Opinion: MAHA is rewriting the vocabulary of American mental health care

OpinionFirst Opinion MAHA is rewriting the vocabulary of American mental health care ‘Wellness,’ ‘metabolic dysfunction,’ ‘dependency crisis’ — this language smuggles in an agenda Manage alerts for this article Email this article Share this article By Sunny PatelJuly 17, 2026 Patel is associate professor of psychiatry and pediatrics at the Georgetown University School of Medicine. He previously served as senior adviser for children, youth, and families at the Substance Abuse and Mental Health Services Administration. At a May MAHA Institute summit organized around the theme of “overmedicalization,” the health secretary announced an action plan to promote psychiatric deprescribing. At first look, it seemed innocuous. The Substance Abuse and Mental Health Services Administration (SAMHSA) would study prescribing trends and publish fact sheets. Medicare would clarify how clinicians can be paid for the attentive work of tapering a patient off of a medication (which is already a part of routine clinical care). Webinars would teach prevention and “holistic” care. A technical expert panel would convene over the summer to make further recommendations. In reality, this announcement, and the steady stream of actions over the past 18 months, mark a quiet rewriting of the vocabulary of American mental health care — a massive rhetorical shift enacted while programs and protections that would actually solve the problem are dismantled.Advertisement The MAHA movement’s mental health agenda rests on linguistic substitutions. “Treatment” becomes “wellness.” Neurobiological complexity becomes “metabolic dysfunction.” Medication treatment becomes “dependency crisis.” Evidence-based care becomes “root cause resolution.” Social determinants of health become “environmental purity.” Each swap reads as a humane correction to a system that MAHA believes overprescribes, overdiagnoses, and underinvests in the conditions — sleep, nutrition, safety, connection — that shape how people feel. Where children are concerned, the MAHA movement points at real problems: ultraprocessed food, sedentary childhoods, inadequate sleep, etc. Though some of the underlying science is still emerging, the relationship between metabolic health and mood is genuine; ketogenic and other metabolic therapies are being studied for serious mental illnesses like bipolar disorder and schizophrenia. Exercise, sleep, and diet most certainly can move the needle on depression. The danger is not in these ideas themselves. It is in the policy conclusion smuggled in alongside them: that metabolic and environmental interventions can serve as the primary pillars of a national mental health strategy, rather than as complements to treatments we already know work. That single rhetorical shift from and to instead of makes all the difference. Advertisement When the problem is recast as overmedicalization and the solution as lifestyle, the locus of responsibility migrates. It moves from systems and infrastructure that government funds toward choices that individuals make. A “metabolic dysfunction” rooted in diet is, conveniently, yours to fix with better groceries and more sunlight. But doesn’t address the root challenges of food insecurity, which in fact, has been exacerbated by administration actions. The vocabulary moves first; the budget is meant to feel like a natural consequence. The research enterprise, the crown jewel of American innovation, that would tell us what actually works for mental health is being both hollowed out and politicized. In the first months of 2025, the National Institutes of Health terminated hundreds of active grants; the National Institute of Mental Health lost more of them than any other institute. A new proposed Office of Management and Budget policy would give political appointees more sway over which studies get funded after scientific peer review. In practice, that means studies on mental health questions the administration disagrees with politically could simply stop getting funded. Despite Robert F. Kennedy Jr. touting real food to address mental health challenges, more than 700,000 children in just 12 states have lost SNAP benefits — which allow low-income families to buy groceries — since the One Big Beautiful Bill became law. The president’s proposed 2027 budget would cut the WIC benefit that helps low-income mothers and toddlers buy fruits and vegetables from $52 to $13 a month for breastfeeding mothers, and from $26 to $10 dollars for young children. Despite the administration’s efforts to make draconian cuts to mental health in two president’s budgets, Congress has so far resisted the deepest cuts by repeatedly keeping SAMHSA intact and rejecting the administration’s proposal to slash the NIH by roughly 40%. But will that continue? The ideological groundwork for all of this is laid in the choice of words, before most of the figures on a spreadsheet have formally changed. The infrastructure is being actively weakened by eroding the safety net and delegitimizing science.Advertisement We have watched a progressive-sounding idea become an alibi for disinvestment before. In 1963, President John F. Kennedy — the health secretary’s own uncle — signed his last bill, which created a national network of community mental health centers meant to empty the country’s grim state asylums and return patients to dignified care close to home. The aims were genuine and radical. But Congress ultimately built only half the centers it had promised and never fully funded even those. The hospitals emptied anyway. What replaced them was not community care but jails, shelters, and sidewalks. Deinstitutionalization did not fail because its ideals were wrong. It failed because the vocabulary of liberation outran the budget and political will. The deprescribe-first framework pushed by RFK Jr. and MAHA risks the same arithmetic. If federal guidance, payment policy, and grant priorities all tilt away from treatment — and the dollars for actual mental health care quietly recede behind them — we will have changed what we call the work without sustaining the work that remains. The language of empowerment will have done the job that austerity could not do openly. The people who would absorb that gap are not the “worried-well” or the overmedicated teenager whose parents reached for a prescription too fast — the cases the movement most often invokes. They are the people with schizophrenia, bipolar disorder, and treatment-resistant depression: conditions with well-characterized neurobiology and decades of evidence that medication, frequently on an ongoing basis, prevents relapse, hospitalization, and death. Unchecked, the MAHA mental health policy is not hard to picture: Politically driven FDA actions like the “black box” warning on SSRIs in pregnancy floated in 2025, echoing the 2004 adolescent warning that was followed by a sharp drop in prescribing. Medicaid programs citing federal “deprescribing” guidance to tighten access to long-term maintenance medications. Research funding steered away from psychopharmacology and toward whatever flatters the wellness narrative. None of it requires banning a single drug, but just enough friction, at enough points in the system, that staying on treatment becomes harder than going off it. But “deprescribing” elevated into a movement, and a cultural default, is a clinical hazard. Antipsychotic discontinuation in schizophrenia carries a steep relapse risk. Lithium remains one of the very few treatments in all of medicine shown to reduce suicide. These are not drugs to taper in the name of a slogan. Advertisement None of this requires defending a status quo that overprescribes, or dismissing legitimate science about metabolism and environment. It requires insisting on the conjunction. Food and mood. Metabolic care and pharmacology. Prevention and treatment. Wellness and health care. Otherwise the agenda goes from being a corrective to a withdrawal. Reframing the careful maintenance of these patients as a failure of “wellness” does not make them well. It makes them invisible. Sunny Patel, M.D., M.P.H., is associate professor of psychiatry and pediatrics at the Georgetown University School of Medicine and a faculty member at the Thrive Center for Children, Families, and Communities. He previously served as senior adviser for children, youth, and families at the Substance Abuse and Mental Health Services Administration. Letter to the editor Have an opinion on this essay? Submit a letter to the editor. 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