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We agree with President Donald Trump that far too many Americans aren’t receiving the behavioral health and substance use treatment that they need. However, we strongly disagree with the president’s demand that states involuntarily commit these people to mental health institutions.
In an executive order last week, Trump called for a return to the institutionalization of those who are mentally ill and are living on the streets or cannot care for themselves. He charged the U.S. attorney general with seeking to overturn legal rulings and consent decrees to force people into institutions against their will.
The order also maligns housing first and harm reduction programs in favor of more punitive approaches, to, as the order says, “restore public order.”
This order, which is built on simplistic notions of solving difficult, complex problems, is both cruel and overreaching. There are many questions surrounding the order. A big one is whether the federal government can dictate state policies. It is likely that some states will use the order as a pretext to crack down on homeless encampments. It is also possible that federal funding will be directed toward more punitive measures rather than supports to help people find housing or access behavioral health treatment.
This is the wrong approach.
To house more people who are homeless, to reduce substance use and to reduce the number of people with mental health concerns who loiter in our cities, states and communities need more resources. There are already long waiting lists for mental health services in Maine, and many other states. Demanding that more people get these services does nothing to increase the number of providers who offer them or the spaces available in treatment programs and facilities.
Instead, the Trump administration and Congress are cutting support for these services, including big cuts to Medicaid that were part of the Big Beautiful Bill that was passed earlier this summer. Without Medicaid, far more Americans won’t be able to afford or access health care, including behavioral health care. The executive order does not explain how the forced care it seeks would be paid for.
Further, more housing, especially affordable housing, needs to be built. That is accomplished in part by changes in local and state regulations — and attitudes — not by selling remote public lands, as some Republicans have proposed.
The affordable housing crisis is also exacerbated by the fact that housing costs have risen far more than wages in the past two decades. In fact, the minimum wage in many parts of the country has been stagnant as rents and home prices have risen.
Rather than offer any solutions to these complex and intertwined problems, Trump’s executive order seeks to return the U.S. to the days when people were held, often for years and sometimes against their will, in “insane asylums” where abuse was often as common as treatment.
Decades ago, Maine and other states closed these institutions, often under court-approved consent decrees. However, Maine and other states did not, and still do not, provide the necessary community-based services that are needed to help these people with their everyday lives. Certainly, not all people who are homeless have behavioral health diagnoses and not everyone with mental health concerns is homeless. But, far too many people who need treatment and support have ended up homeless.
“This order is a horrific backsliding of decades of progress to protect and advance the rights of disabled people. Institutionalizing people under the guise of humane treatment is a false narrative designed to stigmatize and isolate” Kim Moody, executive director of Disability Rights Maine, said in a recent press release. “Forced institutionalization is often violent, harmful, and expensive. What unhoused people with disabilities need is real, robust investments into supportive housing, peer support, and community-based services.”
We concur. Certainly, the homeless, housing and substance use crises are persistent and difficult to solve. But more investments and support, not lockups and cuts to safety net programs, are part of the solution.
