Title IX: Increasing Access to Care and Strengthening the Mental Health Workforce

This is the third article in a series on the 21st Century Cures Act (the “Cures Act”), which was signed into law on December 13, 2016. We will continue publishing a series of articles summarizing various components under the Cures Act. The articles in our series are located here.

This article highlights the wide range of programs and federal grants made available through Title IX of the Cures Act that offer important opportunities to states, health care facilities, educational institutions and other community organizations to strengthen the mental and behavioral health workforce and to support efforts that connect individuals with mental health and substance use disorders to treatment through multiple access points to care.

In addition to creating new programs and grant opportunities, the Cures Act also reauthorizes several existing programs that are currently administered by the Substance Abuse and Mental Health Services Administration (“SAMHSA”) and the Health Resources and Services Administration (“HRSA”). It is important to note that while the Cures Act authorizes or reauthorizes funding for each of the programs highlighted below, the actual funding must be appropriated by Congress for each fiscal year for which it is authorized.

States, mental health systems, health care facilities and other eligible entities, as identified under each grant description below, are encouraged to review each of the new and reauthorized grants to identify potential funding sources.

Increasing Access to Care

Due to a shortage of mental health providers and an increased population with health insurance, access to mental health care professionals can be delayed to a point of crisis for individuals suffering from mental health or substance use disorders.[1] The following programs, which were newly authorized under Title IX, Subtitle A of the Cures Act, are focused on providing individuals and families with broader and more direct access to mental health and substance use disorder assistance resources on both a community and national level.

Community Crisis Response Systems & Bed Database Plans. With the aim of addressing the dramatic rise in emergency department visits by patients with mental health and/or substance abuse conditions, the Cures Act authorizes $12,500,000 for the Department of Health and Human Services (“HHS”) to award grants to states for the development, maintenance or enhancement of internet-based Bed Database Plans that aggregate and display information in real time about available beds at inpatient psychiatric facilities, crisis stabilization units and residential community mental health or substance use disorder treatment facilities to facilitate their identification and designation for the treatment of individuals in mental or substance use disorder crises. The grants may also be awarded to states, local governments, Indian tribes or tribal organizations to develop or enhance community-based Crisis Response Plans that promote integration and coordination between public and private entities engaged in crisis response, such as first responders, law enforcement and health care providers and payers. (42 U.S.C. 290bb-37)

Assertive Community Treatment Grant Programs. States (or political subdivisions thereof), Indian tribes, tribal organizations, mental health systems, health care facilities and other entities deemed appropriate are eligible to apply for SAMHSA grants to support assertive community treatment programs for adults with a serious mental illness. The Cures Act authorizes $5,000,000 for each FY 2018-2022 for the provision of training, technical assistance and grants by SAMHSA to eligible entities with special consideration given to applicants that demonstrate the potential to reduce hospitalization, homelessness and involvement in the criminal justice system while also improving the health and social outcomes of the patient. Not later than the end of FY 2021, SAMHSA must report to Congress an assessment of the grant program, including resulting cost savings and public health outcomes, rates of homelessness and criminal justice system involvement among patients and patient and family satisfaction with program participation. (42 U.S.C. 290bb-44)

Suicide Prevention and Early Intervention. SAMHSA is authorized to receive $30,000,000 for the period of FY 2018-2022 to award Adult Suicide Prevention Grants to support the implementation of suicide prevention and early intervention programs for individuals who are 25 years of age or older that are designed to raise awareness of suicide, establish referral processes and improve patient care and outcomes. Eligible entities for these grants include community-based primary care or behavioral health care facilities, emergency departments, a state mental health agency (or a state agency with mental or behavioral health functions), a public health agency, a U.S. territory or an Indian tribe or tribal organization. (42 U.S.C. 290bb-43)

The Cures Act also supports SAMHSA’s Suicide Prevention Technical Assistance Center for the training of state and local governmental authorities, institutions of higher education, public organizations and private nonprofit organizations in suicide prevention and early intervention for all ages. (42 U.S.C. 290bb-34)

SAMHSA’s Suicide Prevention Lifeline and Treatment Referral Routing Service. The Cures Act recognizes and dedicates funding for SAMHSA’s 24-hour Suicide Prevention Lifeline (1-800-273-TALK) and Treatment Referral Routing Service, known as the National Helpline (1-800-662-HELP), which are critical resources that were not previously authorized or funded explicitly by statute. (42 U.S.C. 290bb-36B)

Strengthening the Mental Health Workforce

Efforts to increase the number of skilled providers – particularly in underserved areas – available to provide treatment for mental health and substance use disorders are another means by which the Cures Act seeks to remove patient barriers to care. Through workforce studies and the availability of federal grants, Subtitle B of the Cures Act seeks to support those training programs that are making investments in today’s learners who will comprise the nation’s future mental health workforce.

