PORTLAND, Oregon — On a sunny late-summer afternoon, Logan Whalen stood outside his barbershop in downtown Portland. Two homeless people who were huddled in a doorway nearby were using illegal drugs. He said drug deals sometimes happen openly on his block. "I'm tired of it. It's mostly a nuisance, but it can also get a little bit scary," he said.
Portland is nothing like the "war zone" that President Trump has described in recent speeches while calling for a deployment of National Guard troops in the city. It's a foodie town, with high-end shops, restaurants and boutiques. On this day, the business district was busy with locals and tourists.
But after years of effort by local officials, on many streets there are still signs of homelessness, often complicated by severe addiction and mental illness. Whalen described one recent encounter where a homeless person blew fentanyl smoke in his face.
"I'm gay, very much a liberal Democrat, but compassion fatigue is a big thing," he said. "I don't want to walk on the street [to avoid homeless people]. I want to walk on the sidewalk."
Trump's answer to growing frustration, and fear, over America's homelessness crisis includes a plan to expand use of a legal process known as civil commitment. He says that in more cases, judges should be able to force people to accept medical care for addiction and mental illness.
"Our once-great cities have become unlivable, unsanitary nightmares, surrendered to the homeless, the drug-addicted and the violent and dangerously deranged," Trump said in a campaign video posted in April 2023. "For who those are severely mentally ill and deeply disturbed, we will bring them back to mental institutions, where they belong."
In July, Trump signed an executive order urging local and state governments to make this kind of forced medical care significantly more common. "Shifting homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment will restore public order," he said.
Democrats and Republicans move to expand civil commitment
As the United States' homelessness crisis has deepened, Trump isn't alone in believing this kind of intervention should be used more often.
Most states already have some form of civil commitment law. The process is typically used only in rare cases, when individuals pose an immediate threat to themselves or others. Judges may force individuals to accept closely monitored outpatient care; in other cases, they may be institutionalized in hospitals or residential care facilities, usually for brief periods.
California, New York and now Oregon are among states led by Democrats that have moved to expand use of forced medical care. Another blue state, Massachusetts, has one of the highest rates of involuntary commitments in the U.S. for people facing drug addiction.
Oregon Democratic state Rep. Jason Kropf, who crafted his state's new law, says he embraced the idea after seeing families and communities struggle.
"How do you balance helping people in crisis who aren't able to help themselves with not abusing that ability to over-institutionalize people?" Kropf said.
Judy Thompson, a longtime advocate for mental illness services in Oregon, lobbied in favor of the new standards. She, too, came to believe that civil commitment should be used more often after her son's bipolar schizoaffective disorder spiraled out of control in 2019. The episode led to a dangerous car crash.
No one was killed, but Thompson said her son put people in grave danger and he ended up with a criminal record, before a judge finally agreed to send him to a mental hospital. "We need some wiggle room [in the law so judges can act] before things collapse and end up in this horrific nightmare," Thompson said.
Thompson's son, Alton Aanderud, said he agrees that civil commitment was an important intervention that forced him to accept the medical help he needed. But he also said being hospitalized, even for relatively short periods of time, is disruptive and disorienting.
"It's not just, throw them all in an institution," he said. "When I got out of Oregon State Hospital, I had nothing when I came home — no place to live, one pair of pants, one shirt," he said. "It's disheartening when you go, 'Geez, I'm back at square one again.'"
With his mother's help, Aanderud was able to rebuild his life and now lives independently in his own apartment. But he says many homeless people don't have that kind of support network.
"Civil commitment is very scary because you don't know what you're getting into. They treat you, you get somewhat stabilized — then you're out the door and left to manage yourself," he said.
Many experts interviewed by NPR agree that civil commitment, even when expanded, should be used sparingly. Some voiced alarm at Trump's goal of using forced medical care to "restore public order," especially if it leads to people being institutionalized for long periods.
"What we don't want is to simply look at these folks as They're annoying. They're on the streets. Let's lock them up where nobody can ever see them again," said Dr. Kenneth Minkoff, a psychiatrist and nationally recognized expert on government-mandated health care. "That's not OK."
Many people who study addiction and mental illness said they believe most homeless Americans should be helped with less invasive programs, including affordable health care and housing subsidies.
"We are talking about using a sledgehammer, removing people's freedom in institutions, in facilities which don't even exist," said Morgan Godvin, a drug policy researcher who spent years on the streets of Portland addicted to heroin, before recovering. "Why are we going to the most expensive thing, that is most concerning for people's civil liberties?"
If more homeless people are institutionalized, who will pay?
One unanswered question in Trump's call for a national effort to expand civil commitment and long-term institutionalization is who would pay for it? There aren't enough residential facilities or trained medical personnel to care for even a tiny fraction of the 270,000 Americans who, according to federal data, live on the streets.
Republicans in Congress have actually cut roughly $900 billion from Medicaid, the government insurance program that pays for most addiction treatment and mental health care in the United States.
Trump administration officials told NPR they believe taxpayer dollars have been wasted by Democrats on "woke" liberal responses to homelessness, including "housing first" subsidies and "harm reduction" addiction programs. Trump's executive order calls for diverting some of those funds.
"Honestly, we think we can solve this without more money," said a senior White House official, speaking on condition of anonymity. "Part of it's simply accountability. We want federal dollars used more efficiently."
Kropf, the Oregon state representative who pushed for Oregon's expanded civil commitment law, disagrees. He points out that Oregon has already budgeted $65 million to pay for new residential facilities to help care for people who may be forced into the health care system under the state's new civil commitment guidelines.
"It's the question everybody should be asking," Kropf said. "If we're going to change the standard, do we have the ability to execute on that standard and make sure people get the services they need?"
Minkoff, the expert on institutionalization, said homeless people with severe addiction and mental illness will be costly to treat.
Many have complex medical needs and require support after they've been stabilized to prevent them from winding up back on the street.
"We need more resources as it is," he said. "These are folks who often, even when they're better, they're extremely vulnerable. They need appropriately ongoing supportive housing. There simply are not enough of those [programs] with adequate resources."
Thompson, the advocate and mother who lobbied for Oregon's expanded civil commitment standards, is also wary of Trump's executive order.
She thinks Oregon's new law is well crafted and nuanced and includes limitations on the amount of time an individual can be hospitalized.
But Thompson worries that many states will expand civil commitment and forced institutionalization in ways designed to sweep homeless people with addiction and mental illness out of sight.
"It's like, throw the garbage away — these people are worthless," she said. "It can be used for good or bad. It can be used to help or to harm."
Supporters and critics of expanding civil commitment say they agree the test will come in the details of how each state law is crafted. The White House official, who spoke on condition of anonymity, said they believe Trump's executive order will be implemented in ways that help more people escape homelessness while respecting their rights.
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