HHS Restructuring Impacts Services

AMHSA Under Threat: Funding and Workforce Reductions Jeopardize Vital Mental Health and Addiction Services 

The Substance Abuse and Mental Health Services Administration (SAMHSA) faces drastic downsizing. Potential workforce reductions of up to 50% loom. This threatens vital services for millions of Americans. The agency serves as a cornerstone in addressing the country’s ongoing mental health and substance use challenges, providing vital support, funding, and policy guidance to improve access to care and strengthen community-based initiatives. 

In Chicago, Dora Dantzler-Wright and her team witness the impact of SAMHSA’s support firsthand. They provide overdose-reversing medication, train individuals on its use, help recovering addicts reintegrate with families, and assist in finding jobs. Federal partnership through SAMHSA was key to their work. The agency assessed their performance, connected them with similar groups, and provided crucial financial backing. 

Communication with federal officials has recently ceased. Ms. Wright’s calls and messages go unanswered. The departure of local federal advisors has left the Chicago Recovering Communities Coalition without key oversight. This organization plays a vital role in supporting addiction recovery efforts across 6 Midwestern states and 34 tribal nations, providing peer-driven services, overdose prevention training, and harm reduction initiatives. Despite the lack of federal updates, Ms. Wright’s team continues its vital work. An atmosphere of disorientation and uncertainty surrounds the future. 

A Critical Agency Facing an Uncertain Future 

Reports indicate that SAMHSA may face a workforce reduction of up to 50% in the coming days, following earlier cuts that have already impacted staffing levels. This information comes from Trump administration officials. The agency, though modest in size, plays a significant role. SAMHSA operates with a workforce of nearly 900 employees, all contributing to its mission of addressing mental health and substance use challenges through funding, policy development, and program oversight. Its budget is $7.2 billion. This money is allocated to substantial state awards and funds various non-profit groups focused on addiction and mental well-being. The agency tackles two critical national health challenges and has garnered bipartisan support. 

SAMHSA holds immense responsibilities. It manages the national helpline for suicides and emergencies. Millions contact this service through regional centers. It regulates facilities providing outpatient treatment for opioid dependency using prescription medication. It channels funds to specialist legal programs focusing on rehabilitation. It produces annual national reports analyzing mental health and substance use prevalence and trends. 

SAMHSA provides educational materials and practical training. It works with countless non-governmental groups and state departments. It facilitates centers focused on opioid dependency, offering intervention, support, and community outreach programs. This federal body oversees the distribution of public funds, including grants for addiction and mental wellness. 

Conflicting Priorities: Addressing Addiction While Cutting Resources 

Robert F. Kennedy Jr. heads the HHS. SAMHSA is a branch of HHS. Both Mr. Kennedy and former President Donald Trump have vocalized prioritizing the nation's substance abuse issues. Mr. Trump cited overdose-related deaths as a reason for economic sanctions targeting Canada, China and Mexico. Robert F. Kennedy Jr. has openly shared his journey of overcoming heroin addiction, describing how faith played a significant role in his recovery. His presidential campaign included a film detailing the impact of substance abuse in America and exploring various intervention strategies. 

While U.S. overdose deaths remain high, a downward trend has existed since 2023. Many public health policy analysts credit SAMHSA for this. A group of fifty-seven Democratic House members, among them Paul D. Tonko from New York and Andrea Salinas from Oregon, collectively addressed a letter to Mr. Kennedy. This initiative underscores their unified stance on the matter at hand, reflecting the broader concerns within their caucus. The letter criticized workforce reductions at SAMHSA, arguing such cuts were reckless without understanding the repercussions. They cited the pervasiveness of mental health challenges impacting communities and suggested personnel cuts could trigger increased relapses. This could overwhelm medical services and result in poorer overall health outcomes. 

Image Credit - NY Times

Immediate Impacts: Lost Staff, Stalled Programs, and Uncertain Funding 

A SAMHSA spokesperson responded to questions about budget restrictions, stating that essential partnerships would endure regardless of staffing changes. They reaffirmed the agency’s commitment to supporting allies across the nation. HHS representatives revealed a consolidation plan this past Tuesday, which would reduce regional divisions housing entities like SAMHSA from ten to four. Workforce reduction recommendations across government offices are expected later this week. 

Roughly one-tenth of SAMHSA’s workforce has already been dismissed. These were probationary positions, a classification that includes many recently promoted staff. SAMHSA employees, and others under Mr. Kennedy, received financial incentives last week offering $25,000, termed a "voluntary departure incentive." This applied to staff leaving before this Friday. 

