President Donald Trump has declared a crime emergency in Washington, D.C., mobilized federal forces and is working to remove homeless encampments — moves that build on a recent executive order linking homelessness to mental illness, substance use and public safety.
The involuntary commitment effort could overwhelm care systems and violate individuals’ rights if implemented without adequate resources or clarity, Russ Micoli, vice president of behavioral health services, business development and strategy at Marlton, N.J.-based Virtua Health, told Becker’s.
“The question is how the order will be executed. If it helps individuals in need of treatment, it can be a good thing,” he said. “If the order is operationalized as a way to remove homeless individuals from the community by attempting to force them into treatment or require that a hospital admit them regardless of their clinical presentation, things will get very complicated. These individuals have rights, including the right to refuse treatment.”
Timely access to mental health and substance use services matters, Mr. Micoli said. When care is not accessible, it can create a ripple effect that worsens a person’s health. Individuals may present significantly worse conditions than if services were available earlier. The system — which he said is “already overburdened or in some cases badly broken” — will face challenges with the growing number of people in need of treatment.
“As an example, will these patients be brought to the emergency department? Emergency departments are already overcrowded with patients of all kinds, and they are not the appropriate place for individuals who do not have acute medical conditions to be directed for care,” he said. “Additionally, inpatient psychiatric bed capacity is lacking in many places as well. The potential backlog of patients, occurring at any point in the current care continuum, does not seem like a solution to a very complex and serious problem.”
With respect to individuals with substance use disorder, relapses can occur as part of the recovery process, as it is often non-linear and should not be classified as treatment failure, he said. Providing additional resources through state or federal investment is the “only way” to address the current and possible future surge in need and demand, Mr. Micoli said.
The order stated a cut in funding for harm reduction efforts and “housing first.” Instead, funding will go toward evidence-based treatment, drug and mental health courts, and efforts to move people off the streets through institutional care, outpatient programs and civil commitment, according to a July 24 White House news release.
“I don’t know of any data related to the efficacy of clinical commitment or forced institutionalization as a ‘treatment intervention’ for addiction, any more than it is for mental health related conditions,” Mr. Micoli said. “That said, I understand the importance of assessing how government funds are spent and that dollars should flow to treatment modalities and organizations that can validate positive treatment outcomes.”
