services.
SAMHSA’s overall approach to training and technical assistance must be responsive to the
communities in which the providers deliver service. With the great diversity in communities
and disparities in access for under-served communities, all SAMHSA-funded training and
technical assistance must include considerations for equitably increasing access and
incorporating trauma-informed approaches, relevant to each setting. Services must be
trauma-informed to respond to individual, family, community, and historical trauma that
impacts populations. This includes working to prevent trauma, including adverse childhood
experiences, and to prevent re-traumatizing those seeking care.
Objective 2.2. Improve training and supports for providers who work with young
people with or at risk for behavioral health conditions.
Behavioral health providers for children, youth, and young adults are historically difficult to
attract and retain in the health workforce.94 It is critical that providers are trained to
respond to the diverse needs of all youth, spanning developmental ages, demographics,
intellectual and developmental abilities, and socio-economic situations.
SAMHSA currently supports the National Training and Technical Assistance Center for
Child, Youth, and Family Mental Health (NTTAC). NTTAC provides an array of trainings,
technical assistance, and resources to providers, organizations, and agencies from across
the system of care. SAMHSA will review how to improve and expand these trainings and
supports to get providers needed assistance. In addition, the development of the
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SAMHSA-wide TAC will enhance the services and skill levels of providers who work with
young people.
Similarly, many of SAMHSA’s Centers offer supports for practitioners aiding targeted
communities, but they do not necessarily have offerings for children, youth, and young
adults in these communities. SAMHSA will review how to create greater synergies and
resources across its Centers to support providers who work with young people.
Objective 2.3. Increase awareness and utilization of practitioners’ education and
training opportunities.
Through its partners, SAMHSA offers a variety of education and training opportunities, but
it is unclear whether practitioners sufficiently leverage these resources or even know about
them. To ensure opportunities for practitioner self-development, SAMHSA will review the
programming and delivery methods to ensure they accommodate providers’ busy
schedules, address identified shortcomings, and mitigate barriers. SAMHSA will launch a
communications campaign to ensure practitioner awareness of available resources.
Objective 2.4. Promote evidence-based professional development to improve
behavioral health providers’ competencies in line with the National Behavioral
Health Quality Framework.
The National Framework for Quality Improvement in Behavioral Health Care is an initiative
established by SAMHSA after the passage of the Affordable Care Act to promote the
quality of health among Americans and reduce costs of care. Major components of the
framework include the patient, population, payor, system, plan, provider, and practitioner.
Achieving safe, high-quality, affordable behavioral health care for all Americans will be the
product of millions of local actions in local communities—actions taken by doctors and
nurses, patients and family members, and systems put in place by health and behavioral
care organizations, providers, payors, and care managers to ensure high-quality, effective,
and reliable care.
To enhance the utility of the framework, progress in achieving goals and priorities can be
assessed in three separate but related domains: (1) among SAMHSA-funded programs
and activities; (2) among behavioral health systems (e.g., states and counties) and
providers (e.g., networks, managed care vendors); and (3) among the general population
or subpopulations reflecting specific demographic and/or clinical characteristics.
Goal 3. To increase the accessibility of behavioral health providers in all
communities, SAMHSA will reduce barriers to the continuum of high-quality
services.
From the COVID-19 pandemic, we learned that accessing behavioral health providers in a
virtual space expands service availability to people without access. 96 Even with virtual
service options, people still face barriers to receiving specialized behavioral health
treatment, and some policy barriers have the potential to reduce the effectiveness.96

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SAMHSA seeks to reduce barriers to high-quality services, regardless of how those
services are delivered, and seeks to decrease disparities in access to care.
The use of telehealth among behavioral health providers is just one promising strategy that
can help increase access to mental health services and SUD treatment by addressing
workforce shortages, which are often more pervasive in certain geographic areas. In
addition to providing services directly to the individual, the use of telehealth can increase
the quality of treatment services. The Extension for Community Healthcare Outcomes
project model utilizes videoconferencing to train primary care clinicians to treat chronic
illnesses and conditions, such as treatment for individuals with opioid use disorder or
children with mild to moderate mental disorders.

