SACRAMENTO, Calif. \u2014 President Donald Trump is vowing a new approach to getting homeless people off the streets by forcibly moving those living outside into large camps while mandating mental health and addiction treatment \u2014 an aggressive departure from the nation\u2019s leading homelessness policy, which for decades has prioritized housing as the most effective way to combat the crisis.<\/p>\n
\u201cOur once-great cities have become unlivable, unsanitary nightmares,\u201d Trump said in a presidential campaign video<\/a>. \u201cFor those who are severely mentally ill and deeply disturbed, we will bring them to mental institutions, where they belong, with the goal of reintegrating them back into society once they are well enough to manage.\u201d<\/p>\n Now that he\u2019s in office, the assault on \u201cHousing First<\/a>\u201d has begun.<\/p>\n White House officials haven\u2019t announced a formal policy but are opening the door to a treatment-first agenda, while engineering a major overhaul of the housing and social service programs that form the backbone of the homelessness response system that cities and counties across the nation depend on. Nearly $4 billion was earmarked last year<\/a> alone. But now, Scott Turner, who heads Trump\u2019s Department of Housing and Urban Development \u2014 the agency responsible for administering housing and homelessness funding \u2014 has outlined massive funding cuts and called for a review of taxpayer spending<\/a>.<\/p>\n \u201cThanks to President Trump\u2019s leadership, we are no longer in a business-as-usual posture and the DOGE task force will play a critical role in helping to identify and eliminate waste, fraud and abuse and ultimately better serve the American people,\u201d Turner said<\/a> in a statement.<\/p>\n Staffing cuts already proposed would hit<\/a> the part of the agency overseeing homelessness spending and Housing First initiatives particularly hard. Trump outlined his vision during his campaign, calling for new treatment facilities to be opened on large parcels of government land \u2014 \u201ctent cities where the homeless can be relocated and their problems identified.\u201d They could receive treatment and rehabilitation or face arrest. Now in office, he has begun to turn his attention to street homelessness, in March ordering Washington, D.C., to sweep encampments<\/a>, potentially separating homeless people from their case managers and social service providers, derailing their path to housing<\/a>.<\/p>\n The administration is discouraging local governments from following the federal policy, telling them it will not enforce<\/a> homelessness contracts \u201cto the extent that they require the project to use a housing first program model.\u201d And, in a recent order<\/a> \u201creducing the scope of the federal bureaucracy,\u201d Trump slashed the U.S. Interagency Council on Homelessness, shrinking the agency responsible for coordinating funding and initiatives between the federal government, states, and local agencies, known as Continuums of Care<\/a>.<\/p>\n \u201cMake no mistake that Trump\u2019s reckless attacks across the federal government will supercharge the housing and homelessness crisis in communities across the country,\u201d Democratic U.S. Rep. Maxine Waters of Los Angeles said in response to the order.<\/p>\n Support Without Forced Treatment<\/strong><\/p>\n Housing First<\/a> was implemented nationally in 2004 under the George W. Bush administration to combat chronic homelessness, defined as<\/a> having lived on the streets with a disabling condition for a long period of time. It was expanded under President Barack Obama as America\u2019s plan of attack on homelessness and broadened by President Joe Biden, who argued that housing was a basic need, critical to health.<\/p>\n The policy aims to stabilize homeless people in permanent housing and provide them with case management support and social services without forcing treatment, imposing job requirements, or demanding sobriety. Once housed, the theory goes, homeless people escape the chaos of the streets and can then work on finding a job, taking care of chronic health conditions, or getting sober.<\/p>\n \u201cWhen you\u2019re on the streets, all you\u2019re doing every day is figuring out how to survive,\u201d said Ann Oliva, CEO of the National Alliance to End Homelessness. \u201cHousing is the most important intervention that brings a sense of safety and stability, where you\u2019re not just constantly trying to find food or a safe place to sleep.\u201d<\/p>\n But Trump wants to gut taxpayer-subsidized housing initiatives. He is pushing for a punitive approach that would impose fines and potentially jail time on homeless people. And he wants to mandate sobriety and mental health treatment as the primary homelessness intervention \u2014 a stark reversal from Housing First.<\/p>\n The shift has ignited fear and panic among homelessness experts and front-line service providers, who argue that forcing treatment and criminalizing homeless people through fines and jail time simply doesn\u2019t work.