Mental Health Funding in 2027
A brief look at what the President's budget
I still remember the days of balancing my checkbook. I wasn’t good at it, at least to start. Sometimes I would forget, would be in a hurry in the checkout line, and not think to ask to write the total down in my checkbook. Then, after perhaps one too many close calls, I realized I needed to get better organized with my money. I needed to take the time, to not worry about the extra fifteen seconds it took in line to write down the amount, and reconcile the account every few days. I got better, and a valuable lesson was learned: you can’t spend what you don’t have.
It’s with this backdrop that I read through the President’s proposed 2027 budget. Now you may ask, “Come on Miller, you didn’t read the WHOLE thing did you?,” to which I must respond, “No,” but I did scan it for the things I cared about. This post might be a bit boring for some of you, but it matters. What’s proposed in the budget often gives us a glimpse of what an administration’s priorities are, and what resources we may have in the future. These proposed budgets also serve as a weathervane for broader structural moves and reforms, helping us see potential moves that may be made in the coming year.
What I found should concern anyone who cares about mental health in this country.
The Structural Shift
For me, the biggest story isn’t a single line item, it’s the reorganization. Sure, we’ve talked about this a bit before, but I think it bears repeating: the administration has proposed consolidating several federal health agencies, including SAMHSA, the federal agency dedicated to substance use and mental health, into a new entity called the Administration for a Healthy America, or AHA. The stated goal for this move? Efficiency. The net result is approximately $5 billion in cuts across consolidated programs, with the AHA’s stated focus on nutrition, food safety, and chronic disease prevention. Mental health is not a named priority.
Worth noting: even within HHS, the AHA reorganization has shown limited signs of operational progress. This budget repeats the proposal, but the distance between what’s proposed and what’s actually being implemented, at least what I can see, is worth keeping in mind as we read these numbers.
The SAMHSA Math
The document is light on detail, much more of a fact sheet than budget table, which makes precision difficult. But what we can piece together is significant. SAMHSA’s enacted funding in FY2026 was $7.4 billion. The budget proposes eliminating the Programs of Regional and National Significance (PRNS), which funded roughly $2.4 billion in targeted grants, and consolidating the remaining behavioral health block grants into a single $4.1 billion flexible grant. Do that math and you’re looking at cuts in the neighborhood of 40 percent to SAMHSA’s budget. And, to be clear, this is all before we know what happens to crisis and suicide prevention funding.
Many of the targeted grants being cut funded evidence-based practices, including specialized treatment programs, and services for populations with fewer alternatives. A flexible block grant gives states more discretion, which sounds reasonable until you consider that it also gives them more room to deprioritize the hardest cases.
Mental Health and Substance Use
The budget explicitly criticizes harm reduction funding, calling out federal dollars previously used for syringe programs and smoking cessation supplies for people who use drugs. These are approaches with strong scientific backing. I don’t think the signal here is subtle: the administration’s vision of mental health and addiction support and the evidence base for what actually works are not the same thing.
The Workforce We Aren’t Building
The mental health workforce is simply not mentioned in this document. Not once. No reference to federal training programs for therapists, psychologists, addiction counselors, or peer support specialists. No mention of loan repayment programs that bring clinicians into underserved communities.
Primary Care and Integration
Integrated care, the model where mental health services are woven into primary care settings making them more accessible and less stigmatized, also goes unaddressed. The federal research agency that has built much of the evidence base for these models faces cuts. The payment innovation programs that have helped community health centers deliver integrated care aren’t mentioned.
For the tens of millions of Americans who first encounter mental health support through their primary care doctor, this matters.
One Counterpoint
It’s worth noting that the Department of Veterans Affairs receives one of the largest increases in the entire budget, over $11 billion, with meaningful investments in mental health and substance use treatment for veterans. That’s real, and it matters. It also makes the contrast with the civilian mental health system harder to ignore.
This Is Not Happening in Isolation
Read this budget alongside the budget reconciliation bill, often called HR1 or the “Big Beautiful Bill,” and a clearer picture emerges. Since this legislation will significantly cut Medicaid and change eligibility, it will affect mental health coverage for millions of low-income Americans. As a pattern recognizer, these two documents don’t just reflect policy preferences, they represent a structural reshaping of how this country finances and delivers mental health care.
Our budgets tell us what we value. This one is telling us something about mental health that I find troubling.
Just some small thoughts here on your deep dive into "Our budgets tell us what we value." This budget tells us what we don't value. Sigh.
This new bit of data about 988 and the drop in suicides among young people speaks to what works.
https://www.statnews.com/2026/04/22/988-hotline-linked-11-percent-drop-youth-suicide-jama-study/
"“Crisis response is a really local thing.” But as of last summer, just 12 states had established those fees, while five set up a different form of recurring funding. More states are considering bills to implement a funding mechanism for the lifeline, but many face an uphill battle against those who see it as another tax. State budgets are already likely to be squeezed next year due to new Medicaid requirements."
Like what's his face said "All politics are local" Seems good mental health can be local as well. Though budgets are needed to make it work.
I wish I was surprised. What worries me even more is how silent the majority of the mental health field has been in the face of anti-scientific rhetoric and policy. Time after time, our local, state, and national associations refuse to take meaningful stances for science and the well-being of our patients. Our leadership is failing us and until we collectively as people, and in this case, mental health advocates, decide to fight back, this is only going to get worse.