‘People are going to die’ if cuts continue, mental health workers warn; Choctaw citizen among those SAMHSA employees who were fired
U.S. Department of Health and Human Services building in Washington, D.C
U.S. Department of Health and Human Services building in Washington, D.C
. (Jourdan Bennett-Begaye, ICT)
MAR 20, 2025
Art Levine and Rob Waters
MindSite News
As Elon Musk and his young engineers at the Department of Government Efficiency have purged thousands of federal employees, they’ve insisted they are only terminating low-performing and probationary workers and that their actions won’t impede the ability of government agencies to do their work, but rather make them more efficient.
But at the agency tasked with leading the fight to ease the country’s mental health and addiction crises, many of the 100 or so workers who’ve been fired – as well as the roughly 800 who, as of today, remain employed – have observed something different. They see a massive downsizing process characterized by almost complete indifference to the impact on the people involved or the ability of the agency to fulfill its mission. They also contend that the charges of poor performance are simply a pretext.
“The motive is more like ‘How can we get more people out?’ said one employee at the Substance Abuse and Mental Health Services Administration (SAMHSA), who remains in their position and asked to remain anonymous. “It doesn’t matter what level of job you have, it doesn’t matter the importance of the work you do.”
A small agency with an $8.1 billion budget, SAMHSA has managed to grow in recent years as federal policymakers looked for ways to help states and cities ease the human suffering of addiction and homelessness playing out on the streets. It sends out the vast majority of its funding in grant programs to state, country and nonprofit agencies to operate mental health and substance abuse services. It also administers the grants that support the running of the 988 Suicide and Crisis Lifeline launched almost three years ago.
More chaos at SAMHSA is coming
Roughly 100 SAMHSA employees were fired during the “Valentine’s Day massacre” weekend starting Feb. 14, and only a week later, some 30,000 probationary employees across the federal government were jobless. Among them were four regional directors of SAMHSA, all of them highly experienced behavioral health providers and administrators. And more chaos at SAMHSA is coming.
This week, SAMHSA’s parent agency, the Department of Health and Human Services, announced it was reducing the number of regional offices from 10 to four. And Friday March 14 is the deadline for 80,000 HHS employees to apply for a voluntary separation program that would pay them up to $25,000 to quit.
Yesterday, all federal agencies were supposed to submit plans for a second wave of mass layoffs to the Office of Personnel Management – a proposed “reduction in force” that could permanently eliminate about 700,000 jobs – or a third of the federal workforce. This includes plans to fire 83,000 people at the Department of Veterans Affairs. That assault on the nation’s largest health care system is sparking controversy in Congress, among veterans groups and unions – and local outrage.
March 13 was also the day when US District Judge William Alsup ordered the reinstatement of all probationary employees fired at six federal agencies – the departments of Veterans Affairs, Agriculture, Defense, Energy, Interior and Treasury – and said he may extend the order to other agencies, potentially including HHS. The judge’s order is certain to be appealed, continuing the chaos and uncertainty across the federal workforce.
Like other fired probationary workers, Nate Billy, the former director of SAMHSA’s Region 10, was notified of his termination via a form letter sent by Jeffrey Anoka, acting chief human capital officer of HHS. “Your ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate to justify further employment at the Agency,” the letter said.
‘Based on a lie’
But Alsup said the contention that the workers fired had been poor performers was a “sham” and that the firings were “based on a lie.” He added: “It is a sad day when our government would fire some good employee and say it was based on performance when they know good and well that’s a lie.”
Former SAMHSA employees are not only worried and angry about the way they’ve been treated, they are concerned about the apparent dismembering of the agency whose mission they deeply believe in. One long-time veteran of SAMHSA who asked to remain anonymous is concerned about the undermining of the 988 Suicide & Crisis Lifeline.
“We’re still getting reports from contractors who can’t access funds for 988 work, and any potential funding pause there could mean life or death,” he said. The slowdown of resources at a time of rising hostility against the LGBTQ+ community is alarming because they “are at significant risk of death by suicide. Those populations are feeling heightened anxiety now, and our work in that area could be reduced.”
One Midwestern state worker involved in administering their state’s 988 lines told MindSite News in late February that SAMHSA officials had stopped communicating with their office and that funds had stopped flowing.
