What does SAMHSA do?

~ Jason Schwartz

What does SAMHSA do, and should I care if their staff are fired in significant numbers?

It’s my impression that most probationary SAMHSA employees have been fired. Terminations started there because terminating probationary employees is easy procedurally. Permanent employees require a process to justify Reductions in Force (RIF) to move ahead with termination.

Some people are cheering for what they hope will be the eventual destruction of SAMHSA (and other federal agencies). This invites questions about what SAMHSA actually does.

In 2024, SAMHSA’s budget included the following:

  • $2,808,546,000 for mental health programs, including nearly $1 billion for Community Mental Health and $385 million to build capacity for mental health care in community-based clinics. These funds also support crisis lines and suicide prevention programs.
  • $4,159,298,000 for substance use disorder treatment, including the $2 billion block grant for community-based addiction treatment, plus programs to support first responders, screening in medical facilities, and support for babies and pregnant moms.
  • $236,879,000 on substance use prevention, including funds to support the development and maintenance of community coalitions to prevent teen alcohol and other drug use and public education.

What does this mean for families, communities, and individuals?

SAMHSA compiles an annual report on publicly funded admissions and discharges for specialty substance use disorder treatment in the US. The most recent report available is for 2022. It reports 1.5 million specialty treatment admissions and more than 8.5 million admissions over a 5-year span. (The pandemic reduced admissions and capacity, and 2022 appears to still be recovering those numbers.)

SAMHSA also conducts an annual census of substance use disorder treatment facilities. 2020 is the most recent year reported, and there were about 16,000 facilities, 73% of which treat patients funded with public dollars. Most facilities are relatively small and community-based.

SAMHSA staff play a key role in funding treatment, monitoring treatment, monitoring trends, collecting information from communities and providers from across the country, and communicating it back to state capitals and Washington so that real-world national, regional, and local information can inform policy decisions.

Most of these small programs cannot survive significant interruptions in funding. Further, as COVID funds recede and demand for treatment climbs, many of these programs are running deficits already.

Our specialty addiction treatment infrastructure depends on the work of public servants within SAMHSA and the states. I’ve no doubt there’s room for improvement and constructive disruption, but this relatively fragile system needs support, not destructive disruption.

I know too many people whose lives have been restored through treatment supported with SAMHSA funding.

Unknown's avatar

Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I currently serve as the Director of Social Work and Spiritual Care for a healthcare system. I've also served as the Director of Behavioral Health at another hospital. I'm also a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.

4 thoughts on “What does SAMHSA do?”

  1. Thanks for the clear summary Jason. So if Trump/Musk take the buzzsaw to SAMHSA, what will happen to the over $6 billion in block grants that SAMHSA currently administers – and what proportion is this of the entire funding received by the treatment and recovery sector in the USA?

    Like

    1. Honestly, I don’t have a clear answer for you.

      The federal block grant and Medicaid are most of the public funding for addiction care. As Medicaid continued expansion, the proportion for Medicaid would have grown. Less than half of Americans have an employer sponsored private health plan, with about 45% on Medicaid, Medicare, or uninsured. Private insurance represents about 35% of American health care spending, and I’m guessing that portion is smaller for behavioral healthcare spending.

      I think it safe to infer that most SUD treatment spending is public (rather than private) and large cuts in public spending would be devastating.

      Like

Comments are closed.