On September 10th, the Substance Abuse and Mental Health Services Administration (SAMHSA) shared its new Strategic Priorities which outlines the new direction of its institutional support. I can’t really even begin to describe the way it made me feel, scared, angry, but mostly I feel a little numb. With the way the news has been, it was greatly disappointing, but I can’t say I’m surprised.
This is what they are saying, verbatim:
“We believe the health and safety of children must be the highest priority. The state of the scientific literature regarding optimal care and support approaches for children and teenagers identifying as transgender and those diagnosed with gender dysphoria is described in the recent HHS review of treatment for pediatric gender dysphoria. This review, informed by an evidence-based medicine approach, found medical interventions, such as puberty blockers, cross-sex hormones, and surgeries, that attempt to “transition” minors away from their sex is unsupported by the evidence and has an unfavorable risk/benefit profile. In accordance with these data, there are clearly more promising avenues of care and support that can be taken to improve the health of these populations other than the use of such interventions for minors. It is a SAMHSA priority to protect children from these harmful practices, and where permissible under law, including applicable court orders, SAMHSA programs will deprioritize applicants that engage in these practices. SAMHSA funds will also not support the costs of such practices where not required by the law.*
HHS released guidance promulgating sex-based definitions rooted in biological truth. It is a SAMHSA priority to recognize that a person’s sex as either male or female is unchangeable and determined by objective biology. Where permissible under law, including applicable court orders, SAMHSA will deprioritize programs that do not accurately reflect science, including the biological reality of sex.**”
*written for organizations applying/using SAMHSA funding
**taking funding away from programs that even acknowledge transgender people
The phrasing is particularly sinister here. In the One Big Beautiful Bill, transgender people are consistently and specifically targeted in regards to healthcare, especially with the coverage cuts to Medicaid. Substance use and recovery services are universal and life-saving. SAMHSA is explicitly reducing safe services to trans people. The federal government is, bit by bit, taking away our rights and our safety nets. I don’t need them to tell me to crawl into a hole and die. The sentiment is quite clear.
SAMHSA has been one of the victims of DOGE–having its budgets slashed and its workforce cut. I want to give SAMHSA the benefit of the doubt and think of this as a we-have-to-comply-with-the-president-or-get-our-funding-cut-completely type of situation but that’s all speculation. I think SAMHSA was, and still is (to a degree), doing essential work and funding a lot of human services–but those services have been greatly reduced. I wish that the institutions we put in place to protect us actually had a backbone and would put their foot down. I guess there really is only so much you can do from inside the system.
No institution will save us. This really confirms what we already know, right? America has been whittling away at its social safety net and services for nearly half a century and the burden on the individual only grows. The system will not protect you–we, individually, must choose to protect each other at all costs. The tyranny of heaven is in full force. Like Milton’s Lucifer, with “Atlantean shoulders fit to bear/The weight of mightiest Monarchies,” we must continue to bear the weight for each other–the onus is on us. There is no other way forward.
The administration has attacked trans people on every front, and on every front, we must retaliate. Through demonstration, through the system, through everyday actions, through kindness, through survival at all costs.
The author declines to be named. They are an avid reader and artist practicing in New York, and they currently work in recovery services to create art programming. Their practice reconciles the urge of individualism with collective responsibility and duty to one’s community.