Many SAMHSA personnel, including administrators, describe the impact. Expected staff reductions and policy changes are already evident, affecting communities nationwide. Inner cities and small, remote regions feel the effects. New SAMHSA initiatives hang in the balance, including one charting locations in Chicago’s subsidized housing to improve naloxone access and another creating systems to connect suicidal individuals with emergency services using the national hotline. Funding for programs targeting marginalized groups is at risk, including minority and LGBTQ+ communities. 

Unwise Reductions and the Risk of Eroding Oversight 

Regina LaBelle, a former Biden administration official who briefly led the federal agency regulating substance control policy, criticized the staff reductions. She deemed them unwise, suggesting such cuts compromise oversight of grant funding and hinder the compilation of mental health data. This weakens administration, review, and accountability. 

During the Biden presidency, SAMHSA’s staff and budget increased. Experts in addiction and mental health viewed this as correcting long-term underfunding. Near 2020, when widespread illness first emerged, SAMHSA employed around 490 permanent staff, with a budget of approximately $5.5 billion. Federal figures show around 70,630 overdose deaths in that year. 

After 2020, annual overdose fatalities surged beyond 100,000, while mental health challenges—including suicides—escalated significantly. In response, SAMHSA’s funding and resources expanded, backed by bipartisan approval to address the growing crisis. 

Speculation and Statistics: A Return to 2019 Levels? 

Current speculation suggests the administration might restructure SAMHSA, possibly merging it with another health division. Staffing and external funding could return to 2019 levels. While overdose fatalities have declined in recent months, the overall figures still surpass those recorded in 2019, underscoring the persistent challenges in addressing substance use and public health concerns.  Updated federal statistics show almost 87,000 overdose deaths in the twelve months ending in late 2024. 

The Human Cost: Frontline Workers Face Uncertainty and Disruption 

Multiple accounts from many staff members reveal a growing sense of unease. The potential repercussions of drastic staffing cuts are already rippling through the agency, creating a climate of uncertainty. This disruption affects ongoing programs, leaving novel initiatives hanging in the balance. A program mapping naloxone availability within Chicago’s subsidized housing faces an uncertain future. Another initiative, designed to swiftly connect suicidal individuals with emergency services through the national hotline, is also under threat. Funding for vital programs targeting marginalized communities, including minorities and the LGBTQ+ population, is jeopardized. 

Regina LaBelle, a former Biden administration official who briefly led the federal agency regulating substance control policy, criticizes the planned staff reductions. She cautions that these reductions could obstruct the agency’s capacity to manage grants effectively and weaken the integrity of mental health data collection. This poses risks to proper administration, review, and accountability. 

Under the Biden administration, SAMHSA saw a boost in staffing and budget, effectively addressing and reversing the effects of prolonged underfunding. Experts viewed this increase as crucial to tackling the nation’s crises with addiction. In 2020, during Covid-19, SAMHSA employed around 490 permanent staff. Its budget was approximately $5.5 billion. Federal data from that year records roughly 70,630 overdose deaths. 

A Crisis Exacerbated: Overdose Deaths Remain Alarmingly High 

Over the following years, annual overdose deaths surged past 100,000, and mental health problems, including suicides, rose sharply. Subsequent budget increases for SAMHSA received bipartisan support, reflecting the urgency of the situation. While overdose deaths have recently declined slightly, the numbers remain far higher than pre-pandemic levels. Recent federal statistics reveal nearly 87,000 overdose deaths in the 12 months leading up to late 2024. 

Current speculation suggests the administration might restructure SAMHSA entirely, potentially merging the agency with another health department division or reverting staffing levels and external funding to 2019 levels. This raises serious concerns, given the persistent high rate of overdose deaths and the ongoing mental health crisis. The rollback of pandemic-era funding has created immediate problems for states. Washington State, for example, saw $160 million in funding terminated abruptly, forcing organizations across the state to halt their work on grant-funded projects. 

The American Association of Suicidology (AAS) expressed deep alarm over the funding reductions, highlighting the devastating impact on vital services such as suicide prevention training, opioid treatment programs, and homeless outreach services. The AAS cautioned that reducing SAMHSA’s staffing and financial resources could severely undermine suicide prevention initiatives, weaken the agency’s capacity to support communities in distress, and intensify the ongoing youth mental health crisis. 

Beyond Budgets: The Importance of SAMHSA’s Expertise 

The AAS emphasizes that these reductions have real-world consequences. Fewer staff mean fewer experts overseeing grant programs, delayed responses for communities in need, and fewer training opportunities for frontline professionals. Teachers, counselors, first responders, clinicians, and community leaders rely on SAMHSA’s expertise and resources, playing essential roles in saving lives. 

