Countering Cuffs and Cages with Compassion

Building a National Behavioral Health Policy Plan Grounded in Science and Equity

🔻 Bottom Line Up Front:
As the Trump administration dismantles SAMHSA and guts prevention funding, we must chart a new course for behavioral health. This piece outlines five national priorities rooted in science, equity, and compassion — a starting point for a field-led alternative to a cruel and regressive federal agenda.

On April 1st, the Trump administration released its 2025 Statement of Drug Policy Priorities. In isolation and without the context of what his administration is doing to SAMHSA and other parts of HHS, one could read the document and perhaps find it to be at least somewhat reasonable direction for drug policy. However, that is still being charitable as a review of the document makes it clear this administration is returning to the failed philosophy of trying to arrest our way out of our nation’s struggles with addiction and overdoses.

Moreover, the Trump administration IS dismantling SAMHSA and decimating our national infrastructure to address addiction. For instance, here is the statement on prevention from the plan:

Prevent Drug Use Before It Starts

Objective: Reduce the initiation of drug use, particularly among young people.

Preventing drug use before it starts is vital to protect future generations of Americans from the devastating impact of addiction. The Administration will encourage educational campaigns and evidence-based prevention programs, particularly in schools and communities. We will collaborate with state and local organizations to focus on building resilience in youth and promoting healthy behaviors. We will use all forms of media, with an emphasis on social media, to connect directly with Americans to raise awareness and educate them about the dangers of illicit drug use and how to avoid it, how to prevent overdoses and save lives, and how to access treatment and recovery services.

Yet, as I wrote about here, this same administration is proposing to end nearly all discretionary grants for prevention, while combining the mental health, substance use disorder, and opioid response block grants into one block grant with no minimum funding amount for prevention services. So this prevention priority is hollow, at best, and seems in the end to mostly be focused on national messaging campaigns. Given this is the same administration building and funding the “Alligator Alcatraz” concentration camp (because yes, that is what it is), I can only imagine prevention messaging will go back to fear-based campaigns.

This administration doesn’t want to build behavioral health solutions that address trauma, it wants to use trauma as tool for prevention, treatment, and recovery. It doesn’t want to implement harm reduction, it wants to increase harms to the underserved and marginalized.

We Need an Alternative National Plan for Addiction and Mental Health Services

Given that we can be certain that we cannot rely on this administration to lead the nation with a science-based, compassion-based plan for addiction and mental health services, it is upon us in the field to rally together to develop and offer a counter to a plan that wants to take us back to the 1980’s. While no one as appointed me shadow Assistant Secretary of Substance Use and Mental Health Services, in modesty and for consideration, I would like to propose a starting point for discussion.

As a former SAMHSA Regional Director, my work and activities were guided by the agency’s 2023-2026 Strategic Plan and the five priority areas within the plan.

The SAMHSA 2023-2026 five priority areas are:

• Preventing Substance Use 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

• Strengthening the Behavioral Health Workforce

To be sure, these are still very good priorities, and technically, are still the priorities that guide the work of SAMHSA. The extent to which this administration allows the good folks remaining at SAMHSA to carry out programs within these priority areas is unclear. But given the Executive Orders on things such as DEI and “gender ideology”, it is quite certain SAMHSA is not allowed to implement truly equity-based programs and activities within the priorities. So, again, it’s up to the rest of us in the field outside of the federal government to set a direction for how we try to fill gaps and move behavioral health forward during this administration.

So, I submit for your consideration, the five following national priorities for behavioral health in 2025. I offer brief commentary on each and will devote future essays with more detail and research supporting the priority:

Americans from all communities have access to culturally responsive behavioral health services

There is no question that “one-size-fits-all” approaches to addiction and mental health are approaches that will fail to properly serve all Americans. Whether we are talking about prevention, treatment, harm reduction, or recovery services, the science is clear that services are most effective when culturally tailored to diverse populations. Indeed, when it came to building and launching the 988 Suicide and Crisis Lifeline, access lines were created for veterans, deaf/hard of hearing, Spanish-speaking, and LGBTQIA+ populations. Why? Because the evidence was clear that the lifeline will be more effective with those culturally-tailored services. But sadly the Trump administration is no longer “siloing” (such shameful language!) services for LGBTQIA+ callers, because apparently offering life-saving care to those callers is “gender ideology”.

This is why, for instance, when you are searching for an evidence based program on Blueprints for Healthy Youth Development, each program on the registry includes a section describing what populations were studied in the program evaluation. Latino youth deserve prevention programs studied and validated with Latino youth populations. African-American students deserve school-based programs that were tested and validated with African-American youth. The Trump Administration does not believe in this and are actively fighting against this with executive orders and policies dismantling anything and everything “DEI”.

We continue to meet Americans where they are at in their recovery journey, with love, not handcuffs

The Trump administration lied to voters when it said in implementing immigration enforcement it would focus only on those people who were dangerous and violent. It was always part of Stephen Miller’s xenophobic master plan to go after every black and brown undocumented individual in the country. It is hard to imagine this lack of deference will not carry over to enforcement of drug policy. That is to say, I don’t believe for a second they will only go after violent individuals selling drugs in communities. If you use any substance that is currently illicit federally, you will be fair game. (Especially if you are also not white)

We need a vigorous and unified campaign of advocacy, and legal challenges, to fight against any and all unjust treatment of people who use substances. We need to continue the philosophy we had at SAMHSA under the Biden administration, of meeting people where they are at, and not leaving them there, bringing compassionate, and science-based harm reduction services to help individuals being their path to recovery.

States, Territories, Tribal Nations, and Communities have access to timely and robust data sources to guide the development and deployment of behavioral health services

It was widely reported that amongst the many firings at SAMHSA (like yours truly), RFK’s HHS fired the entire team working on the National Survey on Drug Use and Health. This development, along with again pointing to the executive orders on DEI and “gender ideology” will but, at best, a chill on timely data that is granular at population levels that encompass diverse populations. The bottom line, it may become much more challenging for states and communities to have the robust data they need to accurately and precisely plan and implement effective behavioral health services.

We need a pressure campaign, both on the administration but also on our Representatives and Senators, to do what needs to be done to preserve NSDUH and other vital sources of behavioral health data. That must include continuing to collect and make available data related to diverse populations including our fellow LGBTQIA+ Americans. Meanwhile, exploring more data sharing between states and the roles that foundations and universities can play in shoring up and building repositories of data.

Restore and Protect the Federal Workforce dedicated to addressing the nation’s behavioral health priorities

This one is simple. SAMHSA must be saved and restored. Before Trump took office we had an amazing workforce of nearly 900 dedicated professionals. Despite what Trump, Elon, or Russ Vought would say, no one was waste, no one was duplicative. We needed everyone in every role, and we still needed more! And yes, that means re-opening and re-staffing all ten of the Regional Offices. Let us get back to work!

Hollowing out SAMHSA and absorbing what’s left into the Administration for Healthy America greatly diminishes the nation’s ability to address our pressing addiction and mental health challenges. It is leaving Americans without the impactful, culturally-responsive, science based services they deserve.

Professionals and Volunteers in the Behavioral Health Workforce have equitable access to culturally responsive training and technical assistance services to promote advancement and effective services for their communities

While it appears this administration is maintaining several of SAMHSA’s training and technical assistance programs in its 2026 budget proposal, many others would be ended, including population-based centers of excellence. While not specifically called out in the official budget, a previous leaked version of the 2026 budget specifically stated it would end funding for these centers.

“The Budget does not include funding for the LBG Center of Excellence, the African-American Behavioral Health Center of Excellence, the Asian-American, Native Hawaiian, and Pacific Islander Behavioral Health Center of Excellence, Hispanic/Latino Behavioral Health Center of Excellence, and LGBTQ Youth Family Support Program.”

We need these centers of excellence. We need a robust infrastructure of training, technical assistance, and professional development for our behavioral health workforce. We need our prevention providers, and our treatment providers, and our harm reduction providers, and our recovery providers to be trained to learn new skills, to be on the leading-edge of science-based services, and to understand the most effective and impactful methods for serving diverse populations. If the administration is going to vacate this space, as a field we need to find a way to fill that gap. It’s an opportunity for foundations and universities to come together to fund and build new programs to take the place of those that are being shuttered.

Moving to Action

These five ideas are all well and good for content for a SubStack article, but how the heck would this even get operationalized? That is the multi-billion dollar question. Clearly we need an effort to organize and galvanize. Whether it’s these five priorities or a different set of priorities, it would be ideal to find a way to bring our field together to develop a north star, a set of goals, principals, whatever you want to call them, to offer a counter vision for behavioral health that is…

ACTUALLY based in science

UNFLINCHINGLY rooted in meeting people where they are at

DEFIANTLY grounded in equity and addressing health disparities

There are so many amazing individuals and organizations in all corners of our country addressing the different facets of work under the umbrella of behavioral health. While on balance this is a good thing it does create a strategic disadvantage in being able to push back against Trump’s trauma machine. Somehow we need to develop communication and collaboration channels to come together and create this central ethos.

I’ve got a zoom account! If you are reading this and have ideas, on how to organize, edits to my suggested national priorities, completely different ones I don’t have on my list, give me a shout! Let’s get together and figure out how we do what needs to get done to push back and serve ALL of our fellow Americans!