That order proposes the vast expansion of a practice that has been around for a very long time. In recent years, in fact, in states across this country, there has been an uptick in involuntary commitment, a trade term for the forced institutionalization of people who are unwell or, now, simply unhoused.
Elected officials of all political stripes, including the current president, have claimed that involuntary commitment is an evidence-based way to treat mental illnesses, including addiction. Research does show that, in certain cases, involuntary commitment can be beneficial. But in all too many cases, its both ineffective and inhumane. A recent report by the Federal Reserve Bank of New York found that the institutionalization of individuals who were involuntarily hospitalized in judgment call cases meaning cases where one physician might recommend hospitalization, while another would not nearly doubled the risk of death by suicide or overdose. It also nearly doubled the likelihood of that person later being charged with a violent crime, perhaps because such institutionalization disrupted employment, subjecting people to still more dire economic circumstances. (Again, dont ask why the addiction, ask why the pain.) Even a recent essay in The New York Times advocating forced treatment conceded that it must be well funded and thoughtfully carried out conditions that are virtually certain to be unmet in the current climate.
In other words, evidence suggests that rounding up masses of unwell people and institutionalizing them will do anything but benefit public safety, while endangering the individuals who are locked up. On-the-ground data also indicates that, even before Donald Trump focused on that tactic, such commitment was unequally applied, with Black and Hispanic people more likely than White people to be institutionalized against their will.
Were not operating with an optimal treatment system, mandatory or voluntary, according to Regina LaBelle, director of the Center on Addiction Policy at Georgetown University and the former acting director of the White House Office of National Drug Control Policy. Were starting from a really bad system. And so pushing people into a really bad system will end really badly.
In response to the presidents executive order, the American Bar Association published a statement saying that it raises grave constitutional and civil rights issues and paves the way for arbitrary and prolonged detention.
Housing Is a Human Right
A response to the presidents executive order, published in the Psychiatric Times, a journal for psychiatry professionals, noted that it invokes fear of people with psychiatric illnesses, talks of indiscriminate incarceration of people who have not committed a crime, as well as collection and sharing of sensitive health information with law enforcement, and yet proposes no actual solutions.
Unfortunately, the president and his crew undoubtedly do regard the involuntary commitment of unhoused people as an actual solution. Indeed, many people who have homes or apartments feel unhappy at the sight of human beings living on the streets of their neighborhood and want something done about it. But the underlying problem isnt that people live on the street or use substances in public in order to tolerate despair. As Helen Leung put it, When someone loses their housing, its not because they need to be institutionalized its because weve allowed housing to become a commodity instead of a human right.
What works best is making sure that we have affordable housing for people, says LaBelle. New research out of Philadelphia, for instance, found that a program of cash assistance for housing costs more than halved the odds of participants becoming homeless.
But our prevailing housing system in which the purpose is less to provide shelter than to generate profits for those who own real estate has resulted in rents or costs that are beyond reach for increasing numbers of Americans. And as if such a state of affairs werent bad enough, President Trump now plans to make alternative investment assets, including real estate, available to anyone with a 401(k). If he succeeds in doing so, far more people will compete to own real estate for the purposes of turning a profit, which will undoubtedly raise real estate prices yet more, driving rents higher still.
Notably, his July 24th executive order provides law enforcement with the vague instruction to institutionalize people who cannot care for themselves, which could result in a kind of real estate roulette. In essence, those who lack the cash to pay for housing at market rates no matter how high those rates rise could be deemed unable to care for themselves, and therefore would become eligible to be rounded up and taken where?
Very Much Precedented
On one matter there is widespread agreement: Theres already a distinct shortage of mental health services, especially for those who cant pay for them.
Our current system does not provide for long-term institutionalization, noted the Psychiatric Times in its response to the presidents executive order, which itself does nothing to expand the inpatient capacity of treatment facilities or increase funding for mental health services. The administration actually slashed funding for such programs this spring and has approved cuts to Medicaid, a program that currently funds 24% of all mental-health and substance-use care in the United States.
So where will people be taken? Health and Human Services Secretary Robert F. Kennedy Jr. has proposed rural camps for addiction recovery, but that (controversial) policy would require substantial new funding, rather than cuts, to healthcare. The president and Congress do seem to have an appetite for increasing funding for military and enforcement programs. The hastily constructed immigration detention facility in Florida known as Alligator Alcatraz offers a nightmarish example of how this administration pursues the development of new carceral space.
Already, immigrants are being rounded up and institutionalized, a practice likely to be expanded to still more of our neighbors. While all of this may feel unprecedented, its all too precedented. This nation has a long history of institutionalizing people who have not committed a crime, including Indigenous people and those with mental health struggles. Its easy to blame Trump for all thats now happening, and he certainly bears enormous responsibility, but hes not responsible for everything.
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