New Policies Impacting Individuals Experiencing Homelessness

July 30, 2025

Background

An executive order titled "Ending Crime and Disorder on America's Streets," released on July 24, 2025, calls for the significant restructuring of federal approaches to supporting people who are experiencing homelessness, the majority of whom have neither a severe mental health nor substance use disorders.

The order directs the Attorney General to seek reversal of judicial precedents and termination of judicial consent decrees that limit civil commitment of unhoused individuals with mental illness. It mandates that federal agencies prioritize grants to states and municipalities that enforce prohibitions on urban camping, loitering, and open drug use. The executive order also requires the adoption of "maximally flexible civil commitment standards"—which would lower the legal thresholds and expand the criteria for when someone can be involuntarily committed to institutional treatment—for unhoused individuals deemed unable to care for themselves.

The order terminates federal support for "housing first" policies, which have traditionally provided immediate housing without preconditions such as sobriety or treatment compliance, and instead emphasizes accountability measures tied to treatment compliance. Federal agencies are directed to end funding for harm reduction programs, including safe consumption sites, while expanding support for drug courts and assisted outpatient treatment programs. Additionally, the order requires enhanced data collection on unhoused individuals receiving assistance and mandates information-sharing with law enforcement authorities in circumstances permitted by law.

Significantly, the executive order advocates for "shifting homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment," representing a marked departure from community-based treatment approaches that have long been the standard of care in mental health services.

APA/APASI Assessment

APA expresses profound concern about this approach, with particular attention to the following impacts on both psychological practice and unhoused individuals:

• Impact on psychological practice and ethics: The executive order's emphasis on civil commitment and institutional placement conflicts with fundamental principles of psychological practice, including respect for patient autonomy, informed consent, and the least restrictive treatment environment. The requirement for data sharing with law enforcement may compromise the therapeutic relationship and confidentiality protections that are essential for effective mental health treatment. Psychologists working with unhoused populations may face ethical dilemmas when institutional policies conflict with their professional obligations to prioritize client welfare.
• Undermining evidence-based treatment approaches: The termination of housing first programs contradicts extensive research demonstrating their effectiveness in reducing homelessness and improving mental health outcomes. Studies indicate that stable housing can serve as a foundation for successful engagement in mental health and substance use treatment (Aubry et al., 2015; Onapa et al., 2021; Padgett, 2020; Tsemberis et al., 2004). By requiring treatment compliance as a precondition for housing assistance, the executive order may create barriers that prevent individuals from accessing both housing and mental health services when they are most needed. Additionally, moving away from community-based care toward institutionalization counters some studies that suggest community-based care can be associated with improved quality of life and physical function. In many cases, community-based care may also be more cost-effective than institutional care, especially when considering the long-term costs of institutionalization. Additionally, serious flaws exist in our nation’s regulation of residential treatment centers. Not all residential treatment centers are regulated in the same way, and the level of oversight can vary significantly depending on the state, the type of treatment provided, and the population served. 
• Criminalization of mental health conditions: The executive order's focus on law enforcement and civil commitment versus treatment and support may further criminalize mental illness and substance use disorders, potentially increasing trauma and reducing trust in the mental health care system. Research demonstrates that punitive approaches to addressing homelessness often exacerbate underlying mental health conditions and create additional barriers to recovery. Additionally, the executive order’s set pathway ignores providing "upstream services" that include prevention and early intervention services that seek to avoid or mitigate individual crises and connect individuals to treatment services much earlier and before interfacing with emergency departments or law enforcement.
• Disproportionate impact on vulnerable populations: Unhoused individuals already face significant disparities in access to mental health care, and the policy changes mandated by the executive order may worsen existing inequities. The emphasis on institutional placement may particularly impact individuals from marginalized communities who have historically experienced discrimination within institutional settings, including veterans, who make up nearly 13% of the adult unhoused population, according to the National Coalition for Homeless Veterans. Estimates indicate that 1 in 10 US veterans have experienced homelessness (e.g., Nichter, B., 2023).
• Potential for increased psychological distress: The threat of involuntary commitment and institutional placement may increase anxiety, fear, and mistrust among unhoused individuals, potentially worsening their mental health conditions and reducing their willingness to seek or accept services. Additionally, requiring treatment compliance as a precondition for housing assistance may create barriers that prevent individuals from accessing both housing and mental health services when they are most needed.
• Human Rights and Community Integration: Forcibly removing unhoused individuals from community settings into institutional placements undermines their human right to community inclusion, disrupts social ties crucial for psychological health, and disregards research advocating for integrated community-based interventions.
• Trauma and Psychological Safety: Policies emphasizing law enforcement and compulsory treatment may retraumatize vulnerable individuals, erode psychological safety and trust, and hinder effective engagement with mental health services by creating a climate of fear rather than therapeutic alliance.
  

