3 things to watch for mental health in Trump's early budget proposals

3 things to watch for mental health in Trump's early budget proposals

Since President Donald Trump released his 2026 budget blueprint in early May and called for $163 billion in federal cuts, much of the attention has focused on his obfuscation of foreign aid and boosting border security. But the proposal also contains important clues — amid some mixed messages — about the administration's approach to two pressing public health issues: mental health and addiction.

In the United States, there are approximately 80,000 deaths each year in the United States, according to recent data, and nearly 50,000 deaths by suicide. Trump's proposal includes severe cuts of more than $22.6 billion to three federal agencies that address these issues and propose eliminating programs aimed at suicide and overdose prevention. The administration says this will streamline its efforts, but advocates, researchers and public health practitioners worry it could make the toll even worse.

Of course, a proposal is far from a final budget.

And this isn't even a complete budget proposal. It's what people on Capitol Hill call a "skinny budget." It covers only discretionary spending that Congress authorizes each year and not major entitlement programs such as Medicare, Medicaid and Social Security. These big-ticket items and many other details will be addressed in the administration's full budget in the coming months.

Still, the early proposal was evaluated alongside the administration's previous actions — including concealing federal health care workers and cutting off grants for addiction recovery programs.

“They haven't given it enough detail to really make assessments about specific policies,” said Rodney Whitlock, a vice president at the McDermott+ consulting firm and a longtime Republican Senate staffer. But "Even on a thin budget, you have to take it seriously and think, 'Oh yeah, they're going to try to make this happen.'"

About two weeks before Trump released his slim budget, a preliminary budget document for the Department of Health and Human Services was leaked, showing deep funding cuts and lists of programs slated for elimination.

Discrepancies between these two documents - the official, slim budget and the more detailed ones, have thrown the budget process into even more disarray than usual.

Here are three things that millions of Americans with mental illness or addiction and their loved ones should keep in mind as the process progresses.

1. There is considerable confusion about the future of suicide prevention programs, including the nation's mental health hotline, 988.

Trump plans to spend $520 million on the 988 system next year - the same amount as in the current fiscal year, said Rachel Cauley, a spokesman for the White House Office of Management and Budget. She told KFF Health News that the president's budget will include an additional $95 million for other suicide prevention programs.

But that's far from clear when you look through the official budget document released so far.

Trump's slim proposal calls for a cut of more than $1 billion to the Substance Abuse and Mental Health Services Administration, the government's lead agency on all things related to mental health and addiction. The proposal says much of this comes from “eliminating inefficient funding” for SAMHSA programs of regional and national importance.

This bucket of spending includes a variety of grant programs in areas including children's mental health and homelessness prevention. Budget documents from the current fiscal year show some of the most expensive programs under that title focus on suicide prevention, including 988 grants to ensure state and regional call centers handle the millions of calls and texts the crisis line receives, Garrett Lee Smith grants focused on youth suicide prevention, and no suicide grants Develop health systems.

Many people consider these programs crucial given the country's ongoing suicide crisis. From 2000 to 2018, the national suicide rate increased by 35%. Although there was a slight dip in the following two years, the rate returned to its peak in 2022.

The 988 system has made more than 9.8 million calls and 2.5 million texts since launching in 2022 under the Biden administration.

“Cutting this funding will be catastrophic,” said Paul Nestadt, a psychiatrist and associate professor at Johns Hopkins University. “There is a lot of suicide prevention going on at the state or even local level, but it is funded through federal programs.”

The slim budget proposal states, “These programs either duplicate other federal spending or are too small to have a national impact.”

Cauley did not respond to questions about where she got the numbers 988 and suicide prevention, or why they differ from what was noted in the skinny budget.

Although it's fairly common to see discrepancies between an administration's various budget documents, these documents — and concerns about the differences — are amplified this year because of the Trump team's efforts to radically downsize federal and state government spending.

“It’s very confusing,” said Laurel Stine, chief advocacy and policy officer at the American Foundation for Suicide Prevention. “We want to make sure the 988 Lifeline is secured,” but the only officially released budget document “doesn’t speak to that at all.”