But Alsup said the contention that the workers fired had been poor performers was a “sham” and that the firings were “based on a lie.” He added: “It is a sad day when our government would fire some good employee and say it was based on performance when they know good and well that’s a lie.”
Former SAMHSA employees are not only worried and angry about the way they’ve been treated, they are concerned about the apparent dismembering of the agency whose mission they deeply believe in. One long-time veteran of SAMHSA who asked to remain anonymous is concerned about the undermining of the 988 Suicide & Crisis Lifeline.
“We’re still getting reports from contractors who can’t access funds for 988 work, and any potential funding pause there could mean life or death,” he said. The slowdown of resources at a time of rising hostility against the LGBTQ+ community is alarming because they “are at significant risk of death by suicide. Those populations are feeling heightened anxiety now, and our work in that area could be reduced.”
One Midwestern state worker involved in administering their state’s 988 lines told MindSite News in late February that SAMHSA officials had stopped communicating with their office and that funds had stopped flowing.
No communication with the federal government
“We’ve had no communication from the federal government,” said the worker, who asked to remain anonymous because of a concern over retaliation. “We don’t really know what’s going on as far as continued funding for 988 moving forward.” She said the office’s regular submissions of progress reports to the SAMHSA project officer hadn’t been acknowledged, and as of late February, the state office had not received its usual grant installment payment.
“If we don’t receive funding moving forward, I don’t know if my job continues or the state has staff,” they said. “I don’t know how we will continue to fund our 988 contact centers. And if there’s not money going out the door to support the people that are doing the work and answering these calls, then people are going to die.”
MindSite News has been unable to learn whether communications or payments have resumed. Representatives of the Department of Health and Human Services didn’t reply to a request for comment sent after hours on Friday afternoon.
The state 988 worker is particularly alarmed about rumors that a feature allowing LGBTQ+ youth who call for help to “press 3” and get connected to specially trained crisis counselors will be shut down.
“If that lifeline goes away, then access to support for queer youth and young adults decreases,” they said. “And that would mean an increase in suicide rates for a very vulnerable population.” Calls to the line have soared since Trump’s election.
Identity erasure at SAMHSA
References to the needs and descriptions of services for LGBTQ+ people were largely eliminated from the websites of SAMHSA and other federal agencies, until a court ordered that they be reinstated. Now, many of the pre-Trump pages have reappeared, as on a page that says, “LGBTQI+ Youth: Like All Americans, They Deserve Evidence-Based Care.”
But the page comes with a surreal warning sticker: “Per a court order, HHS is required to restore this website as of February 14, 2025 at 11:59 p.m. Any information on this page promoting gender ideology is extremely inaccurate and disconnected from the immutable biological reality that there are two sexes, male and female.”
SAMHSA’s new leadership also removed the initials “TQ+” – which stand for transgender and queer – and the renamed “LGB Center of Excellence” links to a resource page that omits any reference to gay or transgender people. Its former title at the same URL was: “Center of Excellence: LGBTQ+ Behavioral Health Equity.”
All this erasure may come at a high cost, since LGBTQ+ teens consider and attempt suicide at more than four times the rate of other adolescents, according to the Trevor Project – with a suicide attempt every 45 seconds on average.
Employees who remain at the agency “are deeply committed to this work, are very committed to making it through this to get us to the other side so that we can do the mission,” said the anonymous current employee. They are “trying to figure out how to make it through this time where there’s indifference to who is being fired.”
Nate Billy and two other senior SAMHSA employees who were fired spoke with MindSite News about their experiences. All bristled at the notion that they were terminated because of their performance. These are their stories.
Nate Billy of the Choctaw Nation: ‘It was a shock’
Nate Billy was raised in the Choctaw Nation in southeast Oklahoma. He earned his license as a mental health therapist, became deputy director of behavioral health at the Choctaw Nation Health Services Authority and then behavioral health director for the National Indian Health Board, a nonprofit advocate for the 574 federally recognized tribes. When he was hired in June 2024 as the director of SAMHSA’s region 10, the move felt logical and appropriate.
Nathan Billy, Choctaw citizen and SAMHSA’s former Region 10 director, in a photo he provided. (Photo courtesy of MindSite News)
“I was a funding recipient and (had) done work on the service end, so I was very confident about joining SAMSHA,” he told MindSite News in an interview. “I always had such great respect for that agency and the mental health services they provide.”
