Psychiatrists Already Practice Comprehensive, Holistic Care—but More Resources Are Needed

The recent US Department of Health and Human Services (HHS) announcement targeting psychiatric “overprescribing” and promoting “deprescribing” has prompted concern and confusion among some clinicians, according to John J. Miller, editor in chief of Psychiatric Times.

In comments responding to the May 4, 2026, HHS announcement and Secretary Robert F. Kennedy Jr.’s proposed action plan, Miller said many of the recommendations being framed as new priorities, eg, proper nutrition, exercise, psychosocial support, and comprehensive patient evaluations,—have long been core elements of evidence-based psychiatric care.

“My first reaction to that was: sounds like he [Secretary Kennedy] is trying to reinvent the wheel,” Miller told Psychiatric Times.

Miller said psychiatrists are already trained to use multimodal interventions before and alongside medication management. “Throughout my 4 years of medical school and 4 years of residency, and all of my years of clinical practice, what I was taught—and the way to evaluate and treat and manage and help all of my patients—utilizes all of the various interventions that he brought up.”

He questioned whether the HHS messaging reflects a misunderstanding of how psychiatric clinicians currently practice.

“I was perplexed at the disconnect,” he said. “The issues that he raised are a part of our current, good evidence-based clinical care.”

Multimodal Psychiatric Treatment Includes More Than Medication

Throughout the discussion, Miller emphasized that psychiatric treatment decisions are rooted in comprehensive assessment, shared decision-making, and individualized care plans, not reflexive prescribing.

“The first intervention is multimodal,” Miller explained. “I may consider a medication, and if so, it will clearly be with shared decision-making and a detailed informed consent.”

Miller also noted an important omission in the HHS proposal: sleep hygiene.

“If we could help our patients get a good night’s sleep, that would go a long way in helping their depression, their anxiety, their stress, and improve quality of life,” Miller explained.

Miller added that psychotherapy, nutrition, exercise, and psychosocial support are routinely incorporated into patient care when clinically appropriate.

‘Lowest Dose, Fewest Medications’: Psychiatry’s Existing Goal

Miller pushed back on the implication that psychiatric clinicians broadly rely on excessive prescribing practices. Instead, he described medication management as a careful balancing act shaped by diagnosis, symptom severity, comorbidities, and patient-specific factors.

“The goal is the lowest dose of the fewest medications for the shortest time,” he said. “Depending on the patient and the diagnosis and the complexities, those variables can vary tremendously.”

He cautioned against oversimplified prescribing algorithms, arguing that psychiatric care requires nuance and individualized clinical judgment.

“I wish it was as simple as an algorithm that it sounds like they’re going to try to create,” Miller said.

Still, Miller said he sees opportunities for collaboration between clinicians and federal policymakers.

“You are in a really good position to help us advocate for improving our patients' access to treatment, to nutritional resources,” he said. “Let's build more playgrounds and access to gyms. Let's educate about sleep hygiene beyond the office.”

“I think we can find some good common ground,” Miller said. “We need to work together, but first you need to understand what we already are doing.”