The Politics of Deprescribing: Deconstructing the HHS Mental Health Agenda

Since May 2026, Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. has promoted an initiative to restructure U.S. mental health delivery. The plan heavily emphasizes "prevention and holistic treatments" while actively discouraging the use of psychiatric medications, under the premise that they are widely overprescribed—especially in children.

A May 4, 2026 memo outlines the core strategy: addressing the "mental health crisis" by making deprescribing (tapering and discontinuing medications) and annual pharmacological reviews reimbursable services, alongside launching federal webinars to teach clinicians how to taper patients off medications.

While these proposals may sound progressive to the public, they collapse under scientific scrutiny for three primary reasons.

1. The Myth of Overprescribing

The administration's central premise—that the mental health crisis is driven by overmedication—is medically inaccurate.

• The Reality of Undertreatment: Up to 23% of the U.S. population has a treatable psychiatric condition warranting antidepressants, yet only a fraction of those individuals receive a prescription.

• Non-Psychiatric Indications: Antidepressants are heavily prescribed for non-psychiatric, FDA-approved or clinically indicated conditions, including migraines, tension headaches, chronic pain, fibromyalgia, and smoking cessation. Studies show that 50% to 64% of all antidepressant prescriptions are written for these non-psychiatric diagnoses [4-8].

• The Gap: When accounting for these physical health prescriptions, only about a quarter of Americans who actually need antidepressants for psychiatric conditions are receiving them. The real crisis is undertreatment, not overmedication [11-13]. Primary care settings miss or misdiagnose depression 40% to 50% of the time, and there is a 90% gap between individuals diagnosed with depression and those receiving clinically effective treatment [14].

2. Redundant "Solutions" to Standard Medical Training

The proposal to have HHS educate doctors on tapering is highly redundant and ignores existing clinical infrastructure.

• Tapering is Foundational Medicine: Psychiatrists and primary care physicians are already trained in tapering and discontinuing medications. Clinicians have been acutely aware of antidepressant discontinuation syndrome since the first case report in 1959, and it has been standard textbook material since at least 1993.

• Complex Cross-Tapering: In practice, stopping a medication rarely happens in a vacuum. Clinicians routinely manage highly complex transitions—such as cross-tapering (stopping one drug while initiating another) or managing patients who arrive with shopping bags full of conflicting medical and psychiatric prescriptions.

• Existing Resources: Detailed clinical guidance on switching and stopping antidepressants has been readily available in industry-standard databases like UpToDate for over 18 years [9,10]. Rather than funding political webinars, a far more effective HHS initiative would be providing free UpToDate access to all practicing U.S. clinicians.

• Routine Care vs. Political Incentives: Assessing medication efficacy, side effects, and whether to continue, adjust, or stop a drug is already a mandatory component of every standard psychiatric visit. Rebranding this routine care as a newly incentivized "deprescribing service" is purely rhetorical.

3. The Clinical Danger of Forced Deprescribing

Both the American Psychiatric Association (APA) and the American Foundation for Suicide Prevention (AFSP) have issued sharp responses to the HHS initiative:

• The APA strongly objects to defining the mental health crisis as an issue of "overprescribing."

• The AFSP warns that aggressive, medically unsupported "deprescribing" carries severe risks, including increased all-cause mortality, cardiovascular mortality, suicidal behavior, completed suicides, decreased quality of life, and long-term disability.

The Double Standard: Fast-Tracking Psychedelics

While the administration seeks to restrict standard, rigorously studied psychiatric medications, it simultaneously pushes to expedite the review and approval of innovative psychedelics (e.g., psilocybin, noribogaine, and methylone/MDMC) under "Right to Try" laws [19-23].

This presents a glaring policy contradiction:

• High Risks: These compounds carry documented risks of severe psychiatric, cardiac, and systemic side effects (such as QT interval prolongation and arrhythmias linked to ibogaine) [22,23].

• No Infrastructure: Administering psychedelic therapy safely requires intensive, highly staffed clinical infrastructure that the current healthcare system does not possess.

• Hypocrisy: It is ideologically inconsistent to demand less medication use while fast-tracking high-risk, under-studied substances with relaxed regulatory oversight.

