The impact of cuts to federal mental health funding in Oklahoma
Over the past five years, Oklahoma has received nearly $750 million in funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), the primary federal agency charged with advancing the nation’s behavioral health.
This funding has largely benefitted children, rural communities, and Native American nations in Oklahoma. Additionally, the state’s mental health crisis services and efforts to address and prevent substance use disorders have also relied upon the agency’s data collection, guidance, and technical expertise.
Established in 1992 as part of a federal public health agency reorganization, SAMHSA operates within the U.S. Department of Health and Human Services (HHS). The agency’s five priority areas are preventing substance misuse and overdose; enhancing access to suicide prevention and mental health services; promoting resilience and emotional health for children, youth, and families; integrating behavioral and physical health care; and strengthening the behavioral health workforce.
On March 27, HHS announced that SAMHSA will be consolidated with several other health-related agencies into a new “Administration for a Healthy America.” This consolidation, along with recent and impending cuts to SAMHSA’s workforce and funding, has prompted significant uncertainty about the agency’s future services and grantmaking.
To better understand how these cuts will affect the behavioral health services available to Oklahomans, Healthy Minds Policy Initiative analyzed SAMHSA funding directed to Oklahoma entities. Our analysis finds that:
- Oklahoma has $449.3 million in active SAMHSA grants, of which $186.4 million has yet to be disbursed and would be at risk if previously awarded grants are not honored.
- At least half of these active grants support services for children, rural communities, and tribes, populations that would be disproportionately impacted by funding cuts. The remaining funding largely supports statewide or regional programs, many of which also benefit these populations.
- Returning to 2019 funding levels would mean a roughly 39% reduction in funding to Oklahoma, yet public health data indicate Oklahomans experience worse mental health outcomes now than in 2019.
SAMHSA funding in Oklahoma
SAMHSA makes funding available via non-competitive formula grants and competitive grants. Formula grants like the Community Mental Health Services Block Grant and the Substance Use Prevention, Treatment, and Recovery Services Block Grant fund critical services for vulnerable communities in the state. These prevention, treatment, recovery support, and other essential services are not covered by public and private insurance for low-income individuals.
The Oklahoma Department of Mental Health and Substance Abuse Services received roughly $33.6 million in funds from the mental health block grant and nearly $38.3 million from the substance use block grant across fiscal years 2021-2025. These grants focus on health promotion, prevention, improving access to services, reducing care disparities, enhancing service quality and accountability, reducing criminal justice involvement, and increasing public awareness. The populations served by block grant-funded services include people with serious mental illness, serious emotional disturbance, substance use disorders, individuals with co-occurring conditions, pregnant women, and individuals at risk for or living with HIV, among others.
In contrast, SAMHSA awards competitive grants based on project proposals that target specific programs, populations, or initiatives to improve mental and behavioral health outcomes. Competitive grants provide a spectrum of mental and behavioral health interventions such as substance use prevention and treatment, suicide prevention, improving mental health services for vulnerable populations, and behavioral health workforce development.
Healthy Minds analyzed SAMHSA grants awarded to Oklahoma since fiscal year 2019, including those with an initial award year as early as 2020. This review focused on active projects and remaining distributions. Between 2020 and 2024, Oklahoma received $749.8 million in SAMHSA funding — $449.3 million of which are part of grants that are considered active because they fund activities over multiple years. Of these, an estimated $186.4 million has not yet been disbursed.
SAMHSA commonly issues multi-year grants that are paid on an annual basis, or in some cases more frequently. For example, a $5 million, five-year grant made in 2022 would commonly be paid in equal installments each year. This means that, as of 2025, two additional years of payments would be expected on this hypothetical grant. The grant recipient — whether a state agency, nonprofit, Native American nation, city, or county — would often budget for offering these services each year through the life of the grant, often carrying staff or other costs to fulfill the terms of the grant.
In fiscal year 2019, SAMHSA awarded more than $83 million in grants to Oklahoma entities. The agency’s funding in Oklahoma grew to more than $136 million in fiscal year 2024, approximately 11% less than the previous award year but about 61% higher than that awarded in fiscal year 2019.
