Trump homelessness executive order targets harm reduction

President Trump issued an executive order that aims to “end crime and disorder on America’s streets,” by addressing homelessness, mental health, and addiction.

The main point: The order promotes a punitive approach, pushing for involuntary treatment and an end to “housing first” policies and harm reduction programs.

The details:

• Harm reduction funding: The order directs HHS to end federal grant funding to “programs that fail to achieve adequate outcomes, including so-called ‘harm reduction’ or ‘safe consumption’ efforts that only facilitate illegal drug use and its attendant harm.”
• Harm reduction enforcement: It also orders reviews of organizations receiving federal homelessness/housing money that offer supervised consumption services or “knowingly distribute drug paraphernalia,” threatening to “bring civil or criminal actions in appropriate cases.”
• Public drug use: The order asks federal agencies to determine whether they can prioritize grants to states/localities that enforce prohibitions on open illicit-drug use, including bans on urban camping, loitering, and squatting.
• Involuntary commitment: The order aims to expand civil/involuntary commitment to put people living on the streets, many of whom use illicit drugs and/or have a mental illness, “into long-term institutional settings.” It aims to do this by reversing judicial policies that restrict the use of involuntary commitment and by providing grants, legal advice, and other assistance to local and state governments.
• Behavioral health funding: It requires HHS to ensure that federal funds for federally qualified health centers (FQHCs) and certified community behavioral health clinics (CCBHCs) “reduce rather than promote homelessness by supporting, to the maximum extent permitted by law, comprehensive services for individuals with serious mental illness and substance use disorder, including crisis intervention services.” It also directs the attorney general to prioritize funding to support the expansion of drug courts and mental health courts.
• Housing First: It calls for HHS and the Department of Housing and Urban Development (HUD) to increase accountability in their grants for homelessness assistance and transitional living programs, including “ending support for ‘housing first’ policies that deprioritize accountability and fail to promote treatment, recovery, and self-sufficiency.” It pushes for participation in mental health/substance use disorder services to be a required condition of participation in housing/homelessness assistance programs.
• Information sharing: HUD would be required to force organizations to collect federal health information from unhoused people who receive services and share the data with law enforcement officials.

The response: The order faced immediate criticism from groups that advocate on behalf of people who are homeless, have mental illness, or use drugs.

• Many public health professionals believe involuntary commitment should be used as a last resort, if at all, and suggest that it lacks sufficient evidence and would only dissuade people from seeking care.

But:

• It is unclear how the White House plans to enact these actions, and some of the specifics are unclear.
• Congress controls funding, meaning the order cannot legally revoke current federal grants.
• While the order tries to discourage harm reduction programs, it does not make them illegal.
• The order lacks teeth for enforcement of the policies it promotes.

Why it’s important: Even without clear bans or enforcement, the order has strong symbolic power, endorsing an approach we know is harmful and ineffective in addressing homelessness, mental health, and addiction. It is likely to change federal funding priorities, and many states/localities are likely to fall in line with the approach and implement its suggested policies and practices.

Read more: Trump chastises harm reduction; Trump threatens supervised consumption of drugs and harm reduction in executive order; Trump seeks to make it easier for people with mental illnesses to be involuntary committed; Trump signs executive order aimed at making it easier to remove homeless people from the streets; Trump signs executive order to crack down on homeless sleeping and drug use