( Tomdispatch.com ) – The United States has been in the throes of a mental health and overdose crisis so severe it has spanned five presidential administrations and been classified as an official state of emergency in three of them. No one knows exactly how this emergency will play out during the current Trumpian cocktail of uncertainty, fear, and cuts to social services, but charts of the recent turbulence of the stock market suggest a relevant visual: imagine the nervous systems of millions of already struggling Americans, along with millions more who are being pushed to the limits of what they can handle, all experiencing deep emotional crashes, briefly recovering, only to collapse again into new lows. And while it might be tempting to think that many of us aren’t affected by the present gut-wrenching emotional tumult because we appear fine and don’t seem to care about what’s happening to the more desperate among us, our recent research suggests that people do care — including, perhaps, those you’d least expect to do so.
Last year brought a widely reported piece of news in mental health. Overdose fatalities in the United States declined substantially, a notable but qualified victory. As overdose deaths fell 9% from 2021 to 2023 for white Americans, such deaths increased 12% for people of other races, according to a Reuters analysis of data from the Centers for Disease Control and Prevention. Street drugs continue to kill more than 84,000 people in the United States annually and overdoses remain the leading cause of death among Americans ages 18 to 44.
In other words, many young Americans and people of all ages attempt to numb difficult, even unbearable feelings, and sometimes that numbing is fatal. Depending on who you are, your preferred numbing agent might be wine, work, prescription pills, social media, street drugs, or something else entirely. But in the second age of Donald Trump, as well as long before him, all too many of us have been grappling with profound pain, whether from a sense of hopelessness about the future, oppression, trauma, grief, job loss, or general financial strain in ever more economically difficult times. Those among us who are not U.S. citizens are increasingly seized with the fear of being deported due to false, unknown, or unsubstantiated allegations and without due process. In addition to sowing terror, this has also been exacerbating an already widespread sense of loneliness, as people stay inside for fear of being detained.
Another source of despair is the urgent overseas humanitarian crisis over which non-citizens and legal permanent residents are now being seized, shackled, and imprisoned or disappeared for expressing moral protest. One (but not both) of the authors of this article has the protection of U.S. citizenship, although experts now question whether even citizenship will continue to provide protection, and so, for safety’s sake, we’re not naming that crisis or the widely shared sense of grief and powerlessness as men, women, and heartbreaking numbers of children die there. Students and people in all walks of life continue to take to the streets in protest, including the one of us who is a citizen.
Indeed, in such a devastating moment, in all corners of American society, people are in ever greater need of mental health services, just as funding for them is being slashed. May is Mental Health Awareness Month and so a ripe moment to take stock of the damage being done and to report that there appears to be surprising agreement among people with divergent political beliefs that it’s time to expand services for those who are struggling.
Dismantled?
In late January, the Trump White House issued a vague memo that put a temporary freeze on the disbursement of federal financial assistance. By early February, NBC News had reported that some health clinics were closing their doors. Then, in March, the Trump administration announced the cancellation of more than $11 billion in funding to deal with addiction, mental health, and related issues. A federal judge subsequently halted that cancellation of funds, saying such a sudden termination caused “direct and irreparable harm to public health.” The Trump administration requested a stay of the order, with plans to appeal.
By mid-April, around the same time that Elon Musk’s DOGE took over responsibility for posting federal grant opportunities for the public, Reuters published an extensive investigation on the subject. It drew on interviews with dozens of experts to conclude that funding cuts and associated layoffs were “dismantling the carefully constructed health infrastructure that drove the number of overdose deaths down by tens of thousands last year.”
In Philadelphia, where one of the authors of this article resides, the Inquirer reported that a forensic research lab that tests the nation’s illicit drug supply for new and harmful substances hadn’t received crucial funds from the federal government. That, in turn, meant the furloughing of staff and a growing backlog of untested samples. If you’ve followed news about the evolving nature of illicit and counterfeit drugs, you know that novel and dangerous molecules are continually turning up in unexpected places, whether the veterinary sedative xylazine or the more potent medetomidine found in batches of fentanyl, or as deadly levels of nitazenes in seemingly innocuous pills. Slowing or halting drug-testing is a dangerous proposition.
Meanwhile, a Philadelphia outreach program run by Unity Recovery was recently forced to shut down, while its workers who had offered services in addiction, nutrition, and other kinds of healthcare suddenly lost their jobs. At the time of this writing, the organization’s website features a red warning symbol and the message: “Due to federal funding cuts enacted on March 24, 2025, Unity Recovery has lost critical access to resources to provide peer support services.” It also notes that “information is changing rapidly” — a nod to the fact that a judge halted the cancellation of funds and no one now knows exactly how the pending cuts will (or won’t) unfold.
And while there is supposedly stark disagreement between the Trumpist and non-Trumpist halves of this country about whether such cuts should be taking place at all, extensive data from the purple state of Pennsylvania suggests there is far more agreement than anyone might have guessed.