Strengthening the Behavioral Health Workforce
Goal 3 Example Programs
The African American Behavioral Health Center of Excellence is designed to help
the field transform behavioral health services for African Americans, making them safer,
more effective, more accessible, more inclusive, welcoming and engaging, and more
culturally appropriate and responsive. This is achieved through collaboration, training,
technical assistance, and a variety of written and recorded resources.
The Telehealth for the Treatment of Serious Mental Illness and Substance Use
Disorders guide reviews ways that telehealth modalities can be used to provide
treatment for serious mental illness and SUDs among adults, distills the research into
recommendations for practice, and provides examples of how these recommendations
can be implemented.

Objective 3.1. Increase investments to reduce disparities in access to specialized
behavioral health care.
A variety of causes—cost, stigma, lack of transportation, personal mobility, hours of
operation, and lack of access to information technology equipment (phone, computer,
internet, etc.), among others—can limit access to specialized behavioral health services. 97
The underlying causes of disparities in access can be tied to a lack of infrastructure, lack
of personal supports, and other reasons.
Some federal programs already exist to reduce barriers, such as the Federal
Communications Commission’s (FCC) Rural Digital Opportunity Fund, and other FCC and
U.S. Department of Health and Human Services programs to expand telehealth.
Partnering with these and other stakeholders to expand access to behavioral health care
has the potential to reach historically under-served communities. Additional programs to
provide targeted populations with access to computer equipment serve as a model for
SAMHSA to explore.

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To address these causes and reduce barriers to specialized behavioral health care,
SAMHSA will expand the availability and use of grant funds to invest in approvable
strategies to mitigate these causes. The agency will also increase partnerships with other
federal, state, territorial, tribal, and community philanthropic programs to decrease
disparities in access.
Objective 3.2. Increase funding opportunity announcements that allow resources to
be used to expand virtual care.
SAMHSA will clarify and expand, where possible, the approvable use of SAMHSA grant
and contract dollars to support virtual care, including support for infrastructure (equipment),
provider reimbursement, supervision, and evaluation of quality impact.
Objective 3.3. Decrease restrictions on credentialed practitioners working across
state lines, particularly for under-served populations.
Individuals have long been able to cross state lines to receive care, but providers have
been restricted to practice in the state in which they maintain active licenses.96 With the
advancement of telehealth and other technologies, we learned that telehealth is effective in
the delivery of behavioral health treatments and that telehealth can result in greater and
more timely access to professional care.96 Each state’s licensure requirements are under
the jurisdiction of state government.91 However, the federal government can facilitate
greater reciprocity of acceptance of licensed practitioners across states so that there is
greater access to providers. One such mechanism is HRSA’s work on interstate medical
licensure compacts, which create agreements across state lines to accept professionals
who are licensed in other states.
SAMHSA will work with federal and state authorities involved with behavioral health, trade
associations representing behavioral health providers, as well as credentialing, certifying,
and licensing bodies to establish common scope of practice guidelines for behavioral
health professionals and paraprofessionals. This work aims to decrease barriers to moving
between states to practice and providing services across state lines as well as support
multidisciplinary, interprofessional collaborative care models. Such common scopes of
practice can form the basis for cross-state compacts for credentialled professionals and
certified paraprofessionals.

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Conclusion

The behavioral health needs of the nation are unquestioningly complex. To address them
as comprehensively as possible, it is critical to recognize that approaches must be personcentered and account for the great diversity of individuals, families, and communities.
There is much work to do to build health systems and approaches that provide high-quality
care and services to those who need them the most. As such, whole-person approaches
are key because they put people at the center, regardless of setting, and integrate their
goals and priorities into individualized plans that are culturally appropriate. As the new
Substance Abuse and Mental Health Services Administration (SAMHSA) mission and
vision clearly convey, the goal is for everyone to have opportunities to thrive and achieve
better health outcomes.
The work before us will be challenging, but ultimately with this Strategic Plan, along with
the many efforts of our federal partners and vast networks of stakeholders across a
diverse range of disciplines, expertise, and lived experience, success is possible. As we
continue in this work and build out new policies, programs, and strategies, it is also
essential to acknowledge that the individuals who comprise SAMHSA’s workforce are
critical to achieving our goals and objectives. As an agency, we are aware that addressing
some of our nation’s toughest challenges requires a dedicated, diverse, and highly skilled
staff, as well as talented and engaged leadership that fosters innovation, collaboration, and
culturally appropriate, data-driven solutions.
SAMHSA’s mission and vision recognize the role that our policies, programs, and grants
play in providing opportunities to promote good mental health and support substance use
disorder prevention, treatment, and recovery at all points along the continuum of care and
lifespan. In a rapidly changing physical and social landscape, it is more important than
ever that evidence-based practices and data-driven decision making inform our work to the
greatest degrees possible. As we consider our great responsibility to improve the
behavioral health of the nation, we must also keep at the forefront the essential tasks of
building a robust and diverse workforce and supporting policies and programs that are
equitable, accessible, adaptable, and sustainable.

