If We Want to Make America Healthy Again, We Are Doing the Wrong Thing

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Over the past several months, like many of my colleagues, I have written repeatedly to state and federal leaders to voice my concerns over the influx of changes. The current administration’s proposed budget threatens to unravel the very infrastructure we rely on to care for patients with serious mental illness. These cuts are not abstract; instead they represent a real and imminent risk to patient outcomes, provider capacity, and community stability.

In my community hospital, approximately 85% of the patients I treat rely on Medicare or Medicaid. The proposed shift of Medicaid to a block grant structure and the imposition of work requirements would be devastating. Medicaid is the nation’s largest payer for mental health services.¹ It provides care for individuals who are often too sick to work, too poor to self-fund treatment, and too vulnerable to navigate a fragmented system. If these changes proceed, many of our sickest patients will lose coverage entirely.

Compounding the problem, these budget cuts also target essential crisis intervention tools—most notably the 988 Suicide & Crisis Lifeline. This service has become an essential part of our nation’s suicide prevention strategy, offering real-time support in moments of acute distress. Reducing funding will translate to longer wait times and missed opportunities to intervene during psychiatric emergencies.

Community mental health providers are already operating at the margins. We provide 24/7 care, reduce psychiatric boarding in emergency departments, and serve as an alternative to incarceration. But we are also chronically under-resourced. The proposed cuts could push many of these programs past the breaking point, erasing years of hard-won progress and jeopardizing the stability of our system.

Over the past decade, we have seen meaningful advancements: the expansion of the Substance Abuse and Mental Health Services Administration, innovative Medicaid waivers that allowed states to build more responsive systems, and the launch of the national 988 crisis line. These initiatives represented a bipartisan recognition that mental health care is essential care. Now, that momentum is at risk of stalling—or worse, reversing.

It is clear that the “Make America Healthy Again” agenda does not meaningfully include mental health. In fact, many of the individuals shaping current policy have publicly expressed skepticism about the value of psychiatric and substance use treatment. Shifting responsibility to states without sufficient federal funding and gutting key programs will only widen existing disparities. Those with privilege will continue to access care. Those without will fall further behind.

From where I stand as a frontline psychiatrist, this crisis is no longer looming—it is already here. When I discharge a homeless patient with schizophrenia, I know they will struggle to access housing, medication, and outpatient support. My clinical decisions are made within a system that is increasingly unable to support recovery. Stabilization without continuity is not treatment—it is triage.

There is no shortage of wealth or resources in this country. The question is whether we are willing to allocate even a fraction of them toward protecting our most vulnerable citizens. Rising rates of depression, anxiety, substance use, and suicide are not theoretical projections—they are realities that we witness every day. As economic pressures mount, we can expect to see these trends worsen.

We have been here before. We know what happens when the social safety net erodes. We see it in the data and in our emergency rooms. We know that deaths of despair increase when people are left behind.²

So, while our leaders may continue to declare “Mental Health is Health,” the current policy trajectory tells another story. Until our legislative priorities align with our public messaging, Mental Health Awareness Month will remain performative a talking point rather than a promise.

The mental health crisis is alive and well in every corner of this country. And unless we act decisively, those with the most serious psychiatric illnesses—those so often forgotten—are about to be left behind once again.

Dr Rossi is an inpatient and consultation liaison psychiatrist who also performs electroconvulsive therapy services at AtlantiCare Regional Medical Center in Pomona, New Jersey. He currently serves on the board of the New Jersey Psychiatric Association, where he has worked on advocacy projects, including enhancing access to collaborative care in the state.

References

1. Behavioral health services. Accessed July 1, 2025. https://www.medicaid.gov/medicaid/benefits/behavioral-health-services.

2. Breslau J, Han B, Lai J, et al. Impact of the Affordable Care Act Medicaid expansion on utilization of mental health care. Med Care. 2020;58(9):757-762.