Where is MHSUD Treatment Available?
Some licensed MHSUD providers – such as psychiatrists, psychologists, and therapists/counselors – practice in office-based settings. Treatment is also available at a range of different types of MHSUD facilities, including clinics, residential treatment centers, and psychiatric hospitals. MHSUD facilities vary in terms of services provided, levels of care, funding sources, and type of ownership (public, private non-profit, and private for-profit). Levels of care available in facilities range from less intensive to more intensive and facilities can offer more than one level of care.
The Substance Abuse and Mental Health Services Administration (SAMHSA) annually attempts to survey all known mental health and substance use disorder treatment facilities in the United States, including U.S. territories. Approximately 14,850 substance use treatment facilities and 9,590 mental health treatment facilities responded to the most recent survey. About 55 percent of MHSUD facilities focus primarily on SUD treatment, 30 percent focus primarily on only mental health treatment, and 16 percent specialize in both mental health and SUD treatment.
Facility Treatment Settings
Settings for MHSUD treatment are available on a continuum that range from least to most restrictive, allowing individuals to enter care at the appropriate level and step up or step down in intensity of services as needed. Outpatient care is the most commonly offered treatment setting for both MH and SUD facilities. The table below describes different treatment settings in specialized MHSUD facilities.
Percent of Facilities that Treat Mental Health or Substance Use Disorders by Type of Available Service/Setting
Source: Adapted from Urban Institute analysis of National Substance Use and Mental Health Services Survey, 2022 as published in Victoria Lynch, Maya Payton, and Lisa Clemans-Cope, State Variation in Substance Use Disorder and Mental Health Treatment Facility Characteristics in 2022, figures 4 and 5, Urban Institute. Modified with permission.
Mental Health and Substance Use Disorder Treatment Setting Types
| Setting | Description |
| Outpatient | Services are delivered with no overnight stay and generally for less than 3 hours at a single visit. |
| Intensive outpatient, day treatment, or partial hospitalization | Services provided in a structured setting generally for multiple hours per day and multiple days per week with no overnight stay. |
| Residential | Combines supervised living with MH and/or SUD treatment and services. Can be short- or long‑term. |
| Inpatient | Generally 24-hour, medically monitored care within a hospital setting. |
| Crisis response | Services delivered in response to an acute MH and/or SUD crisis. Crisis response may include 988, mobile crisis response teams, and crisis stabilization units. |
Types of Facilities
Many types of facilities provide MHSUD treatment services. The table below displays a non-exhaustive list of types of MHSUD facilities and their key attributes based on categories in the SAMHSA National Substance Use And Mental Health Services Survey.
Types of MHSUD Treatment Facilities
| Type of facility | Treatment settings and/or types of services | Oversight and/or funding |
| Outpatient facility | Outpatient care. | Varies |
| Partial hospitalization or day treatment facilities | Often a specialty MH and/or SUD facility. Provides partial day MH and/or SUD services without an overnight stay, typically in sessions of three or more hours on a regular schedule. | Varies |
| Certified Community Behavioral Health Clinics | Provide coordinated, comprehensive MHSUD care. Must serve anyone who requests care, regardless of ability to pay, place of residence, or age. Must provide 9 types of services, directly or through contract: – Crisis Services – Screening, Assessment, Diagnosis & Risk Assessment – Treatment Planning – Outpatient Mental Health & Substance Use Services – Outpatient Primary Care Screening and Monitoring – Targeted Case Management – Peer, Family Support & Counselor Services – Psychiatric Rehabilitation Services – Community-Based Mental Health Care for Veterans | Established by Congress in 2014 as a Medicaid demonstration program. States certify their CCBHCs as compliant with SAMHSA criteria. CCBHCs in the demonstration receive an enhanced, cost-based payment through Medicaid. SAMHSA grants help support planning for, establishment of, and improvements to CCBHC programs. |
