April 23, 2025

By Courtney Wise

Greetings, MindSite News Readers. In today’s Daily, we feature an exclusive interview with Bandy X. Lee, a prominent psychiatrist who risked her career to warn the public of Trump’s mental unfitness for office and danger to the world. In other news, we look at eating disorders and the challenges researchers face in treating them.

Plus, a New York Times investigation uncovers the incidents that led to the closing of Timberline Knolls, a once heralded mental health facility. Researchers offer insight into the relationship between severe mental illness and homelessness. And the potential benefits of a mental health leave.

Finally, this note from our editors:

Starting tomorrow, you will notice some changes in our website and newsletter as we migrate to a different web host. There will, no doubt, be some kinks to work out, but we will continue to bring you the vital mental health news, investigations, features and interviews you have come to expect from MindSite News. So please be patient, and let us know any thoughts, comments or love notes you may have.

‘A public health emergency’: Psychiatrist Bandy Lee on Trump’s danger to the world

Eight years ago, psychiatrist  and prominent violence expert Bandy X. Lee and a cadre of mental health professionals issued a dire warning: President Donald Trump was  mentally unfit to remain in the presidency and his doing so amounted to a public health crisis. Today, she continues to sound the alarm despite ongoing harassment and death threats.

“Perhaps the oddest experience in my career as a psychiatrist has been to find that the only people not allowed to speak about an issue are those who know the most about it,” she wrote in her introduction to the 2017 book she organized and edited, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.

Lee was talking about a 2017 directive from the American Psychiatric Association telling its members it was “unacceptable and unethical” to talk about Donald Trump’s mental capacity for office – even though on the Hare Psychopathy Checklist, where a score of 30 out of 40 indicates dangerous levels of psychopathy, Trump scored 36. 

In this exclusive interview with MindSite News, Lee traces what she and many other mental health experts view as the dire consequences from the APA’s decision, shares evidence for Trump’s cognitive problems and his mental unfitness to be president, and compares his capacity for violence to the violent gang members she has long worked with in prisons. She also analyzes the spreading ‘Trump contagion’ and argues that is crucial for the safety of the United States and the world – and even for Trump himself – that he be evaluated by mental health experts and removed from office. Read our interview here.

–Diana Hembree

As eating disorders rise, scientists hope for new opportunities to research how to treat them

In March, a former colleague of mine buried her daughter. I’d known she’d been sick for some time, and it had been since before I’d met her mother, but I hadn’t known exactly what affliction she’d been battling. Having had two college friends succumb to long-in-remission cancers, I’d assumed it was along those lines. Like those friends, she’d spend some seasons unable to eat, losing weight, eventually landing in the hospital. It wasn’t until she passed that I learned that it was anorexia that had taken her. She’d been fighting the debilitating disorder for decades.

It’s a fight more and more Americans know intimately. Ericka Andersen, author of this report in the Wall Street Journal, is one of them. She’s recovered from her anorexia and bulimia, but diagnoses of eating disorders are on the rise, and effective treatments remain elusive. 

From 2018 to 2022, hospital visits for under-18s with eating disorders doubled, from 50,000 or so to more than 100,000. It’s not clear exactly why, but social media is likely playing a role. “The research suggests that the more someone is using social media, their risk of developing self-esteem issues, disordered eating, anxiety, depression, body image and other issues is elevated,” said Samantha DeCaro, director of clinical outreach and education at the Renfrew Center, which provides residential treatment to patients with eating disorders. Feeds are cluttered with “wellness” content, much of which focuses on diet and exercise. One influencer, Liv Schmidt, even brands herself a “skinni coach,” posting photos featuring her visible ribs, and using captions like, “Nothing tastes as good as being this effortless feels.” 

But eating disorders are deadly, claiming over 10,000 lives each year, and anorexia nervosa has the highest mortality rate of any psychiatric condition other than opiate addiction. The malnourishment eating disorders lead to takes a toll on vital organs, and a 2019 study found that people with “lifetime” eating disorders are at a five-fold greater risk of suicide. Part of the difficulty in finding treatments is that double-sided attack, on both physical and mental health.

Stigma makes the picture even bleaker. They’re stereotyped “as an affliction of privilege” affecting wealthy white women, but these illnesses are just as prevalent among non-white Americans – but not as commonly diagnosed or treated, especially for those without private health insurance. Up to a quarter of those struggling with the disorders are men.

Studies on eating disorders are grossly underfunded, experts say, holding us back from effective solutions. Research spending on eating disorders breaks down to  $9 for each person with one, in contrast to $239 per person with Alzheimer’s disease, $109 per person with autism, and $69 per person with schizophrenia. And much like other mental illnesses, patients are often met with skepticism, putting off treatment and recovery. Dondero Bettwy highlighted that as part of the issue. “People still wrongly believe that eating disorders are a vanity or a choice someone can just snap out of.”

