Donald Trump’s executive order that pushes local governments to remove unhoused people from the streets will exacerbate the issues already facing people who have unstable housing, mental health conditions and substance use disorders – and the vague wording could be used for wider action, experts say.
“It’s one of the most harmful things to happen to folks who live outside in decades. It is not going to help anybody,” said Jesse Rabinowitz, campaign and communications director at the National Homelessness Law Center.
“It sets the stage for rounding up folks who are homeless, folks with mental health issues, folks who are disabled – and instead of helping them, forcing them into detention camps and institutions. So it’s terrifying.”
The order instructs states and municipalities to crack down on public substance use; camping, loitering, or squatting in urban spaces; mental health issues; and sex offender registration. It calls for “shifting” people without stable housing into “long-term institutional settings”.
“It is essentially creating a pathway to criminalize larger and larger numbers of people,” said Margaret Sullivan, a family nurse practitioner and director of programs for immigrant and unhoused communities at the FXB Center for Health and Human Rights at Harvard University.
The order is “vague and broad and potentially leaning toward creating more civil rights violations”, she said.
The conditions for detainment outlined in the order are poorly defined, which means it could be interpreted broadly to detain and involuntarily institutionalize people in public spaces. And it doesn’t detail who may make determinations on institutionalization.
“It doesn’t define ‘mental health crisis’. It also doesn’t define who’s qualified to make an assessment,” said Rabinowitz.
Individuals with mental illness are defined in the order as people who “pose risks to themselves or the public”, which could be broad enough to encompass many people, he said.
And while the order sometimes refers to cracking down on “illicit” substance use, at other times it speaks more generally to substance use disorder – a condition that can include legal substances such as alcohol and prescription medication.
Many states already have laws on involuntary commitment for mental illness, Sullivan said. Typically, the process begins with clinical healthcare providers or mental health professionals and goes through the judicial system.
“There’s a judicial system to ensure that the rights of the individual are not being violated. To strip away those checks and balances, and make it so that there’s more essentially policing on the streets of mental illness … has never been proved to be effective in the long run,” Sullivan said.
“This goes a step further than what we’ve seen in some other states or cities,” she added.
The order would also expand drug courts and mental health courts, and it would “allow or require” anyone receiving federal funding for homelessness support to collect health information and share it with law enforcement.
The Trump administration will also stop supporting housing-first policies, which provide housing and support services as quickly as possible to people experiencing homelessness, the order said.
It comes amid significant proposed reductions for affordable housing.
“The Trump administration is going to make housing more expensive. They’re going to force more people into homelessness. And then once people are homeless, they’re going to take away actual solutions, and instead lock people up for being homeless,” Rabinowitz said.
This approach has serious repercussions for health, he added.
“Housing is the best form of healthcare, period. The health impacts of housing are tremendous, and the health consequences of homelessness are devastating.”
Higher rates of involuntary institutionalization would add greater strain to the healthcare system, Sullivan said. “We know that involuntary commitment leads to more people being in the emergency room and emergency rooms being more overwhelmed than they currently are.”
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Cuts to Medicaid will also make it harder for people with mental illness and substance use disorder to access healthcare, Sullivan said.
And the new federal budget cuts funding for supportive services like mental health care and substance use treatment.
The administration also plans to review grants for existing substance use programs, with explicit instructions not to fund projects on harm reduction – which often includes overdose response and naloxone distribution, needle and syringe exchanges, and education on safer drug use, among other initiatives – and safe consumption. And the order instructed Trump administration officials to pursue possible lawsuits against such programs.
States and cities receiving federal funding could see that money restricted or frozen if they don’t enforce the new rules, the executive order said.
In the wake of last year’s supreme court decision on Grant’s Pass, upholding the Oregon city’s ordinance that effectively criminalizes homelessness, several states and municipalities introduced stricter laws to target people living outside.
“Especially when federal funding is really disappearing, this hamstrings cities and municipalities into compliance in order just to fund vital services,” Sullivan said.
Focusing on programs addressing these issues in innovative ways “makes it seem like this is another mechanism for going after places like LA or Portland or Chicago or any place that is trying to do something different with addressing homelessness and substance use”, Sullivan said.
“That is, to me, what it seems like – this is a way to go after not just individuals and people, but to go after areas,” she said.
But it will have sweeping effects on homeless people and others to whom the order is applied.
“I think that they are motivated by this incorrect belief that homelessness is a choice, that we have to punish people in order for them to make a better choice,” Rabinowitz said.
Even if that were true, he said, “there are no carrots right now, there’s no housing that anybody can afford, but there are a whole ton of sticks, and we know that people don’t need a stick. People want housing; there’s just no housing that they can afford. But the executive order does nothing to address the actual causes of homelessness.”
Sullivan agreed.
“It does nothing to address underlying poverty. It does nothing to address the persistently unaffordable housing crisis,” she said.
“It does nothing to expand access to Medicaid for impoverished people. Meanwhile, the numbers in the US of people who are experiencing chronic homelessness and disability are increasing.”
