Facts Over Fiction: The Current State of Psychiatry

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The government has always played an important role in health care: it has established agencies to ensure drug safety, created Medicare and Medicaid to improve access, etc. Recent changes, however, are actively altering the practice of medicine and are posed to have a deep and lasting psychiatric impact on patients.

Although this is a rapidly evolving situation, here is a closer look at the facts as this issue went to press.

Cuts to Top Health Agencies

In early 2025, the US Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA), Veterans Administration (VA), and other organizations experienced huge slashes to their budgets and staff.¹ Additionally, on January 20, President Donald J. Trump issued an executive order freezing government hiring.²

Elon Musk, formerly a leader of the Department of Government Efficiency (DOGE), was directed to “dismantle government bureaucracy, slash excess regulations, cut wasteful expenditures, and restructure federal agencies.”^3,4

The sudden cuts, as well as terms like wasteful, have startled experts like Robin Weiss, MD, a past president of The Maryland Psychiatric Society and psychiatrist who has worked for the National Academy of Sciences, a federal advisory panel, and in private practice.

“It’s exhausting and demoralizing to find that every day, the institutions one holds dear are not just being defunded but also slandered,” Weiss told Psychiatric Times. “I am 75 years old, and I worked for the National Academy of Sciences in the 1980s during the early years of the HIV/AIDS epidemic. There was plenty of warranted controversy about our country’s response, but I also got to know many public servants during those years. So many people who choose to devote themselves to public service have amazing expertise, and they often forfeit the opportunity to earn more in the private sector in exchange for meaning. They care about us—the public—and they have devoted their careers to serving us, so to watch them be treated shabbily, and their expertise dismissed, is heart-wrenching.”

With much discussion on both sides, what are the actual numbers?

FDA

Budget: The “FDA’s budget request reflects the Agency’s support of the Make America Healthy Again (MAHA) agenda in key areas of importance for human and animal health… [which includes] $234.6 million... to address the nation’s chronic disease epidemic, restore trust in our food system, and strengthen America’s nutritional and food safety.” Official documentation lists a $6.8 billion budget for 2026, which represents a decrease of about $270 million compared with the FY 2025. This includes a 4% increase in user fees, now sitting at $137.3 million.⁵

Layoffs: The FDA lost 3500 full-time staffers to layoffs, including Brian King, PhD, MPH, the chief tobacco regulator, and his fellow deputies, along with Peter Marks, MD, PhD, who led the development of the COVID-19 vaccine. Even more resigned after being offered reassignment in distant US locations.^6-8

Impact: The expansive staffing cuts are expected to slow public notices about recalls and product safety issues, as 130 members of the communications team were part of the layoffs.⁹ Additionally, thus far, notices that have been released contain more mistakes and less plain language, which experts fear could lead to delays in the delivery of critical information.¹⁰

CDC

Budget: The CDC experienced significant cuts to its budget, including the rescinding of $11.4 billion in grant funding to state and local health departments, largely related to COVID-19.¹¹

Layoffs: Approximately 2400 staffers from various departments and programs were laid off. Layoffs fell predominantly in areas involving deaths and injuries, apart from infectious diseases, such as programs focused on the prevention of asthma, smoking, gun violence, climate change, and more, many of which impact patients with mental illness. Also cut were the Freedom of Information Act team, the Division of Violence Prevention, and laboratory teams testing antibiotic resistance. Additionally, the research center focused on protecting worker health was almost entirely eliminated. Lastly, at least 9 high-level directors were placed on administrative leave and offered reassignment to another US Department of Health and Human Services (HHS) agency.^1,8,12

Impact: The administration has shared that the CDC will now “focus on returning to its core mission of preparing for and responding to epidemics and outbreaks.”¹ However, workforce reduction has key opinion leaders concerned that the remaining “skeleton staff” may be “capable only of performative gestures toward the work mandated by law and congressional budgets.”¹²

David Fleming, MD, who chairs the advisory committee to the CDC director and previously served as acting CDC director in 2002, expressed his concern in a recent JAMA report: “It is resulting in a federal agency that is not going to be able to function effectively.”¹³

Weiss echoed this concern, sharing with Psychiatric Times that those who remain employed may be feeling traumatized by the loss of their peers. “I see a patient whose funding comes from the CDC. Some of it is now tied up in the lawsuit that the states brought against the federal government, so for right now, it isn’t cut. But there is worry that their core funding from the CDC will be cut completely in the 2026 budget. This patient coined a tragically apt term in our session: Pre-TSD, or pretraumatic stress disorder. They go to work every day and wait for the other shoe to drop. So many state and federal workers are in similar positions. It’s like a mass trauma.”

