What Behavioral Health Providers Need to Know About the MAHA Commission

This is an exclusive BHB+ story

Robert F. Kennedy Jr.’s confirmation as secretary of the U.S. Department of Health and Human Services creates significant uncertainty for the behavioral health industry.

That puts it diplomatically. Under Kennedy, health care could undergo a brutally painful evolution to bring about his highly skeptical and well-outside-of-mainstream worldview. And I say “could be” because there is still so much waiting and seeing to do. What we are waiting to see is if RFK Jr. will be able to be the reformer he has fashioned himself to be or if he will be rendered largely ineffectual to chase less consequential passion projects.

So far, we have few clues regarding the Trump administration’s health care policy goals. Almost none of the public information we have relates to HHS and Kennedy.

This week, I’m going to dig into what is shaping up to be the foundational initiative for health care policy in the U.S., at least for the first year or so — the Make America Healthy Again Commission.

The MAHA Commission’s initial charge focuses on chronic and inflammatory disease in children. Behavioral health is referenced occasionally. But the specific initiative relevant to behavioral health targets vital clinical tools for the industry, casting a skeptical eye on it as a potential cause of chronic illness.

For this week’s BHB+ Update, I’ll dig into:

— What behavioral health providers need to know about the MAHA Commission’s first actions

— Select industry reactions to it

— Why this may or may not be a problem

What is this MAHA Commission about?

On its face, the Make America Healthy Again Commission is an interdepartmental effort to address chronic disease. Not unusual. However, its general repositioning of federally backed health care and policy research imbues some of the mainstream health care skeptic movement’s more paranoid lilt to said policy.

It calls for research to be open-sourced and free from conflicts of interest. It also demands that the federal government “prioritize gold-standard research on the root causes,” that American farmers make healthy food the “most abundant in the world,” and that health plans have more flexibility in covering lifestyle and prevention efforts.

Passing references to behavioral health exist throughout the document. The bulk of the strategy focuses on the creation of the Make America Healthy Again Commission, which will be chaired by the HHS secretary and will have the assistant to the president for domestic policy serving as executive director.

The initial directive for the commission from President Donald Trump is to generate a report on the scope and potential causes of chronic childhood disease. Again, not unusual. But it specifically highlights areas of examination that, in other instances, would be seen as attempts to address chronic health challenges, not cause them. For example, the commission is to examine the impact of medical treatments as a potential cause of disease.

Key tools that the behavioral health industry and pediatric clinics use are specifically to be examined as potential disease causes. The report states the commission’s first order of business, the creation of a report about childhood chronic disease, will in part “assess prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs.”

The report is due 100 days after the release of the executive order. In this case, the commission will have until May 24, 2025 to release the report. It has 180 days to submit a strategy to address the finding of the report to the president, or until August 12, 2025. After that, the MAHA chairman and executive director can suggest additional work for the president to assign via executive order. Barring that, the commission is to not reconvene after delivering its strategy plan.

What is this MAHA Commission about?

The combination of psychosocial therapies and medications is a settled best practice when it comes to treating all kinds of behavioral health conditions. Looking at the use of these kinds of medications simply misses the point of looking at “root causes of why Americans are getting sick,” as the executive order puts it.

“We have to really be careful not to mix politics with medicine and make decisions based off of personal opinions,” Sharnell Myles, chief clinical officer of Embark Behavioral Health, told me. “I think that when we scrutinize any type of care without true scientific backing, and we make blanket statements, we could potentially be doing more harm than good with our adolescents.”

Embark Behavioral Health is a multispecialty and multisetting care provider that specializes in treating young people and supporting families, headquartered in Chandler, Arizona.

While she acknowledges that overmedication happens, the trade-off of costs and risks to this practice does not call for a serious consideration of curtailing of the use of medication in children.

The use of medications requires an interdisciplinary approach to care. Behavioral health providers must coordinate, or at the very least be aware of, care provided by primary care clinicians and psychiatrists. Health care works best when the various providers acknowledge and address the plurality of specialists that care for a patient. Taking the use of psychiatric medications in children gives a powerful impetus to do so.

“The best practice is, if a kid is on medication, they need to also be receiving therapy because they have that extra layer of assessment to check whether the kid is responding appropriately to a medication or not,” Myles said.

“So there’s definitely some safeguards that are put in place, even outside of that MD’s room.”

Some data shows that medications are not all that common in the treatment of adolescent mental health issues and that the collective health care industry is more inclined in favor of pushing kids toward behavioral health interventions over medications. One study by the National Center for Health Statistics shows that 9.3% of children took medication to treat a mental health condition in 2022; that figure was 8.4% in 2019. On the other hand, children who went to therapy for a mental health condition increased to 13.8%, up over 10%, at the same time.