A key focus of Nate’s work was to address disparities that cause some communities to have worse mental health and more limited access to services – what the agency called mental health “equity” until that term was banned by the Trump administration. (To implement an executive order, federal agencies are now using algorithms to search grant proposals, job descriptions and websites for words that signal a “woke” agenda. The New York Times compiled a list of almost 200 words that raise red flags including Native American, racial diversity and disparity.)
“When I go out into communities, I think, OK, not all communities are experiencing everything equally,” Billy said. “Some have certain vulnerabilities or just health disparities. What can be more human than saying, ‘I want to treat you equitably.’”
He is especially proud of helping Washington State Indian tribes amplify use of the community-based Icelandic Prevention Model, which cut teen drug abuse in Iceland almost in half over 20 years and put the responsibility on adults to create drug- and alcohol-free environments. One secret to the success of the model, Billy said, is that it isn’t a heavy-handed anti-drug program but incorporates fun, drug-free activities for youth.
In Washington, where Indian and Alaska Native tribes have the highest rate of opioid overdoses, five tribes adopted the model. He also helped increase tribal use of the overdose prevention drug naloxone, best known as Narcan. At SAMHSA, Billy became a key expert on the Icelandic prevention program and accompanied then-director Miriam Delphin-Rittmon and officials from the Indian Health Services, tribal leaders and Washington state health officials to visit Iceland last October.
When he came back from the trip, “my brain was on fire” with excitement about ways the model could be incorporated in the U.S., Billy said. But over the next three months, Trump was elected and “all of this turmoil and anxiety started.”
Billy was out with his husband on Saturday, Feb. 15, celebrating their fifth wedding anniversary when he began getting phone alerts about SAMHSA staffers getting termination notices. When he finally got home, he saw a notice on his work phone: “Open Immediately.”
Billy knew better. He and other staffers had been warned through word of mouth and social media – not from any supervisors or administrators — that as soon as they opened the email, their access to work computers would be cut off. He made sure to first print out his personnel files, employment history and other records he would need to file for unemployment insurance and other services.
Then, he hesitated. “There was kind of the hope in the back of my mind that this can’t really be happening and maybe there’ll be a backlash and it’ll be reversed,” he said. He finally went ahead and clicked on the email from Anoka. Like everyone else, he was infuriated by its curt, demeaning language.
“I was appalled, knowing that my performance was outstanding, knowing that I’ve been trusted to travel and got a government clearance,” he said. He was placed on administrative leave until March 14, and wasn’t allowed to attend a critical meeting on suicide prevention, a burning issue in Indian country. It was held in Florida, where local providers and advocates from around the country joined staffers from the decimated SAMHSA regional offices to discuss the looming mental health crisis.
“I was going to learn all these things and bring (them) back to Region 10 and begin our work together here,” he said. “But I was terminated.”
Mirna Herrera: Latino and LGBTQ communities “are scared for their lives”
Mirna Herrera knows what it’s like to struggle with mental health challenges. She grew up in Nazareth, Israel during the Palestinian uprisings known as the intifadas and as a teenager witnessed blown-up buses and dead bodies. She was later diagnosed with PTSD, anxiety and depression.
Support from peers proved to be critical to her own recovery, and she became an impassioned promoter of the power of peers in the mental health system. She came to the United States in 2008 for graduate work in music therapy and played a leadership role in peer support work, beginning with an eight-year stint at the University Health Kansas City hospital system. When she was recruited by a SAMHSA director in 2023, her lived experience was considered an asset.
Herrera had been planning key projects designed to incorporate more peers with “lived experience” in treatment and outreach, including through the expansion of mobile crisis teams that respond to 988 crisis emergency calls in Kansas City and other cities.
Peers “instill hope that recovery is possible,” she told MindSite News. “If you have a peer specialist, you immediately feel like you can trust that system.”
Herrera was less than two months from completing her two-year “probationary” period when she received the termination notice telling her that “your performance has not been adequate” and became one of roughly 30,000 federal employees on probationary status who have been fired to date. She said the wording in the letter was so at odds with the bonus she had recently been promised following a stellar evaluation that the firing seemed impossible.
