How States Can Use SAMHSA Block Grants

Introduction

An estimated 637,000 adults in the U.S. are homeless in a given week, with 2.1 million people experiencing homelessness over the course of a year. Approximately 20-25 percent of people who are homeless have a serious mental illness, and about 50-70 percent have an alcohol or other drug use disorder.^[1] Research and community experience have shown that people who are homeless and have serious mental illnesses and/or substance use disorders have greater difficulty exiting homelessness and require a full range of treatment, housing and supports.

Targeted Federal programs for people who are homeless have provided the foundation of services to address homelessness in many States and local communities. For example, the Projects for Assistance in Transition from Homelessness (PATH) program, administered by SAMHSA’s Center for Mental Health Services (CMHS), awards funds to States to support community-based services to people who are homeless, or at risk of homelessness, and who have serious mental illnesses and/or co-occurring substance use disorders. PATH funds are used by local providers to deliver a range of services including outreach, screening and assessment, case management, mental health and substance abuse treatment, and other supportive services. Homeless assistance programs administered by the U.S. Department of Housing and Urban Development (HUD) have been the primary source of funding for the development, operations, and supportive services costs for emergency, transitional and permanent housing for people who are homeless, including those who have mental illnesses and substance use disorders.

While these and other targeted homeless assistance programs represent a valuable resource for housing and services, they lack capacity to effectively address and end the underlying issues that may give rise to homelessness. Therefore, increased emphasis is being placed on improving access to mainstream services and resources for people who are homeless. While many people who are homeless qualify for mainstream programs and services, they often are unable to access them. Even when the services can be accessed, they frequently are uncoordinated and do not take into account the specialized needs of people who are homeless. These needs include not only housing, but also support services, integrated treatment for co-occurring disorders, and flexible services delivered in community settings.

Given the pronounced need for mental health and substance abuse treatment among people who are homeless, State mental health and substance abuse treatment systems represent a critical resource for this population. Federal block grant funds make up about half of State substance abuse agency budgets and less than five percent of State mental health budgets.

Budget constraints and little to no new resources to expand services or address system gaps have led many States to establish homelessness as a priority and to better target resources to that purpose. Recent efforts at the Federal level to address homelessness have prompted State and local health, mental health, substance abuse, homeless, and housing agencies to work collaboratively to integrate services, improve planning and coordination between treatment and housing providers, and increase access to needed housing, treatment and supports for people who are homeless and have multiple needs. Thus, without explicitly setting specific requirements for block grant spending on the homeless, the States highlighted in this report have created integrated planning mechanisms that insure more effective homeless services in their States. These planning mechanisms are highlighted in this report.

This effort comes at a time of increased national attention to the needs of our most vulnerable citizens. SAMHSA has received increased funding to help end homelessness among people with mental illnesses and substance use disorders, and recently submitted a report to Congress on the prevention and treatment of co-occurring disorders. SAMHSA also is participating in an interagency effort among the Departments of Health and Human Services (HHS) (SAMHSA’s parent agency), Housing and Urban Development (HUD), and Veterans Affairs (VA). These Departments have joined in an historic collaboration to provide $35 million for the development of appropriate housing and supportive services for people who are chronically homeless, and together are sponsoring a series of policy academies for State and local policymakers to improve access to mainstream resources for this population.

Finally, the Administration has expressed its commitment to reduce drug use, build treatment capacity, and increase access to services that promote recovery from substance abuse. It has pledged $1.6 billion over the next five years to do so.

Using this Report

This report presents specific examples of strategies used by State mental health and substance abuse treatment systems to support the provision of services to people who are homeless, and shows how Federal Mental Health and Substance Abuse Block Grant Funds support the funding of these services.

States selected for the case studies presented in this report use a portion of their Mental Health and Substance Abuse Block Grant Funds to support services to people who are homeless. The State strategies profiled here reflect a range of effective and/or innovative approaches that bridge the gap between needed mental health and substance abuse treatment, housing, and other support services - all of which are needed to break the cycle of homelessness.

This report is intended for mental health and substance abuse program administrators at the State and local levels, service providers, and members of the advocacy community concerned with the provision of services to people who are homeless and have mental illnesses or substance use disorders. The examples may be adapted by other States and localities.

The first section summarizes key strategies used by States. The report describes responses to addressing service system inadequacies, including collaborative efforts and the targeting or combining of different funding sources to address unmet needs. The second section presents case study examples of the specific strategies and funding sources used by selected States to address service system gaps and increase access to needed mental health and substance abuse treatment, housing and supports.

An appendix containing contacts for more information on the case studies is included at the end of this report.

^[1] Burt, M.R., Aron, L.Y., Douglas, T., Valente, J., Lee, F., and Irven, B. (1999). Homelessness: Programs and the People They Serve. Washington, D.C. Interagency Council on the Homeless.

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