Even with an administration where political appointees atop health agencies are expected to stand behind the president’s handling of the Covid-19 crisis, former agency officials were taken aback by her comments.

Regina LaBelle, chief of staff in the White House Office of National Drug Control Policy during the Obama administration, said when she heard the last line of the podcast — “paid for by taxpayers” — she started laughing. “It’s so blatantly political and cynical, and it breaks my heart to see this,” said LaBelle, now program director of the Addiction and Public Policy Initiative at the Georgetown University Law Center. “Families are suffering and they deserve to be treated with respect by their government.”

“I’ve always had great respect for her,” LaBelle said of McCance-Katz, but as a political appointee, she’s in “a bubble of the machinery of government. And right now, the machinery of government is being used to reelect the president.”

The podcast is part of a series in which Michael Caputo, a former Trump campaign official appointed as HHS assistant secretary for public affairs in April, interviews department officials. Caputo has become a controversial figure at HHS. His communications team has been pressuring the Centers for Disease Control and Prevention to water down weekly scientific reports on Covid-19 to more closely align with the president’s optimistic views about the course of the pandemic, Politico reported last week. And over the weekend, according to the New York Times, Caputo claimed on Facebook, without evidence, that government scientists were engaging in “sedition” and that left-wing hit squads were preparing for armed insurrection after the election.

The podcasts are posted on the HHS website and distributed through popular platforms, including Apple, Google Play, and Spotify. “Each episode takes the listener behind the scenes at HHS as the experts explain what they’re working on and what you need to know,” an HHS spokesman said.

In the latest podcast, McCance-Katz says reopening schools and businesses is essential for people’s mental health. “There was a study published just a few months ago that said, for every 1% increase in unemployment, we will see an additional 1.3% jump in our suicides,” she says. “So, this is going to be a hugely terrible but important issue for us to address.”

Caputo tells McCance-Katz that the opposition to reopening schools is political, to which she responds, “It makes no sense.”

McCance-Katz, appointed to lead SAMHSA by Trump in 2017, never once challenges Caputo in the podcast – not even when Caputo, the top communications official at HHS, says, “I don’t think the United States media gives a damn about public health information.”

“I don’t too,” McCance-Katz responds.

Bob Lubran, until the end of 2016 the head of SAMHSA’s Division of Pharmacologic Therapies, said he believes McCance-Katz is being pressured to make such comments. “I view that as taking the party line,” he said. “I can’t imagine she would volunteer to do that.”

Another former agency employee, who knew McCance-Katz well, was blunter, saying: “She drank the Kool-Aid.” Like many former and current officials interviewed for this article, this person didn’t want to be identified, fearing retaliation.

McCance-Katz did not respond to an emailed request for comment, nor did spokespersons for SAMHSA and HHS.

SAMHSA leads public health efforts to reduce substance use and mental illness. McCance-Katz was its first chief medical officer, during the Obama administration, but left, afterward writing a scathing letter to Psychiatric Times in which she criticized the agency for not caring adequately for people with serious mental illness. She was brought back by President Trump as assistant secretary for mental health and substance use at HHS at the beginning of his term.

There have been other instances in which McCance-Katz has aligned herself with Trump’s views on the response to Covid-19. In mid-August, she wrote an op-ed in USA Today calling for schools to reopen. She cited the American Academy of Pediatrics (AAP) policy, which urged the return of children to classrooms, but she did not mention the AAP’s caveat that the reopening proceed only if it could be done safely.

“What the data shows clearly is that when schools reopen and community spread has not been adequately controlled, you will have infection in kids and teachers and parents,” Nathaniel Beers, a pediatrician who serves as an AAP spokesman and on its Council of School Health, told STAT.

Children are part of a social network, said H. Westley Clark, former director of SAMHSA’s Center for Substance Abuse Treatment, citing a CDC study that found children infected with the coronavirus at child care facilities had transmitted it to household members. “We have to ask how a child would feel if he/she infects his/her parent, especially if that parent is incapacitated by SARS-CoV-2 brought home by the child,” added Clark, a psychiatrist who is now a dean’s executive professor at Santa Clara University. “Remember, communities of color have been disproportionately affected by Covid-19.”

McCance-Katz also told President Trump during a May 19 Cabinet meeting that it’s vital to reopen the economy. “To put all of this in perspective, I believe it is important to point out that, pre-pandemic, we lose 120,000 lives a year to drug overdose and suicide. How many more lives are we willing to sacrifice in the name of containing the virus?” she said.

At the time, there had been more than 90,000 Covid-19 deaths reported in the U.S. in just three months, and the total is now nearing 200,000.

“When we look at strategies to reopen, as a medical doctor, I ask that you take into account whole health, not just one narrow aspect of physical health,” said McCance-Katz at the White House meeting. “We continually ask ourselves what the health costs and risks may be of reopening, but I ask: What might they be of not reopening or reopening in such a restrictive way that American lives are not restored?”

“As a psychiatrist, I would argue that a life lost to suicide is just as important as a life lost to coronavirus,” she concluded, calling the virus only “one metric,” and adding: “Virus containment cannot be our only goal, no matter the cost to Americans.”

McCance-Katz made no mention of the fact that lockdowns were deemed necessary by public health officials to “flatten the curve” in the spring and keep the U.S. health care system from being overwhelmed.

“Yes, overdoses are increasing and suicide is increasing, probably related to a lot of things including coronavirus,” one former SAMHSA employee told STAT. “Probably everybody in the United States has some form of generalized anxiety disorder right now, but is it ethical to say that we will reduce the suicide and overdose rates by reopening? We don’t know what we don’t know. It’s bad logic.”

STAT interviewed six former senior SAMHSA officials for this article, three other former high-level federal officials, and seven agency contractors and grantees, and most didn’t want their names used, citing fears that they could be retaliated against. Former officials said they feared their current employers risked losing agency funding if they spoke openly.

“As a former SAMHSA employee,” one person said, “I have seen the vindictiveness of this administration and her [McCance-Katz’s] henchpeople firsthand towards those who challenge the status quo, and I can’t afford to put [my organization] in the line of fire.”