Trump executive order calls mental health prescriptions a 'threat' — why?

Our teenagers are in trouble.

Headlines have been ringing loud alarms around adolescent mental health, and the data are sobering. In 2023, 40 percent of high school students surveyed by the Centers for Disease Control and Prevention said they persistently felt hopeless or sad in the past year. Nine percent had attempted suicide.

Some of it is because of COVID. Some of it is related to social media. Then there is bullying, the pressure to succeed academically, the pressure to fit in. Being a teenager in the U.S. is hard.

So it's perhaps heartening to see President Donald Trump address mental health in a recent executive order (EO) targeting chronic health issues in children, one released as soon as Robert F. Kennedy, Jr., was confirmed as the director of the Department of Health and Human Services.

But nestled in this directive, which creates an RFK, Jr.–chaired commission to "Make America Healthy Again," are words that speak to the doubt that he and Trump have tried to sow around established science. This includes suggestions that the research funded by the National Institutes of Health and other agencies isn't "gold standard" and assertions that doctors are overprescribing medicines for conditions such as attention deficit hyperactivity disorder and depression and that "medical treatments" might be part of the pediatric chronic disease problem. Perhaps most troubling is the language the administration uses to describe prescription medications for mood and behavior disorders — they are a "threat."

That language stigmatizes families who choose prescription medication to treat their struggling children. It undermines the expertise of medical professionals. And it opens the door for unproven, improperly studied treatments to gain legitimacy.

The next era of snake oil dawns. Won't anyone think of the children?

According to the CDC, in 2021 and 2022, more than half of U.S. teens talked to a health care provider about their mental health. About 14 percent of teens reported taking medication to manage their emotional state or for concentration and behavior. Yet 20 percent said they have unmet mental health needs.

The Affordable Care Act, and before it, the federal parity law, introduced a lot of Americans, including perhaps these teens' parents, to parity in mental health coverage — in theory, insurance plans can't deny mental health coverage, charge ridiculous rates for coverage that included mental health or put limits on the amount of mental health coverage a plan allows.

But even if you have insurance, depending on where you live, finding mental health care for children can be incredibly difficult. Many providers, whether therapists or psychiatrists, don't take insurance, or don't take certain plans. This includes Medicaid but also large commercial plans. Many primary care doctors, including pediatricians, have limits on what aspects of mental health care they are comfortable managing, including medication. In rural parts of the U.S., there are hundreds of counties that do not have a single child psychiatrist.

Related: At-home brain stimulation could be promising depression treatment, trial hints

Then there is the public education system, bound to provide a suitable education for all children, thrust in the role of mental health adviser. For many children in the U.S., appropriate services first become available when a teacher, an aide, a counselor or another professional says, 'Hey, I think this kid needs help,' or when a kid demonstrates concerning behavior. This is admirable and necessary — one estimate says about 70 percent of mental health services that kids get happen at school.

But now some states are suing the federal government to render Section 504 educational accommodations for those children, and others with disabilities, unconstitutional because it was modified by the Biden administration to recognize youth who are LGBTQ.

This is the cruelty and the inconsistency of this executive order. Children who are LGBTQ have some of the largest rates of depression and anxiety in this country. Some 41 percent considered suicide in 2022–2023. And now we have a government trying to erase their very being from health care data, or at least to tell people who visit certain federal health care websites that the administration doesn't believe the science and evidence around gender. (Those stats from the CDC come from reports that were temporarily pulled down at the beginning of the Trump administration as part of a push to remove references to gender and sexuality that do not align with the male-female binary that drives conservative ideology.)

So what might come of the Trump administration's decision to examine our children's mental health? Federal funding for conversion therapy to "cure" LGBTQ teen depression? RFK, Jr., steering taxpayer dollars to the addiction-treating labor camps that he calls "wellness farms"? Pushing clinical trials for hydroxychloroquine to treat mood disorders (remember this from COVID?) or promoting something like juicing as a treatment for depression? This is speculation, of course, but the broader question of whether Kennedy will, with the administration's blessing, use tax dollars to promote untested, ineffective or harmful treatments remains.

Kennedy is a litigator who is now running our nation's most comprehensive health care agency. He is not a doctor, not a health care specialist, but a litigator — and one who kept saying during his confirmation hearings that he wanted to see the data that support the health care he has been desperately trying to undermine for the past decade. He is a litigator who once called people on certain antidepression drugs "addicts" and who has (falsely) claimed that it is harder to quit selective serotonin reuptake inhibitors — drugs like Prozac — than heroin.

Meanwhile the second Trump administration guts health care agencies when it could be doing what the first Trump administration did during COVID and facilitating telemedicine so that more children can access therapy and psychiatry. The administration pulls data and questions, just for the sake of it, the validity of what data we have. The EO says the administration will work with insurers to increase access, but what does that mean? Our medical schools are not graduating enough child psychiatrists. And it's not clear if Trump will again go after foreign medical graduates, many of whom fill rural medicine shortages, including psychiatry.

Antidepressants do not work for everyone, and some are associated with suicidal thinking in children. Stimulants do not help all children with ADHD. But this is the case for nearly every class of medication in this country — what works for some will not work for others. In the meantime, only 14 percent of adolescents are getting medication, and one in five is telling us they need more help. How is this overprescribing?

Going after antidepressants and claiming — preposterously — that they are harder to wean off of than heroin isn't how we care for children. This commission need not waste any time trying to reinvent the wheel. If its members want to solve mental health disorders as a chronic health condition in children, they need to make evidence-based treatment easier to get, increase incentives for insurance and workforce development and stop stigmatizing the families and children who need — and benefit from — this form of health care.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.

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