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Acronyms
Term

Definition

ACEs

Adverse Childhood Experiences

AI/AN

American Indian/Alaska Native

CCBHC

Certified Community Behavioral Health Clinic

CDC

Centers for Disease Control and Prevention

CIHS

National Center of Excellence for Integrated Health Solutions

CMHI

Children’s Mental Health Initiative

CPSTF

Community Preventive Services Task Force

CSMHS

Comprehensive School Mental Health Systems

DEA

Drug Enforcement Administration

FCC

Federal Communications Commission

FDA

Food and Drug Administration

FEP

First Episode Psychosis

GLS

Garrett Lee Smith Suicide Prevention Program

HBCU-CFE

Historically Black Colleges and Universities Center of Excellence

HHS

U.S. Department of Health and Human Services

HRSA

Health Resources and Services Administration

ISUDCC

Interdepartmental Substance Use Disorders Coordinating
Committee

LGB

Lesbian, Gay, and Bisexual

LGBTQI+

Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex

MBC

Measurement-Based Care

MFP

Minority Fellowship Program

MHAT

Mental Health Awareness Training

MHBG

Mental Health Services Block Grant

MOUD

Medication for Opioid Use Disorder

MTSS

Multi-Tiered System of Supports

NSDUH

National Survey on Drug Use and Health

NTTAC

National Training and Technical Assistance Center for Children,
Youth, and Family Mental Health

OPS

Overdose Prevention Strategy

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Term

Definition

OUD

Opioid Use Disorder

PROJECT
AWARE

Advancing Wellness and Resiliency in Education

PROJECT
LAUNCH

Linking Actions for Unmet Needs in Children’s Health

PTTC

Prevention Technology Transfer Center

SAMHSA

Substance Abuse and Mental Health Services Administration

SDOH

Social Determinants of Health

SED

Serious Emotional Disturbance

SMI

Serious Mental Illness

SPF

Strategic Prevention Framework

SPRC

Suicide Prevention Resource Center

STOP Act

Sober Truth on Preventing Underage Drinking Act

SUD

Substance Use Disorder

SUPTRS

Substance Use Prevention, Treatment, and Recovery Services

TAC

Technical Assistance Center

TBHA

National Tribal Behavioral Health Agenda

TTC

Technology Transfer Centers

VA

Veterans Administration

X-Waiver

DATA 2000 Waiver

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Glossary
Term

Definition

Adverse childhood
experiences

Preventable, potentially traumatic events that occur
in childhood (0–17 years) such as neglect, experiencing or witnessing
violence, and having a family member attempt or die by suicide. Also
included are aspects of a child’s environment that can undermine their
sense of safety, stability, and bonding, such as growing up in a
household with substance use; mental health problems; or instability
due to parental separation or incarceration of a parent, sibling, or other
member of the household.

Appropriate

See “Fit.”

Behavioral health

The promotion of mental health, resilience, and well-being; the
treatment of mental health and substance use disorders; and the
support of those who experience and/or are in recovery from these
conditions, along with their families and communities.

Behavioral
healthcare setting

Treatment settings include those for specific substance use and mental
health conditions, substance use disorder treatment centers, and
healthcare centers.

Behavioral health
condition

See “Mental health conditions” and “Substance use disorder.”

Behavioral health
continuum

An integrated system of care with varying levels of service intensity and
settings in response to an individual’s behavioral health needs.

Behavioral health
crises

May follow trajectories that include intense feelings of personal distress
(e.g., anxiety, depression, anger, panic, hopelessness), obvious
changes in functioning (e.g., neglect of personal hygiene, unusual
behavior), or catastrophic life events (e.g., disruptions in personal
relationships, support systems, or living arrangements; loss of
autonomy or parental rights; victimization or natural disasters).

Behavioral health
equity

The right to access high-quality and affordable healthcare services and
supports for all populations, including Black, Latino, and Indigenous
and Native American persons; Asian Americans and Pacific Islanders
and other persons of color; members of religious minorities; Lesbian,
Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+) persons;
persons with disabilities; persons who live in rural areas; and persons
otherwise adversely affected by persistent poverty or inequality.

