What's Happening Inside HHS

Something unusual is happening inside American mental healthcare. According to the New York Times, the Department of Health and Human Services is forging an alliance with so-called 'critical psychiatry' activists. These are people who fundamentally reject the last 40 years of psychiatric medicine — the biological model, the diagnostic manual, the medication-first approach.

Critical psychiatry activists argue that diagnoses like schizophrenia, bipolar disorder, and major depression are social constructs, not real diseases. They're skeptical of antipsychotics and antidepressants. Some argue that psychiatric hospitals do more harm than good. This isn't a tweak to the system. It's a fundamental rejection of it.

Some of their criticisms have merit. Overdiagnosis is real. Pharmaceutical industry influence on psychiatric research is well-documented. Medication side effects are frequently downplayed. Those are legitimate grievances worth addressing.

But throwing out the entire biological framework of mental illness is another matter.

What 50 Years of Reform Actually Achieved

A 2013 editorial published in Epidemiology and Psychiatric Sciences by Dr. Michael Hogan — a clinical professor at Case Western Reserve, Dartmouth, and NYU — reviewed 50 years of mental health policy since JFK's 1963 push to modernize psychiatric care. His conclusion: outcomes are "better but not well."

Hogan identified five persistent failures: inadequate mental healthcare in primary care, poor services for children, delayed treatment of psychotic illness, rampant disability and unemployment among the mentally ill, and the collapse of specialty public psychiatric systems.

The actual failures Hogan documented are systemic and funding-related. The system underfunds care, fragments services, and fails to connect people to treatment. That's a resource and policy problem.

Who This Affects If It Goes Wrong

The real question is who suffers if federal health policy shifts away from the biological model based on activist ideology rather than clinical evidence.

The answer is the most severely mentally ill Americans. People with schizophrenia. People with treatment-resistant bipolar disorder. People whose lives are stabilized — imperfectly, but meaningfully — by medication and structured psychiatric care.

These are not the well-connected advocates pushing this agenda. They're the people in group homes, in emergency rooms, on the streets.

The History of Policy Gone Wrong

The U.S. has been down this road. In the 1960s and 70s, deinstitutionalization — driven in part by romanticized anti-psychiatry philosophy — emptied state hospitals. The community mental health centers that were supposed to replace them were never adequately funded.

Hundreds of thousands of severely mentally ill people ended up homeless, incarcerated, or dead. The U.S. prison system became the de facto largest psychiatric institution in the country. Hogan's 2013 analysis confirms it: "Establishing mental healthcare specialization in mainstream systems has not been notably successful."

What's Missing From Coverage

The New York Times frames this as a courageous disruption of entrenched medical orthodoxy. Coverage tends to underplay the critical psychiatry movement's own track record — opposing medications that keep people functional, undermining families trying to get loved ones into treatment, and providing intellectual cover for neglect dressed up as liberation.

Coverage also doesn't ask who inside HHS is driving this, what specific policies are being changed, and what the evidentiary basis is.

What Reform Actually Requires

Mental health reform in America is genuinely needed. The system is underfunded, fragmented, and fails too many people.

But needed reform and ideologically driven disruption are two different things. When a federal agency takes direction from activists who reject established medicine, the burden of proof falls on them.

Real reform means more funding, better access, and smarter integration of mental healthcare into primary care. The people who will pay for getting this wrong can't afford a policy experiment.