What in the Health?! 7/25/25
In case you missed it amidst all the news of the Epstein files, Stephen Colbert’s show being cancelled, or a slew of Gen X’s childhood icons dying this week, yesterday another Executive Order dropped that was extremely distressing.
Ending Crime and Disorder on America’s Streets. Who doesn’t want that? Sounds great. But I live in California, a place where every election cycle we vote on a dozen or more propositions that are intentionally written to sound like a great idea, even when they’ll wreak havoc in all sorts of unanticipated ways (unanticipated by the voters, and very much anticipated by the people who drafted the proposition language, of course). So I look at these things that sound great with a lot of skepticism.
Let’s take a close look at what’s in the executive order, shall we?
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There is a heck of a lot of stigmatizing language in there. I’m not going to amplify it by repeating it here in this post, but given that we’re talking about a group of our neighbors who are treated badly by many people who are just walking by, frequent survivors of rape and other violence, arrested just for sitting or lying down, and more, anything that is designed to increase the public’s distrust and distaste for people without stable housing is really just sad. Don’t sleep on this. This is intentional.
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Much of this executive order is designed to push for what’s called “civil commitment” of people who are unhoused, especially those with mental health issues. “Civil commitment” is a nice way of saying “forcing people to be institutionalized against their will.” It means being committed civilly (in a substance use treatment facility, psychiatric hospital, etc.) as opposed to being committed criminally (in a jail or prison). You might have heard this referred to as “having a 72-hour hold” or “being 5150’d.” Typically these are short-term, emergency actions followed by court hearings to decide whether a longer-term forced hold is necessary. However, this executive order doesn’t stipulate that it would be short-term. My read (important: I am not a lawyer) is that this executive order opens the door for a system of conservatorship for people who are unhoused in the US. I hope I’m wrong, but I think we’ve seen a lot of worst case scenarios play out in this country since January, so I think it’s responsible to proceed with concern. Conservatorship is a whole different thing than a short-term hold in an acute situation: it is when a court determines that an individual is not capable of making their own decisions about their personal and/or financial affairs, and appoints another adult (the conservator) to make decisions on their behalf. They get to decide a person’s living arrangements, healthcare decisions, etc. A conservator can consent to someone receiving mental health treatment, including psychotropic medications, even if the conservatee objects. A conservator can agree to indefinite involuntary institutionalization, even if the conservatee objects. Conservatorship is typically granted for a year, and can be renewed annually by a court. Yes, in this executive order it’s framed as “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.” That might sound reasonable. It’s that “or” in the middle that concerns me most, and makes me worry this is opening the door to taking away the civil rights of people who are unhoused. Who decides what makes a person living on the streets unable to care for themselves? Where will that line be drawn? People find themselves living on the streets for all kinds of reasons: losing their job or making such limited income that they can’t keep up with the rising costs of rent and become evicted, getting sick or injured and then drowning financially under medical debt, or plain old racism, homophobia, or transphobia, for example. A recent study of the causes and consequences of homelessness in the state of California (home to 30% of the nation’s unhoused people) found that most people who were homeless said they simply could no longer afford the cost of housing. Participants reported a median monthly household income of $960 in the six months before losing housing, and most believed that either rental subsidies or one-time financial help would have prevented them from ending up unhoused. One in five people who used substances reported they wanted substance use treatment, but couldn’t get it because of long wait lists or other restrictions. The solution to these problems is increasing affordable housing options and rental subsidies, and expanding funding for homelessness prevention programs. Expanding high quality substance use treatment options will help, too. That’s not what this executive order does. Instead, are we soon going to be rounding up all the unhoused people and confining them to locked facilities away from where others have to see them? You might think I’m sounding hysterical. Take a hard look at some of the things that have happened since January 20, then tell me whether it’s outrageous to fear we’ll find ourselves there before we know it.
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This executive order specifically says that the Attorney General will “ensure that homeless individuals arrested for Federal crimes are evaluated, consistent with 18 U.S.C. 4248, to determine whether they are sexually dangerous persons and certified accordingly for civil commitment.” Sure, none of us want sexually dangerous people running amok on the streets endangering us or our loved ones. But having Pam Bondi in charge of deciding what makes someone sexually dangerous (she works for Donald Trump, after all) sounds especially rife for abuse and mistreatment of unhoused folks, without needing to prove there’s real danger.
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It also explicitly reverses the progress SAMHSA has been making toward supporting harm reduction, and prohibits federal funds (at least via SAMHSA) being spent on harm reduction. There is a lot of fear mongering and negative talking points you’ve probably heard 100 times about harm reduction, but despite all that, it is one of the best studied evidence-based interventions to reduce the negative consequences of substance use (both for the person using substances and for those around them). I could provide you dozens of citations here to demonstrate this, but for simplicity I’ll link to a snapshot of SAMHSA’s website from today: this is what the feds say, or at least what they have said until this administration makes them change it (which is why I’m not just linking you to the site directly…it might look different soon). Don’t want to click the link? It says “Harm reduction is part of a comprehensive prevention strategy and the continuum of care. Harm reduction approaches have proven to prevent death, injury, disease, overdose, and substance misuse. Harm reduction is effective in addressing the public health epidemic involving substance use as well as infectious disease and other harms associated with drug use.” But as of yesterday, this administration’s position is that “so-called ‘harm reduction’…only facilitate[s] illegal drug use and its attendant harm.” Just like the executive order on gender being binary, this is simply not based in science or fact. It’s incorrect, and it’s intended to support an ideological agenda that will set us back 50 years in our efforts to address problematic drug use in the United States.
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It also says the HUD Secretary shall “allow or require the recipients of Federal funding for homelessness assistance to collect health-related information that the Secretary of Housing and Urban Development identifies as necessary to the effective and efficient operation of the funding program from all persons to whom such assistance is provided” AND it says it will “require those funding recipients to share such data with law enforcement authorities.” Yes, it says they can do that “in circumstances permitted by law.” But if the last few months have taught us anything, it’s that laws are being redefined (or simply ignored) under this administration, and there’s not a whole lot anyone is doing to stop it. (Does this seem like echoes of the agreement to release personal data on Medicaid beneficiaries to ICE to you? It sure does to me.)
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This executive order also explicitly ends support for Housing First policies and programming and requires recipients of federal housing assistance to require treatment as a condition of housing. It frames Housing First policies as “policies that deprioritize accountability and fail to promote treatment, recovery, and self-sufficiency,” but this is yet another hallucination based in ideology and not facts. The evidence is overwhelmingly clear that Housing First policies—which say that housing is a basic need and people should receive housing first, without requirements for things like sobriety, and then they should receive support for other issues like substance use or mental health while already in housing—improve people’s ability to access mental health care and substantially increase likelihood of staying housed for people who’ve lost their stable housing.
So now we’re back to where we started: If this executive order sounded reasonable to you when you read it over, I implore you to look at the science, and/or listen to people who look at the science for a living. If the feds end support for housing first, you can expect to see a lot more people living on the streets…if they’re not being rounded up and involuntarily committed to locked facilities out of sight, that is.