The central agency addressing mental health concerns in the nation, dubbed the Substance Abuse and Mental Health Administration (SAMHSA), is reportedly at risk of being shut down. In the past year, it has experienced a significant staff reduction of over a third from about 900 employees. This downsizing coincides with recent cutbacks in the federal workforce. Also, there is a proposed decrease of $1 billion in SAMHSA’s funding as outlined in President Trump’s budget plan. Its responsibility for mental health might be assigned to a new division under the leadership of Health Secretary Robert F. Kennedy Jr.
Numerous stakeholders including legislators, researchers, and healthcare professionals have expressed concerns over these changes. The apprehension was palpable in a recent hearing conducted by the House Appropriations Committee where certain Democratic representatives questioned the health secretary intensely. Representative Madeleine Dean, who hails from suburban Philadelphia and has firsthand experience with opioid addiction, inquired about the impact of these tweaks in the context of an observable decrease in overdose fatalities.
Dean referenced a 27% reduction in overdose deaths nationwide, wondering why SAMHSA is facing an uncertain future when progress is palpable. Dean, whose son is battling addiction, stated that overdoses are continuing to wreak havoc on a whole generation, questioning why SAMHSA’s existence is being threatened. To this, Kennedy responded, with a personal reference to his own experiences with addiction, asserting that the aim is not to close SAMHSA but to streamline its functions under a more efficient structure.
Kennedy, collaborating with the Department of Health and Human Services, announced in March that SAMHSA would be integrated along with other divisions into a new framework, named Administration for a Healthy America (AHA). The inception of SAMHSA dates back to 1992, under the bipartisan legislation signed by President George H.W. Bush, with the aim of bolstering mental health services in communities at the grass-root level and addressing substance abuse and prevention efforts.
Over time, SAMHSA has played a critical role in disbursing funds to states, communities, and private organizations to support mental health services and initiatives targeted at substance abuse. In light of the surging demand for mental health and addiction treatment facilities, the SAMHSA budget grew accordingly. By 2024, it stood at a solid $7.5 billion, with the lion’s share being allocated to states for specialized programs dealing with mental health and addiction.
Among other allocations, SAMHSA provided more than $519 million to the Suicide and Crisis Lifeline, as well as behavioral crisis response services. It also provisioned over $1 billion for mental health service block grants. Rachel Winograd, psychologist at the University of Missouri-Saint Louis, is one recipient of SAMHSA’s funding. She helms the university’s addiction science team and has leveraged the funds to procure and dispense medication for substance use disorders, among other uses.
Winograd underscores the indispensable nature of SAMHSA grants, contributing towards various amenities that cater to people grappling with addiction – from drop-in centers to treatment delivery. She reiterates that these funds are the backbone of behavioral health services in the nation. Should the grants be revoked, according to Winograd, it would significantly disrupt the functioning of these services.
Naloxone, a crucial medication that counters opioid overdose, has been made widely accessible through SAMHSA grants to states. This has been instrumental in curbing overdose deaths, as per Miriam Delphin-Rittmon, a former high-ranking official at the agency. Moreover, SAMHSA funds have breathed life into rural communities that typically operate on lean budgets, states Adriatik Likcani, a marriage and family therapist and professor at the University of Central Missouri.
Particularly, rural areas have greatly profited from the influx of SAMHSA funds. As per Likcani, who also heads Recovery Lighthouse, an addiction recovery services nonprofit, these grants have been pivotal in initiating endeavors that previously were impossible due to restricted funding. The funding facilitated the establishment of recovery centers, providing a lifeline to populations in these areas who otherwise had to travel considerable distances to receive treatment.
The incorporation of peer specialists—a concept conceived and funded by SAMHSA—comprising people who have personally experienced recovery and are trained to assist others with addiction, has revolutionized recovery outcomes. This model was successfully implemented in Missouri. Due to the lack of peer support previously, Likcani said SAMHSA grants played a key role in integrating peers into the workforce, addressing insufficient staffing and establishing a more effective recovery ecosystem.
In rural Missouri, the new restructuring at SAMHSA has had direct consequences for Likcani and his co-workers. One immediate loss was the closure of the regional office in Kansas City, from where technical support was provided. Likcani observes how this office provided hands-on assistance, offering operational best practices and helping organizations comprehend federal funding nuances.
Communities and healthcare providers hinging on SAMHSA’s monetary support and technical expertise are starting to feel isolated and reluctant to reach out to federal staff that still remain at the agency, says Dr. Eric Rafla-Yuan, a psychiatrist in San Diego, California. Grantees previously had access to SAMHSA’s wealth of knowledge and practical applications, which facilitated optimal utilisation of disbursed funds. However, today’s grantees are feeling the gap due to the loss of federal personnel, leaving them floundering with issues related to their crisis response systems.
At a forum chaired by Sen. Tammy Baldwin, D-Wis., and Peter Welch, D-Vt., they discussed the potential impacts of changes to the US Health and Human services, including the dissolution of SAMHSA. They expressed concern over the dramatic loss of institutional knowledge and subject matter expertise, which would directly impact states and communities that rely on SAMHSA’s policy and programmatic guidance to promote mental health.
Trina Dutta, the former chief of staff at the agency under the Biden administration, mentioned the strides made towards lowering opioid overdose and suicide deaths in certain age groups, thanks to bipartisan legislations and substantial investments in the agency. During the House Appropriations Committee hearing, Health Secretary Kennedy highlighted that integrating SAMHSA into the AHA would allow tackling mental illnesses and addiction more efficiently.
However, lawmakers, including Rep.Dean, pressed for a detailed explanation, questioning the logic of compartmentalizing a successful institution into another. Kennedy, without providing a direct response, assured that those afflicted by addiction would continue to have access to preventative measures and necessary medications, irrespective of structural changes in administration.