APA’s Position

APA's position is grounded in psychological research demonstrating that effective treatment of mental health and substance use disorders requires voluntary engagement, stable housing, and therapeutic relationships built on trust and collaboration. APA and APA Services advocate for continued investment in evidence-based housing first programs, community-based mental health services, and harm reduction approaches that respect individual autonomy while providing comprehensive support for recovery and well-being.

What Psychologists Can Do

• Advocate for evidence-based policies: Engage with local and state policymakers to share research on effective approaches to address challenges facing individuals experiencing homelessness and their mental health needs. Provide evidence on the effectiveness of housing first models, voluntary treatment approaches, and community-based services.
• Protect client confidentiality: Understand your ethical obligations regarding confidentiality and informed consent. Seek consultation and legal guidance when faced with requirements that may compromise client privacy or therapeutic relationships.
• Provide trauma-informed care: Recognize that policy changes and threats of involuntary commitment and requirements of treatment compliance or reporting to law enforcement may be retraumatizing for patients. Ensure your practice incorporates trauma-informed principles and addresses the additional stressors created by these policy environments.
• Build community partnerships: Create comprehensive support networks for unhoused individuals by strengthening relationships with housing providers, legal aid organizations, and community advocates.
  

Moving Forward

APA and APA Services will continue to vigorously oppose policies that criminalize homelessness and mental illness and will advocate for evidence-based, humane solutions. We will work to:

• Engage with federal agencies, including the Departments of Health and Human Services, Justice, and Housing and Urban Development, to share psychological science, advocate for the reversal of these harmful policies, and seek the restoration of funding for evidence-based programs.
• Connect State Psychological Associations and other state-based partners with state agencies in advocating for services supporting unhoused individuals.
• Equip psychologists and other mental health professionals with resources and guidance to navigate each profession’s ethical and practical challenges posed by these new mandates, ensuring they may continue to provide the highest standard of care.
• Collaborate with coalition partners, including housing advocates, civil rights organizations, and other health care associations, to build a unified front against the criminalization of homelessness and to promote policies that support health and dignity.
• Educate policymakers and the public on the scientific evidence demonstrating the failures of punitive approaches and the success of supportive, community-integrated models of care.
• Continue to advocate for quality health services for unhoused individuals with serious mental illness and substance use disorder, including but not limited to crisis intervention services.
  

What the Science Says

Psychological science provides critical insights into the effectiveness of civil commitment and the best approaches to address homelessness, including the associated issues of mental health and substance use disorders. 

Research indicates that civil commitment raises significant concerns. In the treatment of substance use disorders, involuntary commitment is associated with high relapse rates and emergency department visits post-commitment (Messinger et al., 2023; Messinger et al., 2022); researchers have emphasized coercion, lack of autonomy, and limited access to evidence-based treatment as major ethical and practical problems of civil commitment (Evans et al., 2020; Wahbi & Beletsky, 2022). For youth, involuntary commitment has been associated with reduced trust in providers and decreased likelihood of seeking future care (Jones et al., 2021). Importantly, Black and multiracial individuals are more likely to be involuntarily committed than White individuals, even after adjusting for confounders (Shea et al., 2022). This disproportionate trend may be exacerbated if civil commitment is used in the unhoused population, because people of color are overrepresented in this population ((United States Interagency Council on Homelessness, n.d.). 