“No one really anticipated it,” she said. “We knew our leaders at HHS got the presidential executive order to let go of all probationary employees, but we were all, like, ‘There’s no way it’s going to be happening.”
She and some of her colleagues figured that SAMHSA would be spared because it’s so small compared to other agencies within HHS and because Robert F Kennedy Jr., the newly confirmed HHS secretary, had “lived experience” through his recovery from an addiction. She thought: “Hey, we’re not even on the radar. And behavioral health issues are a bipartisan issue.”
She and her colleagues were wrong. She has now joined two class-action lawsuits that contend the firing of probationary workers was illegal.
Herrera and other former SAMHSA officials who no longer work at the agency are concerned about the fate of communities demonized by the Trump administration that the agency had previously been dedicated to serving. These include Hispanic immigrants, along with gay and trans youth.
“By the time I left my job, we had an increase in calls in our area for Hispanic communities and LGBTQ communities because they’re getting persecuted,” Herrera said. “Now they’re scared for their lives. The crisis is increasing, but I can not participate in that work anymore.”
Complying with Trump’s executive orders, SAMHSA erased all references to LGBTQ people on the agency website. They were later restored by a court in February, which ordered all purged health information on federal websites to be reinstated.
The erasures are deeply worrisome to Herrera. “They’re not going to be acknowledged as who they truly are, so there’s a fear for them losing essential services, medical services, behavioral health services because of their sexual orientation and identity.”
Scott Gagnon: The Trump administration “is simply lying about us”
Scott Gagnon, a veteran addiction specialist, became director of SAMHSA’s Region 1 in New England last June after spending almost 20 years as a program analyst and administrator at a series of behavioral health programs. Among his positions, he spent nearly nine years as an executive of a New England agency that contracts with SAMHSA. He was three months short of completing his one-year probationary period when he received the same form-letter as other probationary hires declaring his performance sub-par and terminating him.
He was so angry about the firing and the letter, he wrote an op-ed about it for the Portland Press Herald. It included this paragraph:
The administration is simply lying about us as they fire us. In the termination letter I received from HHS, it was stated I was being fired for a lack of knowledge, skills and abilities for my position, and for issues with performance. Both statements are provable lies. I received an exceptional rating in my 2024 performance evaluation, of which I have documented proof. I was specifically recruited to apply for this job precisely because of the national reputation I have for my knowledge, skills and abilities in the addiction field…This is the case with so many of my fellow fired feds, to a person, all with exceptional performance ratings and individuals with very impressive resumes.
Last year, while serving as the director of Region 1, Gagnon was honored as the 2024 National Prevention Specialist of the Year by an organization that certifies counseling, peer support and recovery professionals.
“I was pretty angry, because I know I had an exceptional performance review,” Gagnon told MindSite News. He made sure to download the laudatory 2024 review while he still had access to it.
Even before he was fired, he worried about the directions the agency was taking under Trump. He noticed that the freezes on external communications and funding continued past the time the administration claimed they had been lifted. For a regional office, communicating with partners, stakeholders and outside organizations is essential, yet “we couldn’t talk to the outside world,” Gagnon said. “We work with the outside world. So as regional offices, it made us so we couldn’t do our jobs.”
Cancelled were Zoom conferences with healthcare leaders in six states on suicide prevention and improving the 988 services. He also was invited to two conferences on opioid addiction prevention in Rhode Island and Connecticut but was barred from going even before he was fired.
He hears that the freeze on outside communications is still in place, with rare exceptions. “My colleagues who are still there say they’re still getting blocked,” he said.
Like Billy, Gagnon was celebrating his wedding anniversary with his wife on the day after Valentine’s Day when he received his termination letter. He held off reading it until the next day.
He’s not sure what’s coming next, but figures he’ll do consulting work in addiction prevention. Ironically, the destruction of SAMSHA may prove to be a boon for his potential business. “There’s going to be a lot of gaps,” he said.
One thing, he said, is clear: The massive cuts to federal agencies have little to do with saving money or making the government more efficient. “The Musk-Trump war on the federal workforce will have the opposite effect of what was stated. It will make government ineffective and more inefficient,” he writes at the conclusion of his Maine op-ed. “It’s time for Mainers to come together and speak out against this assault upon the country.”