Furthermore, this may impact disease prevention worldwide. The CDC maintains a repository of data for research references, and laboratories globally submit biological samples and data for historical filing; now, there are very few staff left—if any at all—to receive such information, damaging critical research infrastructure.¹²

NIH

Budget: The administration has canceled hundreds of NIH grants. Furthermore, a draft of the budget for the HHS proposes a $20-billion cut for the NIH in 2026, which equates to an approximate 40% reduction.¹⁴ According to a recently released Senate Committee on Health, Education, Labor, and Pensions minority staff report, $2.7 billion in NIH funding for research has also been cut. Additionally, the number of new research grants hit its lowest point in more than a decade.¹⁵

Layoffs: The NIH lost more than 1000 employees in an initial round of firing, followed by at least 1200 jobs in April. Other dismissals included scientists involved in research on the brain, computer specialists, and nearly the entire communications staff. At least 5 directors of the NIH’s 27 institutes and centers were put on administrative leave or removed, including Eliseo J. Pérez-Stable, MD, from the National Institute on Minority Health and Health Disparities; Diana Bianchi, MD, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; Shannon Zenk, PhD, MPH, RN, FAAN, from the National Institute of Nursing Research; Vence Bonham, Jr, JD, the acting deputy director of the National Human Genome Research Institute; and Jeanne Marrazzo, MD, MPH, from the National Institute of Allergy and Infectious Diseases.^8,16

Impact: Approximately $68.8 million in NIH grants related to mental and behavioral health were terminated.¹⁵ Because of canceled grants and loss of funding, many research labs have come to a halt, including in key research areas like Alzheimer disease. One researcher, who previously received a grant of approximately $6 million from the NIH to research the underlying mechanisms of neurodegenerative diseases, claimed, “It is not an exaggeration to say that the true cost of the NIH’s decision may be that thousands of American lives are needlessly degraded or sacrificed.”¹⁷

SAMHSA

Budget: Approximately $1 billion in appropriated SAMHSA funds slated to help reduce the overdose crisis have been rescinded.¹⁸ Additionally, state and county public health departments are facing abrupt cancellations and revocations of approximately $11.4 billion in COVID-19–era funding for grants connected to addiction and mental health.¹⁹

Layoffs: Under the restructuring of the HHS, SAMHSA will become a part of the new Administration for a Healthy America (AHA). This restructuring announcement followed the reduction of the HHS by 20,000 employees. SAMHSA began the year with approximately 900 employees, but up to 50% of them may be part of the cuts.^8,20,21

In a recent statement, an HHS official said, “The reorganization of SAMHSA into AHA is part of ongoing efforts to improve the efficiency and effectiveness of public health programs. By consolidating SAMHSA’s operations under AHA, we aim to streamline resources and eliminate redundancies, ensuring that essential mental health and substance use disorder services are delivered more effectively. This restructuring will enhance the ability to address public health needs by fostering a more coordinated approach to prevention, treatment, and recovery services.”²⁰

Impact: SAMHSA has made profound recent improvements in addressing the mental health, substance use, and suicide crises in America. The 988 Suicide & Crisis Lifeline has helped more than 16.5 million individuals since its launch in 2022.²² In the past year, overdose deaths have decreased by 24%.²³ Leaders of psychiatric organizations are deeply concerned by these new cuts and how they may undo this progress.

