NAMI Advocacy: New Executive Order on Homelessness, Plus Good News on 988
Late yesterday afternoon, Thursday, July 24, the White House released a new Executive Order from President Trump entitled “Ending Crime and Disorder on America’s Streets” (read the full text and fact sheet). NAMI is deeply concerned about this order, which largely focuses on people with serious mental illness and/or substance use disorders. Earlier today, NAMI released a statement, and below is more context and information about the order.
Georouting Text for 988
Before we dive into the executive order, we want to first share some positive news regarding the 988 Suicide and Crisis Lifeline. Yesterday, the Federal Communications Commission (FCC) approved a requirement for telecommunications carriers to georoute text messages sent to 988. NAMI has led the advocacy for georouting – the process by which a person who contacts 988 is connected to the nearest 988 call center without disclosing any exact location information. Last fall, we celebrated the requirement for georouting calls to 988.
The new order requires nationwide carriers, which cover 90-95% of mobile phone customers, to georoute text messages within 18 months. Smaller regional carriers have up to 36 months to implement georouting of text messages. Standards for crisis care reinforce that contacts to 988 should be answered locally, so help seekers can be directed to local resources. Learn more about georouting.
White House Executive Order on Homelessness
On July 24, the White House issued an Executive Order, “Ending Crime and Disorder on America’s Streets,” which directs federal agencies to make it easier to involuntarily treat people with serious mental illnesses as part of a bid to address homelessness across the United States. While addressing the nationwide homelessness crisis is urgent and necessary, yesterday’s executive order promoting institutionalization of people with mental illness raises grave concerns for NAMI and our community.
It is unclear how the executive order will be carried out, as state laws govern the process of involuntary civil commitment. The order:
- Directs the U.S. Departments of Justice (DOJ), Health and Human Services (HHS), Housing and Urban Development (HUD), and Transportation to implement and incentivize policies that expand the use of civil commitment to address homelessness. (Read NAMI’s public policy position on involuntary civil commitment.)
- Requires the Attorney General to review DOJ consent decrees that limit the use of civil commitment. Where in effect, consent decrees protect people with serious mental illness from long-term confinement. It also creates legal precedent that deters other jurisdictions from implementing policies that prioritize confinement. DOJ has the authority to terminate consent decrees and can issue new legal opinions that states may use to craft policy.
- Seeks to prioritize federal grant funding to states that “enforce” laws that criminalize homelessness, such as laws criminalizing urban camping, loitering, and urban squatting.
- Leverages federal funds for local law enforcement to support the clearing of homelessness encampments.
- Ends the promotion of the evidence-based “housing first” model in favor of less effective tactics such as requiring sobriety and recovery in order to access housing.
Overall, NAMI is deeply concerned that this order targets people with serious mental illness and focuses on punishment more than treatment. As noted by our CEO Daniel H. Gillison, Jr. in NAMI’s statement, “It’s always ideal – and best – for an individual to engage in their own treatment. Yet, too many NAMI families know that isn’t always possible. Unfortunately, yesterday’s order concerningly focuses broadly on institutionalization and not on real solutions that we know work in helping people lead better lives.”
There are a few ideas raised in the executive order that are important in this conversation, such as addressing the lack of forensic bed capacity and issues in competency to stand trial, leveraging drug and mental health courts for diversion, and supporting crisis intervention services in Certified Community Behavioral Health Clinics (CCHBCs) and Federally Qualified Health Centers (FQHCs). However, the order does not offer concrete actions on these issues.
Civil commitment laws are determined at the state level, and a White House Executive Order cannot change state laws. So, while this order does little to directly force states and localities to change how they approach civil commitment or homelessness, we suspect this order may add to conversations already happening at the state and local level regarding more flexible civil commitment criteria and criminalizing homelessness. Other important notes to take away include:
- This order would add no resources to expand inpatient capacity or community mental health services, following recent trends in state legislation that indiscriminately expand civil commitment laws without resources.