Mental Health America (MHA) also voiced concerns, highlighting the risk of losing critical behavioral health expertise within HHS. While MHA fully supports integrating mental health into overall health strategies, they worry that the proposed restructuring will diminish the focus on behavioral health. This comes at a time when the country is making progress on the opioid crisis and teen mental health, with SAMHSA playing a vital role in these improvements. 

MHA believes America needs a sustained focus on suicide, overdose, and youth mental health. They urge Secretary Kennedy to reconsider the SAMHSA merger, stressing the importance of SAMHSA’s expertise in guiding other agencies and improving America’s overall health. The HHS press release outlining the restructuring does not explicitly highlight behavioral health as a priority, prompting concerns that substance abuse issues could receive diminished focus within the new framework. 

A Call for Reconsideration: Protecting Vital Services Amidst a Crisis 

The American Psychological Association (APA) and APA Services Inc. voiced strong concerns, cautioning that the proposed reductions to SAMHSA could significantly hinder the nation’s capacity to tackle the ongoing mental health and addiction crises. They noted that the proposed 50% staff cut follows a 10% reduction in February, making it nearly impossible for SAMHSA to meet the urgent challenges posed by these crises. 

The APA highlights SAMHSA’s crucial role in delivering behavioral health services. The agency takes a population health approach, prioritizing “upstream services” informed by psychological science. These services aim to prevent crises through early intervention, including behavioral health integration, trauma-informed care, suicide prevention, and evidence-based treatments for opioid and other substance use disorders. 

The APA points to SAMHSA’s success with the 988 Suicide & Crisis Lifeline. Launched in 2022, the lifeline has helped millions. Over 16.5 million people have used this resource, and over two million have called the companion Veterans Crisis Line. Overdose deaths decreased by almost 25% in the last year, reaching the lowest rate since 2020. SAMHSA’s work with the states has contributed significantly to this progress. 

The Ripple Effect: Funding Cuts Threaten Vulnerable Populations and Underserved Communities 

The APA underscores SAMHSA’s crucial role in supporting states, particularly in underserved communities, including rural areas. They point to the agency’s success with the 988 Suicide & Crisis Lifeline. Launched in 2022, this lifeline has proven invaluable, with millions of people accessing the resource. The companion Veterans Crisis Line has also assisted a significant number of individuals. Overdose deaths have decreased significantly in the past year, marking the lowest rate in several years. SAMHSA’s collaboration with states has been a key factor in this progress. 

The proposed cuts raise serious concerns about the future of these initiatives. A workforce reduction of up to 50% at SAMHSA could severely impact the agency’s capacity to sustain and broaden essential initiatives, particularly as the country remains in the midst of ongoing addiction challenges. The impact of these cuts will be most severe for vulnerable populations and underserved communities, who often rely heavily on SAMHSA-funded programs. 

In Oklahoma, hundreds of millions in active SAMHSA grants are at risk. A significant portion of these funds has yet to be disbursed. At least half of these grants support services for children, rural communities, and tribal nations, making them particularly vulnerable to budget reductions. The remaining funding benefits statewide and regional programs, many of which also serve these populations. A potential return to 2019 funding levels could result in a substantial reduction for Oklahoma alone, representing a significant cut. 

A Disproportionate Impact: Children, Rural Communities, and Tribal Nations Face Heightened Risks 

These potential cuts coincide with rising rates of mental illness. Suicide rates in Oklahoma have increased in recent years. Other federal agencies also provide mental health and substance use services, including the Department of Veterans Affairs. However, proposed Medicaid funding reductions pose an even greater threat, as a significant portion of Oklahoma’s population depends on Medicaid. 

SAMHSA plays a critical role in supporting essential programs designed to meet the unique needs of various communities. The agency provides funding for treatment, recovery support, and other services that often fall outside the coverage of public and private insurance for lower-income individuals. SAMHSA’s technical assistance helps grant recipients and mental health agencies develop effective strategies to enhance services for at-risk populations. These efforts also support the adoption of evidence-based practices, ensure compliance with federal regulations, aid in the development of the behavioral health workforce, and improve financial and performance management. 

In Oklahoma, numerous active SAMHSA-funded programs address children and youth mental health. These initiatives are set to receive substantial funding over the next several years, benefiting school districts, tribal nations, municipalities, and state agencies. In recent decades, the state’s youth suicide rate has consistently exceeded the youth homicide rate. Data from local assessments reveal troubling statistics, with a significant proportion of middle and high school students reporting high levels of psychological distress during the past academic year. 

