Last month, President Trump’s Department of Justice issued an opinion clarifying that institution-based psychiatric care did not constitute discrimination against the mentally ill. This rollback of disability law’s so-called “integration mandate” aligns with other actions Trump has taken to expand involuntary treatment. But it contrasts with the “Make America Health Again” (MAHA) approach to mental health favored by Health and Human Services Secretary Robert F. Kennedy Jr.
Trump is of two minds when it comes to mental health. Kennedy wants to rein in the “overprescribing” of psychiatric medication, particularly selective serotonin reuptake inhibitors (SSRIs) for anxiety and other mild mental disorders. Agencies outside HHS, however, looking to address homelessness, have pushed for more treatment for psychotic disorders.
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These approaches are not necessarily contradictory. What seems like policy incoherence may be better understood as Trump’s surfacing a long-latent debate over the direction of mental-health policy. For years, many reformers and advocates have criticized the system for doing too much for the milder cases and too little for the hardest-to-treat cases.
But more clarity is needed. Does Secretary Kennedy truly intend to apply his anti-medication approach to unsheltered schizophrenics and the “worried well” alike? Or does he envision a carve-out within the MAHA agenda for untreated serious mental illness? The latter option would be reasonable and welcome; the former would be a disaster.
The U.S. government uses the term “seriously mentally ill” to categorize adults who can’t function in ordinary society due to a psychiatric impairment, which often features psychotic symptoms. Bipolar disorder and schizophrenia are the two diagnoses most commonly associated with serious mental illness.
Americans who suffer from serious mental illness experience homelessness at a rate ten to 20 times higher than the general population. It therefore stands to reason that increasing access to psychiatric treatment can reduce homelessness. While not curing schizophrenia or bipolar disorder, treatment manages symptoms. Psychiatric medications cut through the fog of psychosis, enable clearer thinking, stabilize mood swings, and help get behavior under control.
Homelessness is not the only risk of untreated serious mental illness. People with these conditions die 15 to 20 years earlier than the general population, are incarcerated at roughly 20 times the rate of other Americans, and experience unemployment at rates around 20 times higher. All of those metrics would be improved through more use of psychiatric medication among the 30 percent of seriously mentally ill adults (4 million people) who received no treatment last year.
For some, that will require placement in an institutional setting. The recent Justice Department opinion emphasized how courts and past administrations were overzealous in forcing states to place the seriously mentally ill in community settings too unstructured to meet their clinical needs. In its July 2025 executive order, “Ending Crime and Disorder on America’s Streets,” the Trump administration specifically called for expanding the use of involuntary treatment to reduce crime and homelessness. In March 2026, the Department of Veterans Affairs and the DOJ announced a plan to expand guardianship for certain individuals in the veterans’ health system incapable of making their own care decisions. In June, the Department of Housing and Urban Development restructured the main federal homelessness grant program to promote more integration between behavioral-health interventions and housing for the homeless programs. Such intensive-treatment-oriented policies of Trump II build on the first Trump administration’s mental-health policy, which authorized the use of Medicaid funds for inpatient psych care in specialized hospitals.
At HHS, Secretary Kennedy has also expressed interest in addressing homelessness, such as with the STREETS initiative. But his main concern is overtreatment. In May, he rolled out an initiative to “strengthen informed consent” by directing providers to make patients more aware of the risk of psychiatric medication and benefits of nonmedical interventions. Also in May, the New York Times Magazine documented growing ties between Kennedy-aligned MAHA activists and the left-wing anti-psychiatry community. One of that community’s most dubious ideas—that taking psychiatric medication causes violence—has been promoted by Kennedy himself. He has touted the supposed benefits of a keto diet for schizophrenia.
In explaining why he sees overprescribing as mental-health policy’s defining crisis, Kennedy asserted, mainly with SSRIs in mind, “Psychiatric medications have a role in care, but we will no longer treat them as the default.” For schizophrenia, however, psychiatric medication should be the default. Kennedy didn’t indicate whether he sees that case as an exception to the rule.
Yes, serious mental illness can be overmedicalized. Americans with psychotic spectrum disorders benefit from meaningful daily activities, exercise, friendship, housing, and therapy. As expressed by former Los Angeles County Department of Mental Health head Jonathan Sherin, they need “people, place, and purpose.” Medication compliance is not a sufficient cause of recovery from serious mental illness, though it is a necessary one. Nonmedical goods and services will be most effective when working off a foundation of traditional medical treatment. Medication liberates the seriously mentally ill from the cognitive and behavioral constraints that prevent them from living a normal life.
With SSRIs, the problem is excessive consumer demand. Americans failing to live their best life compulsively seek quick fixes for ordinary unhappiness. But with the seriously mentally ill, not enough demand is the problem. At least half of schizophrenics and over one-third of bipolar-diagnosed Americans are so sick that they don’t accept their diagnosis or their need for treatment, a condition known as “anosognosia.” The last thing we should do for someone with anosognosia is encourage his psychiatrist to suggest that he focus on cutting out the carbs instead of taking his meds.
One in six American adults are on psychiatric medication, a rate that Secretary Kennedy has characterized as a crisis of “dependency.” His fix is to bolster consumers’ personal autonomy by “strengthen[ing] informed consent.” But outside HHS, the administration has rightfully taken a paternalistic approach to serious mental illness, one that restricts personal autonomy.
Where MAHA could truly help is in easing strain on the mental-health system, whose resources are now stretched too thin. Communities across the nation face a shortage of mental-health workers, which they’ll never be able to fill at current levels of demand unless they start poaching personnel from other “caring economy” professions. The U.S. also has a shortage of psychiatric hospital beds, which will require authorizing a few billion more dollars in Medicaid spending annually. We do need to spend more on mental health. But at a time of acute sensitivity to waste in the Medicaid program, mental-health advocates would be wise to adopt a message of reform before revenue.
Long before MAHA’s emergence, E. Fuller Torrey argued that our excessive focus on mental wellness accounts for why we persistently fail the seriously mentally ill. It’s a perfectly conservative vision of mental-health reform, one centered around creating a smaller, more effective treatment system.
It’s not a populist one, though. Secretary Kennedy is a lawyer with a marked distrust in medical authority. Politically, he hopes to convert anger over authorities’ undeniable abuse of power during Covid-19 into a broader, permanent campaign against overmedicalization. But deference to expert medical authority is indispensable for treating serious mental illness. Indeed, with respect to questions such as when to commit someone to a hospital who doesn’t want to go, our mental-health system defers too much to lawyers and not enough to psychiatrists. Yes, psychiatric authority needs guardrails. But that’s a lesson we overlearned a long time ago—as street conditions in San Francisco and New York amply demonstrate.