MindSite News, an independent, nonprofit journalism site focused on mental health. Get a roundup of mental health news in your in-box by signing up for the newsletter here.
Support for reporting on mental health policy issues is provided by the Commonwealth Fund.
Art Levine and Rob Waters
MindSite News
As Elon Musk and his young engineers at the Department of Government Efficiency have purged thousands of federal employees, they’ve insisted they are only terminating low-performing and probationary workers and that their actions won’t impede the ability of government agencies to do their work, but rather make them more efficient.
But at the agency tasked with leading the fight to ease the country’s mental health and addiction crises, many of the 100 or so workers who’ve been fired – as well as the roughly 800 who, as of today, remain employed – have observed something different. They see a massive downsizing process characterized by almost complete indifference to the impact on the people involved or the ability of the agency to fulfill its mission. They also contend that the charges of poor performance are simply a pretext.
“The motive is more like ‘How can we get more people out?’ said one employee at the Substance Abuse and Mental Health Services Administration (SAMHSA), who remains in their position and asked to remain anonymous. “It doesn’t matter what level of job you have, it doesn’t matter the importance of the work you do.”
A small agency with an $8.1 billion budget, SAMHSA has managed to grow in recent years as federal policymakers looked for ways to help states and cities ease the human suffering of addiction and homelessness playing out on the streets. It sends out the vast majority of its funding in grant programs to state, country and nonprofit agencies to operate mental health and substance abuse services. It also administers the grants that support the running of the 988 Suicide and Crisis Lifeline launched almost three years ago.
More chaos at SAMHSA is coming
Roughly 100 SAMHSA employees were fired during the “Valentine’s Day massacre” weekend starting Feb. 14, and only a week later, some 30,000 probationary employees across the federal government were jobless. Among them were four regional directors of SAMHSA, all of them highly experienced behavioral health providers and administrators. And more chaos at SAMHSA is coming.
This week, SAMHSA’s parent agency, the Department of Health and Human Services, announced it was reducing the number of regional offices from 10 to four. And Friday March 14 is the deadline for 80,000 HHS employees to apply for a voluntary separation program that would pay them up to $25,000 to quit.
Yesterday, all federal agencies were supposed to submit plans for a second wave of mass layoffs to the Office of Personnel Management – a proposed “reduction in force” that could permanently eliminate about 700,000 jobs – or a third of the federal workforce. This includes plans to fire 83,000 people at the Department of Veterans Affairs. That assault on the nation’s largest health care system is sparking controversy in Congress, among veterans groups and unions – and local outrage.
March 13 was also the day when US District Judge William Alsup ordered the reinstatement of all probationary employees fired at six federal agencies – the departments of Veterans Affairs, Agriculture, Defense, Energy, Interior and Treasury – and said he may extend the order to other agencies, potentially including HHS. The judge’s order is certain to be appealed, continuing the chaos and uncertainty across the federal workforce.
Like other fired probationary workers, Nate Billy, the former director of SAMHSA’s Region 10, was notified of his termination via a form letter sent by Jeffrey Anoka, acting chief human capital officer of HHS. “Your ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate to justify further employment at the Agency,” the letter said.
‘Based on a lie’
But Alsup said the contention that the workers fired had been poor performers was a “sham” and that the firings were “based on a lie.” He added: “It is a sad day when our government would fire some good employee and say it was based on performance when they know good and well that’s a lie.”
Former SAMHSA employees are not only worried and angry about the way they’ve been treated, they are concerned about the apparent dismembering of the agency whose mission they deeply believe in. One long-time veteran of SAMHSA who asked to remain anonymous is concerned about the undermining of the 988 Suicide & Crisis Lifeline.
“We’re still getting reports from contractors who can’t access funds for 988 work, and any potential funding pause there could mean life or death,” he said. The slowdown of resources at a time of rising hostility against the LGBTQ+ community is alarming because they “are at significant risk of death by suicide. Those populations are feeling heightened anxiety now, and our work in that area could be reduced.”
One Midwestern state worker involved in administering their state’s 988 lines told MindSite News in late February that SAMHSA officials had stopped communicating with their office and that funds had stopped flowing.
But Alsup said the contention that the workers fired had been poor performers was a “sham” and that the firings were “based on a lie.” He added: “It is a sad day when our government would fire some good employee and say it was based on performance when they know good and well that’s a lie.”
