Despite spending more on psychiatric services and prescribing psychiatric medications at a higher rate than almost any other nation, mental health in the United States over the last two decades has only been getting worse.

Rates of depression, anxiety, suicide, overdose, chronic disability due to mental health conditions, and loneliness have all been rapidly increasing. No quantity of psychiatric drugs or hospitalisations appears adequate to reverse these trends.

Despite this, the US medical and psychiatric establishment has persistently refused to use its substantial political power to demand the transformation of care by expanding non-medical support systems to address the root social causes of mental illness, such as poverty, childhood trauma and incarceration, rather than focusing on reactive treatment via lucrative medication-centric norms. This failing status quo has created an opening for President Donald Trump and Secretary of Health Robert F Kennedy Jr’s emerging plans to remake the nation’s approach to mental health, with disastrous consequences now coming into focus.

Trump and Kennedy have hijacked legitimate anger at a broken system to justify destroying public care infrastructure, including Medicaid, food and housing assistance, harm-reduction and overdose prevention programmes, and suicide-prevention hotlines for LGBTQ youth, while promoting wellness scams and expanding the police state. They focus on the “threat” supposedly posed by psychiatric medications and call to reopen the asylums that once confined approximately 560,000 people, or one in 295 US residents, in horrific conditions, until protests against their cruelty led to their closure beginning in the 1950s.

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Trump invokes false claims about mental illness to demonise immigrants, whom he is now hunting via a mass arrest and incarceration campaign. Last month, he signed an executive order that allows police to arrest and forcibly institutionalise poor Americans who are unhoused, deemed mentally ill, or struggling with addiction, effectively incarcerating them for indefinite periods.

Trump’s order, which also defunds housing-first programmes and harm-reduction services, while criminalising homelessness and encampments, contains no provisions to protect people from abuse or from the political misuse of psychiatric labels and institutionalisation to target his opponents. This raises concerns about risks to LGBTQ youth and other vulnerable groups. It also threatens groups upon which the administration has shown a eugenicist fixation: transgender people, people with autism, and others with disabilities that RFK Jr and Trump have characterised as a threat or burden on society.

The order appears to grant the government the power to deem anyone mentally ill or abusing substances, and to confine them indefinitely in any designated treatment facility, without due process. In a context where there is already a profound shortage of psychiatric beds even for short-term treatment, there are no provisions for new funding or regulatory systems to ensure that facilities are therapeutic or humane, rather than violent, coercive warehouses like American asylums of decades past.

Trump’s allies, including some medical professionals aligned with ideologies of social control and state coercion, may dismiss this as overly pessimistic. But that requires ignoring the fact that Trump’s executive order follows Kennedy’s proposal for federally funded “wellness farms”, where people, particularly Black youth taking SSRIs (selective serotonin reuptake inhibitors primarily used to treat anxiety and depression) and stimulants, would be subjected to forced labour and “re‑parenting” to overcome supposed drug dependence.

These proposals revive the legacy of coercive institutions built on forced labour and racialised interventions. Kennedy has also promoted the conspiracy theory that anti-depressants like SSRIs cause school shootings, comparing their risks with heroin, despite a total lack of scientific support for such claims. In his early tenure as health and human services secretary, he has already gutted key federal mental health research and services, including at the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH).

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Given this, it is unclear what kind of “treatment”, other than confinement and cruelty, Trump and RFK Jr plan to deliver in their new asylums.

Trump and Kennedy’s lies about mental health, cuts to public care and vision for expanding the incarceration of immigrants, homeless people, and anyone they label as mentally ill, worsen mental health while creating more opportunities to profit from preventable suffering, disability and death. These tactics are not new, and their harmful consequences and political motivations are well established.

From Hungary to the Philippines, right-wing politicians have deployed similar rhetoric for comparable purposes. In a precedent that likely informs Trump’s plan, Brazil’s former president, Jair Bolsonaro, attacked psychiatric reformsas leftist indoctrination and defunded successful community mental health services, replacing them with coercive asylum and profit-based models, while advocating pseudoscience linked to evangelical movements. Bolsonaro claimed to defend family values and national identity against globalist medical ideologies, while sacrificing countless Brazilian lives via policies later characterised by the Senate as crimes against humanity.