New Workforce Grant Opportunities.

  • Minority Fellowship Program. The Cures Act authorizes $12,669,000 for each FY 2018-2022 to HHS for the awarding of fellowships for professionals training in mental health and substance use disorder treatment, with the goal of improving the quality of services provided to racial and ethnic minority populations and increasing the number of culturally competent professionals who teach, conduct research and provide direct mental or substance use disorder services to such populations. Eligible applicants are individuals in postbaccalaureate (including master’s and doctoral degrees) programs for training in professional fields, including psychiatry, nursing, social work, psychology, marriage and family therapy, mental health counseling and substance use disorder and addiction counseling. (42 U.S.C. 290II)
  • Training Demonstration Program. A new demonstration program is authorized under HRSA to provide grant opportunities that support the training of medical residents and fellows to practice in psychiatry and addiction medicine and the training of other provider types who practice in underserved community-based settings that integrate mental and substance abuse disorder treatment with primary care services. In each FY 2018-2022, $10,000,000 will be made available for these training grants, which may also be used to establish or improve academic programs that provide mental health and substance use disorder training for students and faculty or to develop evidence-based practices or recommendations for the design of such programs. Eligible applicants include training programs within institutions of higher education, hospitals, FQHCs, CMHCs, rural health clinics and various other types of health centers and facilities. (42 U.S.C. 294k)
  • Eligibility for Existing Workforce Programs. In addition to reauthorizing and broadening the eligibility criteria for the Mental and Behavioral Health Education Training Grants (under 42 U.S.C. 294e-1, which are highlighted in the chart below), the Cures Act also clarifies the current eligibility standards for the National Health Service Corps Loan Repayment Program to include child and adolescent psychiatrists. (42 U.S.C. 254l)

Mental Health and Substance Use Disorder Workforce Studies. With the goal of informing federal, state and local efforts to enhance the mental health workforce, SAMHSA and HRSA will conduct a study on the national- and state-level projections of supply and demand of workforce by profession; an assessment of workforce capacity and strengths and weaknesses; and information on trends within the workforce over the next five years. Upon completion, the report will be posted on the HHS website. The Cures Act also requires the Government Accountability Office to conduct a study and submit a report to Congress within two years on peer-support specialist programs in up to ten states that receive funding from SAMHSA to examine and identify best practices related to training and credentialing requirements for peer-support specialist programs. (Section 9026)

Liability Protections for Certain Health Center Volunteers. The Cures Act expands coverage under the Federal Tort Claims Act (“FTCA”) to certain health care practitioners who are sponsored as volunteers at HRSA-supported health centers. Generally, in order for a health care practitioner to qualify for professional liability immunity under the FTCA, a health care practitioner must be an employee or a full-time or part-time contractor of a health center that has been deemed by HRSA to be an “employee” of the Public Health Service. The Cures Act will now permit deemed health centers to submit volunteer sponsorship applications to HRSA requesting FTCA coverage for its volunteers who provide health professional services (as defined under 42 U.S.C. 254b) in its facilities or at off-site programs and events carried out by the health center. Health centers should contact legal counsel or obtain guidance directly from HRSA to ensure compliance with other requirements related to volunteers and to ensure that professional liability protections under the FTCA have been granted. (42 U.S.C. 233)

Existing SAMHSA and HRSA Grant Programs Reauthorized by the Cures Act

The chart below summarizes the reauthorized SAMHSA and HRSA grant programs that were previously established under the Public Health Service Act.

