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SAMHSA Should Post Online Substance Use and Mental Health Block Grant Site Visit Reports
The Substance Abuse and Mental Health Services Administration (SAMHSA) Community Mental Health Services (MHBG) and Substance Use Prevention, Treatment, and Recovery Services (SUBG) block grants are awarded each fiscal year based on a complex formula. The block grants support critical screening, prevention, and treatment services for vulnerable populations.
Each state, US territories, freely associated states, and a tribal agency (for substance use) receive block grant funds. In fiscal year 2023, roughly $1 billion was provided to states and territories through the MHBG and $2 billion through the SUBG. Combined, the block grants comprise about 40% of SAMHSA’s total budget. The block grants support such activities as overdose and suicide prevention, efforts to enhance the behavioral health workforce, data collection and infrastructure, and integration of physical and behavioral healthcare.
The Public Health Service Act requires that each fiscal year, SAMHSA assess compliance in 10 states receiving block grant funds. SAMHSA does this in part through on-site or remote/hybrid monitoring site visits that include discussions with block grant agency staff, review of data and documentation, and development of recommendations for improvements and technical assistance. At this time, however, these reports are not posted on SAMHSA’s websites or shared publicly in an organized way within or across states.
As an HHS/SAMHSA employee who at one time planned and coordinated these site visits for the MHBG and because I wanted to share these reports with others, I filed a Freedom of Information Act (FOIA) request and obtained the reports for those site visits I helped to lead and coordinate. SAMHSA FOIA staff eventually shared these reports with me without redaction. (FOIA exemptions sometimes permit redacting/blocking out in whole or part such information as trade secrets or privileged communication within or between agencies, though it is unlikely in most circumstances that any content of mental health or substance use block grant site visit reports could be construed to fall within one of these exemptions). Because these reports are regarded by SAMHSA as internal information, other than each state/territory receiving their own site visit report, reports in my experience are rarely circulated.
Instead of requiring those interested to obtain reports through FOIA or indirectly through an agency receiving block grant funds, SAMHSA should consider putting these reports online so any member of the public can access and review. Posting both past and current/new block grant site visit reports online in a central location on the SAMHSA website would have several potential benefits for community and behavioral health organizations, patients and family members, Mental Health Planning Councils (required by the MHBG), block grant recipients, researchers, behavioral health providers, SAMHSA staff and leadership, and others. Moreover, while not every agency overseeing block grants shares monitoring reports, some agencies do, so this approach would be consistent with important federal partners. The Administration for Children and Families, for example, which administers the Community Services Block Grant, focusing on efforts to reduce poverty, posts its state assessments online.
There are several potential benefits from broadly sharing these reports. First, these site visit reports represent an evaluation of how recipients are using their block grants. Sharing this information broadly and consistently would enable patients and family members, community organizations, health providers, state/territory agency staff, and others to collaborate to improve behavioral health services in their area. Such information, for instance, could be helpful in identifying gaps and planning for use of additional funds such as from the opioid litigation settlements.
Second, posting the site visit reports online would enhance state, health professional and general public understanding of recommendations by SAMHSA or others for technical assistance and other potential improvements across block grant grantees. The information in the site visit reports is typically more qualitative rather than quantitative and represents a snapshot in time when the site visits are conducted. However, it would be possible over time for advocates, patients and family members, researchers and others examining these reports to identify ongoing support needs across states/territories.
Third, knowing these reports eventually will be shared also would support SAMHSA and state staff in preparing for and conducting site visits and implementing recommendations. Consistent with recommendations made in a 2009 independent evaluation of the SUBG grant (the most recent such review), sharing these reports publicly also could promote more engagement, collaboration among community partners and government agencies and pertinent feedback.
Fourth, posting these reports online would be consistent with Department of Justice guidance that agencies proactively share important information and documents with the public even absent a formal FOIA request.
It would not be difficult for SAMHSA to post these documents online once completed and doing so would be consistent with best practices in other HHS agencies as well as SAMHSA’s overall mission.
Mitchell Berger, MPH, has worked on public health and behavioral health programs at the federal and local levels.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. The opinions expressed above represent the author’s personal views and should not be imputed to any other individuals nor to any public or private entities. Perspectives entries are not medical advice.
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