“I am most concerned about federal cuts to agencies like SAMHSA that provide vital funding for community mental health programs, crisis services, and workforce development. These aren’t abstract line items—they’re the foundation of care for patients with serious mental illness, particularly in underresourced areas. Disrupting these supports at a time when our mental health system is already strained will deepen disparities and increase suffering. I also believe that health care funding cuts, in groups under so much strain, will also impact health care professionals who care for them and increase the moral injury they experience in the field,” Jhilam Biswas, MD, FAPA, told Psychiatric Times. Biswas is director of the Psychiatry, Law, and Society Program at Brigham and Women’s Hospital and president of the Massachusetts Psychiatric Society (MPS).

VA

Budget: The VA maintains a vast network of contracts that equate to $67 billion annually. In February, DOGE instructed the VA to cancel approximately 875 contracts; this number was later reduced to 585 “non–mission critical or duplicative” contracts worth $1.8 billion.²⁴

Layoffs: At least 2400 VA probationary employees have already been laid off. Many of those eliminated were veterans; some could be reinstated following pending court actions. However, the administration has shared plans to eliminate 80,000 more jobs and review thousands more contracts.²⁵

Impact: A decrease in staff could equal a decrease in services, with longer wait periods, fewer appointment options, and fewer services for veterans. Studies involving veteran participants and experimental treatments have been disrupted; approximately 200 research staff members involved in 300 or more trials were affected by the changes, affecting treatment for nearly 10,000 veterans.²⁶

“What I think is most important for mental health clinicians outside of the VA to know is that their fellow mental health practitioners and their leaders in VA mental health are demonstrating enormous courage and integrity in fulfilling their commitment to high standards of care for veterans despite facing unprecedented challenges,” an anonymous source shared with Psychiatric Times.

Terminology Under Scrutiny

Although there is no official documentation, agencies and news sources have reported and compiled a list of more than 350 words that have been flagged per directives and guidance issued by the federal government (Table).²⁷ These words have been eliminated from government websites and documents, and their mention can result in the cancellation of research grants or other agreements. However, the list continues to grow, and it is unclear which words are outright banned vs which should be avoided, as the directives are vague and inconsistent across agencies.²⁸

TABLE. Limited Use or Banned Words/ Phrases Related to Mental Health²⁷*

*This is only a selected sample of the longer list of limited-use or banned words/phrases.

“The assault on our science and on our terminology is a fundamental assault on our knowledge and our profession. We are nothing if we cannot explore all that our science and our values point us to. I would point to an example from the Reagan administration. It ruled that the word social be stricken from all federal grants and set American psychiatry back for almost 40 years. The current list of banned words and related concepts is much more extensive, and the costs in terms of progress will be substantial,” Kenneth Thompson, MD, a public service psychiatrist, told Psychiatric Times.

Researchers are scouring existing grants using lists of flagged words and self-censoring future work in the hopes of improving grant likelihood. Others are moving toward safer topics to ensure they can finish their advanced degrees and move into academia. Some may leave academia altogether.²⁸

“The cuts to research funding will have devastating impacts and will undoubtedly stall career pathways for many promising early-career scientists,” said Steve Koh, MD, MPH, MBA, DFAPA, chief of the General Psychiatry Division and director of the Community Psychiatry Program at the University of California, San Diego.

“Restricting the language clinicians and researchers can use—whether implicitly or explicitly—has far-reaching consequences. If we cannot name the realities of public health, trauma, inequity, or systemic risk, we risk creating blind spots in care and innovation. We must not allow fear or politics to erode scientific inquiry or silence clinical truth,” Biswas said.

H. Steven Moffic, MD, an award-winning psychiatrist, longtime activist, and Psychiatric Times columnist, believes these banned words are an attack on the very core of the field. “Psychiatry, at its essence, is based on word interchanges. Starting way back with Sigmund Freud, patients need to feel comfortable in expressing anything, while we have to say the right things at the right time to help patients through very uncomfortable problems that they would rather repress. All of us in mental health care and our connected organizations have to do some soul-searching about how we will react to banned words and books. This list reminds me of the book 1984. One strategy I would not recommend is just ignoring the whole matter,” Moffic said.

