The small federal agency tasked with easing the nation’s profound struggles with mental illness and drug addiction is in crisis itself: Hundreds of employees have left its staff of about 900, and its budget would be slashed as part of President Donald Trump’s proposed overhaul of the nation’s health apparatus. The reshaping of the Substance Abuse and Mental Health Services Administration, or SAMHSA, is already hampering public health efforts in communities big and small.

In California, a regional summit for Indigenous youth aimed at preventing suicide and drug addiction was canceled after a pandemic-era SAMHSA grant was axed. In Bismarck, North Dakota, the abrupt demise of $115,000 in SAMHSA grants stymied plans to build a desperately needed mental health crisis center, probably delaying the project.

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And if Trump’s proposed budget passes as envisioned, Bismarck-Burleigh Public Health said it may need to scale back purchases of Narcan, a naloxone nasal spray that reverses opioid overdoses. That could mean fewer overdose kits for Ministry on the Margins, which receives them free from the health agency.

The Christian nonprofit distributes them on the streets and at the group’s all-night coffee house, which serves as a shelter of sorts for people who lack housing in the state’s capital.

“You’ve got to get the Narcan out there,” said Kathleen Atkinson, the ministry’s executive director. “It’s lifesaving.”

Those cuts offer a preview of how proposed changes at SAMHSA — which include hundreds of millions of dollars in funding reductions and a move to a new health agency — could hurt the government’s already challenging work against mental illness and addiction, public health experts warn.

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Despite sharp declines in overdose deaths, estimates of the number of people killed by drugs in the United States still exceeded a staggering 80,000 in 2024. And nearly a quarter of all U.S. adults have recently experienced mental illness, with the largest percentage among young adults, according to the 2023 National Survey on Drug Use and Health, an annual federal survey.

Health and Human Services Secretary Robert F. Kennedy Jr., whose sprawling department includes SAMHSA, has insisted that tackling addiction and mental health remains a priority as programs are consolidated for efficiency. “These issues now rival chronic disease and their impact,” he said last month during a House Appropriations Committee budget hearing.

SAMHSA’s future is complicated by other factors in Washington. Republicans hashing out Trump’s signature domestic policy bill have targeted cuts to Medicaid, which pays for mental health and addiction treatment for millions of people. SAMHSA grants help pay for treatment for people without Medicaid or other insurance.

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“Even if you doubled the SAMHSA budget, it would never account for what you’re going to lose by the kinds of cuts we’re seeing proposed in Medicaid,” said Richard G. Frank, director of the Center on Health Policy at the Brookings Institution.

This month, the House overwhelmingly passed a bill to renew 2018 legislation that authorized a slew of grants aimed at recovery, treatment and prevention programs. Yet, Democrats have pointed out, Trump’s proposed budget would eliminate some programs currently funded by SAMHSA.

“If Republicans really support these programs, they should be opposing the president’s budget, which lays out plans to cut the very programs they claim to care about,” Rep. Frank Pallone Jr. (New Jersey), the ranking Democrat on the House Energy and Commerce Committee, said on the House floor on June 4.

Established by Congress in 1992, SAMHSA supports treatment and prevention programs for substance use and mental health. It serves as a clearinghouse for resources, best practices and training for the public, first responders and medical providers. The agency also funds the 988 national hotline for people grappling with mental health, suicide and drug-use-related problems.

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SAMHSA’s staff is small compared with other HHS agencies such as the Centers for Medicare and Medicaid Services and the Food and Drug Administration. By 2024, in the wake of an opioid crisis exacerbated by the pandemic, the agency’s budget had grown to $7.4 billion — much of it earmarked for grants to states.

The agency serves as “the backbone of behavioral health,” said Rachel P. Winograd, an associate professor of psychology at the University of Missouri at St. Louis and director of the addiction science team within the Missouri Institute of Mental Health.

As part a sweeping restructuring plan, the administration has said that SAMHSA and four other agencies would be folded into a new Administration for a Healthy America, or AHA.

Between layoffs and departures, SAMHSA’s staff has been reduced by hundreds, perhaps as much as half its staffers, according to an ongoing lawsuit filed by 20 state attorneys general seeking to block the administration’s cuts to HHS.

The agency did not respond when asked how many staffers remain at SAMHSA. HHS’s 10 regional offices — which include SAMHSA offices that help organizations and local health agencies navigate the maze of federal grant bureaucracy — have been consolidated into four.

Crucial SAMHSA research is also in peril, former employees warned. This month, the agency stopped updating the Drug Abuse Warning Network, a nationwide surveillance system of drug use trends and insights drawn from emergency department visits. And there is no longer staff dedicated to the National Survey on Drug Use and Health, the nation’s primary source for understanding drug trends and behaviors.

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A SAMHSA spokesperson said the survey will continue in compliance with federal law. But the former agency official who oversaw survey collection — who was laid off in April — said she worries that contractors will lack sufficient oversight. “I don’t know what kind of trust the public can put in the kind of data that’s coming out right now when the experts overseeing the data systems” were fired, said Jennifer Hoenig, former director of SAMHSA’s office of population surveys.

Across the country, communities are grappling with an expected loss of more than $1 billion in SAMHSA grants tied to pandemic relief. A SAMHSA spokesperson said the agency would no longer waste money “responding to a nonexistent pandemic that Americans moved on from years ago.”

Among those affected is Life Connections Peer Recovery Services in rural southeast Iowa. It runs a respite center called Rhonda’s House, where people experiencing psychiatric distress can stay for as long as a week. Director Todd Noack said that amid the budget turmoil, he’s had to let go of two of 12 staff members and shutter some services on weekends.

Separately, Trump’s proposed budget envisions cutting more than $1 billion from SAMHSA’s budget in the fiscal year that starts in October. That includes certain grants aimed at improving childhood mental health, preventing homelessness, addressing cases of HIV among minorities, and educating youth about alcohol abuse.

The budget would consolidate three mammoth grant pools to states for opioid response, substance use prevention and treatment, and community mental health services. That total would amount to $4.1 billion, half a billion less than in the previous budget, according to Regina LaBelle, a professor of addiction policy and practice at Georgetown University and a former White House drug policy official.

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How that would affect states that have long relied on those grants remains unclear. Some local and state health agencies say they are bracing for at least modest cuts.

In Michigan, state health officials told The Post they may cover shortfalls in those grants by dipping into opioid settlement funds they originally planned to spend on long-term investments such as transitional housing for homeless people recovering from psychiatric and addiction woes.

In Los Angeles County, the public health department uses part of an annual $61 million SAMHSA grant to fund drug prevention programs in schools and communities, and programs for youth at parks and libraries. Those efforts may now be at risk, said Gary Tsai, who heads the county’s substance use services office.

“Now is not the time to divest from overdose prevention and substance use services,” Tsai said. “If we care about public health and the overdose crisis, this is a move that is potentially devastating.”

In North Dakota, the state health department told Bismarck-Burleigh Public Health Director Renae Moch to prepare for 10 percent cuts in opioid response money, she said. If that comes to pass, Moch said, she’ll probably buy fewer Narcan kits, forcing her to choose who gets the supplies — first responders or community groups such as Ministry on the Margins.

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For now, the agency’s biggest challenge is replacing the $115,000 in covid-era grants that were meant to develop a comprehensive plan for a “community triage center.” It is envisioned as a place where people grappling with psychiatric crisis, addiction or homelessness can receive care and stabilization — and avoid visits to jails or emergency rooms that strain public resources.

In March, the health agency was set to announce to the city commission its selection for the grant — until Moch received a phone call less than an hour beforehand, informing her that the funding had been yanked.