‘People will die’: Trump administration cancels up to $1.9bn for substance use and mental health

The Trump administration on Tuesday evening unexpectedly canceled up to $1.9bn in funding for substance use and mental health care, which providers say will immediately affect thousands of patients.“It feels like Armageddon for everyone who’s on the frontlines of the addiction and mental health space,” said Ryan Hampton, founder of Mobilize Recovery, a national advocacy organization for people in and seeking recovery.“The scope of care that’s disrupted by these grants is catastrophic. Tens of thousands, if not hundreds of thousands, of people will die.”As many as 2,800 grantees through the Substance Abuse and Mental Health Services Administration (Samhsa) received a letter immediately ending their funding – about 26% of Samhsa’s entire budget.Staff at Samhsa were not consulted on the cuts or even told they were happening, according to two sources familiar with the cuts who asked for anonymity to speak about sensitive matters. The agency also endured massive cuts throughout 2025.Providers woke up this morning to learn they would need to lay off staff and end programs immediately, Hampton said. Many of these programs are on the frontlines of mental health and substance use, functioning as the first point of contact for people who need care.“These are programs that save lives, so the impact could be really devastating,” said Regina LaBelle, former acting director of the Biden White House office of national drug control policy and professor at Georgetown University.“It really covers the spectrum of prevention, treatment and recovery services, both on substance use and mental health,” said Yngvild Olsen, who until last July served as the director for the Center for Substance Abuse Treatment at Samhsa and is now a national adviser at Manatt Health.The cuts will affect overdose-prevention work, naloxone distribution and use by first responders, mental health and substance use support within schools, support for pregnant and postpartum women who receive assistance for substance use disorder, underage drinking prevention and recovery support programs – all cut without warning.“Overnight, our entire backbone and infrastructure of addiction and mental health in this country flipped up on its head,” Hampton said. “These grants are lifesaving tools that honestly are a good reason why we have started to see a reversal in trends of drug overdoses in this country.”Overdoses soared over the past two decades, but in recent years they began falling. In 2024, the US overdose rate dropped by 27%. Now, with these abrupt cuts, “a lot of lives are going to be lost”, Hampton said. “A lot of harm is happening in real time this morning.”The cuts “came as a surprise, given all the changes that grantees had already made in response to executive orders and Samhsa guidance”, Olsen said. “This potentially could have an unbelievably disruptive impact on people’s access to services. It could mean really thousands of people losing access to the treatment.”The funding was appropriated by Congress to Samhsa, which then disburses funding to organizations around the country. Congress does not appear to have been involved in the cancellations. Republicans and Democrats have been negotiating funding, and these cuts seem to be politically motivated, said LaBelle, who added: “We didn’t know that the administration would just basically use their regulatory authority to pull the plug.”The awards were terminated because they no longer aligned with the Trump administration’s priorities, according to a letter to grantees from Christopher Carroll, the deputy assistant secretary at Samhsa, obtained by the Guardian. The administration’s goals include “innovative programs and interventions” to reduce mental illness, substance use, overdoses and suicide, the letter said.“You can’t tell me that naloxone distribution, providing mental health support in schools, providing outreach to get people into treatment who are unhoused, providing drug court services, that these are not in line with administration priorities. They are 100% in line with administration priorities, as stated by the administration as recently as two or three months ago,” Hampton said.“All of us are in a state of complete and utter shock that the administration would take such a reckless action.”The cuts are for nearly all discretionary funds, which account for nearly $2bn of Samhsa’s budget. The grants that were not affected include the state opioid response block grants, the certified community behavioral clinics program, and the 988 hotline.Samhsa did not respond by press time to the Guardian’s inquiry about whether staff were consulted or informed of these changes and how they would affect care.The cuts were made under the same rule as previous health agency layoffs and cutbacks, which were successfully challenged in court.“My hope is that this will go to court and the courts will stop it,” Hampton said. But “the harm is happening in real time right now, and as this gets sorted out in the courts, people will die. People will die.”