Based on previous awards, Oklahoma is on target to receive over $135 million for fiscal year 2025. However, the state has only received roughly $13.3 million to date. If SAMHSA’s funding were reduced to 2019 levels (a possibility that administration officials have reportedly considered), and if each state received an equal share of that cut, Oklahoma would expect $52 million less in funding from SAMHSA, a 39% reduction.
These potential cuts come at a time of increasing rates of mental illness in Oklahoma. Between 2019 and 2022, the state’s suicide death rate increased from 20.5 to 21.4 per 100,000 people. Overdose death rates also trended upwards, increasing 129% from 14.3 in 2019 to 32.7 in 2023.
Key populations impacted by SAMHSA funding
Children and youth
Oklahoma has more than a dozen active SAMHSA-funded grant programs addressing children and youth mental health. An estimated $109 million in funding will support school districts, tribal nations and organizations, municipalities, and state agencies through 2029.
Between 1999 and 2020, the suicide rate of Oklahoma youth ages 10 to 17 was double the rate of youth homicides. Data from the Oklahoma Prevention Needs Assessment, an anonymous survey of middle- and high-school students, found that more than a quarter reported high levels of psychological distress during the 2023-24 school year.
To address many of these challenges, school districts have seen substantial gains from SAMHSA funding across the state. Since 2018, Oklahoma has received multiple awards through SAMHSA’s Project AWARE (Advancing Wellness and Resiliency in Education) grant program. Project AWARE supports both infrastructure development and direct service delivery for state departments of education, local school districts, and Tribal education authorities.
Oklahoma’s first Project AWARE grant was awarded in 2018 to support mental health programming in Elk City, Weatherford, and Woodward, an area described by state officials at the time as a “mental health desert.” The grant provided mental health awareness training to teachers and staff, no-cost services to students, and increased support for families struggling with basic needs during the COVID-19 pandemic.
As of March 2025, there are three active Project AWARE grants in Oklahoma: Tulsa Public Schools, Maryetta Public Schools, and AWARE South, awarded to the Oklahoma State Department of Education to support Davis, Lawton, and Sulphur public schools. AWARE East, another state department AWARE grant supporting Ada City, Atoka, and Checotah Public Schools, is in its final year. AWARE East and Tulsa Public Schools were awarded almost $9 million over five years, and Maryetta Public Schools will receive almost $3.5 million.
In the last two years, the cities of Tulsa and Edmond received SAMHSA’s Grants for Expansion and Sustainability of the Comprehensive Community Mental Health Services, also referred to as the Children’s Mental Health Initiative (CMHI), for children with or at risk of developing Serious Emotional Disturbance. Like AWARE, CMHI supports infrastructure development and service delivery for children and youth birth through age 21. CMHI helps implement and expand services through the System of Care approach, stressing community-based, family-driven, youth-guided, and culturally competent care. State evaluations show the System of Care approach works in Oklahoma, leading to improvements in functioning while successfully decreasing rates of school suspensions and detentions, law enforcement encounters, self-harm, suicide, and behavioral issues.
Read more about Edmond and Tulsa’s integration of the System of Care approach into their community mental health strategies
The CMHI grant program includes a match component, and both cities have committed resources to developing System of Care infrastructure and programming, with SAMHSA funding amplifying their impact. Tulsa and Edmond received nearly $4 million each over four years and plan to integrate CMHI funding into broader community mental health initiatives.
SAMHSA’s other youth-focused grants in Oklahoma fund programming for urban, rural, and tribal communities. Programs such as Youth and Family TREE and Healthy Transitions support service delivery for transition-aged youth, a population that often faces barriers to mental health care access during a critical stage of psychological and social development. Other programs, such as Infant and Early Childhood Mental Health and Project LAUNCH, support innovation and service delivery for the youngest Oklahomans — notable in a state with consistently high rates of Adverse Childhood Experiences (ACEs).
Native American nations
Since fiscal year 2019, the 38 federally recognized Native American nations and tribes in Oklahoma have received nearly $74 million from SAMHSA. These investments offer essential support to address the mental and behavioral health needs of Indigenous peoples living in the state, with services for Indigenous communities that continue to face serious psychological distress 2.5 times more than the general population. Indigenous people also face disproportionally higher rates of post-traumatic stress disorder, substance use disorders, and suicide.
