Carolyn D. Gorman MAHA’s Mental Illness Blind Spot The Make America Healthy Again movement is not paying sufficient attention to the problem of serious mental illness.
https://www.city-journal.org/article/maha-rfk-jr-mental-illness-health
Health and Human Services Secretary Robert F. Kennedy Jr.’s “Make America Healthy Again” Commission released its initial report in late May, billing it as the “foundation” for a national policy strategy. Meant to assess chronic disease trends—including rising youth mental-health diagnoses and treatment—the report instead marked the movement’s first major setback. The 73-page document, with 522 citations, drew swift backlash for numerous references that were misrepresented, misattributed, or simply false. With citations to nonexistent studies and dead hyperlinks, the report also showed signs of possible AI-generated content. White House Press Secretary Karoline Leavitt dismissed the obvious and embarrassing flaws as “formatting issues,” but nonpartisans weren’t convinced.
The MAHA movement draws support from a diverse coalition: critics of corporate influence and overmedicated living; academics alarmed by pervasive social-media use; skeptics of vaccines and mainstream science; those disillusioned by government cover-ups during Covid-19; advocates of environmental regulation; and, not least, mothers who might otherwise lean progressive but oppose a public-health model that pathologizes issues better addressed through personal responsibility.
Mental health—in particular, youth mental health—has been a MAHA priority. A key sign of the movement’s traction has been its success in prompting others to admit that the current approach isn’t working. In May, the New York Times published an essay by psychiatrist Awais Aftab, pointedly titled “Harm from Antidepressants Is Real. Let’s Not Cede the Conversation to Kennedy.” Earlier, the Times had called out Kennedy for claiming that “15 percent of American youth are now on Adderall or some other A.D.H.D. medications,” but ultimately conceded that the figure is 12.9 percent and acknowledged rising rates of both stimulant prescriptions and psychotherapy. It also noted that these trends have not improved outcomes for low-income or black youth, or for adults with “serious psychological distress.”
Likewise, when Kennedy remarked in April that some autistic children will “never pay taxes, they’ll never hold a job,” drawing fierce criticism, a University of Pennsylvania scholar—no conservative—came to his defense. “If it had been me on that podium [where Kennedy stood],” wrote Penn’s Amy Lutz, the mother of a profoundly autistic son, “reporters would have gotten an earful about traumatic brain injury and blindness from self-injury; seizures, insomnia, and constipation; emergency surgery from pica (the compulsion to eat inedible objects),” and “parents who live in a near-constant state of crisis.” Even Scientific American agreed with Kennedy that 25 percent to 33 percent of children with autism “are far more severely impaired” and “cannot be left alone.”
But the Kennedy/MAHA critique of youth mental-health treatment is largely absent when it comes to the most urgent issue of all: serious mental illness, among both young people and adults. Were the movement to focus more directly on this problem, it could do real good and also strengthen its credibility on its more familiar concerns.
What is the current youth mental-health policy—so ineffective that figures as ideologically diverse as Kennedy, Trump, the New York Times, mainstream academics, and medical professionals find some common ground in criticizing it? At its core, the policy has focused on aggressively “promoting mental health.” Public officials have launched awareness campaigns about mental-health disorders, encouraged early intervention at the first sign of distress, and expanded access to treatment across all levels of severity—reaching younger and younger children.
At the same time, far less attention has been paid to treating serious mental illness, including chronic and disabling conditions like schizophrenia, which often emerges in late adolescence and affects an estimated 4 percent to 6 percent of the population. Instead of concentrating resources on helping those with the most severe needs, public-health officials have largely targeted the “worried well”—a much larger group receiving an ever-growing share of attention and intervention. The shift away from a focus on serious mental illness has dramatically transformed the public mental-health system, from a flawed but critical safety net of now-shuttered state psychiatric hospitals to today’s sprawling network of programs and providers accessible to the less symptomatic.
Under the Affordable Care Act, for example, outpatient mental-health services became a required essential benefit in small and group insurance plans, and Medicaid expansion was associated with a significant increase in mental-health service use. “Although I frequently hear that we don’t have enough mental health providers, the numbers don’t reveal a shortage,” writes Thomas Insel, former National Institute of Mental Health director, in his book Healing. In fact, the mental-health workforce is vast and growing—nearly double the number of all physicians and surgeons.
In 2023, the Bureau of Labor Statistics estimated that the U.S. had 24,830 psychiatrists; 160,600 psychiatric aides; 2,250 psychiatric nurse practitioners; 71,730 clinical and counseling psychologists; 62,790 school psychologists; 76,000 marriage and family therapists; 449,800 counselors for substance abuse, behavioral disorder, and mental health; 360,800 school counselors; and 114,680 social workers. That’s more than 1 million hammers—all trained to find nails.
