Does Trump's plan to get homeless people off the streets violate civil liberties?

0:001963, two years after President John F. Kennedy told Congress he wanted to put a man on the moon. he came to them with a challenge that would prove even tougher, mental illness. It has troubled our national conscience, but only as a problem unpleasant to mention, easy to postpone, and despairing of solution. Kennedy's proposed law would fund research into the causes of mental disabilities. It would also change the way the country treated people with serious mental illness. Our chief aim is to get people out of state custodial institutions and back into their communities and homes without hardship or danger.

0:37At the time, more than half a million people were confined to state-run psychiatric hospitals, many involuntarily. Conditions in these facilities were often abysmal, as Kennedy laid out. Nearly half of the 530 ,000 persons in our state mental hospitals are in institutions with over 3 ,000 patients, getting little or no individual treatment. Many of these institutions have less than half of the professional staff required. 45 % of them have been hospitalized for 10 years or more. The Community Mental Health Act would be the final bill Kennedy signed into law just a few weeks before his assassination.

1:16The idea was that people with mental illness could live independently in their communities and receive care at local health centers. And in its wake, the number of people in large psychiatric hospitals did decline dramatically. The law was one factor. So were advances in treatments and court decisions that made it harder to confine mentally ill people against their will. But the new system was underfunded. And today, many people with severe mental illness end up in hospital emergency rooms, in jail or on the streets. We're making many suffer for the whims of a deeply unwell few, and they are unwell indeed.

1:56President Trump campaigned on a promise to clear homeless people from the streets, including by pushing people with mental illnesses into hospitals. For those who are severely mentally ill and deeply disturbed, we will bring them back to mental institutions where they belong, with the goal of reintegrating them back into society once they are well enough to manage. And now he has a new executive order aiming to do it. Consider this. Trump's plan could force homeless people into treatment against their will. We'll go to a state where that is already happening.

2:36From NPR, I'm Juana Summers.

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3:07It's Consider This from NPR. President Trump's executive order calls for, quote, shifting homeless individuals into long-term institutional settings for humane treatment. The tool to do this, forcing people into treatment for addiction or mental illness, is called civil commitment. Critics say Trump's policy raises big concerns about civil liberties and cost, but civil commitment is gaining traction with some Democratic leaders. Brian Mann dug into it. I meet David on a busy corner in downtown Portland, Oregon. He's 35, living on the streets, carrying his belongings in garbage bags. He seems disoriented.

3:48And when I ask about his situation, he says he's afraid of the government. They put me in a concentration camp, he says. David gives NPR permission to use his full name. It says he doesn't use drugs or experience mental illness. But because David seems to be struggling and at times confused, we're identifying him only by his first name. I ask if he's getting any kind of help, and David shakes his head. He tells me he fears being abducted. All the human trafficking through the drug addiction treatment is no good. David isn't threatening or frightening, but this kind of encounter with vulnerable homeless people, many mentally ill or addicted to drugs like fentanyl, is common in the U.S.

4:28People here in Portland's downtown tell me they want this problem solved. Logan Whelan runs a barbershop. I'm gay, very much a liberal Democrat, but compassion fatigue is a big thing. Wayland says public safety has improved a lot here since the darkest days of the COVID pandemic, when tent encampments were more widespread. But he still deals with homeless people daily, often passed out on sidewalks or using drugs openly. You just blew fentanyl smoke in my face. You know, I'm tired of it. I don't want to walk in the street. I want to walk on the sidewalk. I've come to Portland in part because this is one of the cities President Trump singled out as a hotspot for homelessness, drug use, and crime, problems he promises to eradicate quickly.

5:14When Trump declared a crime emergency last month in Washington, D.C., he described Americans living on the streets as a threat. Drugged out maniacs and homeless people, and we're not going to let it happen anymore. We're not going to take it. Trump said he wants homeless camps purged nationwide. One part of his plan, laid out in an executive order, urges state and local governments to expand use of a policy known as civil commitment. The idea is that judges should have broader authority to mandate care for homeless Americans diagnosed with mental illness and addiction. Trump's executive order says putting people in what he describes as long-term institutional settings would help restore public order.

