Donald Trump boosted mental health efforts in Texas in his first term. Will he do it again?

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Law and order. This motto is the paramount stance of President-elect Donald Trump when it comes to mental health and substance abuse issues.

The president-elect campaigned on promises to shake up public health institutions, reshape federal health programs, and slash high costs across the health system. Trump has also said he’s ready for Robert F. Kennedy Jr. to “go wild” on health, medicine, and food policy. But what exactly does this mean for mental health, and what does it mean specifically for Texas?

Some Texas mental health and substance abuse experts say it can be a mixed bag when it comes to this topic, as the previous Trump administration made groundbreaking advances in mental health and substance use programs, funded in large part by COVID-19 relief dollars that are set to expire soon. But more recently, Trump has spoken very little about his upcoming plans for mental health and substance use beyond fielding an idea about creating federally-funded homeless camps, diverting more people into mental health institutions and ending urban camping, the latter of which has gained traction in Texas.

For the most part, mental health and substance has found bipartisan support, but whether lawmakers can find common ground in a divisive political climate under Trump is uncertain.

“In President Trump’s first term, he did a few things that were actually very beneficial for mental health in general,” said Dr. Octavio Martinez, the executive director of the Hogg Foundation for Mental Health at the University of Texas at Austin. “Now the question is going to be, that was then — will those dollars continue under his second term, as a lot of those dollars are about to end next year? If those dollars expire, then we could see a significant impact on the state’s mental health programs.”

President-elect Donald Trump’s track record

There is a sense of cautious hopefulness around Trump’s second term after he signed the $2 trillion Coronavirus Aid, Relief and Economic Security Act that provided $8 billion to Texas.

This funded many innovative mental health efforts in Texas, including telepsychiatry programs in schools and libraries, community mental health programs in churches, and peer-to-peer services where mental wellness can be practiced in the community without a degree.

The Trump administration also oversaw the creation of the 988 crisis hotline in 2020. Staffed 24/7, the hotline connects people experiencing mental health distress with trained counselors.

“Many advocates in mental health had asked for it for many years, and it finally happened under Trump. It was a huge advancement in connecting people with crisis services,” Martinez said.

However, implementing the 988 program has been difficult in Texas, especially in the rural areas, as staffing these call centers has been problematic.

“Hopefully, he will want to enhance the 988 program because that is one of the legacies of his first term,” Martinez said. “It allowed for a more humanistic approach to a crisis.”

When it comes to substance use and treatment funding, Trump has been a strong advocate of addressing the opioid crisis, calling it a national public health emergency and handing out nearly $2 billion in grants in his last term. Texas received $27 million, which has been used to create fentanyl campaigns and get anti-overdose medication in schools, bars, churches, and more.

But, throw in the potential appointment of Kennedy as the U.S. health secretary, progress seen in Trump’s first term could unravel.

Kennedy has been outspoken about providing more resources for substance use treatment but is critical of medication treatments for mental health conditions. Kennedy, earlier this year, made a series of controversial statements about health care, including that there could be a damaging link between antidepressants and school shootings and the benefits of legalizing psychedelics for mental health treatment.

“Both Republicans and Democrats in Congress have supported increases in substance use funding in recent years, and an optimistic view is that the current level of funding support will continue or increase,” said Katharine Neill Harris, a drug policy fellow at Rice University’s Baker Institute for Public Policy.

Challenges that face the new administration 

The mental health and substance abuse field faces many issues, including a workforce shortage and a lack of diversity in the face of growing demand. However, the biggest challenge the Trump administration might face is replacing the COVID-19 relief funding which ends in 2024.

The Texas Legislative Budget Board estimates the state has received more than $86.1 billion from six funding bills between 2020 and 2021. A significant chunk of the money was spent on mental health resources.

For example, Texas schools received more than $19 billion from the Elementary and Secondary School Emergency Relief Fund and a statewide survey showed more than 73% of school districts reported using those funds for mental health.

“Much of our mental health approach in Texas has been built on this funding,” said Martinez. “The politicization of COVID and the pushback against vaccines in general makes you question if there will be ongoing support for those dollars we got during the pandemic.”

Another issue facing pro-business Trump is forcing health insurance companies to cover mental health and substance use disorders the same way it covers medical and surgical conditions.

In Texas, nearly 1 in 5 youth with private health insurance don’t have coverage for mental or emotional problems, and roughly one-third of adults who have a mental health disorder are not able to see a doctor due to cost, according to Forbes.

“We have to ensure physical and mental health are seen equally in the eyes of insurance companies,” Martinez said.

What has Trump proposed so far? 

The Trump administration has proposed one plan to address mental illness and substance use across the country already — federally-funded homeless camps.

“We are making the many suffer for the whims of a deeply unwell few,” Trump said in a video on his campaign website.

Trump wants to buy large parcels of inexpensive land for tent cities, bringing in doctors, psychiatrists, social workers and drug rehab specialists to treat individuals there.

This controversial concept has alarmed mental health experts who say sequestering those experiencing homelessness is a return to institutionalizing the mentally ill. This movement started to end in the 1980s with the decline of state mental health hospitals.

Martinez said studies have found forcing people into mental health treatment usually doesn’t work.

“The idea of a law and order approach is concerning when it comes to homelessness,” Martinez said. “We have some great diversion programs established that use a health care approach. It’s less expensive than the criminal justice system, which we have tried to use to address this in the past.”

Trump’s desire to use more mental institutions to house and rehabilitate those with severe mental illness jibes with a critical piece of Texas’ mental health plans for the future.

Earlier this year, Gov. Greg Abbott announced seven new state hospital projects funded by $1.5 billion legislators approved in 2023 to expand, renovate and build new facilities across the state.

Also possibly currying favor among Texas lawmakers is Trump’s ban on urban camping.

Bans on homeless encampments in Texas drew backing of the U.S. Supreme Court in a sweeping ruling earlier this year, allowing cities and states to fine people experiencing homelessness for sleeping in public places amid record-high homelessness levels.

Camping bans adopted by state lawmakers and in major cities like Austin and Houston weren’t explicitly challenged in the case. But advocates for those experiencing homelessness saw the ruling as a signal to state and local governments to embrace such policies without providing housing options for people experiencing homelessness.

The number of Texans experiencing homelessness returned to pre-pandemic levels last year, growing by more than 12% in 2023. Some 27,000 Texans were homeless last year, according to federal estimates.

In addition to his homelessness proposals, his substance use strategy intersects with border security, which experts say is not effective.

“Tighter border security and mass deportations will not reduce the flow of drugs into the U.S., but the president-elect may still point to tactics like these as evidence that he is addressing the epidemic,” Harris said.

If Trump does nothing more than maintain the same amount of effort he put into addressing substance use, it will be a win for the mental health community, she said.

Plus, many of the problems in mental health and substance use must be addressed locally anyway.

“Long-term reductions in substance misuse and related harms require a genuine commitment to addressing the country's epidemics of poverty and social isolation,” she said. “Over the next four years, I hope to see more local and state efforts to tackle these problems.”

Disclosure: Hogg Foundation for Mental Health and Rice University's Baker Institute for Public Policy have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.