The nation is facing a worsening mental health crisis. Millions of Americans from all walks of life are struggling with mental illness. To combat this crisis, Health and Human Services Secretary Robert F. Kennedy Jr. introduced a controversial policy agenda aimed at curtailing what he called the ‘overuse’ of psychiatric drugs like antidepressants. The announcement has sparked outrage among many psychiatrists, patient groups, and policy experts who say that a shortage of medication is only part of the crisis — and dangerously frames the broader issue. “It really is an oversimplification. And it really ignores the larger reality, which is that too many patients really cannot access timely comprehensive care that is much needed for our nation,” said American Psychiatric Association president Dr. Theresa Miskimen Rivera. Experts say addressing America’s mental health crisis starts with looking at prescription trends, access challenges, Big Pharma’s role, and more.
Alternative treatment approaches for mental health conditions
There are many effective treatments that do not rely on medication. Evidence based psychotherapies include cognitive behavioral therapy (CBT), dialectical behavior therapy(DBT), Acceptance and Commitment Therapy (ACT) and trauma-informed therapy models which can treat people who have multiple mental health symptoms. CBT has been found to be just as effective as drugs for mild to moderate depression and anxiety. Additionally, studies have shown that therapy can have longer-lasting effects than medication. Other therapies and natural treatments showing promise include exercise, mindfulness-based stress reduction, meditation, nutrition, support groups and more. Peer support, where people who have experienced mental illness help others who have similar challenges, has been found to provide positive outcomes that can be measured. There has been promising research in trials utilizing psychedelic assisted therapy with drugs like psilocybin and MDMA for conditions such as treatment resistant depression and PTSD. The main thing is that doctors can and should offer other avenues of treatment besides just medicating someone.
Patient advocacy in the debate over psychiatric medication use
Above all else, patients stand to benefit or lose the most from policies surrounding psych medication use. Patient organizations and groups are therefore somewhat split on the issue. Some patient groups, especially those consisting of people harmed by psychiatric drugs or those who felt they were forced on patients without proper informed consent have supported increased examination into prescribing practices. Many disability and mental health organizations have cautioned against anti-medication language as stigmatizing and life-threatening to those who need and benefit from psychiatric medications, arguing that this kind of rhetoric can prevent people from taking medications that help them function. They argue that all patients deserve proper informed consent about the benefits, risks, and alternatives to any treatment being offered. What patients need, some say, is not government mandated medication tapering programs, but increased access to care, more time with providers, better education about treatment options and shared decision-making with their care providers.
Challenges in accessing timely and comprehensive mental health care
But there’s another essential — and vastly neglected — factor fueling the country’s mental health crisis: an absolute dearth of access to quality mental health care. Millions of Americans who need psychiatric care face extreme wait times, exorbitant costs, insurance restrictions and limited access to providers. More than 150 million Americans currently live in areas that have been federally designated as mental health professional shortage regions, per the Health Resources and Services Administration. If you live in a rural area, you might have to drive for hours to see a psychiatrist. Telehealth is a positive solution for many patients, but it’s not accessible or feasible for everyone. And for communities of color, low-income communities, and uninsured patients who are already experiencing significant access issues to healthcare in general, the roadblocks to receiving mental health care are compounded. Often times, that pill your primary care provider prescribes is the only access to mental health care you have. Period. It’s not that we should prescribe—we should absolutely prescribe. It’s just that it’s often the only option patients have. If we don’t expand access to mental health care while trying to solve this “overprescription” issue, we risk leaving patients with no care at all.
Addressing the complexity of the United States' mental health crisis
Kennedy's plan simplifies the mental health crisis in America, which is in reality complex and derived from many different sources. Many mental health professionals describe the nation's mental health status as a crisis that's affected by social determinants of health, systemic inequities, trauma and violence, financial strain, addiction, homelessness, and lack of resources due to America's underfunded mental health system. The National Alliance on Mental Illness reports that 1 in 5 American adults live with mental illness yearly. Yet, less than half of that group received treatment from a mental health professional. Suicide has increased by 50% in the last two decades. COVID-19 also had severe impacts on the mental health of Americans. To view this crisis through the lens of overprescription ignores the work that needs to be done to implement what many professionals are calling for: more workforce to support Americans with mental health needs, more integration of mental health care into primary care, less insurance barriers, and acknowledgment of the impact of social drivers of mental illness. Solutions should be multipronged and research driven, taking into account the danger of both overuses of these medications and the dangers of untreated mental illness.
The impact of overuse of psychiatric medications on mental health patients
Concerns over the over-prescription of psychiatric medication are separate from concerns over exactly how pervasive of a problem it is. Patients too often receive prescriptions for antidepressants, antipsychotics, benzodiazepines, etc. without proper psychological assessment, follow-ups, or psychotherapy with the medication they receive. Patients can build up dependencies, deal with unpleasant side-effects, and may even experience their mental illness get progressively worse with prolonged use of psych drugs. Research has indicated that psych drugs can become difficult to wean off of when patients are not given proper therapeutic resources to work with in tandem with their prescription. As many antidepressants have culminated withdrawal effects that range from minor to psychiatrically harmful, RFK Jr.'s solution of helping people wean off antidepressants does pose very real health risks to patients. Stopping psychiatric medications cold turkey, or stopping them too soon, can cause relapses and even death. Pointing out the problems of overuse needs to be specific and clinically accurate instead of drawn out with policy brashness.
The role of pharmaceutical companies in the overprescription of psychiatric medications
Drug manufacturers are heavily responsible for influencing prescribing patterns, and have done so openly and notoriously throughout the United States. For example, since the early 1990s they have been widely criticized for starting intensive advertising campaigns for antidepressants and other psychiatric drugs, targeting consumers as well as doctors. In addition to advertising directly to consumers and encouraging them to ask their physicians to prescribe certain drugs, drug company sales representatives ingratiated themselves with prescribers of psychiatric drugs and offered kickbacks to doctors who wrote the most prescriptions. Consequently, claim some advocates, writes to doctors dramatically increased as did the prescribing of psychiatric medications, which was often unnecessary. Data from the CDC shows that the use of antidepressants in the United States rose nearly 65 percent from 1999 to 2014. Some of this rise is likely due to better identification of depression and less stigma associated with the diagnosis. But industry involvement shouldn't be overlooked. Whatever actions are taken to combat the overuse of psychiatric drugs must acknowledge the role that pharmaceutical companies have played in creating the problem. Steps such as holding drug companies more accountable for their marketing tactics and monitoring doctors who accept kickbacks for writing unsustainable numbers of prescriptions should be considered.
Conclusion
RFK Jr.'s PR stunt does succeed in shining a light on some important issues with American mental health care: overprescription is a real problem, pharmaceutical companies do exert massive influence on psychiatry, and medication isn't always enough on its own to treat mental illness. But those issues shouldn't obscure — or even outweigh — the very real problem of those who aren't able to access the psychiatric care they need. Reducing people's access to medication without replacing it with sufficient alternative care does nothing but harm patients who are already vulnerable. We need to stop acting like there are only two options here: medication or nothing. It's time for big, funded, aggressively holistic change to the way America treats mental illness.
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