The Importance of Targeted Funding: Competitive Grants and Evidence-Based Initiatives 

SAMHSA distributes two types of grants: formula grants and competitive grants. Formula grants, such as the Community Mental Health Services Block Grant and the Substance Use Prevention, Treatment, and Recovery Services Block Grant, provide steady funding to states and territories. These funds support core services for vulnerable populations. 

Competitive grants, on the other hand, finance specific projects based on submitted proposals. These grants target specialized programs, populations, or initiatives aimed at improving mental and behavioral health outcomes. Competitive grants fund a wide range of interventions, from substance use prevention and treatment to suicide prevention. They also help improve services for vulnerable populations and strengthen the behavioral health workforce. 

SAMHSA’s grantmaking process is highly selective, ensuring funding is directed toward initiatives with strong evidence and the potential for lasting impact. By strategically allocating resources, the agency supports the most effective organizations and programs, maximizing progress in addressing behavioral health challenges across the country. 

The agency’s grant recipients include state and local governments, tribal entities, community-based organizations, and academic institutions. SAMHSA funding empowers recipients to develop and implement evidence-based programs, support prevention strategies, and expand treatment options. This comprehensive approach enables a continuum of care tailored to the diverse needs of communities. Funded projects include expanding access to mental health services in underserved areas and implementing youth substance abuse prevention initiatives. 

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SAMHSA's Grant Structure: Supporting a Continuum of Care Through Targeted Investments 

SAMHSA funds programs that support a wide range of needs, addressing various aspects of the behavioral health continuum. This spans prevention, treatment, and recovery. The agency provides educational resources, training, and technical assistance to facilitate the implementation of evidence-based practices, ensuring access to high-quality care. 

Some programs focus on specific populations, including veterans, homeless individuals, and those involved in the justice system. Others address broader issues such as opioid use disorder and suicide prevention. These resources are essential for community-based organizations, empowering them to enhance services and expand the reach of care. 

Examples of SAMHSA-funded projects include expanding access to mental health services in underserved areas, implementing youth substance abuse prevention programs, supporting peer-run recovery initiatives, and training healthcare providers in evidence-based treatments for opioid use disorder. These investments reflect a dedicated effort to address the multifaceted challenges of substance abuse, ensuring support and resources reach diverse communities in need. 

Until its recent restructuring and absorption into the Administration for a Healthy America (AHA) on March 27, 2025, SAMHSA played a pivotal role in shaping the mental and behavioral health landscape in the U.S. Its broad mandate encompassed advocating for individuals with mental health and substance use disorders, administering grants for state programs, and promoting best practices for addiction treatment. 

The Impact of Restructuring: Uncertainty and Loss of Expertise 

The closure of SAMHSA and its merger into AHA raises concerns about how its specialized functions will be preserved. While AHA promotes overall health, SAMHSA’s dedicated focus on mental and behavioral health may become diluted. The restructuring has already led to staff reductions and funding cuts, disrupting ongoing projects and creating uncertainty among grant recipients. This instability could result in service interruptions and reduced access to care for vulnerable populations. 

Additionally, the restructuring threatens to fragment addiction expertise within HHS. While integrating these issues into broader health strategies is important, losing a specialized agency with deep experience creates concerns about program effectiveness. Without clear leadership, federal efforts on mental health and substance use may become fragmented, potentially undermining the progress made in recent years. 

Several organizations, including the American Association of Suicidology, have raised concerns about these cuts. They highlight the potentially devastating impact on suicide prevention training, opioid treatment programs, and youth-centered initiatives. The reductions also threaten SAMHSA’s ability to support communities in need, particularly as the youth mental health crisis continues to escalate. 

A National Crisis: Addressing Mental Health and Substance Use Disorders 

The restructuring and budget cuts come at a critical time in America’s fight against mental health and substance use disorders. The COVID-19 pandemic intensified existing challenges, leading to increases in anxiety, depression, and substance use. While overdose deaths have slightly declined over the past year, they remain much higher than pre-pandemic levels. Meanwhile, the youth mental health crisis continues to deepen, underscoring the need for sustained investment in prevention, treatment, and recovery services. 

The restructuring raises long-term concerns about the nation’s ability to effectively address these crises. Some argue that integrating SAMHSA into a larger agency could improve efficiency, while others worry that it will dilute the focus and resources needed to combat urgent public health issues. The funding cuts will have widespread ripple effects, affecting mental health clinics, addiction treatment centers, and crucial initiatives like the 988 Suicide & Crisis Lifeline. Experts warn that these reductions could lead to increased overdoses and suicides while creating barriers to treatment and support services. 

