As DOGE slashes funding source, Wisconsin behavioral treatment centers worry about programs
Natalie Eilbert- The Substance Abuse and Mental Health Services Administration has experienced significant staff reductions under the Trump administration.
- Critics, including healthcare providers and lawmakers, argue that the cuts will hinder access to vital treatment and support services for vulnerable populations.
- Despite the administration's stated commitment to combating overdose deaths, many experts say that is just one part of the journey, and treatment is key.
For several years, the clinical team at a critical Milwaukee treatment center has had monthly check-ins with program officers at the federal agency that oversees mental and behavioral health grants. They share information from other providers working in addiction recovery, problem-solve struggles with delivering services, and share crucial data on opioid overdoses.
But over the last few weeks, Valerie Vidal, CEO and president of Meta House, said her team has experienced a shift in the availability of contacts at the Substance Abuse and Mental Health Services Administration, or SAMHSA. That's led to uncertainties over the future of grant awards.
It's a feeling that looms large over many grant-funded treatment programs in Wisconsin.
Meta House is a Milwaukee-based nonprofit that offers community-based treatment programs to women across the state struggling with addiction. In 2024, the nonprofit treated 331 women and 168 children. Overwhelmingly, the clients who stayed in outpatient care for at least 90 days maintained abstinence or meaningfully reduced their substance use between admission and discharge.
These life-saving, and life-altering, programs would not be possible without a trio of multi-year grants from SAMHSA, Vidal said. Those grants include addiction treatment for pregnant and postpartum women, housing resources for people who struggle both with substance use and housing instability, and connections to treatment for people with opioid use disorder.
By the end of February, the Department of Government Efficiency had reduced SAMHSA's staff by more than 10% as part of President Donald Trump's overhaul of the federal government. The terminations targeted workers in their probationary period, a designation that applies to all new and recently promoted employees in their first year or two on the job, depending on the division.
The American Psychiatric Association, the largest psychiatric association in the world, condemned cuts to SAMHSA in a March 17 statement, stating that its critical mission is more important now than ever and "will inevitably lead to cutting programs and services that so many people with mental health and substance use disorders depend on."
This week, the hammer came down again.
On Tuesday, the Department of Health and Human Services continued its overhaul, this time canceling more than $12 billion in federal grants allocated to states during the pandemic, including about $1 billion from SAMHSA. Those funds, although not earmarked for COVID programs, were intended to address mental health and substance use issues exacerbated during the pandemic.
“Donald Trump is ripping support for mental health and addiction away from families, actively putting more Wisconsinites in harm’s way,” said U.S. Sen. Tammy Baldwin, Democrat from Wisconsin, in reaction.
That announcement was quickly followed by another announcement Thursday, this time via YouTube. HHS Secretary Robert F. Kennedy Jr. said the department would be consolidating 28 divisions into 15, including the creation of a new division called the Administration for a Healthy America, or AHA, which will absorb SAMHSA and four other federal health offices, according to an HHS factsheet posted Thursday.
In his short time as HHS secretary, Kennedy described what he called a paradox. Despite the number of competent public servants, "the agency has been inefficient as a whole." In the spirit of DOGE, Kennedy announced he'd be axing another 20,000 workers from the health agency, bringing the number of HHS public servants, including SAMHSA employees, from 82,000 down to about 62,000, he said.
SAMHSA, pronounced SAM-sa, is responsible for managing the 988 Suicide and Crisis Lifeline, which has fielded nearly 200,000 calls, texts and chats just in Wisconsin since its launch in July 2022. It also works with clinics on medication-assisted treatments for opioid use disorder, and distributes block grants across U.S. states that bolster community mental health services and substance use prevention. It's the leading federal government agency responsible for behavioral data and research.
SAMHSA employees who worked on projects related to the 988 Suicide and Crisis Lifeline, regional behavioral health advisors, and peer support specialists were among those who received termination emails starting Valentine's Day weekend in the first round of cuts.