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Term

Definition

Behavioral health
provider

A professional who helps individuals to address mental health and
substance use disorders. Professionals include psychologists,
psychiatrists, nurses, peers, patient navigators, therapists, substance
use disorder treatment and mental health counselors, recovery
coaches, case workers, social workers, psychiatric aides and
technicians, psychiatrists, and paraprofessionals working in psychiatric
rehabilitation and substance use recovery fields, as well as other
medical and non-medical professionals who manage and support
behavioral health issues.

Burnout

An occupational condition resulting from chronic workplace stress that
has not been successfully managed and is typically characterized by
three dimensions: sustained feelings of exhaustion, depersonalization,
and professional inefficacy.

Crisis care

A range of services for individuals experiencing an acute mental and/or
substance use disorder crisis.

Culturally and
linguistically
appropriate

Services that are respectful of and responsive to the health beliefs,
practices, and needs of diverse consumers.

Data and Evidence

A guiding principle. The Substance Abuse and Mental Health Services
Administration (SAMHSA)’s commitment to data and evidence includes
ensuring timely, high-quality, ongoing, and specific data, which helps
public health officials, policymakers, community practitioners, and the
public to understand mental health and substance use trends and how
they are evolving; informs the development and implementation of
targeted evidence-based and evidence-informed interventions; focuses
resources where they are needed most; and evaluates the success of
response efforts.

Equity

A guiding principle. Behavioral health equity is the right to access highquality and affordable healthcare services and supports for all
populations, including Black, Latino, and Indigenous and Native
American persons; Asian Americans and Pacific Islanders and other
persons of color; members of religious minorities; veterans and military
service members; older adults; LGBTQI+ persons; persons with
disabilities; persons who live in rural areas; and persons otherwise
adversely affected by persistent poverty or inequality.

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Term

Definition

Evidence-based and
evidence-informed
practice(s)

Interventions that are guided by the best research evidence with
practice-based expertise, cultural competence, and the values of the
persons receiving the services, which promote individual-level or
population-level outcomes.

Family

Families can be organized in a wide variety of configurations regardless
of social or economic status. Families can include biological parents
and their partners, adoptive parents and their partners, foster parents
and their partners, grandparents and their partners, siblings and their
partners, caregivers, friends, and others as defined by the family.

Fit

How well a program matches, or is appropriate for, the community,
organization, stakeholders, and potential participants.

Health disparities

A particular type of health difference that is closely linked with social,
economic, and/or environmental disadvantage.

Health inequities

Differences in health status or in the distribution of health resources
among different population groups, arising from the social conditions in
which people are born, grow, live, work, and age.

Implementation
science

The scientific study of the methods to promote the systematic uptake of
clinical research findings and other evidence-based practices into
routine practice and hence improve the quality and effectiveness of
health care.

Integrated care

The care that results from a practice team of primary care and
behavioral health clinicians, working together with patients and families,
using a systematic and cost-effective approach to provide patientcentered care for a defined population. This care may address mental
health and substance use conditions, health behaviors (including their
contribution to chronic medical illnesses), life stressors and crises,
stress-related physical symptoms, and ineffective patterns of
healthcare utilization.

Lived experience

Personal knowledge gained through direct, first-hand involvement.

Mental health

The state of well-being in which every individual realizes their own
potential, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to her or
his community.

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Term

Definition

Mental health
conditions

Involve changes in thinking, mood, and/or behavior. These disorders
can make daily activities difficult and impair a person’s ability to work,
interact with family, and fulfill other major life functions. Reaching a
level that can be formally diagnosed often depends on a reduction in a
person’s ability to function as a result of the disorder.

Mental illnesses

Conditions involving changes in emotion, thinking, or behavior (or a
combination of these). Mental illnesses are associated with distress
and/or problems functioning in social, work, or family activities.

Natural supports

Personal associations and relationships typically developed in the
community that enhance the quality and security of life for people,
including, but not limited to, family relationships; friendships reflecting
the diversity of the neighborhood and the community; association with
fellow students or employees in regular classrooms and workplaces;
and associations developed though participation in clubs,
organizations, and other civic activities.

Paraprofessional

Individuals in psychiatric rehabilitation and substance use recovery
fields including case managers, homeless outreach specialists, or
parent aides.

Peer Support

Someone with the lived experience of recovery from a mental health
condition, substance use disorder, or both. They provide support to
others experiencing similar challenges. They provide non-clinical,
strengths-based support and are “experientially credentialed” by their
own recovery journey.

