Amid rising concern over the nation’s homeless population, several states are broadening legal avenues for involuntary psychiatric and addiction treatment, seeking to tackle overlapping crises of mental illness, substance abuse and public safety.
Policymakers in California, Oregon, Utah, Texas and New York have revised statutes to allow authorities to compel treatment for individuals deemed a danger to themselves or the public, the Washington Times reports.
Federal policy under the Trump administration has reinforced this approach.
Departing from the previous “Housing First” model, which emphasizes providing stable housing prior to treatment, the administration now ties federal homelessness grants to participation in treatment programs and work initiatives.
A Department of Housing and Urban Development (HUD) spokesman emphasized that the new guidelines prioritize reducing public drug use, requiring psychiatric intervention and limiting the visibility of unhoused individuals in public spaces.
HUD estimates that 771,480 people slept on the streets in January 2024, an 18 percent increase from the previous year and a 33 percent rise from 2020.
The agency’s spokesperson framed the policy changes as corrective measures against prior federal programs that, in their view, encouraged dependency rather than recovery.
“We are stopping the Biden-era slush fund that fueled the homelessness crisis, shut out faith-based providers simply because of their values, and incentivized never-ending government dependency,” the official said.
Several states have pushed back against federal funding cuts tied to treatment-first mandates.
Led by New York, California, Kentucky and Pennsylvania, 18 states filed a lawsuit challenging the conditions.
California alone allocated $683 million toward permanent supportive housing in 2024 while also enacting court-mandated psychiatric care measures for individuals with severe mental illness, including conservatorship expansions.
Experts caution that both federal and state interventions face practical limitations.
Judge Glock, a senior fellow at the Manhattan Institute, noted that involuntary treatment laws remain largely state-controlled and typically apply only to extreme cases.
California’s new system has produced limited results, with just 528 people entering treatment plans by mid-2024 and only 14 placed through court orders.
Policy debates over homelessness strategies remain intense.
A substantial body of research demonstrates that Housing First programs, which provide stable housing without requiring treatment, significantly improve long-term housing retention, with one review showing an 88 percent reduction in homelessness compared with traditional approaches.
Critics argue, however, that Housing First alone does not address underlying mental health or addiction challenges, a primary reason why some states are exploring treatment-first or involuntary approaches.
Local officials have experimented with targeted interventions.
In San Francisco, Supervisor Matt Dorsey supports detaining individuals in an “involuntary sober center” until completing detox programs, citing ongoing open-air drug use in taxpayer-funded housing zones.
Mary Theroux of the San Francisco Salvation Army echoed that mental illness and substance addiction, rather than lack of housing, drive the city’s homelessness crisis.
Conservative analysts advocate policies that combine enforcement with rehabilitation while maintaining flexibility for local authorities.
Scott Ackerson, former administrator at Haven for Hope in San Antonio, emphasized that local control fosters innovation.
“We need to prevent people from entering homelessness while simultaneously strengthening homeless intervention systems,” he said.
As homelessness and addiction continue to rise nationwide, the combination of treatment-first strategies, legal enforcement and local flexibility offers a potential path forward.
Policymakers and communities are now testing whether these approaches can reduce public health risks, improve outcomes for vulnerable populations and provide a sustainable alternative to prior housing-first models.
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