5:55That idea alarms many experts, including Morgan Godwin. We are talking about using a sledgehammer, removing people's freedom in total institutions, in facilities, which don't even exist. We don't even have the capacity for that. Godwin is a drug policy researcher who spent years addicted to heroin on the streets here in Portland. She was pressured by a drug court to accept addiction treatment against her will, a process similar to civil commitment, and says that experience actually slowed her recovery, making her more fearful of care providers, more resistant to public health services. Like many experts interviewed by NPR, Godwin thinks civil commitment is a valid tool, but only in rare cases when homeless people pose an immediate danger to themselves or others.

6:42She thinks the best answer for most homeless people is affordable housing and affordable voluntary health care. Why don't we start with the cheapest and most available thing first? Why are we going to the most expensive, most disruptive, and the thing that is most concerning for people's civil liberties? But despite concern over personal freedoms and cost, Trump isn't alone pushing for wider use of civil commitment. This is the other big reason I've come to Portland. Oregon is one of a growing number of blue states governed by Democrats, including California and New York, that are already making it easier to force people off the streets into medical care.

7:21Oregon Democratic State Representative Jason Krupp says he embraced this idea after a lot of soul-searching. How do you balance helping people in crisis who aren't able to help themselves with not abusing that ability to over-institutionalize people? Krupp says the law he sponsored, which was enacted last month, means a more modest expansion of civil commitment than envisioned by Trump. For one thing, the Oregon measure actually discourages long-term institutionalization. He thinks Oregon found the right balance between personal freedom and public safety. I asked Krupp about the other issue, the price tag, and he agrees that's a big concern.

7:59It's the question everybody should be asking. If we're going to change the standard, do we have the ability to execute on that standard to make sure people get the services they need? Oregon is already investing an additional$65 million taxpayer dollars in new residential facilities. But Emily Cooper with a group called Disability Rights Oregon says costs could spiral out of control. It cost$321 ,000 to commit one person at the state hospital for six months. Cooper says Oregon's health care system is already straining to help people who seek care for addiction and mental illness. she's skeptical lawmakers will spend enough money as more people are taken off the streets.

8:39There's nowhere to put individuals. There's literally not the bed capacity in Oregon. And then the cost to build it would be astronomical. Many experts on homelessness and public health told NPR this question, cost, needs to be answered before Trump's executive order is implemented. A spokesperson for the White House declined to be interviewed on tape, but speaking on background, they said institutionalization of homeless people can be expanded by state and local governments without a big new taxpayer investment. They said that could be achieved by shifting dollars, including federal grants, from other programs and spending money more efficiently.

9:16But Dr. Kenneth Minkoff, a national expert on civil commitment and institutional care, disagrees. Moving resources from things that some people think don't work, it sounds like a good soundbite, but we need more resources as it is. Remember, the federal government says there are more than a quarter million people living on U.S. streets on any given day. Minkoff and others say caring for even a small fraction of that population in institutional settings would be expensive if done right. Meanwhile, Republicans have actually cut funding for Medicaid. That's the government insurance program that funds most addiction and mental health care in the U.S.

9:54Again, Kenneth Minkoff. What we don't want is simply to look at these folks as they're annoying, they're on the street. Let's just lock them up and put them somewhere where nobody can ever see them again. That's not OK. Here in Oregon, it's too soon to know how many more homeless people will be forced into care because of the new state law and how much that will cost.

10:17Back on the street in Portland, two people huddle in a doorway next to Logan Whalen's barbershop. They're getting high. I ask Whalen if he's impatient enough for a fix to this problem to want homeless people swept off the streets. Hell no. Because where do they go? Where are they going to put them? In jail? No, that won't help at all. They need to stop cutting mental health funding. Homeless advocates say they'll be watching closely to see how expanded civil commitment policies are implemented here in Oregon and around the country. Will people get the help some desperately need? Or will this push to clean up streets quickly force homeless Americans out of their communities and out of sight?

10:57That was NPR's Brian Mann in Portland, Oregon.

11:04This episode was produced by Connor Donovan and Erica Ryan. It was edited by Andrea DeLeon and Courtney Dorning. Our executive producer is Sammy Yenigan.

11:19It's Consider This from NPR. I'm Juana Summers.