For people with severe mental illness, a revolving door between housing and the streets

L is overwhelmed. For the past 8 years, her mother, K, has lived unhoused. Diagnosed with schizoaffective disorder, K experiences severe mood swings and delusions, and often can’t recognize that she’s unwell, so refuses treatment. Nearly two years ago, L left her life in Colorado to return to her home state of Montana, hoping she could set her mom up with long term mental health support and secure housing. Unfortunately, L told KFF News and NPR, she’s mostly watched her mother spiral in and out of patchy psychiatric care and homelessness. 

She requested that only their first initials be used – she’s worried the stigma might prevent her mother from being able to find a home. Living with one another isn’t an option, L said. The wounds of growing up with a severely mentally ill mother are too fresh. “It’s pretty painful on cold nights to have to not let somebody in because it will deteriorate your whole mental health and stability,” she added tearfully.

K’s life had been solid, L said. She had an apartment and a case manager who helped her maneuver the mental health system and stay on track with medication. But in 2017, Montana cut its Medicaid budget, eliminating K’s case management services. Then her apartment was sold. With no one to help her secure new housing or keep her on her meds, K drifted into homelessness as her illness grew further uncontrolled. 

Long-term stays in shelters weren’t possible; when her symptoms and behaviors didn’t get her kicked out, incontinence – a side effect of her medications – disqualified her. Trespassing violations from sleeping outside frequently landed her in jail, emergency rooms, and sometimes, Montana State Hospital, the only publicly-funded psychiatric hospital in the state. But in 2022, after the death of several patients, MSH lost its federal certification, making it unable to accept Medicaid.

There have been some modest improvements since those lows. For one thing, L’s efforts got K back into case management. In 2023, state legislators dedicated $300 million to strengthening mental health. Some of that money has reopened crisis facilities, group homes, and deployed mobile crisis teams, among other short-term solutions. The majority Republican state congress also recently approved the construction of a new “step-down facility” to house and treat patients discharged from MSH. Residents would be people well enough to not need a hospital, but unable to live on their own.

For K, more support has meant more nights spent in a shelter rather than the streets, though she still needs a permanent home, something the state doesn’t yet have a plan for. That’s not uncommon, said Ben Miller, a professor who researches systemic mental health reform. Lawmakers spend a lot of time focusing on short-term crisis care, rather than funding services that promote long-term stability, like housing, he said. “If you just get someone stable housing, you can watch how their mental health, the benefits go up overnight,” Miller said. “Our communities are suffering because we’re not doing both [long term and short term care] very well.” 

In other news…

Wholly overwhelmed? Consider mental health leave. Carolina Lasso is glad she did. Her boss was the first to mention the idea, but she still feared the impact it might have on her career. It’s an option many don’t consider, the Associated Press reports. Some employees don’t know it’s a possibility, while others fear retribution for needing mental health support. Still, experts say to do it if you can, and Lasso doesn’t regret it at all.

“I’m thankful for that opportunity to take the time to heal,” she said. “It can really unlock new possibilities once we have the time to do the work — therapy, medication, whatever it is — and have enough distance from (our jobs) to be able to reconnect with ourselves.” 

Horror at Timberline Knolls, a facility once known for treating upscale, celebrity clients like Demi Lovato. An investigation by the New York Times found longstanding abuse and neglect amid regulatory failings. In 2018, four residents reported that a staff therapist sexually assaulted them – and the therapist was arrested. But despite Acadia Health’s claim that it had made changes, “to assure that it won’t happen again,” troubles went on in the years to follow. Different staff went on to rape at least two other residents, and two suicidal patients left unsupervised died as a result of negligence. A third nearly died of overdose from medications that were left out in a common area.

The sexual assaults at Timberline Knolls speak to a nationwide pattern of issues within Acadia, which operates 260 facilities across 39 states. Facilities in Utah, New Mexico, Michigan, and now, Illinois, have been shut after reports of sexual abuse, with Timberline Knolls itself permanently shuttered. 

Spokesperson Tim Blair said the company rejects “any notion that we put profits over patients,” but Former staff paint a different picture, mentioning pressure to keep expenses low and overfill facilities. “We were extremely understaffed,” said Cecilia Del Angel, who worked as a behavioral health aide at Timberline Knolls until last summer. The patient deaths, she said, were “entirely preventable.” 

How our brains keep us going in a marathon: Carlos Matute, a neuroscientist, found himself wondering, on a long run: “How do we make it to the finish line, being conscious, after having our energy stores depleted?” He conducted a small study, scanning the brains of 10 marathon runners, aged 45 to 73, and found an answer: our brains adapt by burning their own fat. It’s not, as some headlines have said, the brain “eating itself,” he told National Geographic. When they’re not getting enough glucose from the blood, our neurons turn to myelin, their sheath – a source of “brain fat”- to keep going. 

Levels returned to normal after a couple of months – our brains seem adaptable and resilient under stress, even as we age. “Nobody foresaw that this would happen, that the structure of our brain may change so rapidly, in the time which it takes you to run the marathon,” he said.

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.