When Donald Trump issued an executive order (EO) to “remove vagrant individuals from our streets” in July, his administration upended decades of precedent and best practices in treating both unhoused people and those with severe mental health disorders. The announced policy shift not only encourages “civil commitment of individuals with mental illness who pose risks to themselves or the public or are living on the streets and cannot care for themselves,” but also ends federal support for Housing First — a policy that provides shelter to people in need without conditions — and instead mandates that housing provision be tied to participation in sobriety programs. It further ends support for safe injection sites and distribution of clean needles, and orders the attorney general and secretaries of Health and Human Services (HHS), Housing and Urban Development (HUD), and Transportation to enforce prohibitions on “urban camping and loitering.”
The administration has marketed the executive order as “compassionate,” but a wide array of public health advocates, unhoused people, mental health and medical workers, civil libertarians, public interest attorneys and mutual aid groups have made clear that the order is anything but.
“To frame something as compassionate when it is punitive, hateful, and plays into stereotypes about the unhoused and people with mental illnesses is wrong,” Jacqueline Seitz, deputy director of health privacy at the Legal Action Center in New York City, told Truthout. “States have enacted strict laws to protect people being treated for mental health conditions, substance use disorders and HIV, so it is not totally clear to me — and may eventually need to be decided by a court — how the EO will play out.” Specifically, Seitz anticipates potential conflicts between police, mental health providers, and medical staff over what information can be shared and for what purpose.
These protections, she says, include both HIPAA and state privacy statutes that govern the sharing of information. “Providers of care have obligations and duties, so, for example, if they illegally share information about a patient, under current law they can be investigated by the Department of Health and Human Services’ Office for Civil Rights and the Department of Justice. Someone who violates a person’s privacy can be forced to pay a monetary penalty or serve time in jail.”
Whether these protections will continue to be enforced remains an open question, of course, which is why advocates are monitoring the executive order’s unfolding policy implementation and are working at both the state and federal levels to support the unhoused, promote community-based mental health and substance use treatment, and create and maintain affordable housing.
“We’ve been anticipating this EO since the Supreme Court issued its decision in Grants Pass v. Johnson in June 2024,” Donald H. Whitehead, executive director of the Coalition for the Homeless, told Truthout. Since the Supreme Court found that the 8th Amendment’s ban on cruel and unusual punishment does not extend to unhoused individuals or protect them from being arrested, fined or jailed for sleeping or resting in public spaces, Whitehead reports that 320 ordinances to criminalize homelessness have been introduced in state legislatures across the country.
And as the unhoused community has fought hard against these measures, the Coalition’s Bring America Home NOW Campaign, a network of more than 1,000 groups, has come together to demand real housing justice, including adaptive reuse of abandoned and underutilized properties and their conversion into housing that is affordable to low-income people. They’re also fighting against policies that stigmatize and criminalize the poor, people with criminal histories, or those facing mental or physical health challenges.
Whitehead calls this unprecedented coalition “a silver lining,” dubbing it an opportunity to bring people together who were not paying attention to these issues before Grants Pass or the recent EO. Folks are fired up, he adds. Among the Coalition’s plans are organizing a national Housing NOW demonstration to take place before the November 2026 midterm elections and a media campaign to contest the stereotypes that the executive order attempts to spread about unhoused people.
“The majority of people who reach out to the Coalition are people over the age of 55 who are experiencing homelessness for the first time,” Whitehead says. “Most are not unhoused because of a mental health issue or a substance use disorder. They’re unhoused because they can’t afford housing. This population — the elderly — is the largest growth population among the homeless. Mothers and children are also a growing part of this sector.” Whitehead added that the executive order “relies on stereotypes and misinformation and does nothing to fix the shortage of affordable housing.”
Moreover, the coalition intends to oppose the idea that institutionalization promotes healing and increases community safety.
Christopher AhnAllen, assistant professor of psychiatry at Harvard Medical School and director of inpatient psychology at Brigham and Women’s Hospital in Boston, told Truthout that current law stipulates just three reasons for involuntary commitment to a psychiatric facility: Suicidal ideation or the desire to self-harm; homicidal ideation or the desire to harm others; or the perception that a person is unable to take care of themselves because of an untreated mental disorder. In many states, this category can include substance use disorders.
Commitment Policies Vary by State
“Providers of care are required to follow the laws of their state regarding psychiatric civil commitment,” AhnAllen began. In Massachusetts, he says, a medical doctor, licensed social worker, police officer, or psychologist can order someone to go to an emergency room to be evaluated if they seem to fall into one of these categories.
“Usually, if someone is brought in because of psychosis or other mental illness, they can be held for 72 business hours unless they consent to treatment. If they oppose treatment, a hearing is held. This is supposed to occur within 5 days, but it often takes two weeks to see a judge,” he explains. Then, if the courts decide that the person needs further treatment, “the judge can commit them for up to 6 months. They are further required to cooperate with the treatment plan, which can include electroconvulsive therapy and medication.”
