How Trump's Budget Impacts Key Mental Health Services

By Isha Weerasinghe

Daily life can be a struggle for people experiencing mental health issues. And for the majority, it would only get harder under President Trump’s budget.

Trump’s proposals for mental health funding would gut Medicaid and focus almost exclusively on opioids, undermining access to a broader array of mental health supports. The budget includes set-asides for opioid overuse prevention, surveillance, treatment, recovery support, and reversing drug overdoses through the Substance Abuse and Mental Health Services Administration (SAMHSA) and Centers for Disease Control and Prevention (CDC). In addition, the budget proposes monies to be allocated toward trauma counseling, violence prevention, and academic support related to opioid use and misuse.

The positives of those proposed funding levels are juxtaposed with significant, damaging cuts to Medicaid and Medicare. These cuts set the stage for per capita caps and Medicaid block grants. The president claims this will provide states with needed “flexibility,” but its true goal is to undercut Medicaid reimbursement payments. That will deter states from providing depression screening, and preventive services that maintain and improve mental health. This would be devastating for populations in poverty, particularly people of color, who are most likely to be insured by Medicaid and would increase racial disparities in mental health.

The president’s budget also includes language to increase the number of mental health services for those with severe mental illnesses through the Community Mental Health Services Block Grant as well as support for veterans’ mental health services, including suicide prevention. The budget fails to provide mental health funding directed toward young children and families, communities of color, people who are poor, and people who are limited English proficient. These groups can experience high rates of anxiety, depression, and myriad other conditions as well as barriers to getting care. They also may not trust the health system because of prior experiences or different cultural norms and fear their immigration status will impact their care. After a year of cruel rhetoric and enforcement policy, immigrants also fear that accessing care may impact their immigration status.

By vilifying the mentally ill and proposing to cut and restructure Medicaid and Medicare, the Administration has made it even harder for people in poverty to access mental health services. That’s deeply inhumane and bad policy for the country. We need to fund sustainable, cross-agency solutions focused on changing systems, getting people into care, and ensuring they stay connected. This would ensure every American can access health care and social supports for a range of mental issues. It would also alleviate the burden that state and county departments experience in addressing mental health and substance use.