Paolo del Vecchio , 2025-04-21 08:30:00
At the age of 23, after years of mental health problems, addictions, and trauma, I found myself on a Philadelphia subway platform ready to end my life.
Thankfully, I found help and got better. But due to the actions of the Trump administration, many others face a bleak future in dealing with these potentially fatal conditions.
I am far from alone in experiencing these issues. The CDC reports that suicide is the second leading cause of death among those aged 10-34. More than 209,000 Americans die each year from alcohol, suicide and drug overdoses. One in four people will experience a mental health or substance use problem. These conditions account for some of the highest-cost drivers in health care, costing the U.S. economy an estimated $700 billion annually.
I was able to find recovery and turn my life around due to a small federal agency called the Substance Abuse and Mental Health Services Administration (SAMHSA). Through SAMHSA, which is part of the Department of Health and Human Services, I contacted and accessed effective treatment and services. I found information on their website to help understand my problems and how to recover. I found peer and family support that the agency funded. Most importantly, I found a reason for living: to support others who experience these conditions.
In 1995, after working in local community mental health, I landed my dream job at SAMHSA. I recently retired after 30 years as a senior leader in the agency, where my roles included director of the Center for Mental Health Services, executive officer of SAMHSA and, most recently, founding director of the first-ever federal Office of Recovery.
SAMHSA was signed into law in 1992 by a Republican, President George H.W. Bush, after being introduced into Congress by a Democrat, Sen. Edward Kennedy (HHS Secretary Robert F. Kennedy Jr.’s uncle) to provide federal leadership to improve mental health and substance use services. Over the past 30 years, SAMHSA has been instrumental in expanding effective services, reducing opioid overdose deaths, establishing the national 988 mental health crisis response network, identifying evidence-based practices, collecting national data on behavioral health, promoting innovations such as the peer workforce, and funding key programs to reduce underage drinking and assist youth with psychosis. Most importantly, SAMHSA’s establishment represented the federal government’s recognition that you can’t improve the health and well-being of the nation without prioritizing mental health and addictions.
That is why I and so many are disheartened by the Trump administration’s decision to eliminate SAMHSA and many of its key programs. In just three months, Trump and Kennedy have dismantled 30 years of federal mental health and substance use leadership.
Since January, Trump and Elon Musk’s Department of Government Efficiency (DOGE) are firing up to one-half of the agency’s staff. The loss of these dedicated public servants severely hampers the ability of SAMHSA to carry out its mission. Remaining staff have told me that they are overwhelmed and have no idea how to proceed. SAMHSA’s Office of Recovery has lost more than 50% of its staff, and the entire team that led the National Survey of Drug Use and Health — which provides key data on mental health and addictions — was part of the reduction in force. These layoffs were seemingly at random with no clear plan or guidance. How does this achieve any semblance of efficiency, let alone effectiveness?
At the same time, $1 billion was cut from state and local behavioral health programs. These funds, appropriated via the American Rescue Plan Act (ARPA), were to help deal with Covid-19. Their termination fails to recognize the ongoing mental health and substance use impacts of the pandemic. While the courts are determining the fate of these funds, critical safety net programs are shuttering their doors. These include crisis services treatment programs for mothers with children, youth programs addressing serious mental illness along with community and collegiate recovery programs.
In March, HHS announced a dramatic restructuring in keeping with Trump’s executive order “Implementing the President’s ‘DOGE’ Workforce Optimization Initiative.” This included the elimination of SAMHSA and combining mental health and substance efforts with disparate and disconnected programs such as occupational health and safety and toxic substances under the new “Administration for a Healthy America.”
What this does is reduce the profile and priority of mental health and addictions in America. Behavioral health issues are to be subsumed and made diminutive by placing them within a larger structure. This will limit access to necessary resources, increase bureaucratic burden, and obfuscate public accountability. No longer will mental health and substance use providers, let alone the American public, know where to turn to for help. Like the firings and budget cuts, SAMHSA’s abolition was done without public input or engagement — including without Congress. If such changes are warranted, why not engage in a deliberative, thoughtful and strategic approach to determine the best way forward?
And perhaps most egregious was recent news leaked on the president’s budget proposals that show SAMHSA zeroed out of the budget and the gutting of more than 40 different mental health and substance use programs. This includes ending critical services such as crisis care, certified community behavioral health clinics, programs serving children and families, tribes, unhoused individuals, those in criminal justice systems, and pregnant and postpartum women along with ending efforts that link primary and behavioral health care and prevent overdoses, among other things. Almost all of the agency’s recovery-focused grants are targeted to end.
These cuts would make it far more difficult for state and local infrastructure to meet the needs of vulnerable Americans. Though the president’s budget is traditionally a wish list rather than something that Congress enacts, this political environment is different. The Republican-led Congress could put this budget into action. If enacted by Congress, these cuts will result in Americans experiencing greater rates of early mortality and disease burden.
We continue to face a mental health and addictions crisis, and the need for effective federal leadership is more important than ever. Instead, we get calls from Kennedy to investigate psychiatric medications that many rely on and calls from Trump to re-institutionalize people by putting them in back wards rather than back home where they can recover. That makes calls to destroy the one agency trying to improve service delivery look intentional, not accidental. There is without a doubt a need to improve SAMHSA and the programs it operates, but wholesale destruction of the agency will only make a bad situation even worse.
Mental health and addictions affect every family in this nation. Trump has shared how alcohol contributed to his brother’s death, and Kennedy has been open about his own recovery from drug use. They witnessed first-hand how these conditions can be deadly. That is why actions to reduce federal leadership on these issues make little sense.
We need SAMHSA and the important programs it supports so that others can find recovery like I have and live healthy, happy, and productive lives in our communities.
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.
Paolo del Vecchio, M.S.W., is former director of SAMHSA’s Office of Recovery as well as its Center for Mental Health Services and served as SAMHSA executive officer.
