Rural Mental Health Services Face Funding Cliff

Federal cuts threaten crucial programs in underserved communities.

Proposed federal budget cuts are putting mental health and addiction recovery programs serving rural communities at risk. For many, the services are a lifeline amid a growing crisis.

Idaho Program at Risk

Ten years ago, after **Nancy Winmill’s** son survived an opioid overdose, she found virtually no local support in Burley, Idaho. This led her to establish Simply Hope Family Outreach, a nonprofit providing support groups and counseling for addiction, codependency, and other issues.

“I had no idea what to do or where to go. I had no help. I had no resources,” **Winmill** said.

Funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) via the Building Communities of Recovery Grant (BCOR) fueled its rapid expansion. “For rural communities like ours…this grant has been nothing short of transformational,” **Winmill** stated.

However, this grant is now on the chopping block, threatening the organization’s future.

Proposed Budget Cuts

The FY2026 Department of Health and Human Services (DHHS) budget proposes cutting nearly $1 billion from SAMHSA, eliminating programs like BCOR. This follows a March announcement to fold SAMHSA into a new Administration for a Healthy America.

“In a region where stigma still silences many, this grant has empowered us to bring these issues into the light, and offer pathways to healing and hope,” **Winmill** explained. “Eliminating this funding would not only stall progress, but potentially reverse hard-earned gains in recovery support for our rural neighbors.”

Mental Health Crisis in Rural Areas

“We’re not being extremist when we say that there is a mental health crisis in rural America,” said **Don Hannaford**, vice president of public policy at Rural Minds.

Rural areas experience similar rates of mental illness as urban centers, but almost double the suicide rate. According to the CDC, in 2021, suicide rates were highest in rural (20.0%), compared to medium/small metro (15.8%) and large metro (12.6%) areas (CDC).

They also have fewer primary care providers and slower workforce growth. Sixty-five percent of rural counties lack a psychiatrist.

These communities also face a 45% higher opioid overdose rate than urban areas, while only 14% of behavioral health facilities are rural.

**Katherine McGuire**, chief advocacy officer for the American Psychological Association (APA), said that “The unmet need for treatment in many rural communities continues to outpace the treatment workforce and other resources available to rural communities.”

Defunding Programs

The proposed budget would defund the vast majority of SAMHSA’s Programs of Regional and National Significance (PRNS), discretionary grants that fund a wide range of mental health, substance abuse treatment, and prevention efforts.

**Jonah Cunningham**, executive director of the National Association for Rural Mental Health (NARMH), noted these programs expand crisis services and connect more people to care. “Behavioral health comes in all shapes and sizes,” **Cunningham** stated. “These grant programs are ways to build upon proven, evidence-based practices, expand them, and then also to respond to pressing issues.”

For Simply Hope, the SAMHSA BCOR grant enabled them to expand programming to adults. Project Director **Sheri Allred** is now uncertain about the future.

“We were supposed to receive just under $300,000 for a second and third year,” **Allred** said. “And that’s when we realized that we haven’t gotten the approval for the continuation grant.”

**Winmill** said they recently used grant funds to hire a new counselor scheduled to start in July. “I made a promise,” **Winmill** said. “She left her job and she’s coming over starting July first. It’s concerning to me that they don’t realize that there’s people with families. It’s stressful.”

Recovery Alliance Duluth (RAD) in Minnesota is facing similar uncertainty and has used its BCOR grant to expand recovery support services.

**Jenny Swanson**, executive director of RAD, said eliminating the BCOR grant will likely mean cutting peer recovery support staff and ending wellness programming. “What’s at stake is not having peer staffing in those treatment courts,” **Swanson** said.

“We would definitely have to stop the whole wellness program immediately,” **Swanson** added.

The Western Idaho Community Action Partnership (WICAP) previously secured $800,000 in Project LAUNCH grants from SAMHSA to advance early childhood mental health.

**Connie Kreps**, WICAP’s executive director, said, “Sadly the elimination of SAMHSA will no longer afford us the opportunity to apply for such competitive grants from SAMHSA that positively impact and teach parents essential skills.”

**Hannaford** emphasized that even small changes to funding can have outsized impacts. “For the rural communities that are already pinched, losing a federal grant of any significance frequently has the result of either eliminating programs or in some cases, eliminating the organization,” **Hannaford** said.

An Uncertain Future

Without visibility, many are scrambling to preserve resources. Clinicians, community organizations, and families are already seeing resources dissolve.

“I use the SAMHSA webpage all the time to get best practices…I’ve seen them already disappearing,” **Swanson** said.

**Winmill** said decreasing overdose deaths indicate these programs work. “If it’s all working, why are they going to reduce the programs? Why are they cutting it now? It’s not over,” **Winmill** said.

**Swanson** also pointed out that the priorities of the new Administration for a Healthy America appear misaligned with SAMHSA’s core programs.

For Simply Hope, any pause in funding could be harmful. “Even if they revise or revamp their programs, that’s still going to take time. And that time is critical when you’re dealing with these populations,” **Allred** said.

Despite the threat of cuts, **Allred** said, “We would take a real hit (with these cuts), but we would figure it out, because we will always fight for the programs.”