Editor’s note: The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team. As part of this project, editorial writer Alex Fryer has been examining issues related to behavioral health and substance use disorders.
On July 24, President Donald Trump announced an executive order directing his priorities on homelessness, substance abuse and mental illness. Condemnation from local advocates and political leaders was swift.
As The Times covered, Alison Eisinger, executive director of the Seattle/King County Coalition on Homelessness, called the order “cruel, stupid and terrible.”
But a closer reading shows there is room for nuance.
Put aside Trump’s bombastic statements about homelessness and urban blight — not to mention hourly departures from the norm regarding everything from vaccines to foreign aid — and the words may not be as troubling as they seem at first blush. There may even be the potential to accomplish good things.
In fact, the political snares contained in the order may be quite different from the ones decried by regional governments and social services.
That’s the takeaway from criminal justice reformer Lisa Daugaard, co-executive director of Purpose Dignity Action, which operates LEAD (pre-booking diversion) and CoLEAD (temporary lodging and intensive case management services) among other services.
Some highlights of the Trump directive:
The federal government will provide technical assistance and funds for “maximally flexible civil commitment, institutional treatment, and ‘step-down’ treatment standards that allow for the appropriate commitment and treatment of individuals with mental illness who pose a danger to others or are living on the streets and cannot care for themselves.”
The order seeks to address those with the most serious mental illness or substance use disorder through “assisted outpatient treatment or by moving them into treatment centers or other appropriate facilities via civil commitment or other available means, to the maximum extent permitted by law.”
It offers federal money for “encampment removal efforts in areas for which public safety is at risk and State and local resources are inadequate.”
The order assesses whether federal resources could be directed toward “ensuring, to the extent permitted by law, that detainees with serious mental illness are not released into the public because of a lack of forensic bed capacity at appropriate local, State, and Federal jails or hospitals.”
This provision, in particular, ought to be welcomed. Releasing gravely ill people accused of crimes back to the streets has long bedeviled Washington. Two years ago, 22 counties sued the Washington Department of Social and Health Services for failing to provide necessary behavioral health treatment under state law.
Most controversially, the order takes on “harm reduction” and “housing first” strategies. But there also appears to be wiggle room.
It directs the Substance Abuse and Mental Health Services Administration to fund “evidence-based programs” and not 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.”
There are no “safe consumption sites” in Washington. And it doesn’t seem too hard for providers to prove that they do not oversee free-for-alls and instead offer counseling, treatment or other services.
Five days after Trump issued the order, SAMHSA issued a “Dear colleague” letter to grant recipients clarifying the federal agency will continue funding overdose reversal drugs, fentanyl test strips, HIV education material and care services, and condom distribution.
Federal money would not be allowed to purchase “pipes or other supplies for safer smoking kits nor syringes or needles.”
This is not a damaging development for King County, which can purchase syringes for needle-exchange programs with local funds.
Another section of Trump’s order directs federal agencies to increase accountability by taking action including “ending support for ’housing first’ policies that deprioritize accountability and fail to promote treatment, recovery, and self-sufficiency … and holding grantees to higher standards of effectiveness in reducing homelessness and increasing public safety.”
This has some housing providers rightfully concerned, said Daugaard. It also seems a fairly low bar. Providing stable housing to people with mental health and substance use disorder is essential. But simply providing walls and a roof with no direction toward a more stable, healthy life doesn’t meet an individual’s complete needs. These restrictions ought not to have much practical impact, anyway. As a matter of practice, most organizations don’t “deprioritize accountability.”
In a July 26 email to her staff and board members, Daugaard wrote: “I believe the Executive Order is not intended to radically disrupt existing funding for low-barrier housing providers, or to eliminate the use of harm reduction methods.”
“This is now what I’m spending about 80% of my waking time thinking about,” said Daugaard in an interview with the board this week. “I think a lot rises and falls on whether we find a way to navigate this landscape.”
Trump could be threatening to go after housing providers that allow drug use on their properties. But it wouldn’t make much sense for the federal government to be funding and legally jeopardizing the same programs. Instead, Daugaard said, the administration could be seeking commonsense improvements.
“No one is mandated to work with people who are active drug users and have been chronically unsheltered. And if you create a risk calculus that makes it unsafe for an organization or an individual, they will do other work,” said Daugaard. “I don’t think that’s actually what the administration’s trying to achieve. I think they are trying to make this area of work more robust.”
In a warning to other advocates and providers, Daugaard recommends a strategy of agreeing that there are ways to make the housing and treatment system stronger and more responsive. A knee-jerk rejection of Trump’s order will only make progressives look defensive and beholden to the status quo.
“We should say, ‘What’s the gap between where we are and where we’d like to be, and what do we need to get there?’ After all, it’s about the well-being of marginalized people. How is that not what we care about?”
“I think it’s a trap and I think it’s an intentional trap,” she continued. “I think it is a trap that was set (for progressives) to denounce it, thus permanently ensuring Republican control in this country. And a lot of people are falling into it, confessing to a crime that they’re not even guilty of, which is not caring about people’s recovery. That is a mistake.”
As Daugaard wrote in her employee message: “We should not play into that caricature by decrying the EO in a way that suggests we are champions of careless, negligent policies that promote drug use or disregard human need and the desire for recovery.”
If the Trump executive order on homelessness and substance use is a Rorschach test, it would behoove service providers to find the positive and call upon the federal government to be partners in making needed system improvements as well as putting more dollars into the work.
It may not be the reaction Trump was expecting. But it will pay the greatest dividends for those most in need.
