Behavioral Health: Reported Funding for COVID-19 and 988 Suicide & Crisis Lifeline, 2020-2025
Fast Facts
Mental health, suicide, and substance misuse issues have increased in the U.S. The federal agency that oversees such issues saw its budget more than double in FY21 due to increased COVID-19 and 988 Lifeline funding. This Q&A examines the use of that funding.
The agency received $8.5 billion for COVID-19. It awarded about $8.3 billion in grants for activities such as community mental health. Recipients spent about $6.9 billion as of July 2025.
The agency got $1.6 billion in FY21-24 for the 988 Lifeline, a call, text, and chat hotline supporting those in crisis. It awarded $1.2 billion to funding recipients, who had spent about $906.3 million.
A person with a headset for phone calls looking concerned and listening.
Highlights
What GAO Found
Behavioral health issues, including substance misuse, mental health, and suicide affect millions of people in the U.S., representing a serious risk to public health.
The Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services (HHS), received $8.5 billion in supplemental appropriations in fiscal years 2020 and 2021 to address behavioral health needs related to the COVID-19 pandemic. Of the $8.5 billion in COVID-19 supplemental funding for behavioral health, SAMHSA awarded approximately $8.3 billion in grants to recipients including Tribes and tribal organizations, states, territories, and non-governmental organizations for projects beginning in fiscal years 2020 through 2025. Supported activities from the awards included community mental health services and programs to address substance use and mental health issues during the COVID-19 pandemic. SAMHSA used about $195 million for internal purposes that included administrative costs.
As of July 2025, recipients had spent about $6.9 billion of the $8.3 billion. About $1.4 billion remained unspent. Of the remaining unspent funds, about $616.5 million were available for awardees to spend. About $787.7 million of the unspent funds were no longer available for awardees to spend because the planned project period for those awards had ended or the awards were terminated.
Additionally, according to SAMHSA, of the $1.6 billion SAMHSA awarded in fiscal year 2021 through July 2025 to create and support the 988 Lifeline, SAMHSA awarded a total of about $1.2 billion for six cooperative agreements to a network administrator, Tribes and tribal organizations, states, territories, and 988 Lifeline contact centers to implement, expand, and support the 988 Lifeline.
The 988 Lifeline provides free and confidential emotional support to people in suicidal or emotional distress via call, text, and chat. According to SAMHSA, the agency uses cooperative agreements, a type of federal assistance similar to grants, for funding when the federal government expects to have substantial involvement in a program, along with the recipient. SAMHSA used about $400 million for additional grants, internally for staffing and program management, and other activities to support the 988 Lifeline.
As of July 2025, recipients had spent about $906.3 million of the $1.2 billion. About $298.9 million remained unspent. Of these unspent funds, about $22 million were no longer available to be spent as the funds had been awarded to a project that had ended.
SAMHSA also hired additional staff—some of them temporary—to manage increased administration responsibilities connected with the COVID-19 supplemental funding and established a new office to support the 988 Lifeline.
To monitor the use of the COVID-19 supplemental and 988 Lifeline funding, SAMHSA officials said they followed the same grant program monitoring processes used for all SAMHSA grants. These processes included award recipients collecting and reporting performance measurement data to SAMHSA, as well as submitting performance progress and financial reports to SAMHSA on a regular basis, such as quarterly or annually.
Why GAO Did This Study
The additional COVID-19 supplemental appropriations in fiscal year 2021 more than doubled SAMHSA's budget from the preceding year, and the 988 Lifeline funding further increased SAMHSA's budget during this period. In light of these large increases in SAMHSA's funding, GAO was asked to examine the use of COVID-19 and 988 Lifeline funding and adjustments SAMHSA made to accommodate this influx of funding.
This report provides information on the funding SAMHSA received and distributed related to COVID-19 and the 988 Lifeline. To conduct this work, GAO reviewed SAMHSA evaluation plans and progress reports, and obtained and analyzed spending data as of July 2025, the most recent period for which data were available at the time of our review. GAO also conducted an interview with and obtained written responses from SAMHSA officials about how SAMHSA managed the COVID-19 supplemental and 988 Lifeline funding.
For more information, contact Alyssa M. Hundrup at hundrupa@gao.gov.