Former SAMHSA employees are not only worried and angry about the way they’ve been treated, they are concerned about the apparent dismembering of the agency whose mission they deeply believe in. One long-time veteran of SAMHSA who asked to remain anonymous is concerned about the undermining of the 988 Suicide & Crisis Lifeline.
“We’re still getting reports from contractors who can’t access funds for 988 work, and any potential funding pause there could mean life or death,” he said. The slowdown of resources at a time of rising hostility against the LGBTQ+ community is alarming because they “are at significant risk of death by suicide. Those populations are feeling heightened anxiety now, and our work in that area could be reduced.”
One Midwestern state worker involved in administering their state’s 988 lines told MindSite News in late February that SAMHSA officials had stopped communicating with their office and that funds had stopped flowing.
No communication with the federal government
“We’ve had no communication from the federal government,” said the worker, who asked to remain anonymous because of a concern over retaliation. “We don’t really know what’s going on as far as continued funding for 988 moving forward.” She said the office’s regular submissions of progress reports to the SAMHSA project officer hadn’t been acknowledged, and as of late February, the state office had not received its usual grant installment payment.
“If we don’t receive funding moving forward, I don’t know if my job continues or the state has staff,” they said. “I don’t know how we will continue to fund our 988 contact centers. And if there’s not money going out the door to support the people that are doing the work and answering these calls, then people are going to die.”
MindSite News has been unable to learn whether communications or payments have resumed. Representatives of the Department of Health and Human Services didn’t reply to a request for comment sent after hours on Friday afternoon.
The state 988 worker is particularly alarmed about rumors that a feature allowing LGBTQ+ youth who call for help to “press 3” and get connected to specially trained crisis counselors will be shut down.
“If that lifeline goes away, then access to support for queer youth and young adults decreases,” they said. “And that would mean an increase in suicide rates for a very vulnerable population.” Calls to the line have soared since Trump’s election.
Identity erasure at SAMHSA
References to the needs and descriptions of services for LGBTQ+ people were largely eliminated from the websites of SAMHSA and other federal agencies, until a court ordered that they be reinstated. Now, many of the pre-Trump pages have reappeared, as on a page that says, “LGBTQI+ Youth: Like All Americans, They Deserve Evidence-Based Care.”
But the page comes with a surreal warning sticker: “Per a court order, HHS is required to restore this website as of February 14, 2025 at 11:59 p.m. Any information on this page promoting gender ideology is extremely inaccurate and disconnected from the immutable biological reality that there are two sexes, male and female.”
SAMHSA’s new leadership also removed the initials “TQ+” – which stand for transgender and queer – and the renamed “LGB Center of Excellence” links to a resource page that omits any reference to gay or transgender people. Its former title at the same URL was: “Center of Excellence: LGBTQ+ Behavioral Health Equity.”
All this erasure may come at a high cost, since LGBTQ+ teens consider and attempt suicide at more than four times the rate of other adolescents, according to the Trevor Project – with a suicide attempt every 45 seconds on average.
Employees who remain at the agency “are deeply committed to this work, are very committed to making it through this to get us to the other side so that we can do the mission,” said the anonymous current employee. They are “trying to figure out how to make it through this time where there’s indifference to who is being fired.”
Nate Billy and two other senior SAMHSA employees who were fired spoke with MindSite News about their experiences. All bristled at the notion that they were terminated because of their performance. These are their stories.
Nate Billy of the Choctaw Nation: ‘It was a shock’
Nate Billy was raised in the Choctaw Nation in southeast Oklahoma. He earned his license as a mental health therapist, became deputy director of behavioral health at the Choctaw Nation Health Services Authority and then behavioral health director for the National Indian Health Board, a nonprofit advocate for the 574 federally recognized tribes. When he was hired in June 2024 as the director of SAMHSA’s region 10, the move felt logical and appropriate.
Nathan Billy, Choctaw citizen and SAMHSA’s former Region 10 director, in a photo he provided. (Photo courtesy of MindSite News)
“I was a funding recipient and (had) done work on the service end, so I was very confident about joining SAMSHA,” he told MindSite News in an interview. “I always had such great respect for that agency and the mental health services they provide.”