The Broader Landscape of Public Health Misinformation

The antidepressant initiative is part of a broader, systemic pattern of health policy distortion outlined below (and in the lead table):

Scientific Debunking vs. Public Policy (from lead table)

Misinformation Claim	Scientific & Empirical Reality	Citation(s)
Vaccines cause autism	Long-debunked conspiracy theory; actively promoted by RFK Jr. to undermine public trust in vaccines.	[1]
SSRIs cause mass shootings	Debunked. Mass shootings correlate heavily with firearm density, not antidepressant use. Meanwhile, the administration is actively rolling back firearm restrictions for the mentally ill.	[1]
Diet/Keto replaces schizophrenia meds	No clinical evidence supports this. While RFK Jr. claims a ketogenic diet can "cure" schizophrenia, medical consensus remains that clozapine and standard antipsychotics are the gold standard.	[2, 16]
SSRIs are more addictive than heroin	Scientifically false statements made by RFK Jr. during his confirmation hearings. Retraction was formally demanded by 25 members of Congress in March 2025.	[2]
Acetaminophen causes autism	Not supported by rigorous sibling-controlled genetic analyses.	[3, 4]
Alcohol is a healthy social beverage	Promoted by CMS Administrator Mehmet Oz. Directly debunked by modern dietary analyses showing no safe level of alcohol consumption.	[14, 15]

The Policy Fallout: Cutting Resources While Mandating Treatment

The administration's legislative agenda, highlighted by H.R. 1 / One Big Beautiful Bill Act (OBBBA) and Executive Orders 14321, 14379, and 14401, represents a systematic defunding of the mental health safety net under the guise of reform.

1. The Homelessness Mandate (EO 14321)

This order effectively ends "Housing First" policies by making federal housing assistance contingent upon unhoused individuals entering mandatory psychiatric and substance use treatment [17].

• The Error: It ignores the reality that homelessness increases are driven primarily by a lack of affordable housing, not sudden spikes in mental illness.

• No Support: It broadens civil commitment powers without building the clinical infrastructure or beds needed to house or treat these individuals.

2. Dismantling Harm Reduction (EO 14379 & 14401)

The "Great American Recovery Initiative" restructures national addiction policy by stripping away proven harm reduction tools [18].

• The Damage: It bans the distribution of fentanyl test strips, defunds medication-assisted treatment (MOUD) programs that do not force annual drug tapering, and bans the very term "harm reduction" from federal programs.

• Data Blackout: It effectively suspended the National Survey on Drug Use and Health (NSDUH), blinding researchers to national addiction and mental health trends, while imposing sweeping budget cuts on SAMHSA.

3. Stripping Medicaid (OBBBA / H.R. 1)

Medicaid is the nation's largest payer of mental health and substance use disorder care, and the primary funding vehicle for addressing Social Determinants of Health (SDOH) (housing, food security, and transportation) [24-29].

• The Cuts: The bill slashes $911 billion from Medicaid over the next decade to offset $4.5 trillion in tax cuts.

• The Toll: Economists estimate these cuts will strip health coverage from 7.6 million to 16 million Americans, resulting in 16,642 to over 140,000 medically preventable deaths annually [24,26].

• The Demographics: These cuts disproportionately harm rural communities, Black and Hispanic populations, perinatal care, and those seeking addiction treatment—all while 92% of Medicaid recipients already meet work and eligibility requirements.

Conclusion: Rhetoric Over Reality

When health policy is systematically distorted, we must look at the underlying political strategy. The current administration relies heavily on creating rigid in-groups and out-groups, framing public health officials, scientists, academics, and social advocates as "enemies" who are oppressing their core demographic.

The HHS antidepressant and "deprescribing" initiative is not a sincere effort to improve clinical care. It is a rhetorical distraction. By framing the mental health crisis as a personal failure of "overprescribing" doctors and "drugged" citizens, the administration conveniently avoids addressing the structural, economic, and social determinants of health—all while actively dismantling the financial and clinical infrastructure that keeps vulnerable Americans alive.

 

George Dawson, MD, DFAPA

 

Supplementary 1:  Not loving the table.  I tried everything possible to convert my 4 page Word table that is the basis for this post to a single continuous image.  I also tried pasting it directly into this post without any success.  The table alone was too large for the Blogger format and I could not find any way in the HTML to modify the size.  The expected continuous images were too narrow and I could not resize them.  Until I find a way - just click on each table page and it is readable.  The references in the table are in the table and not at the bottom of the post.

