HHS unveils MAHA action plan

Psychiatric medication policy is usually technical, slow, and buried in agency guidance. This one is not. On May 4, HHS used a MAHA Institute summit to announce a government-wide push against what it calls psychiatric overprescribing, with Robert F. Kennedy Jr. putting deprescribing and nonmedication treatment at the center of the message. That matters because the federal government is not just talking about therapy more — it is signaling a different default about when psychiatric drugs should start, how often they should be reviewed, and when they should stop. ### What did HHS actually announce? HHS said it wants to “promote appropriate psychiatric prescribing” and “drive deprescribing when clinically indicated.” The department paired that with a Dear Colleague letter urging informed consent, shared decision-making, and regular review of medication risks and benefits. It also explicitly highlighted psychotherapy, family support, nutrition, and physical activity as nonmedication options when appropriate. ### Why is “deprescribing” the key word? Because this is not just a warning against starting meds too quickly. It is a federal push to reassess existing prescriptions and, in some cases, taper or discontinue them. CMS released guidance explaining how physicians and other practitioners can bill Medicare for deprescribing-related care, which turns a broad message into something operational inside clinics. ### What happens next? Several near-term steps are already on the calendar. SAMHSA is supposed to issue a report this month on psychiatric prescribing trends. In June and July, SAMHSA plans webinars on adverse effects, deprescribing approaches, and evidence-based nonmedication treatments, plus a joint summer webinar with HRSA for federally qualified health centers. Then in July, HHS says it will update guidance on psychiatric medications. ### Why the focus on children? Kennedy framed the initiative around overuse “especially among children,” which fits the broader MAHA politics of overmedicalization and childhood health. That does not mean the policy is limited to pediatrics — the billing guidance and future clinical guidance are broader — but it does tell you where the administration thinks the most persuasive public case is. ### Why are psychiatrists pushing back? Because many clinicians do not buy the idea that overprescribing is the main driver of the mental health crisis. The American Psychiatric Association said the bigger problems are poor access to care, workforce shortages, too few beds, barriers to psychotherapy, and fragmented treatment. In other words — the field’s concern is that a real issue, inappropriate prescribing in some cases, is being turned into the master explanation for everything. ### What are suicide-prevention groups worried about? The American Foundation for Suicide Prevention did not argue against careful medication review. The catch is that poorly handled deprescribing can go badly. The group warned that abrupt or noncollaborative tapering can trigger relapse and raise suicide risk, which is why mental-health groups keep stressing individualized care, close follow-up, and not treating medication itself as the villain. ### Why does this matter beyond psychiatry? Because once HHS issues billing guidance, trend reports, webinars, and eventually formal clinical guidance, the message starts flowing into health-system protocols, payer behavior, and digital care workflows. Basically, this is how a political idea becomes administrative pressure. Software that nudges clinicians toward medication. That last step is partly inference — but it follows directly from the tools HHS is rolling out. ### Bottom line? This is a real federal policy move, not just MAHA branding. But it lands in a fragile area where two things can be true at once — some patients are overtreated, and many others still cannot get enough care. The success or failure of the plan will depend less on the slogan than on whether HHS can encourage better prescribing without scaring people away from treatment that helps them.