Trump order pushes forcible hospitalization of homeless people

President Donald Trump has directed federal agencies to find ways to make it easier to forcibly hospitalize homeless people with mental illness and addiction for longer periods — an effort to fight what the administration calls “vagrancy” threatening the streets of U.S. cities.

An executive order signed Thursday pushes federal agencies to overturn state and federal legal precedent that limits how local and state governments can involuntarily commit people who pose a risk to themselves or others.

The order said shifting homeless people into long-term institutional settings will restore public order. “Surrendering our cities and citizens to disorder and fear is neither compassionate to the homeless nor other citizens,” Trump’s order said.

The impact of Trump’s executive order remains unclear because states set laws and handle the process of involuntary commitments. Critics warned that such a policy threatens returning the nation to a darker era when people were often unjustly locked away in mental health institutions, and does nothing to help people afford housing.

“The safest communities are those with the most housing and resources, not those that make it a crime to be poor or sick,” Jesse Rabinowitz, communications director of the National Homelessness Law Center, said in a statement. He called forced treatment unethical and ineffective.

Critics say cash-strapped states will not have the space to keep more people detained. The executive order, however, says federal resources could ensure “detainees with serious mental illness are not released into the public” because of a lack of bed space in jails or hospitals.

The order also instructs agencies to prioritize funding for mental health and drug courts — and to not fund “harm reduction” programs that the administration said facilitate illegal drug use. It also called for agencies to prioritize funding states and cities that to the “maximum extent” enforce laws on open-air drug use, prohibitions on urban camping, loitering and squatting.

The executive order was issued as the Trump administration has slashed more than $1 billion in COVID-era grants administered by the Substance Abuse and Mental Health Services Administration and is proposing to slash hundreds of millions more in agency grants.

“There’s no question we need to do more to address both homelessness and untreated substance use disorder and mental health conditions in the U.S.,” said Regina LaBelle, the director of the Addiction and Public Policy Initiative at the Georgetown University Law Center and a former drug policy official in the Biden White House. “But issuing an executive order, while disinvesting in treatment and other funding that will help prevent homelessness and untreated health conditions, will do nothing to address the fundamental issues facing the country.”

Homelessness — and perceptions of street crime run amok — has proved a potent issue for Trump and Republican leaders as the nation grapples with a mounting housing crisis.

The Supreme Court last year ruled that cities may ban homeless residents from sleeping outside, rejecting a constitutional challenge to a set of anti-camping laws.

Trump signed the executive order about three months after the Justice Department asked agency officials who oversee grant distributions to brainstorm ways to clear encampments and boost involuntary hospitalizations as part of an aggressive push to drive homeless people from public spaces.

Dozens of states have added to or expanded involuntary commitment laws during the past decade. That includes states controlled by Democrats, an illustration that political momentum has shifted toward a more aggressive approach to dealing with the inextricably intertwined crises of mental health and addiction.

Oregon state lawmakers, after years of contentious debate and failed attempts, are pushing forward with a bill that would make it easier to force someone who is a danger to themselves or others into treatment.

In California, a law went into effect this year expanding the criteria for who is eligible for involuntary commitments to include those suffering from substance use disorders. Gov. Gavin Newsom (D), a potential 2028 presidential candidate who is often criticized by Trump on the issue of public safety, said the law would “ensure no one falls through the cracks, and that people get the help they need and the respect they deserve.”

In New York, state lawmakers this year cemented earlier state guidance that allowed first responders to involuntarily commit people with severe mental illnesses who cannot meet their own basic needs such as obtaining medical care, shelter or food. The law was pushed by Gov. Kathy Hochul (D), who has faced criticism regarding public safety against the backdrop of high-profile acts of violence involving mentally ill people in New York City and a push by Mayor Eric Adams for more forced commitments.

While there may be an uptick in police officers transporting people to the hospital, it is doubtful that significantly more people will actually be admitted for forced treatment, said Patrick Wildes, a former assistant secretary for human services and mental hygiene under Hochul.

“I don’t think that there’s all these people who are waiting around, looking unwell, who need to get picked up,” he said. “But I do think that it can make some members of the public feel better that, in theory, it’s easier for the authorities and for the government to try to bring people in.”

States’ beefing-up of involuntary commitment laws illustrates a growing recognition that officials had become too reluctant to employ laws aimed at the most severely ill who are not able to seek treatment on their own, said Lisa Dailey, executive director of the Treatment Advocacy Center. Those people often end up in jail or prison, or harm themselves or others, while conditions such as schizophrenia and bipolar disorder go untreated, she said.

“It does damage to your brain to remain in untreated psychosis. The longer you remain in an untreated psychosis, the harder it is to actually recover,” said Dailey, whose organization has become influential in pushing changes to state laws to treat severely mentally ill people before they succumb to homelessness or incarceration.

The nation has long grappled with how to handle forced hospitalizations.

In 1975, the Supreme Court in a landmark ruling cemented due process rights for people with mental illness, ruling that they could not be involuntarily committed without showing that they posed a danger. Four years later, the court imposed a higher legal threshold for committing someone for treatment against their will.

During the campaign, Trump claimed U.S. cities had been surrendered to the “drug addicted” and “dangerously deranged.” He vowed to put people “in mental institutions where they belong” and floated the idea of putting them in government-sponsored tent cities.

His rhetoric suggests an interest in “retrenchment and a movement back toward institutionalization,” said Jennifer Mathis, deputy director of the Judge David L. Bazelon Center for Mental Health Law.

“At a time when the federal government is making historic cuts to Medicaid services and housing, no state can afford to warehouse people with disabilities in costly institutions,” Mathis said. “Locking up more people is not a solution.”

But the federal government has virtually no power to force states to change how they handle involuntary commitments, said Keith Humphreys, a former White House drug policy adviser who is now a Stanford University psychiatrist specializing in addiction. While the order may be more for show, it will resonate beyond Trump’s conservative base, he said.

“Lots of Americans across the political spectrum are fed up with homelessness disorder and public drug use,” Humphreys said. “And they are right to be. There has been a lot of public policy failure in this area.”