Looking Ahead: The Future of Mental Health 

SAMHSA’s restructuring and associated funding cuts prompt fundamental questions about the future of mental and behavioral health services in the U.S. Advocacy groups, mental health professionals, and community organizations urge the administration to reconsider these measures and prioritize funding for critical services. Ongoing legal challenges reflect widespread opposition to the cuts and a commitment to protecting vital programs for vulnerable populations. 

The situation remains fluid, and the long-term consequences of these structural changes are still unfolding. The results of legal disputes and continued advocacy efforts may significantly shape the trajectory of mental and behavioral health services in the months and years ahead. 

A Shift in Focus: From Dedicated Agency to Integrated Approach 

The restructuring of the Department of HHS significantly impacts the future of mental health services in the US. The SAMHSA ceased to exist as an independent agency on March 27, 2025. Its functions and remaining staff were absorbed into the newly formed Administration for a Healthy America (AHA). This marks a shift from a dedicated agency to a more integrated approach within a larger entity. AHA encompasses various health-related offices, including the Health Resources and Services Administration (HRSA), the National Institute for Occupational Safety and Health (NIOSH), the Agency for Toxic Substances and Disease Registry (ATSDR), and the Office of the Assistant Secretary for Health (OASH). 

This consolidation aims to streamline services, improve efficiency, and harmonize health resources for low-income Americans. AHA comprises six divisions: Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce. The US Surgeon General and a policy team will support these divisions. While the restructuring seeks to enhance coordination and resource allocation, concerns persist about the potential impact on mental health and substance use disorder services.  

The American Society of Addiction Medicine (ASAM), among other organizations, has expressed concerns about the restructuring’s potential to deprioritize addiction care. They advocate for appointing a dedicated leader within AHA to oversee substance use disorder initiatives. They also emphasize the importance of coordinating across divisions and working closely with the Centers for Medicare & Medicaid Services (CMS) to improve coverage and reimbursement for addiction treatment. 

Navigating Uncertainty: Funding Cuts and Workforce Reductions 

The restructuring follows a period of significant funding cuts and workforce reductions at SAMHSA. In the weeks leading up to the merger, SAMHSA experienced a 10% reduction in staff. COVID-era grants to state health departments were canceled early, leaving states scrambling to adjust. The cuts fueled a sense of uncertainty and low morale within the agency. Some SAMHSA leaders described a “doom loop,” reminiscent of the challenges faced during the first Trump administration. Many federal workers at SAMHSA found the layoffs and budget cuts traumatic. 

These funding cuts and workforce reductions occurred alongside the larger restructuring, creating a tumultuous period for the agency and its stakeholders. The cuts affected various programs and services, from community-based mental health clinics to addiction treatment facilities. They also threatened to undermine progress on key initiatives, including the 988 Suicide & Crisis Lifeline. 

The restructuring and funding cuts have sparked widespread concern and opposition. Several states have filed lawsuits challenging the termination of pandemic-era funding. Advocacy groups and mental health organizations are urging the administration to reconsider the cuts and prioritize investment in mental health and substance use disorder services. 

The Path Forward: Balancing Integration and Specialized Expertise 

The future of mental health services in the US now rests on how effectively AHA can integrate mental and behavioral health into its broader health agenda. Maintaining a dedicated focus on these complex issues within a larger agency is crucial. Appointing a dedicated leader within AHA to oversee these services, as advocated by ASAM, could help ensure that substance use disorders and mental health remain a priority. 

Addressing the funding cuts and ensuring adequate resources for AHA’s Mental Health Division are essential. This requires ongoing advocacy and collaboration between government agencies, mental health organizations, and community stakeholders. The lasting effects of the restructuring will be shaped by how well AHA manages these complexities and responds to the nation’s persistent challenges with effective strategies and sustained support. 

The shift towards integrating mental health into broader health strategies has the potential to improve overall health outcomes. However, it’s crucial to balance this integration with the need for specialized expertise and targeted programs. The success of this new approach will depend on continued investment in mental health services, workforce development, and research. It will also require a commitment to addressing the root causes of mental health and substance use disorders. These include social determinants such as poverty, discrimination, and lack of access to quality healthcare. 

Building a more equitable and accessible mental healthcare system will require a multifaceted approach involving government agencies, healthcare providers, community organizations, and individuals. The restructuring of HHS represents a significant turning point in the evolution of mental health services in the US. Its success will depend on navigating the challenges ahead with a continued commitment to serving the needs of all Americans.