HHS launched the MAHA Action Plan to curb psychiatric overprescribing on May 4. The Black-mental-health pattern is under-treatment, not over-treatment.

On May 4, 2026, the US Department of Health and Human Services announced the Make America Healthy Again Action Plan to Curb Psychiatric Overprescribing, a multi-agency federal effort targeting antidepressants, antipsychotics, and stimulants with a child-focused emphasis (HHS press announcement, May 4, 2026; primary-source URL access blocked at hhs.gov/press-room at the time of this publication; the editorial spine below rests on peer-reviewed evidence about who is actually receiving psychiatric medications in the US, not on the HHS framing language). Named priorities the announcement carries include provider education, informed consent, shared decision-making, tapering and discontinuation, and nonmedication approaches.

The peer-reviewed US literature on who receives psychiatric medications runs in the direction the Action Plan does not name. A 2011 analysis of the National Comorbidity Survey-Replication found that among US adults with a 12-month major depressive disorder diagnosis, Black respondents reported antidepressant use at 17.5 percent and white respondents at 37.6 percent (Fleming et al., Journal of the American Pharmacists Association 2011; PMID 21896458). The Black-vs-white antidepressant-use gap, in the population with diagnosed depression, is under-treatment by a factor of roughly two.

The Fleming team's NCS-R analysis is one of five US peer-reviewed studies that triangulate the same pattern across drug classes and care settings.

A 2013 analysis of Florida Medicaid pediatric ADHD claims covering fiscal years 1996 through 2005 found that Black children and adolescents diagnosed with ADHD had lower ADHD-medication utilization than white peers across every year studied (Saloner et al., Journal of Child and Adolescent Psychopharmacology 2013; PMID 23952187). The introduction of long-acting stimulant formulations during the study window did not close the utilization gap.

A 2015 analysis of 5.8 million Medicaid-enrolled children ages 2 to 20 across eight US states covering 2005 through 2009 found that in adjusted analyses, Black children had an antipsychotic prescription fill rate 1.8 percentage points lower than white peers, against a 2.4 percent baseline; that is roughly a 75 percent relative reduction in antipsychotic prescribing for Black Medicaid children compared with white Medicaid children (Cataife and Weinberg, Psychiatric Services 2015; PMID 25975884). A 2023 national trend analysis of Medicaid-insured children ages 2 to 17 from 2008 to 2016 found declines in antipsychotic prescribing across all racial and ethnic groups studied, with the under-treatment direction for Black children persisting through the 2008 to 2016 window (Bushnell et al., Health Affairs 2023; PMID 37406239).

A 2024 analysis of 2017 through 2019 Medicare fee-for-service data on persons living with dementia found that Black PLWD were 11.7 percentage points less likely than white peers to be diagnosed with the behavioral and psychological symptoms of dementia (56.6 percent vs 68.3 percent), and 8.5 percentage points less likely to receive a central-nervous-system-active drug conditional on diagnosis (70.8 percent vs 79.3 percent) (Thunell et al., Journal of Alzheimer's Disease 2024; PMID 38669535). A 2025 JAMA Network Open analysis of 21,193,170 Medicare beneficiaries across Part D, fee-for-service, and Medicare Advantage covering 2016 through 2019 found that Black beneficiaries had high-risk medication use 1.6 percentage points lower than white beneficiaries (12.6 percent vs 14.2 percent) (Raver et al., JAMA Network Open 2025; PMID 40227682). A 2025 Health Affairs Scholar analysis covering community-dwelling Medicare older adults with dementia 2010 through 2018 found that minority-combined antipsychotic prescribing in 2016 to 2018 was 13.8 percent vs white 17.5 percent, with the under-treatment direction persisting across all three Choosing Wisely time periods (Yang et al., Health Affairs Scholar 2025; PMID 40040648).

Five studies, four drug classes, three decades of data, one direction: under-treatment in the Black population, even when diagnosis is established.

