The U.S. Department of Health and Human Services has announced that (SAMHSA) the Substance Abuse and Mental Health Services Administration will be absorbed into HHS’s newly created Administration for a Healthy America—leaving experts concerned about the potential effects on a country grappling with mental health and substance use crises.Under a massive restructuring of the U.S. Department of Health and Human Services (HHS), the Substance Abuse and Mental Health Services Administration (SAMHSA) and other agencies will become part of HHS’s new Administration for a Healthy America (AHA). This comes after HHS announced it was cutting the total number of employees across the department, including at SAMHSA, by 20,000.
As part of its stated mission to “lead public health efforts to advance the behavioral health of the nation,” SAMHSA is responsible for the United States’ response to ongoing mental health and substance use disorder crises. Relatively small, with a budget of about $8 billion and around 900 staff as of the beginning of the year, the agency nonetheless covers a lot of ground, doling out and tracking large grants that states use to fund their mental health infrastructures.
APA has released numerous statements and Advocacy Alerts in response to the cuts at HHS and SAMHSA. In a statement issued in early April along with 11 other national mental health and substance use organizations, APA urged the Trump administration to reconsider the changes it has announced and to ensure that HHS and its agencies are able to “continue their missions unimpeded to support the mental health of our communities as well as to focus on addressing chronic disease with a strong emphasis on prevention and early intervention.”
Many questions remain unanswered about AHA. On social media, HHS Secretary Robert F. Kennedy Jr. said that HHS will “eliminate an entire alphabet soup of departments, while preserving their core functions by merging them into a new organization called the Administration for a Healthy America.” An HHS fact sheet states that AHA’s divisions will include primary care, maternal and child health, mental health, environmental health, HIV/AIDS, and workforce, and will involve “support of the U.S. Surgeon General and Policy team.” The divisions do not appear to include a separate focus on addiction.
“Transferring SAMHSA to AHA will increase operational efficiency and assure programs are carried out because it will break down artificial divisions between similar programs,” according to an HHS news release. In addition to SAMHSA, AHA will include the Office of the Assistant Secretary for Health, the Health Resources and Services Administration, the Agency for Toxic Substances and Disease Registry, and the National Institute for Occupational Safety and Health.
Over the past four years, SAMHSA has grown substantially, from 472 full-time employees and a $5.5-billion budget in 2021 to nearly 900 employees and an $8.1-billion budget in 2025. The Trump administration and its Department of Government Efficiency have positioned their massive reductions to the federal workforce as part of an effort to significantly reduce government spending and shrink the national deficit.
The scope of the cuts has created confusion and anxiety among providers of mental health and substance use services. The CEO Alliance for Mental Health, of which APA CEO and Medical Director Marketa M. Wills, M.D., M.B.A., is a member, released a statement that called the cuts “deeply concerning.” The cuts, according to the statement, “have the potential to cause widespread harm to our communities.”
Community psychiatrists and others who spoke with Psychiatric News say the cuts and reshuffling of SAMHSA’s staff and funding will have a profound effect “on the ground” for millions of American with mental illness and substance abuse problems. When SAMHSA was formed in 1992, it took on the crucial role of supporting states, providing technical assistance, and funding innovative programs and pilot projects to help improve public mental health outcomes and spend money more effectively.
Today, the agency plays a unique role in supporting the entire U.S. public mental health infrastructure—performing a vital coordinating function for substance abuse and mental health services and providing mental health block grants to all 50 states and territories, according to Ken Thompson, M.D., former medical director of SAMHSA’s Center for Mental Health Services and currently chief medical officer for the Pennsylvania Psychiatric Leadership Council. And, while Medicaid is by far the largest source of federal mental health expenditures, Thompson said, “SAMHSA money helps states do innovative things that Medicaid won’t pay for.”