References:

1:  WTAS: HHS Launches MAHA Action Plan to Curb Psychiatric Overprescribing.  https://www.hhs.gov/press-room/wtas-hhs-launches-maha-action-plan-curb-psychiatric-overprescribing.html

An embarrassing collection of attention seekers and compromisers.  Note how the APA position reads compared with the link above.

2: Centers for Medicare & Medicaid Services.  The Mental Health Parity and Addiction Equity Act (MHPAEA): https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity  (accessed 07/13/2026)

3: Kessler, Glenn (January 23, 2021). "Trump made 30,573 false or misleading claims as president. Nearly half came in his final year". The Washington Post. Archived from the original on January 24, 2021.

4:  Mojtabai R, Olfson M. Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Aff (Millwood). 2011 Aug;30(8):1434-42. doi: 10.1377/hlthaff.2010.1024. PMID: 21821561.

5: Rhee TG, Rosenheck RA. Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015. Health Serv Res. 2019; 54: 139–148. https://doi.org/10.1111/1475-6773.13072

6:  Wong J, Motulsky A, Abrahamowicz M, Eguale T, Buckeridge DL, Tamblyn R. Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system. BMJ. 2017 Feb 21;356:j603. doi: 10.1136/bmj.j603. PMID: 28228380; PMCID: PMC5320934.

7:  Zhang X, Nie X, Shi L. Treatment indications for antidepressants prescribed in primary health care facilities in Beijing, China. Int Psychogeriatr. 2025 Aug;37(4):100057. doi: 10.1016/j.inpsyc.2025.100057. Epub 2025 Mar 12. PMID: 40074596.

8:  Camacho-Arteaga LF, Gardarsdottir H, Ibañez L, Souverein PC, van Dijk L, Hek K, Vidal X, Ballarín E, Sabaté M. Indications related to antidepressant prescribing in the Nivel-PCD database and the SIDIAP database. J Affect Disord. 2022 Apr 15;303:131-137. doi: 10.1016/j.jad.2022.02.001. Epub 2022 Feb 5. PMID: 35134393.

9: Hirsch M, Birnbaum RJ.  Antidepressant discontinuation syndrome and discontinuing antidepressants in adults.  UpToDate.  Accessed 7/15/2026:  https://www.uptodate.com/contents/antidepressant-discontinuation-syndrome-and-discontinuing-antidepressants-in-adults

10:  Hirsch M, Birnbaum RJ.  Switching antidepressant medications in adults.  UpToDate.  Accessed 7/15/2026:  https://www.uptodate.com/contents/switching-antidepressant-medications-in-adults

11:  US Preventive Services Task Force. Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(23):2057–2067. doi:10.1001/jama.2023.9297

12:  Jackson-Triche  ME, Unützer  J, Wells  KB.  Achieving mental health equity: collaborative care.   Psychiatr Clin North Am. 2020;43(3):501-510. doi:10.1016/j.psc.2020.05.008

13:  Wang  PS, Angermeyer  M, Borges  G,  et al.  Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization’s World Mental Health Survey Initiative.   World Psychiatry. 2007;6(3):177-185.

14:  Vigo D, Haro JM, Hwang I, et al. Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder. Psychol Med. 2022 Jul;52(10):1948-1958. doi: 10.1017/S0033291720003797. Epub 2020 Oct 20. PMID: 33077023; PMCID: PMC9341444.

15:  White A, Thornton RLJ, Greene JA. Remembering Past Lessons about Structural Racism - Recentering Black Theorists of Health and Society. N Engl J Med. 2021 Aug 26;385(9):850-855. doi: 10.1056/NEJMms2035550. PMID: 34469642

16:  McCoy J, Rahman T, Somer M. Polarization and the global crisis of democracy: Common patterns, dynamics, and pernicious consequences for democratic politics. American behavioral scientist. 2018 Jan;62(1):16-42.

17:  Mason L. Uncivil agreement: How politics became our identity. University of Chicago Press; 2022 Dec 22.

When politics is your identity merged with other identities like race, religion, local culture – the intensity toward out-group hostility intensifies because it seems like an existential threat - but - it is not.