Substance Abuse and Mental Health Services Administration SAMHSA

Federal support for community mental health centers began in 1963, and for decades research and services were combined in a single agency. The ADAMHA Reorganization Act, signed on July 10, 1992, moved the research institutes to the National Institutes of Health and created the Substance Abuse and Mental Health Services Administration to focus on prevention and treatment services. It is led by the Assistant Secretary for Mental Health and Substance Use.

Most of SAMHSA's budget flows to states through block grants for substance use and mental health services, supplemented by targeted grants such as State Opioid Response funding during the overdose crisis. It supports certified community behavioral health clinics, regulates opioid treatment programs that dispense methadone, and runs the National Survey on Drug Use and Health. It also oversees the 988 Suicide and Crisis Lifeline, the three-digit number that replaced a ten-digit hotline on July 16, 2022.

Overdose deaths topped 100,000 a year from 2021 to 2023 and then fell sharply in 2024, a decline credited to wider naloxone access, treatment expansion, and changes in the drug supply. The March 2025 HHS reorganization proposed folding SAMHSA into a new Administration for a Healthy America, and in July 2025 the 988 line ended its specialized option for LGBTQ youth. Supporters said consolidation would reduce overlap and focus on chronic disease, while state officials, providers, and advocates warned of lost expertise and disrupted services.