- Most state civil commitment statutes already include the “danger to self or others” standard outlined in the executive order, and many states have even gone further to include a standard of grave disability. But the issue remains that there is a lack of resources for hospital-based care for people with mental illness.
- In recent years, we have seen a trend towards states and local governments enacting laws that make it a crime to camp or sleep in public, particularly with the 2024 U.S. Supreme Court ruling in Grants Pass v. Johnson.
The recent decision to slash Medicaid and Supplemental Nutrition Assistance Program (SNAP) benefits, combined with funding recissions of Substance Abuse and Mental Health Services Administration (SAMHSA) grants and proposed future cuts to SAMHSA funding, will exacerbate our homelessness crisis. People who cannot afford or don’t have access to mental health care are far more likely to come into contact with law enforcement, go to emergency rooms, or become homeless. NAMI does not accept those outcomes.
To help address the homelessness crisis, NAMI believes the Administration should focus on implementing evidence-based policy to address not only homelessness and mental illness, but public safety. Solving this crisis would require strategies like:
- Reversing changes to Medicaid and ensuring people have access to care at the earliest possible opportunity;
- Eliminating the IMD Exclusion policy that limits capacity of inpatient beds, keeping some people from accessing clinically appropriate care and causing symptoms to worsen;
- Increasing funding for proven models, like supportive housing and housing first; and
- Funding early intervention resources, like Coordinated Specialty Care, school mental health programs, and other resources.
NAMI will continue to advocate with Congress to prioritize legislation that supports evidence-based solutions to help people with mental illness. The following NAMI-supported bills are a few examples of solutions on the table to address this challenge:
- The Treatment and Homelessness Housing Integration Act (HR 577) would establish pilot programs to refer individuals with mental illness in the Department of Housing and Urban Development’s Continuum of Care Program to the nearest Certified Community Behavioral Health Clinic (CCBHC) for treatment.
- The Increasing Behavioral Health Treatment Act (HR 4022) would eliminate the prohibition on Medicaid dollars supporting care provided in Institutions for Mental Disease (IMD) with more than 16 beds and create more access to hospital-based care.
- The Michelle Alyssa Go Act (not yet reintroduced this Congress) would allow Medicaid payment in facilities with up to 36 mental health and substance use disorder beds.
NAMI will also urge the Administration to ensure that people with lived experience are brought to the table during decisions being made that affect our community.
Next Steps for Action
This Executive Order is mostly a policy statement, and the federal government has no authority to change state statutes related to civil commitment or state criminal statutes. We encourage you to reassure your networks of this and share NAMI’s press release. While the immediate impact is that this document furthers stigmatizing beliefs about people who are homeless and people with serious mental illness, we still have the ability to push back on any long-term impact within the states.
We encourage you to push back against the harmful and misleading information in this order. Included below are some resources that can help with talking to the media, policymakers, or people in your community.
Talking Points on Executive Order
- People with serious mental illness deserve to be treated with dignity and respect.
- Addressing the nation’s homelessness and mental health crises is a priority for NAMI.
- The Executive Order “Ending Crime and Disorder on America’s Streets” does not offer policy solutions that will truly address the systematic causes of these crises.
- The Order focuses broadly on institutionalization and not on real solutions we know work to help people engage in recovery.
- This does nothing to address the root causes of homelessness, runs a high risk of exacerbating the homelessness crisis, and is not the way to address our mental health crisis.
- NAMI is concerned that this order comes at a time when funding for mental health services is already stretched thin due to $1 billion in resources for mental health programs rescinded through SAMHSA earlier this year, drastic cuts to Medicaid that were just signed into law, and additional federal funding cuts proposed for next fiscal year.
- When people can’t access mental health care, it will lead to more people entering the cycle of incarceration and homelessness.
- We need to put our energy and resources into more solutions that help people earlier and give them better care.
- Policymakers should focus on enacting policies that create access to critical mental health services, helping people live healthy, fulfilling lives.
Relevant NAMI Public Policy Positions