A key focus of Nate’s work was to address disparities that cause some communities to have worse mental health and more limited access to services – what the agency called mental health “equity” until that term was banned by the Trump administration. (To implement an executive order, federal agencies are now using algorithms to search grant proposals, job descriptions and websites for words that signal a “woke” agenda. The New York Times compiled a list of almost 200 words that raise red flags including Native American, racial diversity and disparity.)
“When I go out into communities, I think, OK, not all communities are experiencing everything equally,” Billy said. “Some have certain vulnerabilities or just health disparities. What can be more human than saying, ‘I want to treat you equitably.’”
He is especially proud of helping Washington State Indian tribes amplify use of the community-based Icelandic Prevention Model, which cut teen drug abuse in Iceland almost in half over 20 years and put the responsibility on adults to create drug- and alcohol-free environments. One secret to the success of the model, Billy said, is that it isn’t a heavy-handed anti-drug program but incorporates fun, drug-free activities for youth.
In Washington, where Indian and Alaska Native tribes have the highest rate of opioid overdoses, five tribes adopted the model. He also helped increase tribal use of the overdose prevention drug naloxone, best known as Narcan. At SAMHSA, Billy became a key expert on the Icelandic prevention program and accompanied then-director Miriam Delphin-Rittmon and officials from the Indian Health Services, tribal leaders and Washington state health officials to visit Iceland last October.
When he came back from the trip, “my brain was on fire” with excitement about ways the model could be incorporated in the U.S., Billy said. But over the next three months, Trump was elected and “all of this turmoil and anxiety started.”
Billy was out with his husband on Saturday, Feb. 15, celebrating their fifth wedding anniversary when he began getting phone alerts about SAMHSA staffers getting termination notices. When he finally got home, he saw a notice on his work phone: “Open Immediately.”
Billy knew better. He and other staffers had been warned through word of mouth and social media – not from any supervisors or administrators — that as soon as they opened the email, their access to work computers would be cut off. He made sure to first print out his personnel files, employment history and other records he would need to file for unemployment insurance and other services.
Then, he hesitated. “There was kind of the hope in the back of my mind that this can’t really be happening and maybe there’ll be a backlash and it’ll be reversed,” he said. He finally went ahead and clicked on the email from Anoka. Like everyone else, he was infuriated by its curt, demeaning language.
“I was appalled, knowing that my performance was outstanding, knowing that I’ve been trusted to travel and got a government clearance,” he said. He was placed on administrative leave until March 14, and wasn’t allowed to attend a critical meeting on suicide prevention, a burning issue in Indian country. It was held in Florida, where local providers and advocates from around the country joined staffers from the decimated SAMHSA regional offices to discuss the looming mental health crisis.
“I was going to learn all these things and bring (them) back to Region 10 and begin our work together here,” he said. “But I was terminated.”
Mirna Herrera: Latino and LGBTQ communities “are scared for their lives”
Mirna Herrera knows what it’s like to struggle with mental health challenges. She grew up in Nazareth, Israel during the Palestinian uprisings known as the intifadas and as a teenager witnessed blown-up buses and dead bodies. She was later diagnosed with PTSD, anxiety and depression.
Support from peers proved to be critical to her own recovery, and she became an impassioned promoter of the power of peers in the mental health system. She came to the United States in 2008 for graduate work in music therapy and played a leadership role in peer support work, beginning with an eight-year stint at the University Health Kansas City hospital system. When she was recruited by a SAMHSA director in 2023, her lived experience was considered an asset.
Herrera had been planning key projects designed to incorporate more peers with “lived experience” in treatment and outreach, including through the expansion of mobile crisis teams that respond to 988 crisis emergency calls in Kansas City and other cities.
Peers “instill hope that recovery is possible,” she told MindSite News. “If you have a peer specialist, you immediately feel like you can trust that system.”
Herrera was less than two months from completing her two-year “probationary” period when she received the termination notice telling her that “your performance has not been adequate” and became one of roughly 30,000 federal employees on probationary status who have been fired to date. She said the wording in the letter was so at odds with the bonus she had recently been promised following a stellar evaluation that the firing seemed impossible.
“No one really anticipated it,” she said. “We knew our leaders at HHS got the presidential executive order to let go of all probationary employees, but we were all, like, ‘There’s no way it’s going to be happening.”