The process is different for Massachusetts residents who are hospitalized by a family member or by the police due to substance use, AhnAllen said, and the involuntary commitment order can send them to a drug treatment or correctional facility for up to 60 days.
AhnAllen finds the fact that the EO encourages these policies extremely worrisome. As a member of the American Psychological Association (APA), he and other professionals stress that criminalization and forced treatment can increase trauma. They further argue that moving away from community-based care, in favor of placing people in institutions, will be counterproductive and cite numerous studies that credit stable housing as the foundation of effective mental health and substance use treatment. Furthermore, AhnAllen says that making sobriety a condition for housing assistance could prevent people from acquiring both shelter and care.
“We need more wraparound programs to help people maintain housing,” he told Truthout. “We need more supportive employment and case management to ensure that people have access to care. We need more peer specialists who can be role models, and we need flexible options to improve people’s living environments so they can live lives of value.”
Unsurprisingly, the executive order does not address or provide any of these things. But what’s even worse, AhnAllen said, is the potential weakening of privacy protections — the kinds of protections outlined by Jacqueline Seitz — that could force practitioners to share patient data with law enforcement or other government actors. Toward that end, he says the APA has issued guidance to members, encouraging them to partner with community organizations working on housing, mutual aid, and legal issues. “There is a great deal of evidence that Housing First works,” he says. “There is a great deal of evidence that voluntary treatment works. But having to share information with law enforcement does not work and may compromise the therapeutic relationship and derail effective treatment.”
This concern is also front-and-center for disabled people, including people with intellectual disabilities. Shira Wakschlag, senior executive officer and general counsel at The ARC, told Truthout that the disability rights community fears that the executive order could lead to the warehousing of people with disabilities.
“Forty percent of people diagnosed with an intellectual disability have a coexisting mental health condition,” she said. “We know that people do best when they receive care in their home communities and have autonomy over their decisions.”
Wakschlag also noted that Trump’s order could turn the clock back decades for disability rights, “Fifty years ago, the Supreme Court ruled in O’Connor v. Donaldson that disabled people cannot have their liberty taken away without due process. But this EO scapegoats people with disabilities, presenting them as dangerous and taking away their civil rights.”
“It is absurd to think that ending people’s right to autonomy will end homelessness.”
Still, like Whitehead and other advocates, Wakschlag sees the “cross collaboration” between people from diverse communities in opposition to the EO as a positive development. “Bringing disability groups and the unhoused and their supporters together is important. Right now, we’re staying vigilant. At a time when people are losing access to Medicaid and SNAP, we’re doing everything we can to stop the country from going backwards. We have to maintain and uphold what we’ve accomplished over the past decades. The deinstitutionalization movement involved the gradual closing of large institutions like Pennhurst and Willowbrook because they were human warehouses.”
Jennifer Mathis, deputy director of the Bazelon Center for Mental Health Law, agrees with Wakschlag. “Long-term institutionalization is outmoded and does not reflect current thinking or practice,” she told Truthout. “Custodial care is not treatment, and we moved away from institutional warehousing because it was not good practice. It’s also expensive, and it’s hard to imagine any state being able to afford it.”
Mathis is also critical of the administration’s plan to eliminate Housing First. “The predictable result of this is that it will increase homelessness,” she said. “Directing HUD to stop supporting Housing First is damaging and problematic.” In addition, she said directing HHS and HUD to promote long-term institutionalization “flies in the face of the effective treatment that is taking place in community-based programs.”
Nonetheless, like other advocates, Mathis is heartened by what she calls “the degree of unanimity in response to the EO,” adding: “There is widespread condemnation of it from groups working in many different worlds. Even organizations that previously supported limited forced treatment are seeing this as a bridge too far.”
Indeed, the move toward renewed institutionalization has left many people shaking their heads — and organizing to oppose it.
“The history of the deinstitutionalization movement is a success story about how people with mental illness and substance use disorders should be treated,” Noelle Porter, director of government affairs at the National Housing Law Project, told Truthout. “It is absurd to think that ending people’s right to autonomy will end homelessness.”
The executive order is also terrifying to those who fear being swept up and locked away.
Trey (who asked to be identified by only one name) is a formerly unhoused person now living and working in Philadelphia, who has been repeatedly hospitalized for severe depression. “I have cycles between doing OK and then needing treatment,” they told Truthout. “At one point, I was being evicted, and because I was so depressed, I signed myself into a hospital. I got help, but if my personal agency had been taken away and I’d been sent to an institution because I was unhoused, who knows what would have happened. My life experience has shown me how easy it can be for things to go haywire and end badly. There is always this feeling, no matter how good things seem at a particular time, that this is temporary and everything can unravel. The executive order has added to this feeling and increased my stress.”
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