Ms. B (identified by first initial of last name for privacy) had never told anyone about the sexual abuse she had suffered at the hands of her uncle as a young child. For years during her adolescence, the secret festered, driving her to run away from home, drop out of school, and begin drinking and taking opioids to numb the pain.

It wasn’t until she was sitting in a brightly lit room with other women at the clinic where she had started treatment for her opioid use disorder, surrounded by rainbow-colored positive affirmations, drinking a cup of hot coffee, and laughing at a joke the peer specialist had just told, that she felt safe enough to start telling her story.

Substance Abuse and Mental Health Services Administration (SAMHSA) grant funds had paid for the affirmation signs, the coffee, and the salary for the peer specialist. Ms. B was one of many women that year who benefitted from this care designed specifically to address the trauma that contributed to the development of their substance use disorders. And it was working.

In early February, Congress passed bipartisan appropriations to preserve SAMHSA’s structure and funding, clearly signaling the little agency and its work is essential to the nation’s behavioral health system. This is welcome relief to the uncertainty just weeks ago. Adding to a recent focus on behavioral health, President Trump issued a related Executive Order, Addressing Addiction Through the Great American Recovery Initiative, on January 29. This order establishes a new interagency taskforce to provide recommendations and guidance for better coordination and alignment of relevant federal programs. On February 2, HHS Secretary Kennedy announced a new $100 million SAMHSA grant program, the Safety Through Recovery, Engagement, and Evidence-based Treatment and Supports, or STREETS Initiative, to fund outreach, mental health care, medical stabilization, crisis intervention, and linkages to housing for people experiencing homelessness and addiction.

These are welcome, if unclear, actions, and they come on the heels of the whiplash caused by mass grant cancellation and reversal—a terrifying stress test that exposed just how fragile America’s behavioral health infrastructure has become.

This is juxtaposed with recent data from the Centers for Disease Control and Prevention that demonstrated another remarkable and welcome increase in life expectancy in America on the heels of reductions in overdose mortality. However, much of the federal infrastructure that contributed to this progress was nearly dismantled overnight.

Confusion About Behavioral Health Care And The Role Of SAMHSA

What happened in mid-January reveals a deeper misunderstanding of how behavioral health care actually works in America, and why weakening SAMHSA puts lives at risk.

Despite progress, substance-related conditions, including accidents and unintentional injuries, and suicides remain among leading causes of death for people ages 25–64 in the United States. Millions of Americans continue to struggle with untreated or inadequately treated substance use disorders and mental illness. And communities everywhere—urban, rural, tribal—are grappling with shortages of trained providers, fragmented systems, and rising demand for services.

SAMHSA is the only federal public health agency whose sole mission is to address the full continuum of behavioral health needs—from prevention to treatment to supporting individuals in recovery. Its work does not replace direct clinical care. It often funds services that fall outside of traditional insurance models yet exist as glue in a system.

Take overdoses, for instance. SAMHSA funding has enabled states to saturate their communities with naloxone, a life-saving overdose reversal medication. SAMHSA investments have supported training for first responders and community organizations on how to recognize and respond to overdose. These investments are not abstract. They show up in emergency departments, resulting in fewer fatal overdoses, and in communities where people survive long enough because of SAMHSA funding to engage with treatment and sustain recovery.

As former career federal officials at SAMHSA and as physicians who continue to see patients, we’ve seen the agency’s work and impacts firsthand at the individual, family, and community levels. We’ve also seen how the programmatic expertise SAMHSA brings has helped other federal agencies make major systems level changes; examples include 1) the Drug Enforcement Administration’s regulatory flexibilities allowing for telehealth initiation of buprenorphine for the treatment of opioid use disorder, and 2) the Centers for Medicare & Medicaid Services promulgating a new billing code for peer support services in the 2024 Physician Fee Schedule. SAMHSA’s unique focus on the behavioral health needs of the country is what makes its role and work so special.

SAMHSA also recognizes that the work of saving lives and improving behavioral health wellbeing is done on the ground by trained and knowledgeable individuals. Few federal agencies other than SAMHSA fund the ongoing training and technical assistance needed to make sure the public health, public safety, and health care professionals serving people with, or at risk for, behavioral health conditions are up on the latest research and best practices. For example, grant programs such as the Addiction and Prevention Technology Transfer Centers, Center for Mental Health Implementation Support, and Opioid Response Network have provided cutting-edge support to thousands of public health and health care professionals, first responders and other public safety officials, state level professionals, and policymakers.

Many of these services and training/technical assistance grants were on the chopping block just a few weeks ago. Even though the cuts were ultimately restored, the whiplash furthered an unnerving sense of instability that began in spring 2025 with Secretary Kennedy’s announcement of a planned new Administration for a Healthy America that would comprise SAMHSA and several other HHS operating divisions. Collectively, these actions have undermined workforce morale, disrupted planning, and eroded trust in the federal government being a reliable partner. The grant funds were restored; the trust was not.

Looking Forward

The next question is what happens now that the fiscal year funding has passed.

Appropriations language alone does not ensure implementation. Take, for instance, the prior massive workforce reductions at the agency and the sudden $1 billion cut last year that required 23 states and the District of Columbia to file suit and obtain injunctions to continue the flow of funding. Most recently, on January 23, $5 billion in essential public health infrastructure funding by CDC to local health departments around the country was suddenly paused and then “unpaused” 24 hours later; these dollars were also appropriated by Congress. And a recent article in Health Affairs Forefront found that SAMHSA had spent only 34.6 percent of its FY 2025 budget allocation, based on a review of USAspending.gov accounts. 

Congress must exercise sustained oversight to ensure the administration fully executes on the will of Congress, that grants are reliably administered, and that the workforce and technical assistance infrastructure are rebuilt rather than quietly hollowed out. Such robust oversight and accountability functions have been lacking. Thus, it will be important for SAMHSA grantees, state behavioral health administrators, family members, and others with a vested interest to raise issues and concerns with their Congressional representatives regularly and urgently when there are future drastic changes to funding and programs. Ensuring that individuals, families, and communities impacted by substance use get the help they need is a bipartisan concern.

We also need hearings on what has happened, as well as Office of Inspector General and Government Accountability Office reports on the work SAMHSA and related agencies are doing and where they are falling short. We need active engagement with Congressional representatives where these dollars are awarded (and that’s every state and territory in the United States) to ensure that the money allocated is being disbursed by the government and reaching the communities it is intended to serve. The lesson of January is that sustained advocacy works, but vigilance is required to ensure follow-through on Congressional intent for appropriated funding.

SAMHSA may be little known to the general public, but its work touches millions of lives. Weakening it when the nation is finally turning the corner on the overdose crisis is a risk we cannot afford to take. Saving it once is not enough; ensuring its stability is the next test. Ultimately, the measure of our national commitment will be whether Congress secures long-term stability for SAMHSA.

Ms. B found her voice in a room funded by a government grant. We must ensure that those healing spaces continue to exist, the lights are still on, and the peer specialist is still employed when the next person walks through the door seeking help.

Authors’ Note:

Manatt Health works with a diverse group of clients, including states; state and federal policy makers and agencies; payers; health care providers and systems; foundations; associations; consumer organizations; and pharmaceutical, biotech, and device companies.

Dr. Olsen is a member of the American Society for Addiction Medicine (ASAM), serves on an ASAM Criteria Implementation Committee, and has a small clinical advisory role with them.

Source: https://www.healthaffairs.org/content/forefront/congress-has-preserved-substance-abuse-and-mental-health-services-administration-samhsa