“It Is in All Our Interests to Give Help and Support”
Over the past year, the two of us have worked on a research project that collected perspectives from thousands of Pennsylvanians about mental health, substance use, and the state’s criminal justice system. We also collected hundreds of surveys from Pennsylvanians who work in law enforcement and criminal justice. We guessed that such anonymous surveys would capture punitive viewpoints and a belief that people who use drugs should be put behind bars. And, yes, there was a bit of that, but to our surprise, on the whole, we found something quite different.
More than a quarter of Pennsylvanians said that, in recent years, they had become more sympathetic toward people who struggle with drugs or alcohol. A majority of the respondents identified stress and traumatic life events as a primary cause of problematic substance use. And most surprising of all, we found broad agreement on policy priorities across — yes, across — the political spectrum.
Eighty-three percent of Pennsylvanians agreed that “addressing social problems such as homelessness, mental health, and substance use disorder” was a greater priority than “strengthening social order through more policing and greater enforcement of the laws.” That view was shared across political affiliations: 71% of respondents identifying as conservative agreed with it, as did 88% of those identifying as liberal.
Asked whether they agreed or disagreed with the statement, “It is in all our interests to give help and support to people who struggle with drugs and/or alcohol,” 68% of respondents identifying as conservative or very conservative agreed, as did 77% of liberal or very liberal respondents. Notably, there was majority support (61%) for increasing government spending for this cause. Even 54% of conservatives said they supported increasing spending to improve treatment and services for substance-use disorder.
We assumed that Americans who work in law enforcement and criminal justice would have more hardline views. Again, we were wrong. Compared with Pennsylvanians overall, over the past five years, those who work in the criminal justice system were — yes! — more likely to report feeling greater sympathy toward people who struggle with drugs or alcohol, and an overwhelming 70% of them believed that this society was obliged to provide them with treatment. Asked what services they believed could help prevent people struggling with substance use from becoming involved in the justice system, 71% said “more access to mental health treatment providers or services.”
Because much drug use in this country is criminalized, those who work in criminal justice are on the frontlines of our mental health crisis. These new findings suggest that, at least in Pennsylvania, justice system workers feel a responsibility to offer genuine help and see bolstering mental health services as the best way forward.
Of course, the opposite is happening. Yet it’s notable that, in this purple state where the current president won more than 50% of the vote, there is majority support across the political spectrum for providing genuine assistance to people who need it.
The ongoing axing of services will likely prove devastating. It leaves many feeling like there is nothing they can do. Yet, as individuals, count on one thing: we are not powerless (as we so often believe).
Looking Out for Others
When life feels scary and uncertain, as it increasingly does in the Trump era, many people respond by thinking a lot about what might happen in their world and trying to anticipate the future in order to make plans and gain at least some minimal sense of control. Both authors of this article — one of us a doctor, the other a writer — struggle with our ruminations on the state and direction of this country, which can lead us deeper into anxiety and isolation.
And while we probably can’t escape those fearful feelings (and probably shouldn’t try to), we can at least stay in touch with others instead of giving in to the common urge to withdraw. That isn’t easy, of course. Both of us find ourselves struggling to pick up the phone. But this is a time when picking up that phone couldn’t be more important. A time when so much of our world is endangered is distinctly a moment to put special effort into looking out for one another and regularly experiencing the energy that comes from human connection.
We also understand that many Americans are living on the edge. We often don’t know who among our neighbors and loved ones is wrestling with the question of whether life is worth living. (Suicide rates remain high for Americans generally and especially for those with drug and alcohol use disorders.) Right now, there is a dire need for better services, but even if every person had access to quality mental health care, our actions as community members would still matter. It’s sometimes possible to save the life of someone you care about just by telling them you care.
Each of us, including you, has a role to play in keeping all of us alive and safe as best we can in ever more difficult times.
From Crisis to Care
No one yet knows exactly how the Trump administration’s potentially staggering cuts to community healthcare and social services will unfold. But amid the chaos, people across this nation continue to do meaningful, lifesaving work.
The Drug Policy Alliance, a nonprofit outfit that seeks to prevent harms associated with drug use and drug criminalization, recently published a report entitled “From Crisis to Care.” It presents an intelligent roadmap for improving mental health and addressing substance use and homelessness, including investing in treatment options that are evidence-based and voluntary, as well as housing programs and community-based crisis response systems. These are anything but radical ideas. They’re grounded in research and can serve as a model for the future. Of course, funding and some political power will be necessary to accomplish such things, and that might sound farfetched in our current situation. But simple actions in the present make it more likely that such services will be launched in the future.
We can save a life by reaching out to friends and neighbors, and it’s no less important to recognize when we ourselves are struggling. Sometimes we worry about others without acknowledging that we, too, are on the edge. With that in mind, we’re writing the following words for you and every other reader but also for ourselves: When you’re struggling, contact someone you trust for support. By doing so, you’re also implicitly giving them permission to ask for help from you when they need it, and by giving and receiving help, you create a new pattern of reciprocity.
Such reciprocity has political significance. It fosters social cohesion, a precursor for coordinated action on a far larger sale.
Copyright 2025 Mattea Kramer and Sean Fogler
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