116 3rd St SE
Cedar Rapids, Iowa 52401
Trump order pushes forcible hospitalization of homeless people
In Iowa, where the order could have significant implications, homeless services provider says it ‘does the opposite’ of ending homelessness
The Gazette offers audio versions of articles using Instaread. Some words may be mispronounced.
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.”
Order has significant implications for Iowa homeless services
The President's executive order has significant implications for Linn County's homeless services, said Alicia Faust, executive director of Willis Dady Homeless Services in Cedar Rapids.
Faust said Trump’s order also reinforces harmful stereotypes about people experiencing homelessness, and diverts resources away from evidence-based solutions in favor of a more punitive strategy.
Only a small percentage of homeless individuals have mental health or substance use disorders, Faust said.
Critics argue that data does not support a strong link between homelessness and increased crime rates, and that policies should focus on providing resources and housing rather than punishment and criminalization. Some research suggests that while unhoused individuals may be arrested at higher rates, it's often for non-violent offenses, and they are also more likely to be victims of violence themselves.
Faust said the nonprofit agency had been preparing for such changes due to the administration's stance on the “housing first” model. The long-standing, evidence-based approach prioritizes providing immediate access to permanent housing for individuals experiencing homelessness, without requiring them to first meet preconditions like sobriety or participation in treatment programs. It emphasizes that stable housing is a fundamental need and a crucial first step toward addressing other challenges individuals may face, such as substance abuse, mental health issues or lack of employment.
Municipalities like Cedar Rapids and Iowa City have increasingly turned to supportive housing instead of shelters as a solution to homelessness. The type of housing offers voluntary supportive services, such as substance use and mental health counseling and employment training, to enhance housing stability and overall well-being.
The practice has been validated by numerous national studies as more cost-effective than allowing unhoused people to stay in shelters, jails or hospitals.
Faust said Trump’s order could affect more than half a million dollars in federal funding for Willis Dady’s HUD-supported programs, including rapid rehousing and permanent supportive housing, which are Housing First programs.
“Every person deserves a safe and affordable place to call home, and that's really what we're working towards by following the housing first model,” Faust said. “We have had success by investing in permanent supportive housing programs, including purchasing and renovating homes, and expanding our Chandler Pump Supportive Housing Complex. This approach provides low barrier housing for individuals who have faced chronic homelessness, along with personalized case management services to address their needs.”
Recent reports show that more than 90 percent of participants have retained their leases for the past 12 months, highlighting the effectiveness of the program and the Housing First model in Linn County, she said.
Faust said Willis Dady and its community partners will keep serving individuals facing homelessness or housing crises despite the order and ongoing misconceptions about individuals that are experiencing homelessness, including potentially seeking alternative funding sources.
“Because we believe in the services that we are providing, and we believe in the best practices that have been researched and have data backing them up, and will continue to provide those services as long as we possibly can,” she said.
Christine Hayes is director of development and communications at Iowa City-based Shelter House, which provides permanent supportive housing.
Hayes said the order ignores decades of research and removes proven strategies to end homelessness from the tool kit of service providers and municipalities, and risks defunding ongoing supportive services that keep 60 people housed in Johnson County.
“Nothing in the order does anything that is proven to end homelessness,” she said. “And in fact, it does the opposite. There's no evidence that criminalization has ever done anything to decrease the number of people who are sleeping outside, and it doesn't address the fact that the one thing that is proven to end homelessness is ensuring that there is an adequate supply of safe, affordable housing with wraparound services that people have access to be able to stay housed.”
Hayes said people make positive changes when they can make their own decisions, and the housing first approach meets people where they are and allows them to address issues according to their own personal priorities.
Studies have also shown it is significantly cheaper to house someone with supportive services than to incarcerate them. In 2022, Iowa state and local governments spent 1.2 times more money on incarceration than the amount spent on housing and community development, according to the National Alliance to End Homelessness.
Hayes also criticized the notion that there will “magically” be more institutionalization options available, given the current state of mental health services in Iowa. Iowa ranks last in the nation for the number of state psychiatric beds, at two per 100,000 residents, according to Treatment Advocacy Center reports.
She said people are already coming to emergency shelters from hospitals due to a lack of mental health beds, and emphasized the need for local solutions tailored to specific community needs.
“There isn't a one-size-fits-all solution to how we address the people who are sleeping outside and who need our support and care; not to be forced to a suboptimal solution,” Hayes said.
States have expanded involuntary commitment laws
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.
Recommended Reading
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.
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.
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.”
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.”
Tom Barton of The Gazette contributed to this report.
Daily Newsletters