Using civil commitment to address homelessness is also likely to have a disproportionate impact on U.S. Veterans. Veterans still made up about 5% of all adults experiencing homelessness in 2024, despite a reduction of over 50% since 2010 (United States Department of Veterans Affairs, 2023; U.S. Department of Housing and Urban Development, 2024), possibly due to an increase in grants and affordable housing programs (U.S. Department of Veterans Affairs, August 2024; October 2024).

It is important to note that “while rates of homelessness for people with severe mental health or substance use issues are high, the majority of people experiencing homelessness have neither a severe mental health nor substance use issue.” (United States Interagency Council on Homelessness, n.d.). However, veterans and adolescents experiencing homelessness are particularly vulnerable, with elevated risks of suicide, trauma, and psychiatric disorders (Nichter et al., 2023; Liu et al., 2022).

Research also supports the use of harm-reduction interventions as the best approaches for homelessness and substance use disorders. Harm reduction strategies incorporate community-driven public health strategies — including prevention, risk reduction, and health promotion (SAMHSA, 2023). For example, housing interventions, particularly programs that house unhoused persons before requiring enrollment in treatment or other programs, are associated with increased long-term housing stability and improvements in physical and mental health, well-being, and quality of life (Aubry et al., 2020; Onapa et al., 2023; Tsemberis et al., 2004). Moreover, an economic evaluation found that investing in stable housing for unhoused people who use opioids, even with no requirement to enter treatment, was associated with cost-effectiveness, fewer deaths, and improved health outcomes (Rao & Brandeau, 2025). 

Conversely, research indicates that criminalization of homelessness and mental illness alongside with stigma and discrimination have a negative impact on the healthcare, housing and employment of persons experiencing homelessness (e.g., Canham et al., 2024; Westbrook & Robinson, 2020). In addition, criminalization of homelessness is costly:the cost of law enforcement combined with increased health care costs creates an economic burden without solving the problem. For example, a 2016 San Francisco budget analysis concluded that the $20.6 million spent on law enforcement measures against homelessness had limited results (San Francisco Budget and Legislative Analyst, 2016). 

References

Aubry, T., Bloch, G., Brcic, V., Saad, A., Magwood, O., Abdalla, T., Alkhateeb, Q., Xie, E., Mathew, C., Hannigan, T., Costello, C., Thavorn, K., Stergiopoulos, V., Tugwell, P., & Pottie, K. (2020). Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: a systematic review. The Lancet. Public Health, 5(6), e342–e360. https://doi.org/10.1016/S2468-2667(20)30055-4 

Canham, S. L., Weldrick, R., Erisman, M., McNamara, A., Rose, J. N., Siantz, E., Casucci, T., & McFarland, M. M. (2024). A scoping review of the experiences and outcomes of stigma and discrimination towards persons experiencing homelessness. Health & Social Care in the Community, 2024, Article ID 2060619. https://doi.org/10.1155/2024/2060619 

Evans, E. A., Harrington, C., Roose, R., Lemere, S., & Buchanan, D. (2020). Perceived benefits and harms of involuntary civil commitment for opioid use disorder. The Journal of Law, Medicine & Ethics, 48(4), 718–734. https://doi.org/10.1177/1073110520979382 

Jones, N., Gius, B. K., Shields, M., Collings, S., Rosen, C., & Munson, M. (2021). Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care. Social Psychiatry and Psychiatric Epidemiology, 56(11), 2017–2027. https://doi.org/10.1007/s00127-021-02048-2 

Liu, M., Koh, K. A., Hwang, S. W., & Wadhera, R. K. (2022). Mental health and substance use among homeless adolescents in the US. JAMA, 327(18), 1820–1822. https://doi.org/10.1001/jama.2022.4422 

