US Public Health Alphabet Soup Explained: What is the SAMHSA?

“What is the SAMHSA?” is often asked by public health learners in the United States (US) who are studying mental health, especially behavioral health prevention and intervention. If you are working for a public health department, depending upon your bureau, your budget might include SAMHSA money. Therefore, it is important to get an answer to the question, “What is the SAMHSA” if you want to work in public health, especially where psychiatry and mental health are concerned.

What is the SAMHSA?

SAMHSA stands for Substance Abuse and Mental Health Services Administration. It is a federal agency that is like HRSA in that it is a big laundromat for taxpayer money. HRSA provides money from the federal government to local public health agencies and efforts for “physical” healthcare, and SAMHSA provides money to the same places for “mental” healthcare.

As you can see, there is already a problem, because physical health and mental health are pretty intimately connected. Imagine an HIV patient supported by HRSA funding – how do they support their mental health? Or the drug addict being supported by SAMHSA funding – how do they access physical healthcare as their body is negatively impacted by their drug addiction? You can immediately see the challenge with separating these agencies.

What does the SAMHSA do?

I’d like to say that SAMHSA does more than give out funding from the federal government to local efforts ostensibly for “substance abuse and mental health” programs, but in reality, I think that’s all that it really does. SAMHSA itself does not help patients directly through direct services or programs. Of course, it tries to funnel the local funding in particular directions to promote a certain agenda. For example, among their offices is an Office of Behavioral Health Equity which is focused on reducing racial and other disparities in behavioral health, so I imagine that office tries to fund those efforts.

But SAMHSA has a lot of problems with it, just like HRSA does. One of the main problems is that the “substance abuse” happening today is largely from prescription drugs that were supposed to have been regulated by the FDA. In contrast, state-level marijuana programs have been found to be associated with some alleviation of state opioid problems, but SAMHSA is a federal agency that cannot recognize marijuana as therapeutic.

My Take on the SAMHSA

As I pointed out in my HRSA post, SAMHSA has been linked directly to Drug War policies and the carnage that followed. I feel that today, SAMHSA really has lost its way. It has a ridiculous amount of funding, and that’s because we have a lot of opioid addicts and a high prevalence of other mental health issues in the US. But as with HRSA, due to corruption, that funding does not go toward evidence-based policies or programs. I have worked in public health departments that had SAMHSA funding, and they were managed atrociously. It is really a shame, because we have such a big problem with mental health in the US, and it seems that a lot of SAMHSA funding ends up wasted on programs that don’t work, or vendors that just want to be paid.

So when we ask, “What is the SAMHSA?”, I say it is an agency that has lost its way. Today, SAMHSA has a totally unclear mandate. I think it needs an overhaul. What is it really there to do in today’s context? Why can’t HRSA do what SAMHSA is doing, so that physical and mental health care can be unified? Is there a way to dismantle it and make other agencies do its work? SAMHSA as an agency needs to do some soul-searching, in my opinion. Mental illness in the US has skyrocketed under their funded programs. Where is the accountability?

Updated banners July 11, 2023.