Since President Donald Trump released his 2026 budget blueprint in early May, calling for $163 billion in federal spending cuts, much of the attention has focused on his slashing of foreign aid and boosting of border security. But the proposal also holds important clues \u2014 amid some mixed messages \u2014 about the administration\u2019s approach to two pressing public health issues: mental health and addiction.<\/p>\n
There are about 80,000 overdose deaths<\/a> in the United States each year, recent data shows, and nearly 50,000 deaths by suicide<\/a>. Trump\u2019s proposal includes heavy cuts<\/a>, totaling more than $22.6 billion, to three federal agencies that address these issues and suggests eliminating programs aimed at suicide and overdose prevention. The administration says this will streamline its efforts, but advocates, researchers, and public health practitioners worry this could make the death toll even worse.<\/p>\n Of course, a proposal is far from a final budget.<\/p>\n And this isn\u2019t even a full budget proposal. It\u2019s what people on Capitol Hill call a \u201cskinny budget.\u201d It covers only discretionary spending that Congress authorizes each year, not larger entitlement programs like Medicare, Medicaid, and Social Security. Those big-ticket items and many other details will be addressed in the administration\u2019s full budget, expected in the coming months.<\/p>\n Still, evaluated alongside the administration\u2019s actions so far \u2014 including slashing the federal health workforce<\/a> and disupting grants to addiction recovery programs<\/a> \u2014 the early proposal hints at Trump\u2019s priorities.<\/p>\n \u201cYou don\u2019t have it in enough detail to be able to really make assessments\u201d about specific policies, said Rodney Whitlock<\/a>, a vice president at the McDermott+ consulting firm and a longtime Republican Senate staffer. But \u201ceven in a skinny budget, you have to take it seriously and think that, \u2018Oh yeah, they\u2019re going to try to accomplish this.\u2019\u201d<\/p>\n About two weeks before Trump released his skinny 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.<\/p>\n Discrepancies between those two documents \u2014 the official, skinny budget and the more detailed leaked one \u2014 have muddled the budget process even more than usual.<\/p>\n Here are three things that millions of Americans experiencing mental illness or addiction, and their loved ones, should watch as the process continues.<\/p>\n 1. There is considerable confusion about the future of suicide prevention programs, including the nation\u2019s mental health crisis hotline, 988.<\/strong><\/p>\n Trump plans to propose spending $520 million on the 988 system next year \u2014 the same amount as in the current fiscal year, said Rachel Cauley, a spokesperson for the White House Office of Management and Budget. She told KFF Health News that the president\u2019s budget will include an additional $95 million for other suicide prevention programs.<\/p>\n But that\u2019s far from clear when looking through the only official budget document released so far.<\/p>\n Trump\u2019s skinny proposal calls for more than $1 billion in cuts to the Substance Abuse and Mental Health Services Administration, the government\u2019s lead agency on all things related to mental health and addiction. The proposal says much of that comes from \u201celiminating inefficient funding\u201d for SAMHSA\u2019s Programs of Regional and National Significance<\/a>.<\/p>\n This bucket of spending includes a variety of grant programs, in areas including children\u2019s mental health and homelessness prevention. Budget documents<\/a> from the current fiscal year show some of the costliest programs under this title focus on suicide prevention, including 988 grants to ensure state and regional call centers have the capacity to handle the millions of calls and texts the crisis line receives, Garrett Lee Smith<\/a> grants focused on preventing youth suicide, and Zero Suicide<\/a> grants that help health systems develop comprehensive suicide screening and response protocols.<\/p>\n Many people consider these programs vital given the country\u2019s ongoing suicide crisis. From 2000 to 2018, the national suicide rate increased 35%<\/a>. Although there was a slight dip the following two years, the rate returned to its peak in 2022.<\/p>\n The 988 system, since launching in 2022 under the Biden administration, has fielded<\/a> more than 9.8 million calls and 2.5 million texts.<\/p>\n \u201cCutting this funding is going to be disastrous,\u201d said Paul Nestadt<\/a>, a psychiatrist and an associate professor at Johns Hopkins University. \u201cA lot of suicide prevention does take place at the state or even local level, but it\u2019s funded by federal programs.\u201d<\/p>\n The skinny budget proposal says, \u201cThese programs either duplicate other Federal spending or are too small to have a national impact.\u201d<\/p>\n Cauley did not respond to questions about where she got the 988 and suicide prevention funding numbers she cited or why they differ from what\u2019s noted in the skinny budget.<\/p>\n Although it\u2019s fairly common to see discrepancies among an administration\u2019s various budget documents, attention to these documents \u2014 and concerns about differences \u2014 are heightened this year amid the Trump team\u2019s efforts to radically downsize the government and federal spending.<\/p>\n \u201cIt\u2019s very confusing,\u201d said Laurel Stine<\/a>, chief advocacy and policy officer with the American Foundation for Suicide Prevention. \u201cWe want to ensure that the 988 lifeline is safeguarded,\u201d but the only officially released budget document \u201cdoesn\u2019t speak to it at all.