Mental health agency eviscerated under Trump

The Trump administration’s plan to revamp the entire Health and Human Services Department, which Congress has rejected, has nevertheless led to the gutting of a 33-year-old agency that had been leading the nation’s response to the drug and mental health response epidemic. Since February, staffing at the Substance Abuse and Mental Health Services Administration has shrunk by more than half to about 400 people, according to multiple sources. Many of its duties, assigned by Congress, have been given to a sister agency that primarily focuses on primary care, not substance use and mental health.

The damage to the agency, described in interviews with congressional staffers, former workers and health advocates, appears to line up with the Trump administration’s plan to reorganize the department, including the absorption of a much leaner SAMHSA and other subagencies into a newly created “Administration for a Healthy America.” That’s after Congress rejected such a plan as committees put together fiscal 2026 spending bills that have yet to become law. The changes have raised concerns among lawmakers and activists who say the administration is upending the agency meant to lead the response to the substance use and mental health crises facing the United States.

“We are concerned by reports that the administration is taking steps to stop SAMHSA from serving its statutorily approved role as an independent agency,” Rep. Paul Tonko, D-N.Y., and five other members of Congress wrote in a letter in October to HHS Secretary Robert F. Kennedy Jr. “Let’s not forget that the whole reason Congress moved SAMHSA into an independent agency was to ensure that mental health and substance use disorder treatment was prioritized despite the longstanding stigma.” SAMHSA, which is primarily a grant-making agency, doesn’t have the same name recognition as health care agencies like the Centers for Disease Control and Prevention, but the programs it administers touch the lives of millions of Americans.

“Cutting more capacity for the nation’s only mental health agency doesn’t improve the mental health of Americans,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. “I’m not sure how there’s going to be capacity across the agency to continue to deliver these grants and ensure accountability for grants.” Employees don’t just administer funds. They provide technical assistance and guidance while ensuring grantees are pursuing the latest evidence-based approaches to substance use prevention and treatment. The efforts appeared to be working, proponents say. Last year was the first drop in opioid overdose deaths in several years; about 80,000 people died of drug overdoses in 2024, a 27% drop from the year prior.

Many experts and advocates give credit, in part, to the work of the federal government and this agency, particularly for supporting treatment access and tools that help reduce the harms of drug use like naloxone, which reverses opioid overdoses.

“Here we have SAMHSA — an agency that has been incredibly successful helping to reduce overdose deaths significantly in the country ... due in large part to the incredible promotion of community-based care,” said Paolo del Vecchio, who was director of SAMHSA’s Office of Recovery until he retired earlier this year. “What we see with Trump and RFK Jr. is dissolving the agency and proposing massive budget cuts to mental health and addiction services. This will make America sick again.”

Earlier this year, the Trump administration launched the plan to reorganize the department, which would cut several agencies and offices and fold them into the new Administration for a Healthy America. The president’s fiscal 2026 budget request suggested that several SAMHSA offices and grant programs administered by the agency should be eliminated.

Congress, which created the agency through legislation in 1992, has rejected those changes. While the Trump administration requested funds to create the new Healthy America agency in its budget proposal, Congress is not looking to provide any funding, instead proposing to fund SAMHSA as it has for the past several decades. House appropriators, for example, approved fiscal 2026 spending legislation that would give it a $7.1 billion topline, even as the administration has worked to de-staff it. Those appropriations bills have not yet passed their chambers amid the government shutdown stalemate.

Congress even passed a bill to reauthorize several SAMHSA grant programs focused on substance use treatment and prevention. The legislation would support many programs proposed for elimination by the administration that had been administered by offices that have essentially been eliminated or downsized.