SAMHSA’s Tribal Opioid Response Grant is a significant funding source for multiple tribal nations in Oklahoma that increases access to culturally appropriate and evidence-based treatment, including medications for opioid use disorder. The grant covers the spectrum of opioid and stimulant use by addressing prevention, treatment, and recovery support activities.
Additionally, SAMHSA funds other substance use disorder initiatives in Oklahoma, such as expanding treatment capacity in drug courts, increasing access to medications for opioid use disorder, and providing resources for first responders to administer opioid overdose reversal medications. For example, these grants have allowed the Cherokee Nation to implement a robust harm reduction program, including a new facility.
Additionally, the Cherokee and other nations in Oklahoma are grantees for the Strategic Framework for Prescription Drugs. Despite comprising less than 6% of Oklahoma's population, nearly one-third of opioids distributed in the state in recent years went to communities within the Cherokee Nation. This grant aims to raise awareness about the harms of sharing medication and overprescribing, as well as increase utilization of the prescription drug monitoring program.
Suicide prevention is another critical focus of SAMHSA's grant allocation to tribal nations. The Tribal Youth Suicide Prevention and Early Intervention grant supports tribes implementing strategies in schools, juvenile justice systems, and other youth-serving organizations. While this grant serves youth, SAMHSA also offers grants for adult suicide prevention through the Zero Suicide model, a comprehensive approach most often deployed in health care settings to reduce suicide ideation, attempts, and deaths.
Native nations in Oklahoma have also benefited from the Native Connections grant program, which aims to reduce suicidal behavior and substance use among native youth and support youth as they transition to adulthood. The program also funds anti-homelessness efforts, HIV prevention, and the integration of tribal behavioral health services with the 988 Suicide and Crisis Lifeline.
Rural communities
One-third of Oklahoma’s population — nearly 1,295,000 people — live in the state’s 42 rural counties. These counties face unique challenges in the availability and accessibility of behavioral health care professionals and services. Nationally, rural areas face a shortage of providers, with 20% fewer primary care providers than in urban settings. Furthermore, 65% of rural counties do not have a psychiatrist, and 81% have no psychiatric nurses. Many rural residents must travel long distances to receive behavioral health care and rely on access to emergency care funded by federal grants.
Around 15 SAMHSA-funded grant programs exclusively address behavioral health issues in Oklahoma's rural counties, totaling $39 million. However, this total is likely vastly underestimated because the state receives significant funding for statewide and regional projects that affect large swaths of the state, including rural areas. Additionally, grants to some community mental health providers, such as Red Rock, also fund services in rural areas.
Grants targeting rural areas would be especially vulnerable to any claw backs of previously awarded grants — 42% of the awarded funds, or just over $16 million, have yet to be disbursed.
For example, the Rural EMS Training grant program recruits and trains EMS personnel to provide services such as administering naloxone or mental health first aid. Oklahoma currently has two of these grants, with nearly half of the award amount remaining unallocated.
Rates of depression and suicide are as much as 66% higher among people living in rural areas than for those living in urban settings. The Garrett Lee Smith Suicide Prevention grant program addresses these challenges by supporting the infrastructure needed to promote wellness and encourage people, particularly vulnerable students dealing with mental health and substance use issues, to seek treatment. Studies have found the program effective in decreasing suicide rates, especially in rural areas.
SAMHSA also offers the Mental Health Awareness Training grant, which trains people to recognize the signs and symptoms of mental disorders and how to safely de-escalate crisis situations involving individuals with a mental illness. Oklahoma has two of these grants, with nearly two-thirds of the funding still awaiting disbursement.
The impact of SAMHSA’s work in Oklahoma
As the leading entity responsible for training, guidance, and oversight of mental health functions in America, SAMHSA has long helped the nation’s front-line behavioral health clinicians and agencies deliver appropriate, evidence-based care. Outside of SAMHSA, state mental health agencies and local treatment providers often have little guidance outside on how to implement programs and effectively fund behavioral health treatment. Arguably, SAMHSA’s workforce drove the development of nationwide initiatives like the 988 mental health crisis call line and the framework for how to help alleviate the burden of mental health crises on law enforcement and other first responders — both of which have translated to critical new systems being developed in Oklahoma. We’ve compiled examples of impact in Oklahoma from the work of SAMHSA staff.
