Influential Lobby Group Tells Trump to “Abolish” SAMHSA

The Manhattan Institute is also pushing for more psychiatric coercion and incarceration

Axe chopping down a building, and the building has the SAMHSA name on it

When this mental health policy op-ed from the influential Manhattan Institute “think tank” and lobby group appeared in early January, I was struck by its draconian attitudes and proposals. “Policy analyst” Carolyn Gorman’s key arguments and positions were so extreme and self-contradictory, though, that I didn’t take it very seriously.

However, the political climate has changed drastically since President Donald Trump’s inauguration. Trump and Elon Musk have already in a few short weeks empowered a mini-army of operatives to dramatically reshape, neutralize, gut, or completely destroy a wide range of public agencies. Consequently, one has to consider seriously what just a month ago seemed utterly unlikely: The federal Substance Abuse and Mental Health Services Administration (SAMHSA) could be next on the hit list.

That’s because it’s actually what more than one prominent, influential right-wing lobby group has long pushed for—and based on what we see happening, these arguments may catch Trump’s ear, and support, more than ever. If the Manhattan Institute gets its way, all financial support would also be cut for any investigations of systemic abuses in mental health facilities around the country. In addition, involuntary commitments will increase dramatically—because there will be ever-fewer alternatives.

And all of this is all the more concerning and frustrating when, as is becoming much too common in public debates, a lot of the “evidence” presented to build the case for these sweeping changes is misrepresented and/or misleading.

Gorman’s op-ed for the Manhattan Institute’s City Journal doesn’t mince words: It’s titled “Trump Should Abolish the Federal Mental-Health Agency—SAMHSA harms those it is designed to help.” And she immediately appeals to popular conservative tropes, claiming that completely shutting down SAMHSA would “improve public safety, push back on progressive cultural politics, and cut wasteful federal spending.”

As regular readers know, I criticize SAMHSA a lot myself—especially on how the agency blocks freedom of information requests and helps the 988 Lifeline mislead callers about the likelihood of unwanted law enforcement interventions and forced psychiatric hospitalizations. However, I also know that $8 billion annually is a lot of money, and SAMHSA is a sprawling agency that helps fund a vast range of untold thousands of different state-government agencies, nonprofit organizations, programs, and initiatives around the country—one needs a carving knife more than an axe if one truly wants to improve such a large, diverse institution.

But that’s not Gorman’s thinking, because she has one very specific goal in mind—a goal that gradually emerges from under the thin pretense of wanting to “help” people who are “the seriously mentally ill.”

Interestingly, more right-wing commentators in America seem to be catching on lately to the dubious science underlying many mental health initiatives. I couldn’t help but agree with Gorman’s criticisms of the epidemic of psychiatric misdiagnosing and overdiagnosing, the often shoddy or non-existent outcome reporting from mental health programs, and practitioners’ growing tendencies to reframe common worries and serious social issues such as isolation, poverty, and urban violence as rooted in “mental disorders” allegedly requiring ever-more-costly “mental health” interventions.

However, when Gorman then invokes the common lament that the people “with serious mental illnesses” aren’t getting the mental health treatments they need and therefore are over-represented in “homeless, incarcerated, and violent-criminal populations,” I couldn’t help but wonder from where she derived this apparent confidence, all of a sudden, that there isn’t any problematic overdiagnosing and mis-treating at all going on among these particular populations. As I found when researching Your Consent Is Not Required, prison wardens, for example, have many reasons to seek blank-check “diagnostic” approvals for administering powerful tranquilizing drugs on large numbers of the inmates they’re trying to manage.

In any case, Gorman then proceeds to further assert that (impeccably, reliably diagnosed) “mental illnesses” have been important factors in “nearly all of the deadliest mass shootings” in America over six decades—and provides twenty-two links to sources to back this assertion.

Her sources, though, tell a different story.

Her primary source, the Violence Prevention Project, actually does not identify mental illness as a primary “motivation” in any of the 195 mass shootings it has gathered information on—instead highlighting employment conflicts, economic issues, racism, religious hate, misogyny, homophobia, fame seeking, and so on.

Source: The Violence Prevention Project “Mass Shooter Database”

Many of the twenty-one news stories Gorman links to do the same. Shooters are described as people struggling in the midst of long battles fighting poverty, unfairness at work, abuse, and vicious bullying. Some are described as avowed racists, white supremacists (also here), and anti-Semites who targeted specific groups. Sometimes, key sources in the stories are even specifically saying that they don’t believe mental illness was a factor—here, here, here and here.