| Community Mental Health Centers | A facility that provides the following regardless of a person’s ability to pay: – Outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and residents of its mental health service area who have been discharged from inpatient treatment at a mental health facility; – 24‑hour emergency care services; – Day treatment or other partial hospitalization services, or psychosocial rehabilitation services; and – Screening for patients being considered for admission to state mental health facilities to determine the appropriateness of the admission. | Established in Community Mental Health Act of 1963. Eligible for funding though the Community Mental Health Services Block GrantMust meet applicable licensing or certification requirements in the state in which it is located. |
| Opioid treatment programs | The only type of facility or program that can provide methadone. – May also provide other types of FDA-approved medication for opioid use disorder. – Must also provide adequate medical, counseling, vocational, educational, and other screening, assessment, and treatment services to meet patient needs. | OTPs must be accredited, certified by SAMHSA, licensed by the state they operate in, and registered with the Drug Enforcement Administration. |
| Residential treatment centers | MH and/or SUD treatment and other services in a 24/7 structured living environment. | Generally licensed and regulated at the state level. |
| Psychiatric hospitals | Provides 24/7 inpatient care. May provide other levels of care or programs. | A state, county or private facility licensed as a psychiatric hospital. |
| General hospitals with separate psychiatric and/or substance use unit | Provides 24/7 inpatient mental health and/or substance use services in a separate unit within the general hospital or in another building. | A public or private facility licensed as a general hospital. |
| State hospitals | Provides 24/7 inpatient care. Primarily serves individuals charged with or convicted of a crime related to their mental illness. Can also serve voluntary commitments or involuntary civil commitments. | State-operated psychiatric hospital. |
Percent of Facilities That Treat Mental Health Disorders by Facility Type of Operation and Treatment Setting
Source: Reprinted from Victoria Lynch, Maya Payton, and Lisa Clemans-Cope, State Variation in Substance Use Disorder and Mental Health Treatment Facility Characteristics in 2022 (figure 10), Urban Institute. Used with permission. Urban Institute authors’ analyses of the National Substance Use and Mental Health Services Survey, 2022.
Types of Facility Ownership
MHSUD facilities vary in their type of ownership: public, private non-profit, and private for-profit. For-profit ownership is more common among SUD treatment facilities than mental health treatment facilities, while mental health treatment facilities are more likely to be non-profit or government-owned than SUD facilities. Acquisitions of MHSUD facilities by private equity firms and other for-profit entities accelerated rapidly between 2010 and 2021.
In some states, as much as 20 percent of MH or SUD treatment facilities are now private-equity owned or controlled. A facility’s type of ownership can have implications for cost, quality, and access to care. Research suggests that individuals who are uninsured or unable to pay face more barriers to care in for-profit SUD outpatient treatment facilities, and that private-equity ownership of health care entities in general frequently leads to higher costs for individuals and can compromise quality.
Percentage of Mental Health and Substance Use Disorder Treatment Facilities by Type of Ownership, 2022
Office-Based Care
Outside of MHSUD facilities, licensed MHSUD providers, such as psychiatrists, psychologists, clinical social workers, and counselors can provide MHSUD treatment in office-based settings, sometimes referred to as “private practice,” including in solo and group practices. Research suggests that office-based psychiatrists and therapists working in private practice are more likely to be located in higher income areas than lower income areas. Primary care providers can also deliver MHSUD care from office-based settings.
Many types of treatment, including psychotherapy, medication management, provision of medication for opioid use disorder, can be provided by clinicians in office-based settings. One of three FDA-approved medications to treat opioid use disorder, methadone, can only be dispensed in a certified Opioid Treatment Program, but prescribing clinicians in facilities or office-based settings can still prescribe the other two medications, buprenorphine and naltrexone.
Recovery Supports
Recovery support services can be offered in clinical settings or a range of non-clinical settings that are outside of the scope of our study. Examples of these settings or supports include: recovery housing, permanent supportive housing, supportive employment, clubhouse services, and 12-step or self-help groups.