Appendix F

Calculations for Recommendation 6-1

CURRENT FUNDING LEVEL: $4.57 BILLION

From Appendix C, about funding for prevention of substance use disorder (SUD) ($1.81 billion):

“Approximately 80 percent of the $1.8 billion in prevention spending was for prevention delivered by HHS, with most spending by SAMHSA and the CDC.”

From Appendix C, about funding for prevention in mental health (MH) (total of $2.76 billion):

“Approximately 40 percent of the MH prevention spending occurred under the direction of the Administration for Children and Families (ACF) for programs aimed at preventing child maltreatment ($1,126 million). The next largest funding amount was spent by SAMHSA ($919 million), of which $617 million was for suicide prevention and the rest of the funding was mainly aimed at children and youth. The Health Resources and Services Administration (HRSA)’s MH prevention spending ($517 million) went toward the Maternal, Child, and Home Visiting Program ($500 million). The CDC had a variety of programs aimed at preventing suicide, domestic and sexual violence, ACEs, firearm injury, and two programs aimed at improving student emotional health.”

OPTION 1: FROM A $1.8 BILLION INCREASE

The lower end estimate (i.e., increase by 40 percent main sources of funding for prevention of MEB disorders) would involve adding to the funding of agencies with a role in MEB disorder prevention (relevant rows highlighted in the table below). For some, this means adjust to inflation, for others, a justification for additional modest increases to expand capacity.

Table 5 from Appendix C (highlights on 4 major sources of funding for prevention of MEB disorders)

The 4 main funding sources in Table 5. See below for calculations to fill in the “Shortfall” column.

1. Parts of ACF funding have not kept up with inflation (and in some cases decreased)—see blue highlights

Sources: ACF Congressional Budget Justifications for 2008, 2009, 2010, 2019, 2020, and 2024. The years 2021-23 were omitted due to the temporary increases due to COVID-19 related supplemental funding.

2. CDC funding for MEB prevention could be increased in some key areas (according to TFAH 2024 recommendations); currently it’s about $733M

According to Appendix C, CDC spent $204M for MH prevention, including the following:

• Suicide $30M, ACEs $9M
• Domestic Violence and Sexual Violence: $38,200,000
• Youth and Community Violence Prevention: $18,100,000
• Domestic Violence Community Projects: $7,500,000
• Rape Prevention: $61,750,000

According to Appendix C, CDC spending for SUD prevention in 2024: $528.6M

TFAH’s 2024 report on public health spending recommended increases in the following MEB related areas in the CDC budget:

(Source: TFAH, 2024, page 6)

3. SAMHSA funding in several key areas has not kept up with inflation, or does not include sufficient support for SU prevention

NASADAD (2018) shows - Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG) was $1.779 billion in 2009, and SAMHSA budget request was $2.0 billion in 2024; adjusting 2009 amount for inflation (x0.47) = $2.6 billion.

4. HRSA – main contribution to MEB prevention is MIECHV (Maternal, Infant, and Early Childhood Home Visiting) programs. Funding has increased over the years, not quite keeping up with inflation. However, funding allows the evidence-based programs covered here to only reach approximately 15 percent of the more than 465,000 families who are likely eligible at any given time and could benefit from MIECHV services (Zaid et al., 2022).

Based on the discussion above, the committee could recommend a minimum increase in the 4 key federal sources for MEB prevention (ACF, CDC, HRSA, and SAMHSA) as follows:

OPTION 2: TO A $14 BILLION INCREASE

Developing an estimate for preventive services for children

Why the focus on children? The onset for more than half of mental health conditions is before age 18 (Solmi et al., 2022). Also, intervening in early life offers best opportunities for prevention and associated benefits (NASEM, 2019).

The cost of mental health treatment in children has been estimated at approximately $4,361 (Loo et al., 2024). The public health and prevention portion of the 2021 National Health Expenditure Accounts (all health care spending) is approximately 5 percent (Martin et al., 2023). Five percent of $4,361 is $218 per individual.

If $218 were spent on each of 73.2 million US children¹ 0 to 18 years old for a package of interventions that met their needs (from nurse family partnership to family and school-based interventions), that would cost approximately $16 billion.

___________________

¹ https://www.childstats.gov/americaschildren/tables/pop1.asp (accessed January 2, 2025).

Subtract from $16 billion the current amount being spent on prevention in children by the primary federal agencies working on MEB health.

1. Amounts from federal agencies prevention funding for MEB disorders that seems largely devoted to children (not including SAMHSA):
   
   
   1. $1,146 million for ACF
   2. $500 million for HRSA home visiting
   3. $57 million + $9 million for CDC (Division on Adolescent and School Health and Adverse Childhood Experiences program), and
   4. $109 million for Department of Education (Appendix C; TFAH, 2024).

That is $1.8 billion.

2. SAMHSA funding for prevention efforts in children (some portion of $1,557 million SAMHSA prevention spending on BH disorders—see above), which is calculated below. Amounts that seem largely or entirely relevant to children and are either definitely prevention or very likely prevention:
   
   

   Substance Use Prevention, Treatment, and Recovery Services Block Grant proportion for children under 18: $16 million Calculated by using the demographics information from Fiscal Year 2022 reported in SAMHSA’s Fiscal Year 2025 Justification of Estimates for Appropriations Committees (SAMHSA, 2024): Children 17 years old and under: 3.89 percent, rounded up to 4 percent The 20 percent set aside of the $2 billion SUBG = $400 million 4 percent of the $400 million = $16 million of the prevention set-aside supports services for children
   Project AWARE	$190 million
   Project LAUNCH	$25 million
   Partnerships for Success	$135 million
   STOP Act	$14.5 million
   TOTAL	$380 million

Assuming that includes much of prevention spending on children, $380 million is approximately 24 percent of the $1,577B.

3. Estimated total spending on prevention in children:
   • $1.8 billion + $380 million is the amount currently spent by federal agencies on prevention for children.
   • $16 billion − $2.18 billion = $13.62 billion, or approximately $14 billion more could be spent on prevention of MEB disorders in children under 18.

This does not include the percentage of prevention spending out of the combined state funding for prevention in children (some small portion of the combined SUD and MH $45.8B [2014 figure] spent by states on all prevention and treatment) (SAMHSA, 2017).

REFERENCES

This page intentionally left blank.