Amid rising concerns over the homeless population in the United States, states such as California, Oregon, Utah, Texas, and New York are amending legal frameworks to facilitate involuntary psychiatric and addiction treatment for individuals considered a danger to themselves or others. This legislative shift comes as federal policy under the Trump administration has reinforced a treatment-first approach, moving away from the previous "Housing First" model.
The "Housing First" model, which has been the cornerstone of homelessness policy, emphasizes providing stable housing as a primary goal, with the expectation that treatment and other services will follow. However, the Trump administration has altered the course by conditioning federal homelessness grants on the participation of individuals in treatment programs and work initiatives.
A spokesperson for the Department of Housing and Urban Development (HUD) highlighted the new guidelines' focus on reducing public drug use, requiring psychiatric intervention, and decreasing the visibility of unhoused individuals in public spaces. HUD's data from January 2024 shows that approximately 771,480 people were sleeping on the streets, marking an 18 percent increase from the previous year and a 33 percent rise since 2020.
The policy changes have been framed by HUD as necessary corrections to previous federal programs that, according to their perspective, promoted dependency instead of 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," stated the HUD official.
However, these policy shifts have not gone unchallenged. Eighteen states, led by New York, California, Kentucky, and Pennsylvania, have filed a lawsuit against the federal funding cuts tied to treatment-first mandates. In response to the changing landscape, California allocated $683 million toward permanent supportive housing in 2024 while also enacting court-mandated psychiatric care measures, including conservatorship expansions.
Despite these efforts, experts warn of the practical limitations facing both federal and state interventions. Judge Glock, a senior fellow at the Manhattan Institute, pointed out that involuntary treatment laws are predominantly under state jurisdiction and are typically reserved for extreme cases. As of mid-2024, California's new system had seen limited success, with only 528 people entering treatment plans and a mere 14 placed through court orders.
The debate over strategies to address homelessness continues to be a contentious issue. Research suggests that Housing First programs can significantly improve long-term housing retention, with one review showing an 88 percent reduction in homelessness compared to traditional methods. Critics, however, argue that Housing First does not sufficiently address the underlying mental health or addiction issues.
Local officials have been exploring targeted interventions. In San Francisco, Supervisor Matt Dorsey has advocated for detaining individuals in an "involuntary sober center" until they complete detox programs. Mary Theroux of the San Francisco Salvation Army has also highlighted that mental illness and substance addiction are the primary drivers of the city's homelessness crisis.
Conservative analysts are calling for policies that balance enforcement with rehabilitation and allow for local autonomy. Scott Ackerson, a former administrator at Haven for Hope in San Antonio, stressed the importance of preventing homelessness and strengthening intervention systems through local control.
As the nation grapples with rising homelessness and addiction rates, the amalgamation of treatment-first strategies, legal enforcement, and local flexibility presents a possible solution. Policymakers and communities are now evaluating whether these approaches can mitigate public health risks and improve outcomes for vulnerable populations, offering a sustainable alternative to the prior housing-first models.
