A Return to Forced Institutionalization and Mass Incarceration

The cartoon depicts deinstitutionalization, a movement that ultimately led to transinstitutionalization with people with mental illness moving from psychiatric hospitals to jails, homeless shelters, nursing homes, prisons, and the streets.

We have to understand President Trump’s recent executive order on homelessness and mental illness through the lens of history.

This executive order dangerously echoes failed policies from our nation’s past, including the transinstitutionalization movement and the height of the War on Drugs—periods marked by the forced movement of Black, Brown, and marginalized people from psychiatric hospitals into jails, prisons, and other custodial settings, as well as aggressive criminalization of substance use that disproportionately devastated our communities. Rather than providing meaningful care or support, these strategies substituted one form of institutional control for another, deepening trauma, stigma, and systemic harm.

The transinstitutionalization movement began as deinstitutionalization closed state psychiatric hospitals, but without adequate community-based supports, many people with serious mental illness were funneled into the criminal justice system or other custodial settings. Similarly, the War on Drugs framed addiction as a criminal matter, leading to mass incarceration and devastating Black and Brown communities without addressing root causes such as poverty, trauma, and lack of health resources.

Now, President Trump’s executive order revives these same punitive strategies—prioritizing coercion over care, punishment over housing, and surveillance over support. Instead of investing in affordable housing, voluntary and culturally informed care, and community-based solutions, the order pushes forced institutionalization and criminalization of homelessness and mental illness. History and lived experience show us that these approaches fail: they amplify generational harm, entrench trauma, and further erode trust in public systems among the very people they claim to help.

The Order seeks to dismantle decades of disability rights progress by undermining Olmstead v. L.C., the landmark Supreme Court ruling that affirmed the right of people with disabilities to live freely in their communities with appropriate support, rather than being forcibly confined.

Homelessness and the mental health challenges tied to it are symptoms of systemic failures: chronic underfunding of Black mental health, disinvestment in our neighborhoods, and legacies of discriminatory policies. True solutions demand that we prioritize Housing First models, accessible and affirming mental health care, and investments grounded in dignity, respect, and the lived expertise of those most affected.

This order regrettably aims to withdraw support and funding from proven, evidence-based initiatives such as Housing First and Harm Reduction. At the same time, it seeks to establish federal surveillance of all homelessness funding recipients, forcing them to collect and share personal data on people experiencing homelessness with the federal government and law enforcement.

We at Black Mental Health Village urge policymakers to reject this executive order, block any attempts to expand forced institutionalization, and instead redirect funding toward Housing First, voluntary mental health care, and community-driven solutions that center the dignity of those most impacted. Join us in championing approaches rooted in justice, healing, and community investment. 

Everyone deserves a safe home and care that honors their humanity, not forced confinement or criminalization.

References

Alexander, M. (2012). The New Jim Crow: Mass incarceration in the age of colorblindness. The New Press.

Greenwood, R. M., Stefancic, A., Tsemberis, S., & Busch-Geertsema, V. (2018). Housing first: Ending homelessness, transforming systems, and changing lives. Oxford University Press.

Henry, M., Watt, R., Rosenthal, L., Shivji, A., & Brethauer, P. (2020). The 2019 Annual Homeless Assessment Report (AHAR) to Congress. U.S. Department of Housing and Urban Development.

Lamb, H. R., & Weinberger, L. E. (2005). The shift of psychiatric inpatient care from hospitals to jails and prisons. Journal of the American Academy of Psychiatry and the Law, 33(4), 529–534.

Mauer, M., & King, R. S. (2007). Uneven justice: State rates of incarceration by race and ethnicity. The Sentencing Project.

Metraux, S., Marcus, S. C., & Homburger, J. (2017). Incarceration and homelessness. Social Service Review, 85(4), 575-607.

Padgett, D. K., Henwood, B. F., & Tsemberis, S. J. (2016). Housing First: Ending homelessness, transforming systems, and changing lives. Oxford University Press.

Torrey, E. F. (2014). American psychosis: How the federal government destroyed the mental illness treatment system. Oxford University Press.

Watson, A. C. (2017). The criminalization of people with mental illness: Time for change. Social Work in Mental Health, 15(5), 533-545.

Williams, D. R., Lawrence, J. A., & Davis, B. A. (2018). Racism and health: Evidence and needed research. Annual Review of Public Health, 40, 105–125.