The Civil Commitment Executive Order: Mixed Messages for Behavioral Health Stakeholders, State and Local Governments

On July 24, 2025, President Donald Trump issued Executive Order 14321, titled “Ending Crime and Disorder on America’s Streets” (“the E.O.”).

Although the E.O. has a number of elements, the one most notable for behavioral health stakeholders is a policy to increase use of involuntary commitment for mental health and substance use disorder treatment. The introduction proclaimed: “Shifting homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment will restore public order.”

The backlash to the suggestion of a sweeping lock-up of people because of mental illness and addiction was swift and fierce. Many advocates and commenters immediately called out the E.O. as criminalizing mental illness, addiction, and homelessness. However, as a matter of federal policy, the civil commitment provision of the E.O. may have less impact than some of its other components.

The Executive Order

The E.O. is framed as a public safety measure directed at “vagrancy, disorderly behavior, sudden confrontations, and violent attacks [that] have made our cities unsafe.” Claiming that the homeless population is responsible for these conditions, the E.O. states that the “overwhelming majority of these individuals are addicted to drugs, have a mental health condition, or both.” A set of statistics is included, without citations.

Based on the presumption that links exist between homelessness, mental illness, addiction, and crime, the E.O. sets forth a number of policy initiatives and directives to federal agencies, which include:

• A federal policy of encouraging the civil commitment of “individuals with mental illness who pose risks to themselves or the public or are living on the streets and cannot care for themselves in appropriate facilities for appropriate periods of time”;
• Tasking the Attorney General, in partnership with the Department of Health and Human Services, with seeking reversal of judicial precedents at both the federal and state level that interfere with the policy of encouraging civil commitment;
• Instructing the Attorney General to terminate consent decrees that are inconsistent with the federal policy;
• Assisting state and local governments, through technical guidance and grants, to implement “maximally flexible civil commitment, institutional treatment, and ‘step-down’ treatment standards”;
• Instructing federal agencies to use their grant programs in favor of states and local governments that enforce prohibitions on open drug use, urban camping, and loitering;
• Giving enforcement priority to various criminal laws, including those related to sex offenders;
• Stating that federal grants are not to be used for “harm reduction” initiatives, such as clean needle programs, but only for “evidence-based” substance use disorder treatment;
• Increasing “accountability” in housing programs by ending support for “housing first” programs and prioritizing “treatment, recovery, and self-sufficiency”; and
• Collecting health data from recipients of federally funded housing assistance, which will be available to the U.S. Department of Housing and Urban Development (HUD) and law enforcement authorities.

What the E.O. does not include is access to federal funds to build out treatment capacity for people who are civilly committed. Over the last sixty years, inpatient and residential capacity for mental health treatment has been reduced on a massive scale, without an accompanying build-up of community services. The E.O. does not answer the question of how more civil commitments will be paid for while the administration aggressively cuts funding for mental health services.

Policy Priorities Behind the Executive Order

The elements of the E.O. reflect themes and priorities of Trump’s presidential campaign: cleaning up communities, being tough on crime, removing homeless people from public spaces, denying public housing to individuals who use drugs, and viewing cessation as the only acceptable response to substance use.

For example, the end of “Housing First” initiatives was a policy priority in Project 2025, the conservative blueprint for the Trump administration. A chapter authored by former HUD Secretary Ben Carson called for the end of “Housing First” policies in favor of treating mental health and substance abuse issues before offering permanent housing. This is the exact opposite of the approach recommended by many studies and experts, who believe that treatment interventions are not possible without stable housing.

And the idea of more civil commitment also is not new. According to media reports in April of this year, the Department of Justice (DOJ) was considering how to use its grant authority to clear homeless encampments and increase forced treatment of people with mental illness.

Implications

While the proposal to force more people into locked settings for mental health treatment may have the greatest shock value, it is probably not the part of the E.O. that will have the most impact. Realistically, the ability of the federal government to influence the number of civil commitments is limited. This is because civil commitment is almost entirely a matter of state law and takes place in state courts, where the federal government has little sway.

In addition, there is a large body of federal and state case law, built up over decades, that makes civil commitment difficult. This includes decisions of the U.S. Supreme Court. The core constitutional concept is that, if a state is going to lock a person up and force treatment they object to, there must be a strict set of procedural protections, and the confinement cannot be indefinite. The Trump administration cannot wish this set of protections away, even with a friendly Supreme Court, nor is it likely to have standing to ask courts to change them.

In a strange alignment, however, a policy of making it somewhat easier to civilly commit people has already caught hold in some places. A number of states have recently passed laws doing exactly that, including ones that typically do not align with the policies of the Trump administration, such as California, New York, and Oregon.

Finally, after decades of deinstitutionalization, there are limited resources for treatment. Without many more treatment beds, increasing civil commitments would not be possible. The Trump administration’s efforts so far have involved cutting funds for mental health treatment, not offering to fund increased capacity. Most states would welcome federal money to expand treatment capacity, depending on the strings attached, but so far the Trump administration has not indicated that any such funding would be made available.

Some of the other provisions of the E.O., less discussed so far, may have greater and more immediate impact. This is especially true in the areas of housing, programs to reduce homelessness and provide shelter, addiction treatment, and data collection. State and local governments have designed their programs in these areas with federal funds as a key component. The requirements of the E.O., if enforced (and if they survive legal challenges), could require significant changes of approach. 

The civil liberties aspect of the E.O. may also be significant, in a different way than the discussion so far about mass civil commitment. In its goals of collecting personal and health data and sharing it across agencies and with law enforcement, the E.O. is doing something that will be alarming to many privacy advocates and other stakeholders.

The next steps will come from federal agencies: changes in grant programs, regulatory guidance, rulemaking, and enforcement. We will watch closely for these developments and report on them as they occur.