This may be Donald Trump's most damaging legacy

"Pelosi is a sick woman," Trump responded. "She's got a lot of problems, a lot of mental problems."

Because this is Trump, the remark didn't draw that much attention. It should have -- because it's part of a broader pattern of Trump making denigrating comments about mental health and, in the process, making a mockery of those who suffer from mental illness.

Consider:

* In January, Trump tweeted this about House Intelligence Committee Chairman Adam Schiff: "Shifty Adam Schiff is a CORRUPT POLITICIAN, and probably a very sick man."

* In late 2019, Trump said that Pelosi "had a total meltdown in the White House today," adding: "It was very sad to watch. Pray for her, she is a very sick person."

* In September 2019, Trump called Schiff "a sick man."

* In August 2018, Trump said that the media was "very dangerous & sick!"

* In May 2016, Trump said then Fox News host Megyn Kelly was "sick, & the most overrated person on tv."

Trump has also repeatedly questioned the mental fitness of 2020 presumptive Democratic presidential nominee Joe Biden.

"Joe has absolutely no idea what's happening," Trump said earlier this month. He did the same thing to Hillary Clinton during the 2016 campaign. "She's got bad temperament. She could be crazy," Trump said of Clinton on the campaign trail in 2016. "She could actually be crazy."

He's also tagged Vermont Sen. Bernie Sanders with the nickname "Crazy Bernie," referred to entertainer Bette Midler as a "washed-up psycho," called Republican Texas Sen. Ted Cruz "nuts" and "unstable," and described Republican South Carolina Sen. Lindsey Graham as a "nut job."

For Trump, deriding someone as "sick" or "crazy" or "nuts" is just a garden-variety insult that he likes to sling around. To him, it's the equivalent of calling someone a "loser" or a "dog" -- which he also does frequently.

But whether Trump realizes it or not, what he's doing is a massive disservice to the millions of Americans struggling with mental illness. According to the National Alliance on Mental Illness, almost 44 million Americans experience mental illness in a year. About 18% of Americans cope with anxiety disorders every year, according to the Anxiety and Depression Association of America. (I am one of them).

These numbers are staggering. And only in recent years has there been a concerted effort to treat mental health as on par with physical health, to bring it out from the shadows and sanitariums and have honest conversations about why we feel the way we do and what active steps we can take to help ourselves.

What Trump is doing is taking the gains that have been made on the mental health front and erasing them with the stroke of a tweet. Unfortunately, he's not the only Republican doing this. In a commencement speech over the weekend, Nebraska Sen. Ben Sasse "joked" that:

"There are a whole bunch of people who make a whole bunch of money by just trying to help other people forget high school. They're called psychologists. In fact, 95% of all gainfully employed psychologists -- and I'm serious, there are dozens of them that are gainfully employed -- their job is really just to help people forget high school."

To the extent that Trump ever refers to mental illness and mental health in a serious way is when speaking about its connection to mass shootings. In August 2019, he said this:

"Mental illness is something nobody wants to talk about. These people are mentally ill, and nobody talks about that. ... I think we have to start building institutions again because, you know, if you look at the '60s and '70s, so many of these institutions were closed."

So, yeah. The idea that the solution to dealing with mental illness is more institutions is, well, something.

He's also suggested that PTSD -- and suicide -- is an issue of strength (or weakness).

"When you talk about the mental health problems, when people come back from war and combat and they see things that maybe a lot of folks in this room have seen many times over and you're strong and you can handle it but a lot of people can't handle it. They see horror stories, they see events you couldn't see in a movie, nobody would believe it," Trump said in the fall of 2016.

It's impossible to overstate the impact of Trump's casual use of words like "crazy" and "nuts" and his willingness to accuse his political rivals of having "mental problems" or being "sick" or "unhinged" has on public perception about mental health. Not only how the general public feels about it but, more importantly, how people who are suffering from some form of mental illness feel about themselves and how/whether they are willing to seek help.

And again, we know that mental illness is rampant in this country and is growing rapidly among young people. The suicide rate among those 15-24 years old is the highest it has been in nearly two decades. According to the American Psychological Association, "the rate of individuals reporting symptoms consistent with major depression in the last 12 months increased 52 percent in adolescents from 2005 to 2017."

And that was before a two-plus month forced isolation as we sought to slow the spread of the coronavirus!

Yes, Donald Trump's presidency has already done damage to the idea of truth. And to the idea of moral leadership. And to how America is perceived around the world. But his most damaging legacy may well be his dismissal of mental health -- at a time when so many Americans of all political stripes are struggling with it.