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.