Vantage Policy Watch Week of September 15, 2025
- jameliahand
- Sep 15
- 4 min read
Updated: Sep 22
Behavioral Health & Substance Use Policy at a Turning Point
By Jamelia Hand MHS CADC CODP I
What’s at Stake
This week marks a critical moment in U.S. behavioral health and substance use policy. On Today, the Massachusetts Joint Committee on Mental Health, Substance Use, and Recovery will hold a hybrid public hearing on harm reduction bills. Legislators will be considering legislation including An Act relative to preventing overdose deaths and increasing access to treatment, which would allow communities in Massachusetts to open overdose prevention centers under the regulatory authority of the Department of Public Health. View live stream here.
At the same time, the federal policy landscape is being reshaped by Executive Order 14321, “Ending Crime and Disorder on America’s Streets.” Signed July 24, 2025, this EO directs major changes in how homelessness, mental illness, and substance use disorders intersect with public safety, civil commitment, housing policy, and federal grant‑making. Key directives include:
Prioritizing civil commitment and institutional treatment for people who are homeless and meet criteria around serious mental illness or substance use disorder. Navigating the Executive Order on Homelessness and Involuntary Psychiatric Holds: Implications for California Hospitals | Davis Wright Tremaine
Enforcing prohibitions on open drug use, urban camping, loitering, etc., as conditions in certain grants.
Ending or reducing support for “Housing First” models in federal homelessness assistance programs, in favor of housing conditional on treatment or sobriety.
Restricting use of federal funds (e.g. from SAMHSA) for harm reduction or safe consumption programs that are seen as facilitating illicit drug use.
These shifts are more than semantics as they could reshape how service providers operate, how state laws align (or don’t) with federal mandates, and how people with substance use and mental health challenges experience care.
Emerging Risks and Opportunities
Risks
There is a significant risk that policies emphasizing civil commitment, institutionalization, and conditional housing will erode voluntary and low‑barrier services. When programs require treatment or sobriety before housing, or when stable housing is contingent on participation in a clinical program, many people will be excluded. These changes threaten individual dignity, trust in systems, and may raise legal concerns under disability rights or housing law.
Another risk is the potential rollback of harm reduction‑oriented programs. If federal funding is restricted for key interventions like syringe service programs, safe consumption sites, or mobile harm reduction outreach, this could lead to higher rates of overdose, infection (e.g. HIV/HCV), and unaddressed substance use needs. Communities that have built harm reduction infrastructure may face retrenchment under the new policy direction.
Operationally, many behavioral health systems are already stretched: shortages in psychiatric beds, insufficient step‑down facilities, and limited access in rural or under‑resourced areas. Introducing broader civil commitment or requiring institutional treatment without matching support and capacity expansion could overwhelm providers, delay care, and degrade quality.
Privacy, civil liberties, and legal compliance also loom large. With directives to share data between homelessness assistance, housing, law enforcement, and other agencies, there’s risk that privacy protections (especially around substance use disorder or mental health information) could be compromised or misused.
Opportunities
Even in this shifting landscape, there are strategic openings. First: policy influence. The Massachusetts hearing offers a platform for providers, people with lived experience, and advocates to shape the narrative and evidence around harm reduction. Testimony, data, and stories can help counterbalance the push toward coercive models.
Second: advancing legal and regulatory equity through enforcement of mental health/substance use parity (MHPAEA). The momentum around civil commitment could coincide with stronger scrutiny of insurer and Medicaid behavior around nonquantitative treatment limitations and coverage denials. Providers could leverage parity laws to defend access to care.
Third: for providers, coalitions, and states to double down on documenting outcomes and cost savings of voluntary, housing‑first, harm reduction, and community‑based services. Demonstrating that these models prevent hospitalizations, reduce emergency costs, improve recovery outcomes helps make the case for sustained or increased investment even under federal pressure to shift models.
Fourth: strategic communications and narrative framing matter. Shaping public understanding of behavioral health and addiction, stressing dignity, equity, and effectiveness of community‑based care, can influence courts, legislatures, and regulatory agencies. It may help prevent overreach, preserve patient rights, or even influence how new laws or rules are implemented on the ground.
Vantage Take
We see this moment as a crossroads. The executive branch’s policy direction is pressing toward institutional approaches, civil commitment, and conditionality. But decades of evidence show that coercive models are not sustainable for good health, recovery, or stable outcomes. Community‑based, voluntary, harm reduction and Housing First programs have delivered measurable benefits in housing stability, reduced emergency and inpatient utilization, reduced overdose fatalities, and improved trust, especially among marginalized and underserved populations.
Providers and advocates must not treat the current EO mandates or grant conditions as simply inevitable. There is space to push back, to demand clarity, to assert rights, and to preserve alternative models. Those who can align with both regulatory demands and maintain dignity, autonomy, and person‑centeredness will be best positioned in the coming shifts.
What to Do This Week
Submit written or in‑person testimony in Massachusetts for the September 15 hearing on harm reduction / overdose prevention centers.
Map out which grants or programs your organization receives might be affected by the civil commitment / housing conditionality parts of EO 14321 — anticipate compliance risks or changes.
Review parity laws (state and federal) to identify where insurers or payors may be violating nonquantitative limits or imposing unjustified restrictions.
Audit data sharing / privacy practices, especially around mental health or substance use information, to prepare for any new requirements or risks of misuse.
Craft stories or case studies showing how harm reduction or Housing First models work in practice. These can be powerful in legislative, regulatory, or public advocacy settings.
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