Basically, in the same way as she accuses mental health practitioners and SAMHSA-funded organizations of rampantly and improperly “overdiagnosing” people with mental illnesses, Gorman takes a slew of events that were driven by a complex range of sadly too-common feelings and serious social problems, and suggestively reframes them all as shootings linked to “mental illness.”

So, via her personal parade of overdiagnosing, towards what kind of recommended “treatments” is Gorman trying to lead us all?

First, Gorman tells us what kind of mental health treatments and programs she doesn’t like—SAMHSA’s kind. Pretty well all $8 billion of them.

And Gorman’s characterization of what SAMHSA does with that $8 billion is somewhat… shall we say… limited and biased?

Gorman describes SAMHSA as “a hub for progressive activism” where billions of taxpayer dollars get “hijacked” for programs like “non-traditional holistic support” and “affirming, comprehensive care” for LGBTQ+ families and youth.

Described that way, it does sound like something any god-fearing Christian conservative and hater of pricey woo-woo services for the worried well should rightly loathe.

But what are the particular programs that Gorman criticizes, in actual fact?

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Looking slightly more closely into one, a North Carolina military base clinic provides a range of practical supports to high-risk military and veteran youth and families in poverty where there are high rates of victimization by sexual violence and suicide. Another is a housing provider helping homeless young people in New York City grappling with substance use disorders.

To wit: These and several other programs Gorman singles out for mockery are mainly trying to help the very people she professes to most want to help—people who are homeless, at risk of homelessness, formerly incarcerated, and/or at risk of developing serious psychotic reactions from histories of abuse.

So if not programs like these, what does Gorman advocate?

Gorman throws her support behind “proven solutions” such as “intensive psychiatric treatment” and “involuntary commitment.” She also identifies forced outpatient drugging as worth saving.

Notably, while she compiled twenty-two reference links about mass shooters and a number of links to detailed documentation of particular larger-scale problems at SAMHSA, Gorman discusses no evidence and no specifics, and provides not a single reference link to any alleged “proven solutions.” Yet, it’s the heart of her entire argument.

And she did not respond to my emailed questions. This is likely because, as I discuss at length in my book, there is no evidence to support the effectiveness of intensive psychiatric treatments administered through involuntary commitment. Indeed, the best evidence we have suggests psychiatric coercion during inpatient commitment isn’t effective and tends to backfire as traumatic. And even the American Psychiatric Association’s official position acknowledges “there is no broad consensus about [forced outpatient drugging’s] effectiveness.”

Nevertheless, Gorman goes further, revealing more fully the Manhattan Institute agenda. She targets specifically the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program funded by Congress through SAMHSA to provide legal services and investigate abuse, neglect, and rights violations. The PAIMI program was established in the 1980s in the wake of revelations of horrible, systemic abuses at psychiatric facilities that had continued since the closure of asylums—and as I show in my book, have continued to this day. So what’s Gorman’s problem with having at least somebody funded to expose and fight such abuses? The PAIMI program, she writes, “often directs funds to lawyers seeking to prevent needed hospitalizations.” She then cites a two-decades-old case of a man who was released from a hospital and killed someone.

Gorman doesn’t explicitly say it in so many words, but the implication clearly seems to be that, in her opinion, people detained under mental health laws shouldn’t be allowed to get publicly funded legal representation to appeal their incarcerations. And equally shockingly, she’s definitely advocating for getting rid of independent investigations of systemic abuses in psychiatric facilities. (Importantly, state governments separately fund public defenders and, in some states, specialized mental health law attorneys to represent involuntarily committed people. But they don’t have authority to launch systemic investigations.)

In summary, Gorman says SAMHSA is full of “nonsense programs” and Trump should “zero” its budget and put the agency “out of business.” (For a different view, here’s a 37-page 2020 Congressional Research Service overview of SAMHSA’s major programs and activities.)

Really, Gorman’s whole essay is case-exemplar of contemporary online debating: She gives a simplistic, inflammatory, captivating argument that is actually contradicted by the evidence and sources she herself provides—but how many people will read so closely? Meanwhile, with perplexing and painful hypocrisy, the Manhattan Institute describes upholding “individual liberty” as core to its mission.

Completely axing the entire budget of SAMHSA—the main federal funding source for voluntary mental health services and a key buttress to state agencies doing the same—without any careful thought, consultations, and planning, would go a long way to helping create an America where psychotropic drugs, electroshock, and psychiatric incarcerations are the only options left. A month ago, taking such a political position would have seemed far-fetched and outlandish … Today, be warned.