This week in US mental health policy: fifteen states sued to stop the administration from defunding school mental health grants in defiance of a court order; SAMHSA survived elimination again but faces deep cuts; and the One Big Beautiful Bill’s Medicaid dismantling enters the rulemaking phase where the real damage is determined.

One year since the One Big Beautiful Bill Act became law, the cuts to Medicaid are moving from spreadsheet projections to shuttered psychiatric units. Here is what has actually happened — and what is still coming.

The US mental health system is navigating a cascade of funding cuts, a new Medicaid rule that threatens coverage for millions with mental illness, and a government that keeps reversing itself — with real people absorbing every shock.

The federal government is simultaneously proposing new SAMHSA cuts, enforcing a narrowed Medicaid medical-frailty rule that threatens coverage for millions with serious mental illness, and leaving mental health parity protections unenforced. This is a structural attack on the behavioral health system at the moment of greatest need.

The One Big Beautiful Bill Act is law. SAMHSA is being hollowed out. Mental health parity enforcement is suspended. This is where the US mental health system stands in June 2026 — and it is not where it was promised to be.

A new House appropriations bill deepens mental health funding cuts, Medicaid rollbacks take concrete legal shape, and parity enforcement remains suspended. The US mental health system is being systematically dismantled while demand is at a historic high.