Messinger, J. C., Vercollone, L., Weiner, S. G., Bromstedt, W., Garner, C., Garza, J., Joseph, J. W., Sanchez, L. D., Im, D., & Bukhman, A. K. (2023). Outcomes for patients discharged to involuntary commitment for substance use disorder directly from the hospital. Community Mental Health Journal, 59(7), 1300–1305. https://doi.org/10.1007/s10597-023-01112-2 

Messinger, J. C., Ikeda, D. J., & Sarpatwari, A. (2022). Civil commitment for opioid misuse: do short-term benefits outweigh long-term harms?. Journal of Medical Ethics, 48(9), 608–610. https://doi.org/10.1136/medethics-2020-107160 

Nichter, B., Tsai, J., & Pietrzak, R. H. (2023). Prevalence, correlates, and mental health burden associated with homelessness in U.S. military veterans. Psychological Medicine, 53(9), 3952–3962. https://doi.org/10.1017/S0033291722000617 

Onapa, H., Sharpley, C. F., Bitsika, V., McMillan, M. E., MacLure, K., Smith, L., & Agnew, L. L. (2022). The physical and mental health effects of housing homeless people: A systematic review. Health & Social Care in the Community, 30(2), 448–468. https://doi.org/10.1111/hsc.13486 

Rao, I. J., & Brandeau, M. L. (2025). Modeling health and economic outcomes of providing stable housing to homeless adults with OUD. JAMA Network Open, 8(6), e2517103. https://doi.org/10.1001/jamanetworkopen.2025.17103 

San Francisco Budget and Legislative Analyst. (2016). Homelessness and the cost of quality of life laws. https://sfbos.org/sites/default/files/FileCenter/Documents/56045-Budget%20and%20 Legislative%20Analyst%20Report.Homelessness%20and%20Cost%20of%20Quality%20of%20 Life%20Laws.Final.pdf

Shea, T., Dotson, S., Tyree, G., Ogbu-Nwobodo, L., Beck, S., & Shtasel, D. (2022). Racial and ethnic inequities in inpatient psychiatric civil commitment. Psychiatric Services, 73(12), 1322–1329. https://doi.org/10.1176/appi.ps.202100342 

Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Harm reduction framework. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration.

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651–656. https://doi.org/10.2105/ajph.94.4.651 

U.S. Department of Housing and Urban Development. (2024). The 2024 Annual Homelessness Assessment Report (AHAR) to Congress: Part 1—Point-in-Time Estimates of Homelessness. https://www.huduser.gov/portal/sites/default/files/pdf/2024-AHAR-Part-1.pdf

U.S. Department of Veterans Affairs. (2024, October 24). VA housed nearly 48,000 Veterans experiencing homelessness in fiscal year 2024 [Press release]. https://www.va.gov/wilmington-health-care/news-releases/va-housed-nearly-48000-veterans-experiencing-homelessness-in-fiscal-year-2024/

U.S. Department of Veterans Affairs. (2024, August 26). VA awards over $800 million in grants to help homeless and at-risk Veterans and their families [Press release]. https://www.va.gov/wilmington-health-care/news-releases/va-awards-over-800-million-in-grants-to-help-homeless-and-at-risk-veterans-and-their-families/

United States Department of Veterans Affairs. (2023, December 15). Veteran homelessness increased by 7.4% in 2023. https://news.va.gov/126913/veteran-homelessness-increased-by-7-4-in-2023/

United States Interagency Council on Homelessness. (n.d.). Homelessness data & trends. https://www.usich.gov/guidance-reports-data/data-trends 

Wahbi, R., & Beletsky, L. (2022). Involuntary commitment as "carceral-health service": From healthcare-to-prison pipeline to a public health abolition praxis. The Journal of Law, Medicine & Ethics, 50(1), 23–30. https://doi.org/10.1017/jme.2022.5 

Westbrook, M., & Robinson, T. (2020). Unhealthy by design: Health & safety consequences of the criminalization of homelessness. Journal of Social Distress and the Homeless. https://doi.org/10.1080/10530789.2020.1763573