In addition to more staffing cuts, Health and Human Services had already announced on March 11 it would be consolidating its number of regional offices from 10 to four, maintaining offices in Philadelphia, Atlanta, Kansas City and Denver. However, in the fact sheet posted Thursday, HHS said there would be five remaining offices, although the cities were not named.
Wisconsin had been part of a six-state Midwestern region, designated as Region 5, based in Chicago. Nearly all staff members representing Region 5 have been terminated. It's not clear where Wisconsin will land now.
"We’ve been able to recruit higher quality personnel to HHS than in any time in its history,” wrote Kennedy in supporting the March 11 changes. “These are individuals who will return the agency to gold-standard science, evidence-based medicine, and recalibrate its trajectory toward public health rather than industry profiteering.”
Losing direct lines of contact has caused delays
Centers for Independence, which serves about 3,000 people per year for behavioral health issues in the greater Milwaukee area, is in the second year of a $4 million multi-year grant from the Substance Abuse and Mental Health Services Administration.
CEO and president Leif Elsmo told the Journal Sentinel that its partnership with the agency goes far beyond grant funding. Centers for Independence collaborates with agency officers to identify the best practices used across the country. That informs the organization's approach to addressing the considerable behavioral health needs impacting Milwaukee and Waukesha counties.
The organization works primarily with underserved populations. Its clients have severe and persistent mental illness like schizophrenia and severe bipolar disorder, said Jim Welsh, senior director of behavioral health services.
The multi-year grant addresses staffing shortages, a perennial problem across Wisconsin and the United States. It helps improve and enhance clinical treatment needs of patients across their lifespan. It also allows the Milwaukee center to reach children with behavioral health needs by establishing parenting supports, autism services and screening, and a children's behavioral health center.
But like Vidal from Meta House, layoffs at the federal level have caused delays.
Carson Maule, director of business operations, said Centers for Independence lost the government project officer it's been working with since June. The organization was assigned a new officer March 17, but the officer hasn't contacted leaders yet.
In the meantime, if the center has technical questions, it has to go through a call center, which guarantees neither immediate assistance nor access to someone familiar with the Milwaukee organization.
"The more support we have, the better. I don't know another way to say it," Elsmo said.
Saving lives is one thing; treatment is another
In a letter penned to Kennedy on March 6, some members of Congress, including U.S. Rep. Mark Pocan, a Democrat from Madison, expressed concern over what they described as reckless staff reductions. Congressional members pointed to the now-vacated Region 5 HHS office, representing Wisconsin, as well as Region 4, which represents eight states including Florida from the Southeast United States.
"Cutting SAMHSA employees without understanding the impact is extremely dangerous given the behavioral health crises impacting every corner of our nation," the letter said.
Baldwin, who introduced the National Suicide Hotline Designation Act that recast the crisis lifeline to the three-digit number 988, said that cuts to the agency jeopardize treatment.
"This one’s personal for me and the tens of millions of Americans who have watched a loved one battle addiction or mental illness," Baldwin said. "When calls start getting dropped at the suicide lifeline, first responders can’t reverse overdoses, and Americans lose lifesaving substance use treatment.”
Republican U.S. Sen. Ron Johnson could not be reached for comment.
A spokesperson from the White House declined to answer questions about the cuts to staff and funding, and said SAMHSA would continue to uphold its mission.
Trump and Kennedy have both been vocal about preventing opioid overdose fatalities. But some of those involved in treatment see a disconnect. Saving lives is one thing; treating people to avoid repeat episodes is just as — if not more — important to individual and community well-being.
"Saving people from the overdose incident isn't the end, it's the beginning of their journey," Vidal said. "They're going to need treatment resources to ensure that they're not in a life-threatening circumstance again."
Natalie Eilbert covers mental health issues for the Milwaukee Journal Sentinel. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her X (Twitter) profile at @natalie_eilbert.