Make America Mentally Healthy (Again)

As Donald Trump prepares for his new term as president, one of his stated priorities is to stop the long and deadly trend of overdose deaths and addiction.

Strengthening border security against drug cartels is important, but this is not just a border problem. He should also demand a major overhaul of every federal program tasked with dealing with drug addiction, suicide, homelessness, and mental illness. As the president looks to apply DOGE to federal agencies that have not been doing their job well, he can start with the Substance Abuse and Mental Health Services Administration (SAMHSA).

Over the past 20 years, the deaths from drug overdoses, suicides, and premature deaths associated with untreated mental illness (including murders and victims of murder), exceed the total number of U.S. soldier combat deaths in WWI, WWII, Korea, Vietnam, Iraq, and Afghanistan. Suicide rates are now the highest in 80 years. Since 2000, nearly one million people have died of a drug overdose. Untreated Serious Mental Illness (SMI) has caused a massive economic burden on communities, families, and taxpayers. There is no end in sight as long as policies remain the same and leadership remains weak.

Schizophrenia, one of the most dangerous and neurodegenerative SMI conditions, involves hallucinations, thought disorders, and disorganized behaviors. Treatment, especially with antipsychotic medications, can make a major difference in symptoms, but there is no cure. Although schizophrenia only affects around 1 percent of the population, the annual cost of schizophrenia alone is likely much larger than the entire 2025 budget request ($369 Billion) of the Veterans Administration, according to preliminary data collected by Schizophrenia and Psychosis Action Alliance. These costs include housing, healthcare, homelessness, criminal justice, disability payments, family costs, and long-term care. The staggering truth is that much of this spending is due to a failure to treat schizophrenia.

Consequences of Failing to Treat SMI

When I introduced major mental health reform legislation in 2015 (Helping Families in Mental Health Crisis Act, HR 2646,), we asked the Government Accountability Office (GAO) to audit total federal government spending for SMI. The reported total was an “educated guess” of $130 billion, spread across 112 programs and agencies, with no detail about spending costs and the consequences of non-treatment. SAMSHA still does not collect essential data across government agencies needed to make sound legislative and executive decisions.

Failure to treat SMI has additional societal consequences. Two-thirds of inmates in jail and over half of state prisoners have mental illness. About 20 percent have SMI conditions. Due to limitations on Medicaid coverage for inmates, many states provide little or no psychiatric treatment behind bars. The absence of treatment is particularly troublesome for acute psychiatric illnesses like schizophrenia. Without treatment, suffering individuals are 15 times more likely to engage in violence.

Schizophrenia plays a part in 10 percent of all murders and 30 percent of mass murders. With effective antipsychotic medications and treatment, violence rates due to schizophrenia are no more than those occurring among people without mental illness. SAMHSA, along with the mainstream media and government agencies have constantly sought to minimize rates of violence associated with SMI.

The recent death of Jordan Neely focused media attention on Daniel Penny’s response to Neely’s aggressive behavior on a New York subway. The media often referred to Neely as a “homeless man” and gave little attention to Neely’s reported history of schizophrenia, depression, and lack of sufficient treatment.

In November 2024, Ramon Rivera allegedly stabbed three innocent people to death in Manhattan. Mayor Eric Adams referred to Rivera as a “homeless man” with “severe mental health issues.” Despite a history of criminal assaults, lawyers for Rivera argued for less restrictive community-based supervision when he was released from jail. While Rivera is now facing murder charges, there are no charges against those who advocated for his release or failed to provide proper treatment.

Robert Card, who killed 18 people in Maine’s largest mass murder, had reported paranoid delusions and made violent threats. Due in part to psychosis linked to poor insight into his illness, he was unwilling to voluntarily seek necessary treatment. The commission that investigated Robert Card blamed the police and the Army for failing to restrict his access to weapons. However, the commission failed to comment on the healthcare system that significantly restricted Card’s access to treatment.

A possible case of mental illness likely played a role in the July 2024 assassination attempt on President Trump, based on records of the shooter’s internet searches and reports of his behavioral history by classmates. There was no direct evidence, however, that he was being treated, or what would be his true diagnosis. (RELATED: Before the Bullet: Was Crooks a Victim of America’s Mental Health Crisis?)