She and some of her colleagues figured that SAMHSA would be spared because it’s so small compared to other agencies within HHS and because Robert F Kennedy Jr., the newly confirmed HHS secretary, had “lived experience” through his recovery from an addiction. She thought: “Hey, we’re not even on the radar. And behavioral health issues are a bipartisan issue.”
She and her colleagues were wrong. She has now joined two class-action lawsuits that contend the firing of probationary workers was illegal.
Herrera and other former SAMHSA officials who no longer work at the agency are concerned about the fate of communities demonized by the Trump administration that the agency had previously been dedicated to serving. These include Hispanic immigrants, along with gay and trans youth.
“By the time I left my job, we had an increase in calls in our area for Hispanic communities and LGBTQ communities because they’re getting persecuted,” Herrera said. “Now they’re scared for their lives. The crisis is increasing, but I can not participate in that work anymore.”
Complying with Trump’s executive orders, SAMHSA erased all references to LGBTQ people on the agency website. They were later restored by a court in February, which ordered all purged health information on federal websites to be reinstated.
The erasures are deeply worrisome to Herrera. “They’re not going to be acknowledged as who they truly are, so there’s a fear for them losing essential services, medical services, behavioral health services because of their sexual orientation and identity.”
Scott Gagnon: The Trump administration “is simply lying about us”
Scott Gagnon, a veteran addiction specialist, became director of SAMHSA’s Region 1 in New England last June after spending almost 20 years as a program analyst and administrator at a series of behavioral health programs. Among his positions, he spent nearly nine years as an executive of a New England agency that contracts with SAMHSA. He was three months short of completing his one-year probationary period when he received the same form-letter as other probationary hires declaring his performance sub-par and terminating him.
He was so angry about the firing and the letter, he wrote an op-ed about it for the Portland Press Herald. It included this paragraph:
The administration is simply lying about us as they fire us. In the termination letter I received from HHS, it was stated I was being fired for a lack of knowledge, skills and abilities for my position, and for issues with performance. Both statements are provable lies. I received an exceptional rating in my 2024 performance evaluation, of which I have documented proof. I was specifically recruited to apply for this job precisely because of the national reputation I have for my knowledge, skills and abilities in the addiction field…This is the case with so many of my fellow fired feds, to a person, all with exceptional performance ratings and individuals with very impressive resumes.
Last year, while serving as the director of Region 1, Gagnon was honored as the 2024 National Prevention Specialist of the Year by an organization that certifies counseling, peer support and recovery professionals.
“I was pretty angry, because I know I had an exceptional performance review,” Gagnon told MindSite News. He made sure to download the laudatory 2024 review while he still had access to it.
Even before he was fired, he worried about the directions the agency was taking under Trump. He noticed that the freezes on external communications and funding continued past the time the administration claimed they had been lifted. For a regional office, communicating with partners, stakeholders and outside organizations is essential, yet “we couldn’t talk to the outside world,” Gagnon said. “We work with the outside world. So as regional offices, it made us so we couldn’t do our jobs.”
Cancelled were Zoom conferences with healthcare leaders in six states on suicide prevention and improving the 988 services. He also was invited to two conferences on opioid addiction prevention in Rhode Island and Connecticut but was barred from going even before he was fired.
He hears that the freeze on outside communications is still in place, with rare exceptions. “My colleagues who are still there say they’re still getting blocked,” he said.
Like Billy, Gagnon was celebrating his wedding anniversary with his wife on the day after Valentine’s Day when he received his termination letter. He held off reading it until the next day.
He’s not sure what’s coming next, but figures he’ll do consulting work in addiction prevention. Ironically, the destruction of SAMSHA may prove to be a boon for his potential business. “There’s going to be a lot of gaps,” he said.
One thing, he said, is clear: The massive cuts to federal agencies have little to do with saving money or making the government more efficient. “The Musk-Trump war on the federal workforce will have the opposite effect of what was stated. It will make government ineffective and more inefficient,” he writes at the conclusion of his Maine op-ed. “It’s time for Mainers to come together and speak out against this assault upon the country.”
MindSite News, an independent, nonprofit journalism site focused on mental health. Get a roundup of mental health news in your in-box by signing up for the newsletter here.
Support for reporting on mental health policy issues is provided by the Commonwealth Fund.
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