A blanket federal effort to reduce psychiatric prescribing, applied without race-stratified safeguards, runs into the population evidence above in a specific way. The provider-education and prior-authorization-tightening mechanisms named in the MAHA Action Plan target a population the policy assumes is over-prescribed. The five studies above describe a Black-patient population that is under-prescribed across antidepressants, stimulants, antipsychotics, and CNS-active drugs in dementia. Applying a uniform reduction-in-overprescribing policy to a non-uniform prescribing baseline produces an asymmetric squeeze.

For Black children specifically, the Saloner 2013, Cataife 2015, and Bushnell 2023 findings describe a pediatric Medicaid prescribing baseline that is already low and trending lower across both stimulants and antipsychotics. A child-focused MAHA priority that adds further prescribing-reduction pressure on top of this baseline operates against a population whose access was already constrained.

For Black older adults with dementia, the Thunell 2024 11.7-percentage-point lower BPSD diagnosis rate is the upstream constraint. A clinician who does not document BPSD in a Black patient's chart cannot prescribe an FDA-approved on-label treatment for it. Our coverage of the FDA's April 30, 2026 approval of Auvelity for Alzheimer's-related agitation walks through this gate-then-prescription chain in detail.

The pattern fits the same primitive that has shown up in two other recent federal-policy expansions. The FDA's Auvelity approval did not include race-stratified efficacy and safety data from its two larger registration-supportive trials. The American Cancer Society's 2023 lung-cancer-screening guideline update widened the Black-vs-white eligibility disparity for former smokers who developed lung cancer from 7 percentage points to 12 percentage points (Manful et al., Chest 2026; PMID 41580073; our coverage). MAHA joins those two as a third recent federal-policy frame applied without race-stratified design to a population the evidence describes as differently treated, not over-treated.

Three things the May 4, 2026 announcement does not currently pin down in the publicly-accessible portion. The Action Plan's specific reduction targets and metrics by drug class are pending direct retrieval from the HHS press-office text; the SAMHSA companion announcement returned navigation-only content at access. Whether the policy includes race-stratified safeguards or equity considerations is pending the same direct retrieval. State-level implementation policy, including state-level prior-authorization changes, will likely determine which populations bear the downstream squeeze. Black Health is requesting direct access to the announcement text via the HHS press office and will update this piece when the verbatim policy framing is available.

The published evidence base is anchored by Marc Fleming, PhD, RPh, of the University of Texas at Austin College of Pharmacy (lead author Fleming 2011 NCS-R analysis); Brendan Saloner, PhD, of the Johns Hopkins Bloomberg School of Public Health Department of Health Policy and Management (lead author Saloner 2013 Florida Medicaid ADHD analysis; at Penn Robert Wood Johnson Scholars Program at time of original publication); Guido Cataife, PhD, of IMPAQ International (lead author Cataife 2015 8-state Medicaid pediatric antipsychotic analysis); Greta Bushnell, PhD, of Rutgers University (lead author Bushnell 2023 national Medicaid pediatric antipsychotic-trend analysis); and Mark Olfson, MD, MPH, of Columbia University Vagelos College of Physicians and Surgeons and the New York State Psychiatric Institute (senior author on the Bushnell 2023 analysis and the canonical US voice on psychiatric-prescribing trends).

The Black-mental-health-policy voice is Rahn Bailey, MD, FAPA, ACP, current president of the Black Psychiatrists of America and concurrently American Psychiatric Association President-Elect; the dual role makes him uniquely positioned to speak for both the Black-psychiatry constituency and the incoming APA leadership perspective on the Black-mental-health implications of the Action Plan. Black Health has requested an interview through BPA media relations and will update this piece with his on-the-record response when it lands.

For Black adults or caregivers of Black children currently on a psychiatric medication. If your prescriber raises tapering, discontinuation, or dose reduction as a response to the new federal framework, ask for the clinical rationale in your specific case, separate from the policy framing. The Action Plan named tapering and discontinuation as priorities; clinically appropriate tapering is the standard of care for many medication-and-symptom combinations, but a policy-driven taper applied without your clinical specifics is a different conversation. Ask the prescriber to document the rationale in the chart.

