The Trump administration’s policies regarding homelessness have shifted away from prevention strategies, like the Housing First model promoted by the National Alliance to End Homelessness, and toward a “treatment-first” approach, calling for increased involuntary commitment nationwide.
The system — which Russ Micoli, vice president of behavioral health services, business development and strategy at Marlton, N.J.-based Virtua Health, told Becker’s is “already overburdened or in some cases badly broken” — will face challenges with the growing number of people in need of treatment, leaving leaders to question the shift.
“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.”
Here is a timeline of events:
- In March, President Donald Trump established the District of Columbia Safe and Beautiful Task Force through an executive order, detailing how the National Park Service would start a “prompt removal and cleanup of all homeless or vagrant encampments and graffiti.”
- In July, President Trump declared a crime emergency in the district, promoting involuntary commitment as a solution to crime linked to homelessness across the country. The order emphasized a direct link between homelessness, mental health conditions, substance use disorders and threats to public safety and stated the federal government would no longer prioritize harm-reduction efforts.
Mr. Micoli said the order’s execution would be key.
“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.”
Emergency departments — which leaders say is the worst environment for a behavioral health patient — have already become overcrowded, leaving the patients waiting hours, possibly days, to receive care.
- In August, approximately 800 D.C. National Guard soldiers were activated as part of the D.C. Safe and Beautiful Task Force and the city’s Metropolitan Police Department. Their duties included “administrative and logistical roles” and being a “physical presence in support of law enforcement.” The military presence would also “contribute by helping to stop violence on city streets in the nation’s capital.”
White House press secretary Karoline Leavitt said the police would begin enforcing “pre-existing laws that are already on the books” to clear encampments.
“Homeless individuals will be given the option to leave their encampment, to be taken to a homeless shelter, to be offered addiction or mental health services, and, if they refuse, they will be susceptible to fines or to jail time,” Ms. Leavitt said.
- In November, the Department of Housing and Urban Development launched a Continuum of Care funding competition for fiscal 2025.
The policy shift redirects support for permanent housing toward transitional housing, moving most funding into a nationally competitive pool and elevating faith-based and treatment-centered solutions, according to a news release from the department.
The department will now require 70% of projects to compete for funding, eliminating automatic renewals for most programs.
