President Donald Trump has made it clear that he wants homeless people off the streets of Washington, DC — along with the rest of the nation’s cities.
Alongside encampment sweeps, a key component of Trump’s homelessness policy is involuntary commitments, also known as civil commitments. The idea is to force an unhoused person into a facility to undergo mandatory drug or mental health treatments. That might sound extreme, but it’s a practice that has been around for decades — and it’s now gaining popularity across the country.
“We were committing people before we had medications, before we had electroconvulsive therapy,” says Alex Barnard, assistant professor of sociology at New York University and author of the 2023 book Conservatorship: Inside California’s System of Coercion and Care for Mental Illness. “This is something that’s been enabled by state law for hundreds of years, and when we look in the archives, we see the extent to which this tool was really abused in the mid-20th Century.”
That began to change in 1960, when the State of California issued a report describing these psychiatric hospitals as “a dust bin marked ‘miscellaneous’ to receive every problem that doesn’t fit a place in society,” Barnard says. But despite involuntary commitments’ spotty record, they’ve become an increasingly widespread intervention as America seeks to reduce the number of unhoused people. Barnard says these types of commitments only work best when paired with available housing.
Today, Explained co-host Sean Ramewaram spoke further with Barnard about the efficacy of involuntary commitments and about what he thinks about Trump’s initiatives on homelessness.
Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.
President Trump has just issued an executive order that’s trying to change the way the US approaches homelessness and mental illness, largely by bringing us back to a more heavy-handed course of approach to homelessness, through the mental health system combined with greater criminalization of this population.
And his executive order is not just about the District of Columbia.
No, the executive order is nationwide. It’s trying to change policy really around three different issues. First, it’s trying to expand the use of civil commitments; that’s involuntary mental health treatment. It’s usually reserved for people who are a danger to themselves, danger to others, or unable to meet their basic needs. And he’s looking to expand that. It’s not totally clear how he’s gonna do that, because that’s determined by state law, but in any case, that’s one of his objectives.
The second is to expand the criminalization of homelessness: to increase the use of things like encampment sweeps to force people who are homeless to move along. It’s not really clear where he imagines those people [will go], but that’s certainly what they’re doing in DC.
And they wanna move away from that towards a system in which housing is not given; it’s earned based on your participation in rehab programs, or something like that.
What motivated the president of the United States to call for more involuntary commitments?
This is one of those things that, for whatever reason, Trump has a bit of a fixation on. In 2018, in response to the Parkland shooting, rather than talking about gun control, he wanted to talk about bringing back asylums, bringing back large psychiatric hospitals that were really significantly downsized in the 1960s. We closed a lot of those hospitals, but civil commitment never went away.
Over a million Americans are subjected to some kind of involuntary psychiatric treatment per year. That often starts with a law enforcement officer, seeing somebody in the community who’s not doing well and bringing them to an ER for evaluation. And then that person can be placed in a hospital and medicated involuntarily. That’s civil commitment. The laws for that vary by state, but it exists everywhere — and [Trump’s] vision is that we should ramp up civil commitments to deal with homelessness.
We really don’t have robust evidence that civil commitment is a good solution to homelessness. In fact, there’s some recent research that came out that suggests that somebody being placed in a psychiatric hospital actually may increase their risk of losing housing, because they’re in a psychiatric hospital, which means they’re not going to their job, they’re not connecting to family.
If the problem leading to unsheltered homelessness was that there wasn’t enough civil commitments, we would see a really different pattern of civil commitments nationwide. Oklahoma and Utah, for example, are two states with very low levels of civil commitments and very little homelessness. The story there is not that we’re not forcing enough mentally ill people into treatment; the story is that there’s a lot of cheap housing in those states, and as a result, you’re not seeing the kind of unsheltered homelessness that you see in New York or California. California actually has a much higher rate of civil commitments than the national average, and also is home to one half of the unsheltered homeless population.
I’m sorry. Before we continue, did you just say that half of the nation’s unsheltered people live in California?
That’s correct.
I did not know that statistic. It makes sense, but also wow!
It’s a catastrophic failure. And I think that it does kind of bring disgrace upon the governments of these left-leaning coastal states that despite years and years of policy conversations around this, they have not really moved the needle on homelessness.
I’m glad you brought up California, because I think it gets at something interesting when it comes to involuntary commitments here, which is that it isn’t a left/right, red/blue issue in the United States.
