How Might President Trump’s Policies Affect Mentally Ill?

Laurie Flynn former Executive Director of NAMI National saw my post announcing the good news that Dr. Elinore McCance Katz was nominated as Assistant Secretary of Mental Health and sent me this note. It is her analysis of what Trump policies mean to the seriously mentally ill. I thought it was a very good succinct analysis. I understand others may disagree.
 It may be “good news” that Pres.Trump has appointed Dr. McCance-Katz to the post of Assistant Secretary of Mental Health and Substance Use.  But this hardly mitigates the ongoing disaster for people with serious mental illness. The Trump Administration’s determined efforts to gut the ACA, repeal mental health parity, block grant Medicaid and permit governors to waive minimum essential benefit requirements will devastate care for severe mental illness and addiction.  And in terms of improving treatment and outcomes, let’s not forget that Trump’s proposed budget would cut research funds at NIH by 20%! That was a driving force behind yesterday’s huge “March for Science”. There is clearly no rational basis to congratulate Trump for mental health policy.
The new Assistant Secretary is well-intentioned.  I hope she does well.
But in helping coordinate mental health policy across several government agencies, she faces a challenging task. There will be major pressure from the Hill to focus attention and resources on the opioid crisis. While she can work to re-structure and reorganize SAMHSA, she still must deal with the reality of staffing. Career civil servants are hard to get rid of and Pres. Trump has announced a federal hiring freeze.  So “draining the swamp” and creating a strong new focus on severe mental illness will likely be slow going.  Most high level federal appointees serve less than 4 years, so their impact is usually modest.  As advocates we cannot be satisfied with what may be a symbolic rather than a substantive advance.  Everything we’ve seen and heard thus far makes me skeptical that people with serious mental illness will fare well under Trump’s policies.
DJ Jaffe is Executive Director of the non-partisan Mental Illness Policy Org., and author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill. He is a critic of the mental health industry for ignoring the seriously ill, and has been advocating for better treatment for individuals with serious mental illness for over 30 years. He has written op-eds on the intersection of mental health and criminal justice policy for the New York Times, Wall St. Journal and the Washington Post. New York Magazine has credited him with being the driving force behind the passage of New York’s Kendra’s Law and Congress incorporated ideas proposed by DJ in the Helping Families in Mental Health Crisis Act.