Physical healthcare
setting

A broad array of services and places where health care occurs,
including acute care hospitals, urgent care centers, rehabilitation
centers, nursing homes and other long-term care facilities, specialized
outpatient services (e.g., hemodialysis, dentistry, podiatry,
chemotherapy, endoscopy, and pain management clinics), and
outpatient surgery centers.

Practitioner or
Provider

Refers to individuals providing services. Any individual (practitioner) or
entity (provider) engaged in the delivery of healthcare services and who
is legally authorized to do so by the state in which the individual or
entity delivers the services.

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Term

Definition

Public health
approach

A focus on the health, safety, and well-being of entire populations. A
unique aspect of the field is that it strives to provide the maximum
benefit for the largest number of people. It is defined by multiple steps,
including (1) define the problem, (2) identify risk and protective factors,
(3) develop and test prevention strategies, and (4) ensure widespread
adoption.

Recovery

A guiding principle. A process of change through which individuals
improve their health and wellness, live self-directed lives, and strive to
reach their full potential. Four major dimensions of recovery include (1)
health: overcoming or managing one’s disease(s) or symptoms, and
making informed, healthy choices that support physical and emotional
well-being; (2) home: having a stable and safe place to live; (3)
purpose: conducting meaningful daily activities, such as a job, school,
volunteerism, family caretaking, or creative endeavors, and the
independence, income, and resources to participate in society; and (4)
community: having relationships and social networks that provide
support, friendship, love, and hope.

Resilience

An individual’s ability to cope with change and adversity. Resilience
develops over time and gives an individual the capacity not only to
cope with life’s challenges but also to be better prepared for the next
stressful situation.

Service provider

See “Practitioner or Provider.”

Social determinants
of health

Social determinants of health (SDOH) are the conditions in the
environments where people are born, live, learn, work, play, worship,
and age that affect a wide range of health, functioning, and quality-oflife outcomes and risks.

Stakeholders

Individuals, organizations, or communities that have a direct interest in
the process and outcomes of a project, research, or policy endeavor.

Stigma

Discrimination against an identifiable group of people, a place, or a
nation. Stigma about people with substance use disorder might include
inaccurate or unfounded thoughts like they are dangerous, incapable of
managing treatment, or at fault for their condition.

Substance misuse

Use of illegal drugs and the inappropriate use of legal substances, such
as alcohol and tobacco.

Substance use

Encompasses all forms and frequencies of using harmful substances.

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Term

Definition

Substance use
disorder

A health condition characterized by a cluster of cognitive, behavioral,
and physiological symptoms that describe an individual’s compulsive
use of a substance despite significant adverse problems associated
with the use.

Suicidal ideation

Refers to thinking about or planning suicide. The thoughts lie on a
continuum of severity from a wish to die with no method, plan, intent, or
behavior, to active suicidal ideation with a specific plan and intent.

Systems of care

A comprehensive spectrum of effective services and supports for
children, youth, and young adults with or at risk for mental health or
other challenges and their families that is organized into a coordinated
network of care, builds meaningful partnerships with families and youth,
and is culturally and linguistically responsive in order to help them to
thrive at home, in school, in the community, and throughout life. A
system of care incorporates mental health promotion, prevention, early
identification, and early intervention in addition to treatment to address
the needs of all children, youth, and young adults.

Trauma-informed
approaches

A guiding principle. Trauma-informed approaches recognize and
intentionally respond to the lasting adverse effects of experiencing
traumatic events, defined through six key principles: (1) safety:
participants and staff feel physically and psychologically safe; (2) peer
support: peer support and mutual self-help as vehicles for establishing
safety and hope, building trust, enhancing collaboration, and utilizing
their lived experience; (3) trustworthiness and transparency: decisions
are conducted with the goal of building and maintaining trust; (4)
collaboration and mutuality: importance is placed on partnering and
leveling power differences; (5) cultural, historical, and gender issues:
culture- and gender-responsive services are offered while moving
beyond stereotypes/biases; and (6) empowerment, voice, and choice:
organizations foster a belief in the primacy of the people who are
served to heal and promote recovery from trauma.

Under-served
communities

Population groups that experience greater obstacles to health, based
on characteristics such as, but not limited to, race, ethnicity, religion,
income, geography, gender identity, sexual orientation, and disability.

