On April 2, 2025, the U.S. Department of Health and Human Services (HHS) issued layoff notices to the 17-member team responsible for analyzing the National Survey on Drug Use and Health (NSDUH), a critical annual survey that has monitored substance use and mental health trends across the United States since 1971. This move is part of a broader reorganization under Health Secretary Robert F. Kennedy Jr., aiming to consolidate various HHS agencies into a new entity, the Administration for a Healthy America (AHA).

The NSDUH provides essential data on tobacco, alcohol, and drug use, as well as mental health indicators, informing prevention programs, treatment services, and policy decisions nationwide. The layoffs have raised concerns about potential delays or gaps in the analysis and dissemination of the 2024 survey data, which could impact public health initiatives.

Health Secretary Robert F. Kennedy Jr., confirmed on February 13, 2025, has initiated a significant restructuring of HHS. The plan includes merging the Substance Abuse and Mental Health Services Administration (SAMHSA) with other agencies to form the AHA, aiming to improve operational efficiency and reduce redundancy within the department. The reorganization also involves a reduction of approximately 10,000 full-time employees, representing about 25% of the department's workforce. These cuts are expected to save $1.8 billion, approximately 0.1% of HHS's $1.7 trillion annual budget.

Public health experts have expressed alarm over the potential consequences of these layoffs. Dr. Ruth Potee, medical director for seven methadone clinics in Massachusetts, stated, "There’s a reason why we have reduced overdose in this country, it’s because SAMHSA has been doing its job so well." She emphasized that the restructuring could stall progress on overdose deaths and disrupt essential services.

The creation of the AHA and the broader HHS restructuring have drawn criticism from public health experts, former officials, labor unions, and Democratic lawmakers. Critics argue that the layoffs will severely impact the department's capacity to respond to public health crises. Senator Patty Murray described the plan as "an absurd suggestion" that "defies common sense," citing ongoing outbreaks of bird flu, measles, and the fentanyl epidemic. Labor unions also raised concerns. Doreen Greenwald, president of the National Treasury Employees Union, which represents around 18,500 HHS staff, stated the administration's claims that deep cuts to agencies like the Food and Drug Administration would not be harmful were "preposterous," and vowed to "pursue every opportunity to fight back."

The reorganization plan also includes a controversial cap on research grant overhead costs. Calley Means, a close adviser to Kennedy, defended the restructuring but struggled to demonstrate how it would enhance public health, especially as the National Institutes of Health has faced grant cuts and staffing losses under previous administrations.

The layoffs and restructuring under Kennedy's leadership are reminiscent of past efforts to reform mental health treatment, such as the 18th-century "moral treatment" practices that emphasized manual labor and natural settings. However, historical precedents like the Retreat and federal narcotic farms failed when scaled, often leading to abuse and high relapse rates. Critics argue that Kennedy's emphasis on natural remedies and rejection of psychiatric medication is overly simplistic and detached from current debates.