The Trump Administration recently released an executive order that further stigmatizes homelessness and essentially shifts grant funding toward forced treatment and away from evidence-based solutions.
The executive order is called “Ending Crime and Disorder on America’s Street” and moves away from a Housing First approach and encourages the institutionalization of people experiencing homelessness.
In other words, let’s lock people away rather than give them the housing coupled with the support services that they need.
The National Homelessness Law Center sums it up this way:
“Specifically, this order:
- Expands the use of police and institutionalization to respond to homelessness.
- Prioritizes funding for states that treat homelessness as a crime and end housing-based solutions.
- Cuts off funding for life-saving programs like harm-reduction.
Today’s executive order, combined with MAGA’s budget cuts for housing and healthcare, will increase the number of people forced to live in tents, in their cars, and on the streets.”
The National Alliance to End Homelessness is running a series of blogs to explain the different aspects of the executive order and its implications (visit endhomelessness.org/blog).
While executive orders are not laws, they weigh heavily in on how different departments adjust their policies. In other words, if department heads want to keep their jobs, they better follow the instructions.
And while we all expected the Trump Administration to move away from a Housing First approach, the order still sent a shock wave through the advocacy community.
The executive order specifically directs the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Housing and Urban Development (HUD) “to mandate that recipients of homelessness assistance participate in mental health or substance abuse treatment as a condition of receiving aid,” as stated by the National Low Income Housing Coalition.
Federal grants will be reallocated to those cities and states that, in the words of the National Low Income Housing Coalition, “implement harmful, ineffective, and costly policies, such as bans on encampments and the forced institutionalization of people experiencing homelessness.”
My worst fears are coming true. Locking people away to move them out of sight is becoming the norm. Some national leaders share my concerns that we are on the road to setting up government-funded camps in order to move people out of sight.
Frankly, this is our own fault. The executive order takes advantage of our state and local failures to improve the systems that essentially create homelessness to begin with.
For decades, we have blamed people who have lost their housing when a job loss, medical bills — and yes, some people’s mental health struggles — have pushed them into homelessness. And rather than fixing our safety nets, we only managed to increase their barriers to housing. Trump’s executive order calls for interventions that will exacerbate those issues.
Making homelessness invisible does not solve it.
Forced mental health treatment will cost us more than housing people. And the social cost for individuals and communities will likely be even higher because we know this approach will not stem the increase in homelessness we’re about to see across the nation.
In my conversation with Rod Wipond, the author of “Your Consent Is Not Required,” a book about forced treatment, he mentioned that on average a psychiatric bed costs between $2,000-$3,000 per night. The Contributor put this piece to press in the days before the executive order was released.
That number Wipond quoted blew my mind. I found a cost chart to check it online, dated 2024, that showed that an inpatient psychiatric bed at East Tennessee Behavioral Health has a per diem rate ranging between $675 and $2,500.
In comparison, through my consulting work with local nonprofits, I know that the average cost for permanent supportive housing per day currently adds up to about $80 per household in Nashville. This cost specifically is for PSH units that serve people with severe and persistent mental health and/or substance use disorders. And finally, the average cost per night for a temporary bed with intensive supportive services also comes to about $80.
We know what ends homelessness, and locking people away in jails and mental health facilities is not it. As a matter of fact, the Veterans Administration has a proven track record. It has successfully reduced Veteran homelessness nationwide by 55 percent since 2010 through a Housing First approach, which offers housing plus support services.
I wish we would not focus so much on the term Housing First. In a recent conversation with Dr. Sam Tsemberis, who is credited with founding Housing First (see June 18 issue), he stressed the importance of focusing on building ongoing relationships with people living on the streets and being there and accessible for them throughout the housing process, even after they’re housed.
Tsemberis said that fundamentally, that’s what Housing First is all about — relationship building. This will allow us to give people with severe mental health issues and/or substance use issues a choice, and following alongside them is key to helping them find the solutions that stick. If they are not successful and lose housing, we immediately focus on rehousing them — because we have that strong relationship with each other.
Critics of the Housing First approach focus on the fact that too many programs that claim they’re doing Housing First help people obtain housing and then drop the support services part of it. That’s what some advocates, including me, call Housing First Light. It doesn’t work for the populations who need intensive mental health and recovery services. And it creates a schism between those who promote Housing First and those who promote recovery services.
Another criticism I have heard is that Housing First is not feasible because it calls for a low case management ratio of one case manager for every 10-12 people. The criticism is that such a low case management ratio is not sustainable due to a lack of resources.
However, going back to the cost of forced treatment for people with severe and persistent mental illness ($675 per day at a minimum) versus the cost of housing-based treatment ($80 per day), that argument won’t stand. By the way, the cost of a 30-day inpatient drug treatment facility can cost as much as $80,000-$100,000. And a jail stay in Davidson County currently averages $115 per night.
Which then makes me ask, who will get the grants and dollars of the federal government to run these treatment centers and forced confinement facilities? If we talk about forced treatments, we are really speaking about jail, a mental health treatment hospital, or a drug rehab center. Could it possibly be that the government will end up funneling grant dollars to private organizations that enrich themselves on the poor? I guess time will tell.
What can local governments do?
For one, let’s focus on what it truly means to build a system. In Nashville, the Mayor and Metro Council have increased the city investment in the Office of Homeless Services from less than $2 million in 2022 to $11 million in FY2025/26.
That is a good amount of money: we need a transparent plan from Metro to show how the city intends to invest its dollars, and how it will supplement the shift in federal grant dollars. This could lead to productive conversations within the homelessness sector that show how we could utilize federally allocated dollars to overhaul our antiquated outreach strategy.
We could then further outline what dollars would support services for shelter/temporary beds to move more people indoors within a system that focuses on helping people access permanent housing within an average of 90 days.
Such an approach would focus on how our community could utilize city funding to come alongside PSH providers and fund much-needed long-term recovery services for people with mental illness and substance use disorders.
Essentially, what Nashville needs is to invest in a strong Assertive Community Treatment (ACT) team. If we do this in a smart and collaborative way that shows results, it will make sense for local funders to come alongside Metro and expand this approach in a sustainable way.
Having an approach that sustainably reduces street homelessness by taking a multi-sector team approach that follows people on their journey from street to housing and continues to support people once they are housed will counteract some of the effects of the White House executive order on homelessness.
If we do this right, Nashville can be at the forefront and be a model to show how cities can reduce street homelessness by housing people long-term and providing them with treatment options rather than locking people away through forced institutionalization.