Upstream
prevention

Like wellness promotion, this is also delivered prior to the onset of a
disorder. These prevention interventions are intended to prevent or
reduce the risks of developing a behavioral health problem, such as
underage alcohol use and prescription drug and illicit drug misuse.

Whole-person care

See “Whole-person health.”

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Term

Definition

Whole-person
health

A person-centered, integrated approach to health care that focuses on
health creation and well-being by incorporating patients’ goals into their
health care.

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26 Volkow N. Investing in prevention makes good financial sense, April 2022. Accessed June 21, 2023.
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28 Substance Abuse and Mental Health Services Administration. Risk and protective factors. Substance
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31 Carroll JJ, Green TC, Noonan RK. Evidence-based strategies for preventing opioid overdose: what’s
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36 Substance Abuse and Mental Health Services Administration. Certified Community Behavioral Health
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37 Substance Abuse and Mental Health Services Administration. Treating concurrent substance use among
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41 National Institute of Mental Health. Suicide. National Institute of Mental Health. Accessed August 15, 2022.
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44 Substance Abuse and Mental Health Services Administration. HHS Secretary: 988 transition moves us
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49 Stanley B, Brown GK, Currier GW, Lyons C, Chesin M, Knox KL. Brief intervention and follow-up for
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50 Stanley B, Brown GK, Brenner LA, et al. Comparison of the safety planning intervention with follow-up vs
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52 Substance Abuse and Mental Health Services Administration. Helping children and youth who have
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55 Substance Abuse and Mental Health Services Administration. 2020 NSDUH detailed tables. Substance
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58 Kidman R, Margolis R, Smith-Greenaway E, et al. Estimates and projections of COVID-19 and parental
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61 American Academy of Child and Adolescent Psychiatry Committee on Health Care Access and Economics
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63 Substance Abuse and Mental Health Services Administration. Justification of estimates for the
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64 McDaid D, Park A-La, Wahlbeck K. The economic case for the prevention of mental illness. Annual
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67 Hoover S, Lever N, Sachdev, N, et al. Advancing comprehensive school mental health: Guidance from the
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Martini R, Hilt R, Marx L, et al. Best principles for integration of child psychiatry into the pediatric health
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U.S. Department of Health and Human Services, Health Resources and Services Administration, National
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71 Panchal N, Kamal R, Cox C, et al. The implications of COVID-19 for mental health and substance use.
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Center for Health Care Strategies, Inc. Family and youth peer support literature review. Center for Health
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75 Walker J, Baird C, Welch MB. Peer support for youth and young adults who experience mental health
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76 Gargan L, Donnelly T, Baker D. (2018, March 21). The benefits of family peer support services: let’s
examine the evidence [PowerPoint slides]. Substance Abuse and Mental Health Services Administration.
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78 Substance Abuse and Mental Health Services Administration. 988 Lifeline performance metrics.
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Romer D, Moreno M. Digital media and risks for adolescent substance abuse and problematic gambling.
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81 Bruce ML, Sirey JA. Integrated care for depression in older primary care patients. Canadian Journal of
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84 National Council for Mental Wellbeing. The Comprehensive Healthcare Integration (CHI) Framework.
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86 National Center for Complementary and Integrative Health. Whole person health: what you need to know.
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88 Substance Abuse and Mental Health Services Administration. Addressing burnout in the behavioral health
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89 COVID-19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety
disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet.
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114th Congress of the United States of America. 21st Century Cures Act. Pub. L. No. 114-255. December
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92 Substance Abuse and Mental Health Services Administration. Peer support. Substance Abuse and Mental
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Hoge MA, Morris JA, Daniels AS, et al. Action plan on the behavioral health workforce development. The
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95 Horstman CE, Federman S, Williams II RD. Integrating primary care and behavioral health to address the
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Substance Abuse and Mental Health Services Administration. Telehealth for the treatment of serious
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97 United States Government Accountability Office. Mental Health Care: Access challenges for covered
consumer and relevant federal efforts. United States Government Accountability Office. March 2022.
Accessed March 15, 2023. https://www.gao.gov/assets/gao-22-104597.pdf

Publication No. PEP23-06-00-002
Released 2023

74

SAMHSA’s mission is to lead public health and service delivery efforts that promote mental
health, prevent substance misuse, and provide treatments and supports to foster recovery
while ensuring equitable access and better outcomes.

1-877-SAMHSA -7 (1-877-726-4727) . 1-800-487-4889 (TDD) . www.samhsa.gov