Health and Human Services Secretary Robert F. Kennedy Jr. has announced a new HHS initiative intended to “curb psychiatric overprescribing” by promoting “appropriate prescribing” and encouraging doctors to wean their patients off of meds when possible.
Kennedy alluded to his intentions to reduce the number of Americans taking psychiatric medications early in his tenure as HHS secretary, but this initiative marks his first step forward in doing so. Millions of Americans — somewhere between 16% and 20% of the population — take one or more psychiatric medications.
“Today, we take clear and decisive action to confront our nation’s mental health crisis by addressing the overuse of psychiatric medications — especially among children,” said Kennedy. “We will support patient autonomy, require informed consent and shared decision-making, and shift the standard of care toward prevention, transparency, and a more holistic approach to mental health.”
Kennedy outlined that HHS is calling on medical providers to stop overprescribing mental health meds — meaning giving them to patients who may not need them or who may have at one time, but no longer do — and to instead rely on other forms of treatment, including psychotherapy and even dietary education.
In a “Dear Colleague” letter to medical professionals, HHS reminded them that there are “a number of non-pharmacological services relevant to behavioral health care,” including “diet modification and medical nutrition therapy,” “group medical nutrition therapy,” and individual and family therapy. The initiative also encourages providers to clearly lay out the risks and potential side effects of medications throughout a patient’s use, and to follow well-established tapering schedules when it’s appropriate to wean someone off a medication.
Over the summer, HHS will convene a panel of experts to develop “formal HHS clinical guidance on the appropriate use of psychiatric medications and tapering and discontinuation.”
However, HHS’ announcement does not include data verifying that there is an overprescribing problem. Kennedy has previously claimed antidepressant use may contribute to violence, increase the risk of birth defects, and incite withdrawal symptoms that are more severe than withdrawing from heroin. Doctors and researchers have said he is wrong about all three points, and that his statements are not based in scientific evidence.
Experts are supportive of HHS’ plan to invest in more research, but say honing in on “overprescribing” to solve the nation’s mental health crisis is a red herring. “We may take issue with this blanket ‘overprescribing’ hypothesis that underpins the secretary’s statements,” said Dr. Marketa Wills, the chief executive and medical director of the American Psychiatric Association. “There is probably overprescribing and underprescribing in all parts of medicine, and mental health care is no different. And there are people who still can’t access care at all who need it.”
For example, the most recent data from the NIH found only 40% of U.S. adolescents with depression received treatment. There is a widespread, nationwide shortage of mental health professionals, from therapists and counselors to psychiatrists, and many providers do not accept insurance because reimbursement rates for mental health care are so low. Patients often face long wait times for appointments, even when in crisis.
This new HHS plan does not elaborate on how the agency might make non-medication treatment options — like therapy — more accessible to Americans. Kennedy did state that the Centers for Medicare and Medicaid Services is introducing a mechanism that will allow providers to be paid for the time spent helping a patient get off medications, but he did not share how patients are supposed to access therapy more readily than they can today.
It’s hard to say how this initiative will affect actual patient-doctor interactions, since the idea that they are overprescribing is not borne out in actual data. The vast majority of psychiatrists likely do have in-depth conversations with their patients about medication use, side effects, and when and how to taper.