RFK Jr. Wants to Crack Down on Psychiatric Overprescription. A Psychologist Says It’s More Complicated Than That

Health and Human Services Secretary Robert F. Kennedy Jr. announced a new federal plan this month aimed at addressing what the department calls “psychiatric overprescribing,” including efforts to promote appropriate prescribing, support deprescribing when clinically appropriate and increase awareness of non-medication mental health treatments.

The announcement enters an ongoing debate in mental health care: how to address inappropriate prescribing without discouraging people from treatments they may genuinely need.

Dr. Kevin Chapman, a clinical psychologist and anxiety specialist, said the concern behind the plan isn’t baseless. It’s just incomplete.

“I think there is truth to what the secretary is saying,” Chapman told RELEVANT. “You could argue, based on some studies, that certain psychotropic medications are overutilized. But then you also could argue that there’s plenty of psychotropic medications that are underutilized.”

That nuance matters because “psychiatric medication” covers a huge range of conditions, prescriptions and clinical realities. A conversation about benzodiazepines such as Xanax or Valium is different from a conversation about antidepressants, ADHD medication or antipsychotic drugs used to treat psychosis. Chapman said some medications, including certain anti-anxiety drugs and sleep aids, are controlled substances because of dependency and tolerance risks, which makes appropriate oversight important.

Still, he said, the broader problem isn’t new.

“I think it’s not a new problem,” Chapman said. “It’s been a problem since psychotropic medications were introduced.”

What has changed is the level of need. The pandemic pushed many people who were already dealing with anxiety, chronic sadness or depression into more severe symptoms. More people sought help, which meant more people entered a mental health system where medication is often the easiest available intervention.

Chapman said medication has long been the “first-line” treatment for many psychiatric problems in the United States, but he was careful to distinguish that from the best-supported approach.

“I didn’t say gold standard,” he said. “I said first line.”

A first-line treatment is often the option someone encounters first. A gold-standard treatment is what research and clinical practice suggest will best address a particular condition. For many emotional disorders, Chapman said, medication can be extremely helpful, especially when symptoms are severe or persistent. But the strongest outcomes often come when medication is combined with psychotherapy, particularly cognitive behavioral therapy.

That’s where the American mental health system runs into one of its most obvious problems: therapy can be harder to access than medication.

Chapman said he understands why some people choose the prescription route first. Therapy can be expensive, insurance coverage can be inconsistent and finding the right provider is not exactly intuitive. Patients may encounter psychiatrists, psychologists, counselors, licensed clinical social workers and other mental health professionals without knowing who does what or which person is right for their specific issue.

“Most people in the public, frankly, are unaware of who they should seek treatment from,” Chapman said.

The confusion starts with two words people often use interchangeably: psychiatry and psychology. A psychiatrist is a physician who went to medical school and can prescribe medication. A psychologist is trained in research, assessment and psychological treatment, often through approaches like CBT. Chapman said people call him a psychiatrist all the time, which may sound harmless until a national policy debate hinges on the difference between prescribing medication and providing therapy.

Cultural stigma also shapes the problem. Medication can feel easier to explain because Americans are often more comfortable framing distress as a physical issue than a mental one. Chapman gave the example of people saying their “nerves are bad,” a phrase that sounds more bodily than psychological.

“It’s way less stigmatizing to say that I have something physically wrong with me than something mentally wrong with me,” he said.

The better question, Chapman said, is not whether someone feels anxious, sad or overwhelmed. Those emotions are part of being human. Anxiety, in particular, is a normal emotional experience and even serves a purpose.

The clinical question is whether symptoms are causing personal distress and impairing daily functioning. If someone’s anxiety, depression or emotional distress is disrupting relationships, work, school, sleep or the ability to do what they used to do, it may be time to seek professional help.

That kind of framework avoids two mistakes at once. It doesn’t reduce ordinary stress to a diagnosis, and it doesn’t dismiss serious symptoms as something people should simply push through.

Chapman said any conversation about overprescribing also has to avoid creating shame around medication itself. Some people would not be able to function without psychiatric medication. Others may need therapy, lifestyle changes or a better diagnostic picture before medication makes sense. Many need more than one form of care.

“There’s no stigma or shame attached to it,” Chapman said. “People do need help.”