988 lifeline and crisis care support
SAMHSA has been instrumental in building infrastructure across the country for the 988 Suicide and Crisis Lifeline. SAMHSA’s Crisis Behavioral Roadmap helped Oklahoma establish its first crisis response system and launch of 988 in the state.
The agency provides crisis system training and technical assistance for 988 implementation, resources for partners like toolkits and publicity assets, and Lifeline Workforce and Infrastructure grants and cooperative agreements for states, territories, and tribes. SAMHSA also collects and makes available key data on 988 utilization and network performance metrics.
Beyond 988, SAMHSA also operates targeted 24/7 helplines, such as for people seeking information or treatment referrals for mental health or substance use needs or for people who need crisis counseling and support following natural or human-caused disasters.
For more than two decades, SAMHSA's support has helped Oklahoma shape and sustain mental health and substance use services, particularly for children and youth, by providing foundational resources that have molded the state's approach to service delivery. This partnership has enabled Oklahoma to build a sustainable infrastructure for children's mental health, ensuring that effective, community-based services are available and produce lasting, positive outcomes for children and families.
Data collection, analysis, and reporting
SAMHSA works closely with its grantees, federal and tribal partners, and others to collect valuable data that otherwise may not be accessible to local, state, or national agencies. Its data strategy includes systems for data collection, analysis, and dissemination to the public. Through multiple sources and surveys, SAMHSA makes available public-use data files and documentation to better understand behavioral health in the U.S.
One key data source is the National Survey on Drug Use and Health, which supplies population-based statistical data on alcohol, tobacco, drug use, and mental health. Additionally, SAMHSA collects data on mental health facilities, state agencies, and hospital emergency rooms across the country. This access allows for comprehensive data analyses across states, programs, and disorders. SAMHSA's data collection is important for funding requests and tracking behavioral health trends and outcomes.
Technical assistance and guidance
SAMHSA’s technical assistance helps grant recipients and mental health agencies nationwide develop effective programs and improve services for populations at greatest risk for adverse behavioral health outcomes. These services also aid in the adoption of evidence-based practices, ensuring compliance with federal regulations, developing the behavioral health workforce, and improving performance and financial management.
Furthermore, SAMHSA guidance helps Oklahoma comply with federal law and provide high-quality mental health and substance use services. For instance, Oklahoma’s mental health and Medicaid agencies’ administrative rules rely on SAMHSA guidelines for setting standards in treatment facilities, mental health services, and prevention programs. Without SAMHSA, Oklahoma could face challenges to compliance, a misalignment between state and federal standards, and an impact in the quality of services available to Oklahomans.
Considerations moving forward
Amid the Trump administration’s efforts to reduce federal spending and personnel, the full extent of cuts to SAMHSA’s funding and workforce is not known. To date, confirmed cuts include a reduction in grant funding from the American Rescue Plan Act and a 10% reduction in SAMHSA’s workforce.
Importantly, SAMHSA is not the only federal agency that supports mental health services in Oklahoma. Grants and funding through the Bureau of Justice Assistance and the U.S. Department of Housing and Urban Development, among others, also flow to Oklahoma entities serving people with mental health needs. Other federal agencies like the Department of Veterans Affairs directly provide mental health and substance use disorder services. Funding and services from these agencies are not included in our analysis of SAMHSA’s impact on Oklahoma.
Additionally, any cuts to Medicaid funding would likely affect Oklahoma far more profoundly than cuts to targeted and competitive grants via these agencies. With a proposed $880 billion cut to the federal budget, experts predict a potentially significant cut to Medicaid, which is utilized by roughly 1 in 4 Oklahomans.
As our state navigates this rapidly changing funding landscape, we encourage policymakers, treatment providers, and philanthropists to evaluate ways of ensuring the continued availability of critical behavioral health services that so many vulnerable Oklahomans rely on.