There is clearly a need to address psychiatric prescribing among small, vulnerable populations of children, especially those involved with government systems such as the child protective system.

“Medication in adolescents should not be looked at as this big experimental thing,” Myles said. “What I don’t want people to do is think that medication is used to weaponize or to control adolescence because, again, that’s not what it is.”

Targeting behavioral health medications also oversimplifies the issues that would lead children to manifest a need to have these kinds of medications in the first place. Social determinants account for as much as 50% of disparities in health outcomes among various groups. Focusing exclusively on medications overlooks the consumer and lifestyle evolutions that are also significant factors.

Dr. Monika Roots, co-founder, president and chief medical officer of Bend Health, told me that mental health issues among children were an issue pre-pandemic and were worsened. Increased social isolation and screen usage are manifesting greater distress in children, even leading children to appear to have ADHD. Despite increased awareness, there is still a shortage of pediatric specialists in behavioral health.

“Looking at medications as just simply the causative factor is way too narrow-minded,” Roots said. “You don’t put a person on Lipitor unless they have high cholesterol. It’s not that Lipitor is causing high cholesterol.”

Where the use of medication in a child’s treatment could be seen as a problem is if a parent’s decision to do so is itself a cry for help. It may also be a manifestation of a lack of resources and lack of investments by the powers that be in access to alternatives, Roots added.

Even then, certain behavioral health conditions such as ADHD are “highly biological,” Roots said. The condition itself in non-mild cases requires medication due to brain structure and functional deficiencies.

The conversation also discounts the impact of social trends such as perfectionism cultures worsened by social media. In 2023, the U.S. Surgeon General released a report that found that teens who used social media more than 3 hours a day had double the risk of reporting poor mental health and that teens used social media about 3.5 hours a day on average. Social media is not mentioned in the MAHA Commission executive order.

Maybe this won’t be a big deal

Much of Kennedy’s pre-appointment discourse focused on Big Food and Big Pharma. Taking away tools for treating behavioral health conditions may not be a top priority.

For example, Kennedy has given American food producers an ultimatum to proactively self-regulate when it comes to potentially harmful processed food ingredients.

“Kennedy expects ‘real and transformative’ change by ‘getting the worst ingredients out’ of food,” a Consumer Brands Association member email said, according to Bloomberg.

The day before that report came out, Kennedy announced in a press release that he had charged the Food and Drug Administration commissioner to explore ways to rework how the federal government oversees safety day for processed food ingredients. The charge to the FDA also includes the potential elimination of the FDA’s acceptance of private and independent claims about the safety of food ingredients.

The MAHA Commission had its first meeting on March 11. It focused on regulating processed food, baby formula and eliminating processed food from food assistance programs, according to the White House press secretary. After the meeting, the United States Department of Agriculture announced it would rework federal dietary guidelines. Assessing the dietary guidelines is not part of the MAHA Commission executive order mandate.

On top of his crusades against food companies, he apparently will find ample opportunities to fill his time when it comes to vaccinations, disease outbreaks and far-fetched looks at the causes of autism.

While I don’t think it is yet clear that Kennedy’s conspiratorial thinking on the American vaccination regimen being the cause for elevated autism rates is going to be impactful on the behavioral health industry, his previous and likely continued assertion to tie current medical practices to the rise in autism could spill over into heightened anti-autism therapy thinking.

And none of this takes into account South-African-billionaire-turned-Trump-right-hand Elon Musk’s apparent carte blanche to hamstring the executive branch and surrounding nongovernmental organizations with firings and funding cuts. How exactly is a weakened executive branch going to beef up its regulation of private industry? With deregulation and capitalistic tendencies on the mind of Trump and others in the White House, what place does an activist reformer have in trying to assert more federal dominance over big-money industries?

We will still have to wait and see how that all shakes out. But there is more than enough reason to suppose that the oddly threatening posture of federal health oversight will forget about making behavioral health-related medications a target for scrutiny.

And what we have seen so far,is that it’s still in the realm of possibility that a lot of what comes from Trump and Kennedy is just more posturing. An example: Ironically, perhaps hypocritically, the MAHA Commission’s first meeting was barred to the public, despite his calls for greater transparency in health care and research.

What obviously is a big deal is what Trump and the GOP-controlled Congress could do to Medicaid. That will hurt the industry. For now, Kennedy and HHS are a sideshow.