For Black parents of children diagnosed with ADHD, depression, or another condition for which stimulants, antidepressants, or antipsychotics are part of the care plan. Document the diagnostic basis for any current prescription and ask the prescriber what the under-prescribing-in-Black-Medicaid-pediatric-populations finding from peer-reviewed studies (Saloner 2013, Cataife 2015, Bushnell 2023) means for your child's specific care. A prior-authorization denial or formulary-tier change citing the MAHA framework is a moment to ask for an exception based on the documented diagnostic and treatment record.

For Black mental-health-policy advocates and Black-led mental-health organizations. The Black Psychiatrists of America operates at blackpsychiatrists.org and is the institutional anchor for Black-psychiatry policy positions. The American Psychiatric Association's Caucus of Black Psychiatrists is the larger-APA structural counterpart. State-level implementation comments on prior-authorization changes for the affected drug classes are likely the primary policy lever in the coming 12 months. The Black Health provider directory lists Black psychiatrists, psychologists, and primary-care clinicians with verified active licenses for readers who want a clinician engaged with the under-treatment-vs-over-treatment evidence base.

We will update this piece when the HHS press-office text becomes directly accessible, when Black Psychiatrists of America President Dr. Rahn Bailey's response to our interview request lands, when state-level prior-authorization implementation data emerges, or when peer-reviewed post-implementation Black-stratified prescribing data publishes.

HHS Press Room. HHS Launches MAHA Action Plan to Curb Psychiatric Overprescribing. May 4, 2026. (Primary-source URL access blocked at time of publication; pending direct retrieval via HHS press office.)

Fleming M, Barner JC, Brown CM, Smith T. Treatment disparities for major depressive disorder: Implications for pharmacists. Journal of the American Pharmacists Association. 2011;51(5):620-624. PMID 21896458.

Saloner B, Fullerton C, McGuire T. The impact of long-acting medications on attention-deficit/hyperactivity disorder treatment disparities. Journal of Child and Adolescent Psychopharmacology. 2013;23(6):401-409. PMID 23952187.

Cataife G, Weinberg DA. Racial and Ethnic Differences in Antipsychotic Medication Use Among Children Enrolled in Medicaid. Psychiatric Services. 2015;66(9):946-953. PMID 25975884.

Bushnell GA, Lloyd J, Olfson M, Cook S, Das H. Antipsychotic Medication Use In Medicaid-Insured Children Decreased Substantially Between 2008 And 2016. Health Affairs. 2023;42(7):973-980. PMID 37406239.

Thunell JA, Joyce GF, Ferido PM, Chen Y, Guadamuz JS, Qato DM, Zissimopoulos JM. Diagnoses and Treatment of Behavioral and Psychological Symptoms of Dementia Among Racially and Ethnically Diverse Persons Living with Dementia. Journal of Alzheimer's Disease. 2024. PMID 38669535.

Yang AW, Leng M, Arbanas JC, Tseng CH, Fendrick AM, Sarkisian C, Damberg CL, Harawa NT, Mafi JN. Trends in antipsychotic prescribing among community-dwelling older adults with dementia, 2010-2018. Health Affairs Scholar. 2025. PMID 40040648.

Raver E, Jung J, Carlin C, Feldman R, Retchin S, Xu W. Racial and Ethnic Differences in Potentially Inappropriate Medication Use Among Medicare Beneficiaries. JAMA Network Open. 2025. PMID 40227682.

Manful A, Amanna N, Park SL, Petrick JL, Rosenberg L, Tindle H, Palmer J, Wilkens L, et al. The Impact of the 2023 American Cancer Society Screening Recommendations on Racial, Ethnic, and Sex Disparities in Lung Cancer Screening Eligibility. Chest. 2026. PMID 41580073.