Behavioral Health: Activities of the National Mental Health and Substance Use Policy Laboratory

What GAO Found

Legislation enacted since 2016 to address the nation's pressing substance misuse and mental health issues has led to an expansion of the Substance Abuse and Mental Health Services Administration's (SAMHSA) activities. SAMHSA, an agency within the Department of Health and Human Services (HHS), leads federal efforts to advance the behavioral health of the nation. SAMHSA's outlays increased from about $3.5 billion in 2016 to an estimated $8.3 billion in 2023, according to federal budget documents.

SAMHSA has several offices that support and coordinate the work of the agency, including the National Mental Health and Substance Use Policy Laboratory (Policy Lab), which was launched in 2018.

The Policy Lab has varied responsibilities including facilitating policy change, coordinating policies and programs, and promoting evidence-based practices. SAMHSA defines these practices as "interventions that are guided by the best research evidence with practice-based expertise, cultural competence, and the values of the people receiving the services, that promotes individual-level or population-level outcomes." Examples of evidence-based practices include approved medications to treat opioid use disorders and strong follow-up plans following inpatient psychiatric hospitalization to prevent suicide.

GAO found that the Policy Lab performs activities that generally align with its statutory responsibilities. Policy Lab activities include the following:

• Facilitating SAMHSA's implementation of policy changes from multiple sources such as the White House, Congress, and HHS, including SAMHSA leadership.
• Coordinating cross-SAMHSA and inter-agency policy efforts, and promoting coordination and collaboration of SAMHSA programs.
• Facilitating communication between SAMHSA's training and technical assistance providers, who are SAMHSA grantees that offer training and technical assistance to practitioners in the fields of mental health and substance use through webinars and other activities.
• Reviewing budget formulation and funding announcements to identify and develop recommendations to address SAMHSA programs that are potentially duplicative or not evidence-based or effective.
• Working with SAMHSA's Center for Behavioral Health Statistics and Quality to collect, evaluate, and disseminate information on evidence-based practices in consultation with other agencies and experts.

Why GAO Did This Study

The Consolidated Appropriations Act, 2023, includes a provision for GAO to review the Policy Lab's activities and the extent to which it is meeting its statutory responsibilities as set forth in Section 501A of the Public Health Service Act. This report provides key information on the Policy Lab's work, including its role in SAMHSA, and examines its key activities and progress toward meeting its goals. GAO reviewed relevant regulations and statutes, as well as Policy Lab documentation, including evidence-based practice products published by the Policy Lab.

GAO also interviewed Policy Lab officials, and subject matter experts from SAMHSA's centers and the National Institute on Drug Abuse within the National Institutes of Health. Additionally, GAO collected information from SAMHSA's Office of the Assistant Secretary for Mental Health and Substance Use, and the training and technical assistance providers that participate in the Policy Lab's coordination calls. GAO compared the Policy Lab's statutory responsibilities with its activities to determine the extent to which they align.

For more information, contact John E. Dicken at (202) 512-7114 or DickenJ@gao.gov.