\u201d<\/p>\n Another point of confusion: The skinny budget suggests that states can accomplish the work supported by the eliminated funding through separate block grants they receive from the federal government to address mental health and addiction.<\/p>\n However, those grants are specifically aimed at caring for people with serious mental illness and cannot be spent on suicide prevention for the general public.<\/p>\n 2. The administration wants to cut certain tools used for preventing drug overdoses.<\/strong><\/p>\n In the skinny budget, the Trump administration says it is \u201ccommitted to combatting the scourge of deadly drugs that have ravaged American communities.\u201d<\/p>\n It goes on to propose eliminating the Centers for Disease Control and Prevention\u2019s National Center for Injury Prevention and Control, which has overseen a lot of overdose prevention work, and consolidating the infectious disease and opioids program with three other programs, effectively reducing its budget and capacity.<\/p>\n Some advocates, clinicians, and researchers worry such actions<\/a> could reverse the recent progress<\/a> made on overdose deaths.<\/p>\n \u201cPresident Trump says that he wants to protect Americans from fentanyl,\u201d said Hanna Sharif-Kazemi<\/a>, who works on federal affairs for the Drug Policy Alliance, an advocacy organization for people who use drugs. \u201cBut the plan that he has outlined in his budget proposal really doesn\u2019t match those words.\u201d<\/p>\n The proposal refers to \u201charm reduction\u201d efforts, including providing sterile syringes to people using drugs, as \u201cdangerous activities\u201d and suggests federal funds should not support them.<\/p>\n But syringe service programs are among the most studied interventions and are proven<\/a> to reduce the transmission of infectious diseases, such as HIV and hepatitis, without increasing crime<\/a> or drug use<\/a>.<\/p>\n They also \u201cdo so much more than just give syringes,\u201d Sharif-Kazemi said, adding that they typically distribute naloxone, which can reverse opioid overdoses, and connect people to resources for food, housing, and treatment, which help keep them alive.<\/p>\n Without these programs, infectious diseases are more likely to spread and affect the broader community, said Nestadt, the Johns Hopkins professor. \u201cEliminating those programs is going to have terrible effects on the population of the United States, regardless of whether they\u2019re using opiates or not.\u201d<\/p>\n 3. Research cuts aimed at \u201cDEI\u201d could worsen disparities in suicide and overdose rates.<\/strong><\/p>\n The Trump proposal takes an axe to the National Institutes of Health, wiping out nearly $18 billion of the research agency\u2019s budget and eliminating several centers within it, including the National Institute on Minority and Health Disparities.<\/p>\n These actions align with Trump\u2019s ongoing attacks<\/a> on \u201cdiversity, equity, and inclusion\u201d programs, which he calls \u201cwoke\u201d ideology.<\/p>\n Researchers say the proposed cuts, if enacted, could hamper efforts to address racial disparities in mental health and addiction that have become increasingly prominent.<\/p>\n Although national overdose deaths dropped last year<\/a>, rates have increased<\/a> in many Black and Native American communities<\/a>.<\/p>\n Suicide rates have been rising faster for Black Americans<\/a> than for their white counterparts. Early in the covid-19 pandemic, when suicide rates decreased for white Americans, they trended in the opposite direction<\/a> for Black Americans and other communities of color.<\/p>\n \u201cIt might seem to the layperson that suicide is suicide, overdose is overdose,\u201d Nestadt said. But the data shows that trends are different for different groups. That means the factors that drive them to suicide \u2014 and the interventions that could save their lives \u2014 may be different.<\/p>\n \u201cIf I want to reach people with suicidal thoughts that are a highly educated, affluent population that has access to health care, I\u2019m going to go to primary care doctors and pediatricians\u201d to implement interventions, Nestadt said. But when trying to reach urban Black teens who have limited access to health care, \u201cmaybe it\u2019s a church\u201d or barbershop, he said.<\/p>\n Nestadt is currently working on a CDC-funded study in which he interviews the family and friends of Black youths who died by suicide to understand what led to that point and how it could be prevented. He worries his funding could be cut any day.<\/p>\n What happens next?<\/strong><\/p>\n Nothing in any Trump budget proposal is final. Lawmakers hold the power to determine federal spending.<\/p>\n Although some advocates worry that congressional Republicans will simply accede to Trump\u2019s demands, Whitlock, the McDermott+ consultant, said, \u201cCongress is always going to want to express its will, and this will be no different.\u201d<\/p>\n Susan Collins, the Republican chair of the Senate Appropriations Committee, which oversees the budget, has stated<\/a> that she has \u201cserious objections\u201d to some of the proposed cuts.<\/p>\n 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\u2019s plans. Rep. Madeleine Dean (D-Pa.) held up a packet of naloxone and said the government should amplify what works to decrease overdose deaths instead of shuttering SAMHSA.<\/p>\n \u201cHelp us save more lives,\u201d she said. \u201cDon\u2019t shift it and shaft it.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n