The Trump administration’s plan to revamp the entire Health and Human Services Department, which Congress has rejected, has nevertheless led to the gutting of a 33-year-old agency that had been leading the nation’s response to the drug and mental health response epidemic.
Since February, staffing at the Substance Abuse and Mental Health Services Administration has shrunk by more than half to about 400 people, according to multiple sources. Many of its duties, assigned by Congress, have been given to a sister agency that primarily focuses on primary care, not substance use and mental health.
The damage to the agency, described in interviews with congressional staffers, former workers and health advocates, appears to line up with the Trump administration’s plan to reorganize the department, including the absorption of a much leaner SAMHSA and other subagencies into a newly created “Administration for a Healthy America.” That’s after Congress rejected such a plan as committees put together fiscal 2026 spending bills that have yet to become law.