Another point of confusion: The slim budget suggests that states can do the work by eliminating funding through separate block grants they receive from the federal government to address mental health and addiction.

However, these grants are specifically aimed at caring for people with serious mental illness and cannot be spent on suicide prevention for the general public.

2. The administration wants to cut certain tools used to prevent drug overdoses.

In the slim budget, the Trump administration says it is committed to "reducing the scourge of deadly drugs that have devastated American communities."

It proposes eliminating the Centers for Disease Control and the National Centers for Disease Prevention and Injury Prevention and Control, which oversees much overdose prevention work, and consolidating the Infectious Diseases and Opioids Program with three other programs, effectively reducing budget and capacity.

Some advocates, clinicians and researchers worry that such measures will overshadow recent progress in overdose deaths.

“President Trump says he wants to protect Americans from fentanyl,” said Hanna Sharif-Kazemi, who works on federal issues for the Drug Policy Alliance, an advocacy group for people who use drugs. “But the plan he described in his budget proposal really doesn’t match those words.”

The proposal refers to “harm reduction efforts,” including providing sterile syringes to those using drugs, as “dangerous activities” and suggests that federal funds should not support them.

However, injection service programs are among the most studied interventions and have been shown to reduce the transmission of infectious diseases such as HIV and hepatitis without increasing crime or drug use.

They also "do so much more than just syringes," Sharif-Kazemi said, adding that they typically distribute naloxone, which can reverse opioid overdoses and connect people to resources for food, housing and treatment that help keep them alive.

Without these programs, infectious diseases are more likely to spread to and impact the broader community, said Nestadt, the Johns Hopkins professor. “Eliminating these programs will have a terrible impact on the population of the United States, whether or not they use opioids.”

3.. Research cuts targeting “Dei” could worsen disparities in suicide and overdose rates.

The Trump proposal takes an ax to the National Institutes of Health, wiping out nearly $18 billion of the research agency's budget and eliminating several centers within it, including the National Institute on Minority and Health Disparities.

These actions correspond to Trump's ongoing attacks on "diversity, equity and inclusion programs," which he calls "woke" ideology.

Researchers say the proposed cuts, if enacted, could hamper efforts to address racial disparities in mental health and addiction that have become increasingly prominent.

Although national deaths have fallen over the past year, rates have risen in many Black and Native American communities.

Suicide rates rose faster for black Americans than for their white counterparts. At the start of the Covid-19 pandemic, as suicide rates declined for white Americans, they trended in the opposite direction for Black Americans and other communities of color.

“It seems to the layman that suicide is suicide, overdose is overdose,” Nestadt said. However, the data shows that trends vary for different groups. That means the factors that lead them to suicide—and the interventions that could save their lives—can vary.

"If I want to reach people with suicidal thoughts, who are a well-educated, affluent population that has access to health care, I will go to doctors and pediatricians to implement interventions," Nestadt said. But when he tried to reach urban black teenagers who have limited access to health care, "maybe it's a church" or barber shop, he said.

Nestadt is currently working on a CDC-funded study in which he is interviewing the family and friends of black youth who have died by suicide to understand what led to this point and how it could have been prevented. He fears his funding could be cut any day.

What happens next?

Nothing in a Trump budget proposal is final. The legislature has the power to determine federal spending.

Although some advocates worry that congressional Republicans will simply acquiesce to Trump's demands, Whitlock, the McDermott+ adviser, said: "Congress will always want to express its will, and this will be no different."

Susan Collins, the Republican chairwoman of the Senate Appropriations Committee, which oversees the budget, has said she has "serious objections" to some of the proposed cuts.

And when Health and Human Services Secretary Robert F. Kennedy Jr. appeared before House and Senate committees on May 14, some lawmakers pushed back on the administration's plans. Rep. Madeleine Dean (D-Pa.) held up a package of naloxone and said the government should step up the overdose deaths instead of shutting down Samhsa.

“Help us save more lives,” she said. “Don’t move it and turn it off.”

Sources: