����������

Alliance Alert: Ron Manderscheid, one of the nation’s most prominent thought leaders and mental health and substance related advocacy champions has issued the following stark warning around federal proposals that threaten hard-won policies that promote recovery, self-determination, equity, social justice and peer support. See here for our summary of SAMHSA’s recent release detailing those threats.

In less than 2 weeks, our Alliance’s Annual Conference will feature a number of presentations and panels designed to assess these threats and recommend a host of actions that we can take. Entitled  the conference will be held from September 29-Oct. 1^st at the  in Callicoon, NY. Please use the following links to register today for the  and for . Come Join Us!

See below for details of 2 prominent keynote panel presentations:

• September 30, 2015   10:00-11:15 am          FIGHTING FOR OUR RIGHTS AS IF OUR LIVES DEPENDED ON IT!

Leah Harris, Independent Journalist; Vesper Moore, COO, Kiva Centers; Vanessa Ramos, Senior Advisor, Disability Rights California; Ruth Lowenkron, Director of the Disability Justice Program, ���������� Lawyers for the Public Interest; Harvey Rosenthal, CEO, Alliance for Rights and Recovery; Moderator: Laura Van Tosh, Board Chair, aves-Mental Health (formerly Global Mental Health Peer Network)

• October 1, 2025         10:00-11:15 am          TAKING UP THE FIGHT TO ADDRESS FEDERAL POLICY THREATS!    

Congressman Paul Tonko; Paolo del Vecchio, Independent Consultant; Jennifer Mathis, Deputy Director Bazelon Center for Mental Health Law; Rob Kent, President, Kent Strategic Advisors; Angelia Smith-Wilson, Executive Director, FOR-NY, representative for Faces and Voices of Recovery. Moderator: Luke Sikinyi, Vice President for Public Policy, Alliance for Rights and Recovery

=========

SAMHSA’s New Priorities Can Undercut 25 Years of Progress in Behavioral Health
By Ron Manderscheid, PhD Adjunct Professor Johns Hopkins University and University of Southern California  September 11, 2025

Yesterday, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a new set of strategic priorities intended to guide federal investment and policy in the field of behavioral health. While the agency presents these priorities as forward-looking, responsive to current needs, and aligned with cross-agency initiatives, they represent a sharp departure from the principles and progress painstakingly built over the past quarter century. For many practitioners, researchers, advocates, and people with lived experience, this realignment risks undoing the advances made since the late 1990s in recovery orientation, consumer voice, peer support, integrated care, and the recognition of behavioral health as inseparable from overall health. The purpose of this commentary is to examine SAMHSA’s newly announced priorities, explain their significance, and outline why they may undermine decades of hard-won progress.

Over the past quarter century, U.S. behavioral health policy has moved—haltingly but measurably—toward four pillars: (1) harm reduction integrated with treatment and recovery; (2) person- and community-centered care that elevates lived experience and addresses inequities; (3) crisis response that diverts from jail and hospital whenever safe; and (4) rigorous, transparent science. The “SAMHSA Strategic Priorities” page updated September 10, 2025, signals a major turn away from that trajectory. The document recasts the agency’s mission around six headings—preventing substance misuse; addressing serious mental illness; expanding crisis intervention; improving access to evidence-based treatment; achieving “long-term recovery and sobriety”; and tracking “emerging threats”—but embeds them in explicitly political frames, repudiates prior investments as “misguided,” and warns against “any unlawful focus on specific populations (see SAMHSA).”

Why does that matter? In practice, the words and omissions mark a shift from the field’s consensus—meet people where they are; reduce immediate harm; uphold choice and dignity; build equitable, coordinated systems—toward an abstinence-primary posture that narrows what counts as “evidence-based,” sidelines harm reduction, and widens coercive levers. Three immediate examples show how the new priorities could undercut hard-won gains.

First, the new approach reframes harm reduction itself. It asserts that naloxone and nalmefene have been “lumped into an ideological concept of harm reduction” and aligns SAMHSA with guidance to ensure grants “do not fund” harm-reduction or “safe consumption” efforts, except for tightly circumscribed supplies, while explicitly prohibiting federal support for syringes, safer smoking supplies, sterile water and other materials that decades of research link to reduced infectious disease transmission and overdose risk. This is not a minor clarification; it walks back a central plank of overdose response that has helped keep people alive long enough to access treatment and recovery.

Second, the priorities page cites expansion of Assisted Outpatient Treatment (AOT) and civil commitment as exemplars of “putting priorities to work.” While AOT can be narrowly helpful for some, the evidence base is mixed and deeply context-dependent; scaled loosely, it can crowd out voluntary, community-anchored supports and damage trust, particularly for communities that have borne disproportionate surveillance and coercion. The page also emphasizes “strong partnerships between crisis care systems and law enforcement,” a step backward from the last decade’s cross-agency push to build civilian, health-led crisis continuums (988 + mobile teams + stabilization) precisely to reduce unnecessary police contact. The risk is a major pull back to public-safety frames and away from the health-first, diversion-first model that jurisdictions have been painstakingly assembling.

Third, the updated priorities are being rolled out amid major structural uncertainty. HHS is moving to consolidate agencies into a new “Administration for a Healthy America,” with credible reporting that SAMHSA could be absorbed. Even if the final contours change, the signal is unmistakable: fewer dedicated behavioral-health champions inside the federal architecture, more central control, and potential dilution of specialized grant-making and technical assistance capacity—the very capacities that powered the field’s progress on crisis systems, block grants, and community-based innovations (see Politico+1).

Seen against the last quarter-century, the consequences could be profound:

• Harm reduction is a bridge, not a wedge. Since the late 1990s, federal and state policy learned (often the hard way) that harm reduction and treatment are complements. Syringe services cut HIV/HCV transmission; safer-use education and supplies reduce fatality risk; low-barrier engagement builds trust and opens doors to MOUD and recovery supports. SAMHSA’s new guidance draws a bright red line through many of those tools. Programs will scramble to fill funding gaps with state, local, or private dollars; many will not succeed. The likely result: more infections, more disengagement, and fewer opportunities to transition to care—especially for people at the margins of the system.

·       Equity and lived experience will move off center stage. The

strategic text’s warning against “any unlawful focus on specific populations” sounds neutral but, in practice, chills targeted investments that the field has used to close gaps (e.g., culturally grounded services; youth-specific prevention; programs for people exiting jails; tribal initiatives). It also contrasts sharply with SAMHSA’s 2023–2026 plan, which organized around prevention, access to suicide prevention and mental-health services, resilience for children/youth/families, integration with physical health, and workforce—priorities developed with and for communities and explicitly attentive to underserved groups. That prior framing aligned with the science of health equity; the new language risks flattening policy into one-size-fits-all funding that reproduces disparities.

• Crisis care is re-policed. The last decade’s progress on crisis response—culminating in 988, civilian mobile teams, and stabilization alternatives—has been about right-sizing law enforcement’s role. The priorities page re-centers “strong partnerships” with police and elevates AOT/commitment. That creates perverse incentives for states and grantees: faster growth for coercive levers, slower build-out of voluntary, health-led teams; more transport to EDs or lock-ups when a therapeutic alternative existed; more people deterred from dialing 988 if they fear a police response or a court order. These shifts directly threaten the logic many systems (including California’s) have been developing around diversion and continuity of care.

• Science under threat. The priorities page repeatedly invokes “gold-standard science” while, in the same breath, pre-judging whole classes of interventions as “misguided” and aligning the agency to slogans. That posture blurs the boundary between evidence synthesis and political messaging. Over time, it weakens SAMHSA’s convening credibility with states, researchers, clinicians, and peers—the network that powers guidance, TA, and continuous improvement.

• Housing, with coercion over choice. Recent funding announcements emphasize “building cross-system capacity” for people who are “non-adherent to voluntary outpatient treatment” and promote AOT in homelessness work. Again: some courts use AOT carefully as a last resort; but embedding it as a “key priority” within housing initiatives risks conflating access to shelter with compliance mandates, undercutting Housing First principles that have decades of supportive evidence.

What should leaders, advocates, and providers do now?

·       Protect the continuum. Document, publish, and brief local

officials on how harm-reduction services feed engagement and treatment; quantify infections averted, overdoses reversed, and transitions to MOUD. Move quickly to braid state/local/private dollars to avoid service breaks.

·       Keep crisis care health-led. Maintain MOUs and dispatch

protocols that default to civilian teams, with law-enforcement backup only when necessary. Track—and publicly report—metrics on diversion, safety, and user experience to show why the health-first model outperforms carceral alternatives.

·       Safeguard equity. Continue legally sound targeting of

resources to populations with the largest gaps; ground this in scientific epidemiology. Reuse the 2023–2026 plan’s framing—integration, youth resilience, workforce—as a crosswalk for state plans and grant applications to maintain momentum inside today’s shifting federal landscape.

·       Defend scientific independence. In advisory bodies, peer

reviews, and public comments, insist that “gold-standard science” means open methods, unbiased reviews, and complete evidence summaries—including findings that favor harm-reduction modalities and voluntary care.

Conclusion

SAMHSA’s newly announced priorities represent more than a bureaucratic shift—they threaten to reverse 25 years of progress in behavioral health. By sidelining recovery, weakening consumer voice, marginalizing peer support, narrowing integration efforts, and retreating into fragmented categorical silos, SAMHSA risks undoing reforms that have improved lives across the country. Stakeholders must respond quickly to ensure that behavioral health policy continues to move forward—not backward—so that the vision of recovery, dignity, and full community inclusion remains central. This will involve reaching out to work with SAMHSA to change the priorities just announced. The next 25 years of progress depend on it.

© 2025 R.W. Manderscheid