How will RFK Jr.'s budget cuts allocate dependence and mental health services? : Blows

The country's main mental health agency, The administration of drug addiction and mental health, commonly known as Samhsa, is being dissolved. He has lost more than a third of his staff of around 900 this year in the context of recent reductions in federal workforce. President Trump's budgetary bill reduces $ 1 billion in the agency's operating budget, and its mission is be folded in a new entity In good shape by the health secretary Robert F. Kennedy Jr.

Legislators, researchers and health care providers are affected. During an audience held by the Credit Committee of the House last month, some Democratic legislators burned out the Secretary of Health on this subject. Rep. Madeleine DeanRepresenting the suburbs of Philadelphia, interviewed Kennedy about these changes in light of recent progress of deaths by overdose.

“A 27% reduction in overdose deaths in this country,” said Dean, who has a personal experience of dependence on opioids through one of his sons which is recovering. “The overdose always steals a generation in this country. So why in the name of God we are closing Samhsa?”

“We are not closing Samhsa,” replied Kennedy, mentioning his own story of dependence and the relatives he lost overdose. “What we want to do is that we want to move this function in a place where we can administer it more effectively.”

In March, Kennedy and the Ministry of Health and Social Services announced that Samhsa and other divisions, would be combined In a new entity called the administration for a healthy America, or AHA.

Samhsa was created in 1992 Through bipartite legislation signed by President George HW Bush. The agency was responsible for supporting community mental health services, treatment and prevention of drug addiction. This has mainly accomplished this thanks to subsidies to states, communities and private groups for mental health and services related to drug addiction.

In recent years, the agency’s budget has increased to meet the growing demand for mental health care and drug addiction. In 2024, Samhsa's budget was About $ 7.5 billionmost of which have flowed to states for specialized programs to solve mental health problems and dependence.

For example, the agency has given more than $ 519 million for 988, suicide and Crisis Lifeline and response to the behavioral crisis, and just over a billion dollars for mental health service subsidies.

“ Empower of behavioral health ''

“Samhsa subsidies are absolutely necessary,” said the psychologist Rachel Winograd at the University of Missouri-Saint Louis. She heads the university's drug addiction team, which receives Samhsa funding. They used money to buy and distribute drugs for disorders related to substance consumption, overdose prevention and for a range of services to drug addiction, known as Winograd, “whether it be access, recovery, housing, treatment, delivery, you call it.”

These funds “are the backbone of behavioral health in this country,” she said. “If these subsidies were to leave, we would be screwed up.”

Improving access to naloxone, a medication to reverse the overdose of opioids, made possible thanks to samhsa subsidies to the states, contributed to the reduction of deaths by overdose, said Miriam Delphin-Rittmonthe former assistant secretary of the agency. Based on the data collected by Samhsa, she says: “The number of [overdose] The inversions continued to increase. “”

Agency funds have become a rescue buoy for rural communities, known as Adriatik LikcaniMarriage and family therapist and professor at the University of Missouri Central, in Warrensburg, Mo.

“Rural communities do not have much locally funding to finance treatment or recovery, so Samhsa subsidies have brought life to these communities,” explains Likcani, who also directs Recovery lightA small non -profit organization offering recovery services for dependence. “He financed initiatives that they have never been able to finance and helped start these recovery centers that helped us meet the needs.”

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

They would “go into a detoxification treatment for 21 days or 30 days, then come home and no service is present to be able to continue working on their recovery or go to prison due to crimes related to drugs,” he said.

An example of an initiative introduced and financed by Samhsa, he said, was the idea of ​​using specialist peers-people themselves in recovery who are trained to help other people with dependence.

“In Missouri, we had no support for peers and it was through Samhsa subsidies at the beginning of 2000 when they financed these systems to hire peers to reach the job market,” explains Likcani.

This helped respond to a labor shortage, he adds and helped develop a more effective system for recovering consumption disorders. And it was such a success, he says, that the State finances peer support programs across the Missouri. “It has gone from zero to more than 60 organizations which are translated within the framework of state systems to provide support by peers.”

Loss of technical expertise

The immediate impact of recent changes in Samhsa on Likcani and its colleagues from Missouri Rural, was the loss of technical support from the regional office of the agency in Kansas City, which was closed on April 1 as well as all the regional agency offices across the country,

“They came to the field by teaching us best practices,” explains Likcani. “They worked with organizations, developing strategic plans [to helping] You understand how federal funding works. “”

And although he has not yet lost funding, it is impatient that he and other communities like his lose funding to keep their recovery centers open.

Elsewhere in the country too, state agencies and providers that rely on the financing and technical support of Samhsa feel isolated, lost and reluctant to reach out to the federal staff left to the agency, says Dr Eric Rave-YuanA psychiatrist in San Diego, California.

“Often, their contacts have been dismissed, the contacts remain unanswered. You have a sense of many health agencies that you are alone,” said Rafla-Yuan, who also works with the California Office of Emergency Services, co-reprimanding a group to ensure fair access to 988.

The agency not only provided funds to its beneficiaries, explains Rafla-Yuan, they also provided expertise and advice to use these funds effectively. For example, for states and communities that have received Samhsa subsidies to set up a crisis response system up to 988, the agency has provided guidelines for what a “crisis system,” he said. “What endowment ratios should be, what type of qualifying people should have.”

But now, with so many federal staff members, the beneficiaries have no one to help them solve problems with their crisis response systems. “All this is really uncertain,” he said. “There is no response at all.”

These questions were among the subjects addressed during a forum organized by Senator Tammy Baldwin, D-Wis., And Peter Welch, D-VT., To understand the potential impacts of changes in American health and human services, including the dismantling of Samhsa.

“This spectacular loss of institutional knowledge and expertise in matters will be felt by the states and communities which are based on Samhsa's program and programmatic orientations to promote mental health, prevent the abuse of substances and provide treatments and support for favorable recovery,” said Trina Dutta, the agency's former staff chief.

Recent investments in the agency – thanks to bipartite legislation – have succeeded in reducing both opioid overdose and, in certain age groups, suicide deaths in the country, said Dutta.

During the hearing of the Chamber's credit committee, Kennedy told legislators that his moving Samhsa in his new administration for a healthy America (AHA) would allow the agency to better address all chronic diseases, including mental illnesses and dependence. But the representative pressed him to explain his thought behind it.

“Why, when we finally see some success, buried this success, will we put it in an AHA program?” Dean asked. “We must now rehire people and understand what their roles will be within the AHA?”

Kennedy did not answer his question, but said that he would make sure that people in terms of dependence have access to overdose prevention and other drugs.