The country's major mental health institutions, Substance abuse and mental health management, commonly known as SAMHSA, is in the process of dissolution. This year, employees lost more than a third of their 900 employees due to the recent decline in federal labor. President Trump's budget bill cut $1 billion from the agency's operating budget, and its mission has been shaped into a new entity by Health Secretary Robert F. Kennedy Jr.

Legislators, researchers and healthcare providers. During a hearing held by the House Appropriations Committee last month, some Democratic lawmakers fostered the issue with the health secretary. Rep. Madeleine Dean, representing the suburbs of Philadelphia, asked Kennedy about the changes in light of recent progress in overdose deaths.

"The number of overdose deaths in this country has dropped by 27%," said Dean, who has experienced an opioid addiction in a recovering son. "Overdosage is still stealing a generation in this country. So why close Samsa in the name of God?"

Kennedy replied: “We didn’t turn off Samhsa. “What we wanted to do is to transfer that feature to where we can manage it more effectively. ”

In March, Kennedy and the Department of Health and Human Services announced that SAMHSA and other departments would merge into a new entity called the Healthy America or the "AHA".

SAMHSA was formed in 1992 by bipartisan legislation signed by President George HW Bush. The agency’s mission is to support community-based mental health services as well as addiction treatment and prevention. It achieves this primarily through grants to state, community and private groups that provide mental health and addiction services.

In recent years, the agency’s budget has been strengthened to meet the growing demand for mental health and addictive care. In 2024, SAMHSA's budget is approximately $7.5 billion, with most of it remitted to states in search of professional programs to address mental health issues and addiction.

For example, the agency provides over $519 million in $988, suicide and crisis lifeline and behavioral crisis response services, and $1 billion in mental health services block grants.

"The backbone of behavioral health"

"SAMHSA grants are absolutely necessary," said Rachel Winograd, a psychologist at the University of Missouri University of Louis, who directed the university's addiction science team, which received SAMHSA funding. Winograd said they have used the money to buy and distribute medications for drug use disorders, prevent overdoses, and provide a range of services for addicts.

The funds, she said, “are the backbone of behavioral health in this country.” “If those grants were to go, we would be screwed up.”

Miriam Delphin-Rittmon, former assistant secretary of the agency, said that naloxone from naloxone through the SAMHSA grant is a drug that reverses opioid overdose, which helps reduce overdose deaths. "The number of (overdose) reversals continues to increase," she said, according to data collected by SAMHSA.

Adriatik Likcani, a marriage and family therapist and family therapist and professor in Warrensburg, Missouri, said the agency’s funding has become a lifeline for rural communities.

“The rural communities don’t have a lot of money locally to fund treatment or recovery, so the SAMHSA grant brings life to those communities,” said Likcani, who also runs the Recovery Beacon, a small nonprofit that provides rehabilitation services for addiction. “It funded initiatives that they could never provide funding and helped create a recovery center that helped us meet our needs.”

Before that, he said, addicted people had to travel for an hour or more for treatment.

He said they will "go to recover for 21 days or 30 days and then go home without services to continue recovering or to be jailed for drug-related crimes."

He said an example of an initiative introduced and funded by SAMHSA is the use of peer experts - people in recovery are trained to help other addicts.

"In Missouri, we didn't have peer support, but in early 2000 we went through SAMHSA grants, where they funded these systems to hire peers to join the workforce," Likcani said.

He added that it helps address labor shortages and helps develop a more efficient system to recover from substance use disorders. He said it was so successful that the state is funding Missouri’s peer support program. “It ranges from zero to over 60 organizations and is now signed in the state system to provide peer support.”

Loss technical expertise

The direct impact of the recent changes in SAMHSA on Likcani and colleagues in rural Missouri is the loss of technical support from the agency’s Kansas City regional office, which closed on April 1 with the agency’s regional offices across the country,

“They came to teach us best practices,” Likcani said. “From creating a strategic plan (helping) you understand how federal funding works, they operate with the organization.”

Although he hasn't lost funds yet, he is worried that he and other communities like him may lose funds to keep his rehabilitation centers open.

Elsewhere in the country, state agencies and providers relying on SAMHSA funding and technical support feel isolated, lost and reluctant to contact federal staff left by the agency, said Dr. Eric Rafla-Yuan, a psychiatrist in San Diego, California.

"Their contacts are usually fired and the contacts are not answered. You are just one person and have a feeling of being a health facility," said Rafla-Yuan. Rafla-Yuan also worked with the California Office of Emergency Services to co-chair a group to ensure fair access to 988.

Rafla-Yuan said the agency not only provided funds to grantees, but also provided expertise and guidance to use them effectively. For example, for states and communities that receive SAMHSA grants to build crisis response systems, the agency provides guidance on “the appearance of crisis systems.” “What should the staffing ratio be and what qualifications should be.”

But now, with many federal workers disappearing, no one can help them solve problems with crisis response systems. "All of this is uncertain," he said. "There is no answer at all."

These questions are D-Wis Senator Tammy Baldwin (D-Wis).

“National and communities that rely on SAMHSA’s policy and procedural guidance to promote mental health, prevent substance abuse and provide treatment and support for rehabilitation will feel this huge loss of institutional knowledge and subject matter expertise,” said Trina Dutta, former chief of staff of the agency at the Beden administration.

Duta said the latest investment in the agency through bipartisan legislation has been a huge success in reducing opioid overdoses and suicide deaths in certain age groups.

During a hearing on the House Appropriations Committee, Kennedy told lawmakers that his SAMHSA moved into his health. The new U.S. administration (AHA) would allow the agency to better address all chronic diseases, including mental illness and addiction. But Rep. Dean urged him to explain his thoughts.

"Why do we bury its success when we finally see some success?" Dean asked. “We have to rehire people now and figure out what their roles will look like in AHA?”

Kennedy didn't answer her questions, but he said he would make sure people who are addicted can get access to prevent overdoses and other medications.