The Trump administration has continued to move forward with its plans to reorganize the Department of Health and Human Services (HHS), including by folding the Substance Abuse and Mental Health Services Administration (SAMHSA) and other agencies into a new Administration for a Healthy America (AHA), despite Congress’s rejection of the plan.

Why it’s important: This has amounted to a gutting of SAMHSA, through deep staffing and funding cuts that have ground much of the agency’s work to a halt.

The details:

Staffing: More than half of SAMHSA’s staff have been laid off or left the agency this year (~400 employees remain vs. 900 in January), with just 5 of the agency’s 17 most senior leaders remaining. Deep cuts have impacted the Center for Substance Abuse Prevention, the Center for Substance Abuse Treatment, the Children and Families Branch, the Criminal Justice Branch, and the Provider Support Branch, among others. Remaining personnel are demoralized and fearful that the agency is on the brink of collapse.
Funding and executive orders: The administration has clawed back emergency funding for behavioral health issued during COVID, and the agency has terminated $1.7 billion in block grants for state health departments and cut roughly $350 million in addiction and overdose prevention funding. The administration has also announced executive orders targeting harm reduction efforts and proposing to expand the use of involuntary civil commitment. SAMHSA also instructed many grantees to rewrite applications for funding renewals to conform to executive orders.
Shift to HRSA: Many of SAMHSA’s duties, assigned by Congress, have been given over to the Health Resources and Services Administration (HRSA), which primarily focuses on primary care, not mental health and substance use. Several offices and core internal functions, such as policy, communications, contracting, IT, and HR, have been transferred. And there are so few people left at SAMHSA that HRSA employees are now administering some of the grants.
No administrator: Nearly 10 months into his term, President Trump has not named an administrator to lead SAMHSA. Its highest-level official, Principal Deputy Assistant Secretary Arthur Kleinschmidt, now reports to HRSA.
Omitted from planning: The administration did not create a budget justification for SAMHSA, instead submitting one for the new AHA. Pages within the HHS website refer to SAMHSA in the past tense.
Lack of information: States, lawmakers, and grantees have not been able to get reliable information about what is happening. Grantees have been unable to make contact with employees who managed their grants and provided technical assistance.

The bottom line: While SAMHSA still exists under federal law and hundreds of employees are still there, the agency no longer functions as an independent body. The cuts could hamper organizations that rely on agency funding and support and force them to reduce services for people with mental health and substance use disorders.