Program Description Eligible Applicants
Treatment and Recovery for Homeless Individuals Grants (42 U.S.C. 290aa-5)
Authorizes $41,304,000 for each FY 2018-22 for programs that provide mental health and substance use disorder services to homeless individuals. Eligible applicants include community-based public and private nonprofit entities.
Jail Diversion Program Grants (42 U.S.C. 290bb-38)
Authorizes $4,269,000 for each FY 2018-22 for programs that divert individuals with mental illness from the criminal justice system to community-based services. The Cures Act requires special consideration for grant proposals aiming to support jail diversion programs for veterans. Eligible applicants include states (or political subdivisions thereof), Indian tribes and tribal organizations acting directly or through agreements with other public or nonprofit entities, or a health facility or program operated by or in accordance with a contract or grant with the Indian Health Service.
Promoting Integration of Primary Behavioral Health Care (42 U.S.C. 290bb-42)
Authorizes $51,878,000 for each FY 2018-22 for demonstration projects that co-locate primary and specialty care services for adults with mental illness and co-occurring physical health conditions or chronic diseases. Eligible applicants include states, or other appropriate agencies of a state, in collaboration with qualified community mental health centers, child mental health programs, psychosocial rehabilitation programs, mental health peer-support programs, mental health primary consumer-directed programs or health centers defined under 42. U.S.C. 254b.
Projects for Assistance in Transition From Homelessness (Path) (42 U.S.C. 290cc-22 et seq.)
Authorizes $64,635,000 for each FY 2018-22 for various outreach, prevention, screening, case management and other services to homeless individuals (or individuals at imminent risk of homelessness) who suffer from serious mental illness and/or substance use disorder. Eligible applicants include states.
Youth Suicide Early Intervention and Prevention Strategies (42 U.S.C. 290bb-36)
Authorizes $30,000,000 for each FY 2018-22 for the development, implementation and support of state-sponsored statewide or tribal strategies for suicide early intervention and prevention in youth. The Cures Act requires SAMHSA to consider the applicant’s need, including the incidence and prevalence of suicide in the state and among the population of focus. Eligible applicants include states, a public organization or private nonprofit organization designated by a state or an Indian tribe, tribal organization or urban Indian organization.
Mental Health Awareness Training (42 U.S.C. 240bb-41)
Authorizes $14,963,000 for each FY 2018-22 in grants to train teachers and other school personnel on the recognition of symptoms of childhood and adolescent mental disorders, appropriate community resources available for individuals with mental illness and the safe de-escalation of crisis situations involving individuals with a mental illness. Eligible applicants include states (or political subdivisions thereof), Indian tribes, tribal organizations and nonprofit private entities.
Assisted Outpatient Treatment Programs (42 U.S.C. 290aa note)
Authorizes between $15,000,000 and $20,000,000 in FYs 2017-2022 for the implementation of assisted outpatient treatment programs that aim to reduce hospitalization, homelessness, incarceration and interaction with the criminal justice system for individuals with serious mental illness while improving the health and social outcomes. Eligible applicants include counties, cities, mental health systems, mental health courts or any other entities with authority under the law of a state in which a grantee is located to implement, monitor and oversee assisted outpatient treatment programs.
Community-Based Coalition Enhancement Grants (42 U.S.C. 290bb-25b(e)(1))
Authorizes $5,000,000 for each FY 2018-2022 for the design, testing, evaluation and dissemination of effective strategies to maximize the effectiveness of community-wide approaches to preventing and reducing underage drinking. Eligible applicants include organizations that currently receive or have received grant funds under the Drug-Free Communities Act of 1997 (21 U.S.C. 1521 et seq.).
Reducing Underage Drinking Through Screening and Brief Intervention (42 U.S.C. 290bb-25b(g))
Authorizes SAMHSA to make grants to eligible entities to increase best practices of health care providers treating individuals under the age of 21 aimed at reducing the prevalence of alcohol use among these individuals. Eligible applicants are entities consisting of pediatric health care providers qualified to screen, diagnose and treat children and adolescents for alcohol use.
Mental Health and Substance Abuse Disorder Services on Campus (42 U.S.C. 290bb-36b)
Authorizes $7,000,000 for each FY 2018-2022 for the enhancement of diagnosis, prevention and treatment services on campus for students with or at risk for mental health and substance use disorders with the goal of enabling students to complete their studies. The Cures Act broadens the grant criteria for FY 2018 and onward. Eligible applicants include institutions of higher education.
Mental and Behavioral Health Education Training Grants (42 U.S.C. 294e-1)
Authorizes $50,000,000 for each FY 2018-2022 to support the education and recruitment of students in mental and behavioral health care fields. To be eligible FY 2018 and onward, programs must demonstrate the ability to recruit and place students in areas with high need and a high-demand population, and priority will be placed on psychology, psychiatry and social work programs that train professionals to work in integrated care settings and paraprofessional programs that emphasize the role of the family and lived experience of the consumer and family-paraprofessional partnerships. Eligible applicants include institutions of higher education and accredited professional training programs.