Donald Trump signed this executive order, and then days later — almost instantly it felt like — [New York City Mayor] Eric Adams was saying, “We’re asking state lawmakers to extend the lifeline of involuntary commitment to those struggling with serious addiction. We’ve already made it easier to use involuntary commitment to help people with untreated severe mental illness to get care.”
I think Donald Trump is trying to put forward the most cruel possible version of a policy shift that actually has pretty broad support. So with some research assistants here at NYU, we’ve cataloged 1,900 bills around involuntary treatment that have been introduced in state legislatures in the last decade. And of the 10 states that introduced the most bills on this topic, nine of them voted for Democrats in the last presidential elections.
Wow!
So this has been largely an initiative that is coming from, you know, blue coastal states. And what we’ve seen is that there’s been almost a reframing of coercion as a form of compassion — that it’s actually progressive not to let somebody die in their feces on the street, but to force that person into treatment that they can’t necessarily accept.
Governors like Gavin Newsom have also embraced encampment sweeps, and other kinds of criminalization measures as another way to deal with urban disorder and homelessness. So in a lot of ways, the blue states have paved the way for this executive order, which is pushing this movement towards a more institutional response to homelessness even further.
And is it controversial on the left? Is it creating division in progressive circles that we need to solve this problem, and some think to do so we have to do this thing that some of us find distasteful?
This has been an area that often puts civil liberties groups and disability rights groups in pretty open conflict with other progressives, sometimes elected officials, mayors particularly — also some clinicians and a lot of families that see their loved ones not able to accept the treatment that we think they need.
I think, in reality, to really move forward on this policy discussion, we need to realize that people who are experiencing homelessness are a really diverse group. And for the vast majority of them, including many of them with severe mental illness, giving them an apartment is the fastest way to solve their homelessness. But there is a subset of people for whom voluntary services and an independent apartment, where a case manager checks on you once a week, but otherwise you’re left on your own — that actually isn’t gonna be enough to meet those individuals’ needs. And it’s that group that, now, the right is really focusing on and treating as the entire homelessness population — these people who need to be coerced into treatment, because they’re so sick.
Is there a story that you’ve come across or that you tell in your book about involuntary commitment that can help people wrap their heads around the issue?
This is a story of somebody who consented for me to tell his story. His name was Serge. He had no hands and was missing one eye as a result of an accident when he was younger, and had lived with schizophrenia. He spent a decade homeless in Hollywood.
And this is one of these people where probably, you know, a thousand times a day somebody was walking by and saying, “why isn’t somebody doing anything for this guy?” In reality, he was being picked up by the police and either thrown in jail or taken to an ER dozens and dozens of times. And every time they’d just kick him back out, and sometimes they’d pay for an Uber to send him back to Hollywood.
In the end it was a private citizen, Kerry Morrison, who was in charge of the business improvement district there, who said, “what is going on here?” She actually convened a meeting of all the stakeholders, everyone who was involved in this person’s case. And they kind of hatched a plan to get this guy into treatment longer term.
[But] the tragic way this panned out was: the police came, they stopped him, they tried to handcuff him, because that’s how we take people to psychiatric hospitals. But he didn’t have hands, so they had to use zip ties. You know, that’s how we help people in America.
In the end, he was taken to a hospital. They shepherded him through the system, so he went on to a conservatorship. Once he was conserved, he was sent to a locked facility with barbed wire all around it, way far out of Los Angeles. He was there for months, and no one even really knew; none of the people who had a connection with him even knew where he was. And then, eventually, he stepped down out of that, and went to live in an unlocked facility and got his GED. And when I talked to him, I said, “What do you wish the system had done differently?” And he said, “I wish they had conserved me sooner.”
That’s a story that really sticks with me. It’s the happy story of civil commitment, but with a lot of unnecessary pain and suffering along the way. Way to go, Serge. Seems like he’s doing pretty well.
If Donald Trump called you tomorrow and asked you what he should do to meaningfully solve this in DC and other cities across the country, what would you tell him?
I think, in some ways, states like California are at least on the right track, which is that we need an all-of-the-above solution. We have to address the root causes of homelessness, which is that housing is too expensive, and when housing is too expensive, the most vulnerable people are gonna be the ones who become homeless. And at the end of the day, you can put somebody in a psychiatric hospital, but if they’re not gonna land in an apartment at the end of it and they’re gonna instead go back to the street, you’ve just wasted a lot of money and restricted somebody’s civil liberties for nothing.
I do think we need a targeted use of civil commitments — a thoughtful use of civil commitments for some individuals who have been frankly abandoned [for] so long that they’re not able to consent to services that might be necessary to save their lives. But it wouldn’t look at all like this executive order.
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