Role of Public Policy in the Treatment of SMI

Critical interventions are necessary to curb the epidemic of untreated SMI that is contributing to violence, criminal justice costs, homelessness, and poor outcomes. Since the 1960s, shifts in public policies shuttered psychiatric hospitals, limited Medicaid psychiatric coverage for inpatient hospital treatment to just 14 days, and implemented a lifetime cap of 190 days. Similar policies restrict SMI conditions from access to Medicaid-funded assisted living services. This represents a grave disparity relative to funding for developmental disabilities or other neurodegenerative conditions. These federal policies have excluded and abandoned the most dangerous and disabled in society.

Another critical intervention is Assisted Outpatient Treatment (AOT), a type of court-ordered outpatient treatment with high rates of satisfaction and improvement in quality of life. AOT programs have been shown to prevent psychiatric hospitalization, incarceration, homelessness, violence, and suicide but states are slow to enact them. To date, only one county in Pennsylvania has begun to adopt an AOT program, but the implementation has stalled due to a lack of funds. Pennsylvania counties without AOT programs are instead spending exorbitant funds to incarcerate their SMI population. Meanwhile, SAMHSA grants for AOT in 2024 were a meager $15 million dollars for the entire nation.

SAMSHA has failed to advocate for improved access to inpatient care or changes in Medicaid policy for SMI and incarcerated populations. SAMHSA has been silent regarding how these terrible policy flaws may have contributed to the deaths involving Neely, Rivera, Card, and Crooks. Silence is negligence, not leadership.

The homelessness epidemic is another government failure affecting 3 million Americans each year. About 30 percent of the homeless have an SMI condition and require treatment and living assistance. Despite billions in ineffective homelessness spending, little data exists to hold any agency accountable. SAMHSA should be leading the charge to collect data on homelessness outcomes involving SMI and substance use, but they do not.

California spent $24 Billion between 2018 and 2023 in a botched attempt to reduce homelessness. A California State Auditor report blasted the programs, saying most are not cost-effective. California failed to track both the money and the people supposedly receiving services. The homeless population in the state actually increased. SAMHSA should be working closely with the Department of Housing and Urban Development to track the dollars, effectiveness, and costs of treating the homeless mentally ill in every state, but they do not.

My mental health reform legislation created the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) which required federal agencies to work effectively together. Unfortunately, the ISMICC 2024 report dedicated a few pages describing their new colorful logo but did not provide essential data across agencies evaluating the effectiveness of care for SMI.

Necessity of Accurate Data Collection

Essential data must include a national census of psychiatric beds, psychiatric emergency rooms, community facilities, and the efficacy of medication. We must document SMI in jails and prisons, and track utilization of mental health courts. We must understand suicide rates linked with psychiatric diagnoses, types of care for the homeless, outcome of care, use of prescription medication, and details on economic impact.

Every day I hear from families who have lost a loved one to suicide, overdose, untreated SMI violence, or an absence of psychiatric treatment behind bars. Community groups comprised mostly of mothers of SMI individuals have sprung up in various states to call out failures of government and policy. The Arizona Mad Moms is one such group showing how mothers and caregivers are usually the victims of violence when the treatment systems for SMI fail. They shoulder a great unpaid burden for society in caring for the sickest psychiatric patients. Their grassroots effort succeeded in passing four laws relating to SMI treatment in Arizona in 2024. Colorado and other states have recently started their own chapters. SAMHSA should take advocacy lessons from them.

If the Pentagon had SAMHSA’s record of failure it would justifiably fire every general and admiral. In my legislation, we created the office of the assistant secretary to lead SAMSHA. Those of us in the mental health community pray the president appoints someone ready to fight for better accountability and care. We need someone with the grit of Teddy Roosevelt and the compassion of Mother Theresa. President Trump can do more to change the outcome for millions of families than all the mayors and governors put together who have failed to lead: Make America Mentally Healthy (Again).

READ more from Tim Murphy:

Before the Bullet: Was Crooks a Victim of America’s Mental Health Crisis?

Mental Health Is an Important Swing Issue This Year

Veterans and Suicides: It’s Worse Than the VA Reports

Tim Murphy, Ph.D., is a psychologist specializing in trauma recovery and the author of three books, including The Christ Cure: 10 Biblical Ways to Heal from Trauma, Tragedy and PTSD (2023). He served as a psychologist in the U.S. Navy Medical Service Corps, was elected eight times to the U.S. House of Representatives, and authored major mental health reform legislation receiving wide bipartisan support. His podcasts on mental health are available at DrTimMurphy.com and LinkedIn.

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