By limiting the ways in which research can be communicated, scientific integrity is threatened, and the evidence base that informs public health policy becomes skewed.²⁹ This ultimately harms minoritized populations.

“Banning specific words in clinical research and health care will not erase the realities and needs of the individuals those words represent. These bans only create obstacles to studying the very populations they aim to obscure, which further emphasizes the underlying political motives behind them. Given how long the list of words is, there comes a point in time when one must ask: Which words aren’t banned? Ironically, banning words that represent minority experiences actually hurts everyone. Neglecting the distinct influences of race, gender, ethnicity, sexual orientation, and/or gender identity in research obscures vital insights that could improve health care outcomes for all,” said Scott Leibowitz, MD, a child and adolescent psychiatrist who worked in 3 academic pediatric gender clinics and is a board member at-large for the World Professional Association for Transgender Health.

Many clinicians are expressing particular fear for LGBTQ+ individuals, specifically transgender individuals, who seem to bear the brunt of research censorship initiatives.

“Recent actions by the federal government have completely decimated research that aims to improve the health of LGBT people. We are likely to lose an entire generation of researchers who had dedicated their careers to supporting this population, which experiences dramatic mental health disparities,” said Jack Turban, MD, a pediatric psychiatrist, author of the book Free to Be: Understanding Kids & Gender Identity, and Psychiatric Times advisory board member. “Perhaps even more insidious is that recent anti-LGBT laws and other government actions are likely worsening the health of these populations, but we will not be able to study or document these impacts to protect future generations. LGBT people already suffer from dramatic disparities in terms of both mental and physical health. These will undoubtedly worsen as we lose our ability to study and support the health of this population.”

This panic has trickled down to patients and their caregivers as well, as shared by Weiss. “I have patients who are fearful: one with a transgender kid who worries that the country’s mood is turning against her child; a lesbian in a gay marriage who fears that, in an economic downturn, things could get ugly for them; others who feel defeated because there’s hate in the air.”

A White House spokesman claims that this compiled list is an error and that the only words that do need to be prohibited revolve around “gender ideology”: gender, inclusion, identity, diversity, inter, intersex, equity, equitable, transgender, and trans.³⁰ However, the list of banned words circulating at the National Science Foundation includes several other words that raise red flags, such as women, disability, bias, status, trauma, Black, Hispanic, socioeconomic, and ethnicity.³¹

“Many researchers in this area will try to find research funding from nongovernment sources, but there simply are not enough private foundations to compensate for this massive loss of research funding,” Turban told Psychiatric Times.

Concluding Thoughts

In the wake of change and uncertainty, mental health clinicians are banding together and relying on community to help navigate the new reality.

“At MPS, we are actively listening to our members across the state to understand how these policy shifts are affecting their work on the ground. Our strategy is to advocate clearly and collaboratively—with legislators, community stakeholders, and other medical organizations—to protect research integrity and patient-centered care. Clinicians and researchers should know they are not alone. We must stay informed, speak up, and support our professional voice and solidarity through these uncertain times,” Biswas said.

Psychiatric clinicians believe a united front is the best way to communicate the importance of mental health care for all.

“It is of paramount importance to ensure that we maintain scientific integrity and keep patients at the heart of all the research work that we do. Regardless of changes from the federal government, our commitment to our patients will remain our top priority. We will continue to value and treat all patients with equal regard and respect. Some words may change but our research initiatives to seek the truth and to improve patients’ lives will not change. We encourage our colleagues to focus on our truth north of continuing to advance our knowledge and improvements to care for our patients,” Koh said.

“The attacks on the funding and the direction of federal health and mental health policy will injure all populations who depend on federal policy and federal resources. All marginalized communities will feel the brunt, including communities of color and sexual minorities. Psychiatry must respond by unfalteringly continuing to build a diverse workforce that reflects the people of the nation. It must advocate for communities in need, and it must oppose the inhumane, antihuman rights initiatives of this regime,” Thompson said. “We have a hard fight before us. The questions will be: What side did psychiatry take in the struggle—for democracy or against it? For human rights or against them? For a humane, caring society or against it?”

References

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