Bolsonaro’s record is instructive for anticipating Trump’s plans. Trump has made no secret of his admiration for Brazil’s disgraced former president and their shared political ideologies. Bolsonaro’s reversal of Brazil’s internationally recognised psychiatric reform movement, which emphasised deinstitutionalisation, community-based psychosocial care and autonomy, inflicted profound harm. Under his rule, institutionalisation in coercive “therapeutic communities”, often operated by evangelical organisations, with little oversight, and similar to RFK Jr’s proposed “wellness farms”, skyrocketed.

Investigations revealed widespread abuses in these communities, including forced confinement, unpaid labour, religious indoctrination, denial of medication, and physical and psychological violence. Bolsonaro’s government poured large sums into expanding these dystopian asylums while defunding community mental health centres, leaving people with severe mental illness and substance use disorders abandoned to punitive care or the streets.

This needless suffering pushed more people into Brazil’s overcrowded prisons, where psychiatric care is absent, abuse rampant and systemic racism overwhelming, with Black people accounting for more than 68 percent of the incarcerated population. Bolsonaro’s psychiatric agenda enhanced carceral control under the guise of care, reproducing racist and eugenicist hierarchies of social worth under an anti-psychiatry banner of neo-fascist nationalism.

Trump and Bolsonaro’s reactionary approaches underline a crucial truth: Both psychiatry and critiques of it can serve very different ends, depending on the politics to which they are attached. Far-right politicians often use anti-psychiatry to justify privatisation, eugenics and incarceration. They draw on ideas from the libertarian psychiatrist Thomas Szasz, who argued in the 1960s that mental illness was a “myth”, and called for the abolition of psychiatric institutions.

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In the US today, these political actors distort Szasz’s ideas, ignoring his opposition to coercion, by gutting public mental health services under the guise of “healthcare freedom”. This leaves vulnerable populations to suffer in isolation, at the hands of police or fellow citizens who feel increasingly empowered to publicly abuse, or even, as seen in the killing of Jordan Neely in New York City, execute them on subways, in prisons, or on the streets.

By contrast, critics of psychiatry on the left demand rights to non-medical care, economic security and democratic participation. Thinkers such as Michel Foucault, Frantz Fanon, RD Laing and Ivan Illich advocated for deinstitutionalisation not to abandon people, but to replace coercion with community-led social care that supports rights to individual difference. Their critiques targeted not psychiatry itself, but its use by exploitative, homogenising political systems.

To oppose reactionary anti-psychiatry, mental health professionals and politicians cannot simply defend the status quo of over-medicalisation, profit-driven care and the pathologisation of poverty. Millions justifiably feel betrayed by current psychiatric norms that offer little more than labels and pills while ignoring the political causes of their suffering. If the left does not harness this anger towards constructive change, the right will continue to exploit it.

The solution is not to shield America’s mental health systems from critique, but to insist on an expansive political vision of care that affirms the need for psychiatric support while refusing to treat it as a substitute for the political struggle for social services. This means investing in public housing, guaranteed income, peer-led community care worker programmes, non-police crisis teams and strong social safety nets that address the root causes of distress, addiction and disease.

Mental health is fundamentally a political issue. It cannot be resolved with medications alone, nor, as Trump and RFK Jr are doing, by dismantling psychiatric services and replacing them with psychiatric coercion.

The fight over mental health policy is a fight over the meaning of society and the survival of democratic ideals in an era where oligarchic power and fascist regimes are attempting to strangle them. Will we respond to suffering with solidarity, or with abandonment and punishment? Will we recognise the collective causes of distress and invest in systems of care, or allow political opportunists to exploit public disillusionment for authoritarian ends?

These are the questions at stake, not just in the United States, but globally. If the psychiatric establishment refuses to support progressive transformation of mental health systems, we may soon lose them altogether as thinly disguised prisons rise in their place.

If you or someone you know is at risk of suicide, these organisations may be able to help.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.