Expanded access to treatment has coincided with industry and policy shifts that together have funneled more people into the mental-health system—though not always for the better. Diagnostic criteria for mental disorders have broadened significantly, meaning that more individuals now meet the clinical threshold for treatment than in years past. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has expanded from a 130-page clinician’s guide listing 106 diagnoses to a fifth edition spanning 992 pages and nearly 300 conditions—including schizophrenia, but also caffeine withdrawal, restless leg syndrome, and severe PMS. Clinical psychiatric diagnoses no longer require abnormal, severe, or chronic impairment. Some psychiatrists have begun to question whether these labels retain real clinical value.
The proliferation of psychiatric disorders hasn’t occurred in a vacuum. Since the 1960s, American society and its public institutions have increasingly met nonconformity and antisocial behavior with excuse and rationalization. A new ethos has elevated victimhood and downplayed personal responsibility. At the same time, public benefits tied to individual conditions have expanded dramatically. Securing a formal diagnosis has become key to accessing disability payments, insurance-covered services, and school-based accommodations. More and more of what were once seen as ordinary life experiences are now reclassified as “disorders.”
Clear empirical evidence points to the overdiagnosis, misdiagnosis, and overtreatment of ADHD, among other conditions. Studies show that referrals, diagnoses, and medication for ADHD cluster by age, with the youngest kids in a grade—those born just before the grade cutoff—more likely to be diagnosed. This pattern suggests that immaturity is being pathologized. Overdiagnosis is also reflected in 2023 national survey data, which estimate that a shockingly high proportion of adolescents—nearly one in three—have received medication, professional counseling, or other mental-health treatment in the past year, even though only one in five reported experiencing a single two-week or longer period of psychological distress.
Widespread access to mental-health treatment and services has not reduced serious mental illness. Nor has it lowered the overall prevalence of mental disorders, even as the pursuit of mental wellness has become a cultural fixation. “If there’s one theme in the medical literature in the last five years, it’s that we’ve been doing too much,” said Marty Makary, Trump’s FDA commissioner and a longtime Johns Hopkins physician, in 2020. “Indications for things we thought were appropriate we now realize were too broad. We are narrowing indications for all kinds of conditions.” Makary was speaking broadly about medical practice, but his point applies to how we diagnose and treat mental disorders as well.
MAHA’s anti-medicalization approach has real value for the many who experience distress as a normal part of life rather than a clinical condition. For most children and adolescents, improvements in diet, sleep, exercise, and time outdoors will do more than a diagnosis and a pill. Lenore Skenazy and Jonathan Haidt have shown the positive—even therapeutic—effects of offline play and greater independence. Kennedy’s take on tough love also has a place: young people often rise to meet high expectations.
MAHA can—and should—remain vigilant about overmedicalization and diagnostic inflation. But Kennedy must broaden the movement’s mental-health focus to include serious mental illness. Without doing so, he will have no answer to the inevitable questions that arise when problems can’t be solved by diet or exercise. What, for example, is MAHA’s position on medication for adults who are clearly psychotic and dangerous? Or on involuntary commitment for those individuals? How does MAHA align with President Trump’s long-standing support for expanding psychiatric hospital bed capacity? Addressing untreated serious mental illness has been a priority for Trump since 2018, when a severely mentally ill 19-year-old carried out the deadliest high school shooting in U.S. history at Marjory Stoneman Douglas High School in Parkland, Florida.
Serious mental disorders rank among the costliest and most life-altering chronic conditions; they are linked to poor outcomes across nearly every measure. Adults with serious mental illness and youth with serious emotional disturbances—a legal designation, not a clinical diagnosis—are the least likely to receive adequate medical and therapeutic care. A shortage of psychiatric beds for youth in need of inpatient and residential treatment has led to “boarding” in emergency departments, a problem long known to exist among adults with serious mental illness. When psychiatric needs are severe, both medication and therapeutic intervention are invaluable. Rigorous evidence shows, for instance, that antipsychotic medications can reduce violent behavior in individuals with schizophrenia. High-quality residential treatment programs can be important for youth with serious disorders.
Absent balance and transparency, Kennedy’s efforts may stall or, worse, deepen public distrust in health policy. Yet he has recruited talented experts like Makary and Jay Bhattacharya to his team, and the MAHA initiative still has the potential to recover from its early missteps and offer something more serious and constructive to the American public. What the movement needs from Kennedy isn’t medical advice—it’s leadership. He can demonstrate it by turning MAHA’s attention to the crisis of serious mental illness among the young.
Photo: Robert F. Kennedy Jr.’s MAHA movement is rightly skeptical of overmedication but should acknowledge the importance of psychiatric drugs for the seriously mentally ill. (Eric lee/The New York Times)
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