<\/p>\n \u201cIt\u2019s only going to make things much worse,\u201d said Donald Whitehead Jr., executive director of the National Coalition for the Homeless. \u201cThrowing everybody into treatment programs just isn\u2019t an effective strategy. The real problem is we just don\u2019t have enough affordable housing.\u201d<\/p>\n Trump got close to ending Housing First during his first term when he tapped Robert Marbut to lead the U.S. Interagency Council on Homelessness in 2019<\/a>. Marbut pushed for<\/a> mandating treatment and reducing reliance on social services, while curtailing taxpayer-subsidized housing. He argued that forcing homeless people to get sober and enter treatment would help them achieve self-sufficiency and end their homelessness. But covid-19 stalled those plans.<\/p>\n Now, Marbut said, he believes the president will finish the job.<\/p>\n \u201cTrump knows that what we need to do is get funding back to treatment and recovery,\u201d Marbut said. \u201cThe Trump administration is laser-focused on ending Housing First. They realized it was wrong the first time and that\u2019s why I was selected to change it. They still realize it\u2019s wrong.\u201d<\/p>\n Trump and administration officials did not respond to questions from KFF Health News. A request to interview Turner was not granted. Project 2025\u2019s \u201cMandate for Leadership<\/a>,\u201d a conservative policy blueprint from some of Trump\u2019s closest advisers, explicitly calls for an end to Housing First.<\/p>\n Under Attack<\/strong><\/p>\n Housing First is under attack not only from Republicans who have long criticized taxpayer-subsidized housing for homeless people, but also from Democrats responding to public frustration over homeless encampments multiplying around the nation. Last year, the federal government estimated that more than 770,000<\/a> people in the U.S. were homeless, a record high. That was up 18% from 2023. And while housing grows increasingly unaffordable, homeless camps have exploded, spilling into city parks, crowding sidewalks, and polluting sensitive waterways<\/a>, despite unprecedented public spending<\/a>.<\/p>\n Already, cities and states, liberal and conservative, are cracking down on street homelessness and targeting the mental health and addiction crisis. This is true even in deep-blue states like California, where Gov. Gavin Newsom has created a \u201cCARE Court<\/a>\u201d initiative that can mandate treatment even though housing isn\u2019t always available and threatened to withhold funding from cities and counties that don\u2019t aggressively clear encampments.<\/p>\n San Francisco Mayor Daniel Lurie has proposed ending harm reduction<\/a> for drug users. Los Angeles Mayor Karen Bass is prioritizing encampment sweeps even though the promise of housing or shelter is elusive. And San Jose Mayor Matt Mahan won initial City Council support<\/a> for plans to arrest people<\/a> who refuse shelter three times in 18 months and to divert permanent housing funding<\/a> to pay for an expansion of homeless shelters.<\/p>\n Mahan believes liberals and advocates have been too \u201cpurist\u201d because housing isn\u2019t being built fast enough, while investments in shelter and treatment have been inadequate. \u201cIt can\u2019t only be about Housing First,\u201d he said.<\/p>\n Homelessness crackdowns have exploded since the U.S. Supreme Court made it easier<\/a> for elected officials and law enforcement agencies to fine and arrest people for living outside. Since June, roughly 150 laws imposing fines or jail time have been passed, with about 45 in California alone, said Jesse Rabinowitz, campaign and communications director for the National Homelessness Law Center.<\/p>\n Rabinowitz and other experts say both Republicans and Democrats are undermining Housing First by criminalizing homelessness and conducting encampment sweeps that hinder the ability of front-line workers to get people into housing and services.<\/p>\n However, there\u2019s disagreement on whether to entirely dismantle the policy. Liberal leaders want to maintain existing streams of housing and homelessness funding while expanding shelters and moving people off the streets. Conservatives blame Housing First for the rise in homelessness and are instead pushing for mandatory treatment and cutting housing subsidies.<\/p>\n \u201cI used to think it was just a waste of taxpayer money because it wasn\u2019t treatment-based, but now I think it actually enables people to remain homeless and addicted,\u201d Marbut said of the Housing First approach. He favors requiring behavioral health treatment as a prerequisite to housing.<\/p>\n Evidence shows Housing First has been successful in moving vulnerable, chronically homeless people into permanent housing. For instance, a systematic review<\/a> of 26 studies indicated that, compared with treatment-first, \u201cHousing First programs decreased homelessness by 88%.\u201dAnd the approach has shown remarkable improvements<\/a> in health, reducing costly hospital and emergency room care.<\/p>\n Experts say Housing First has been severely underfunded<\/a> and implemented unevenly, with some homelessness agencies taking federal money but not providing appropriate services or housing placements.<\/p>\n \u201cMaking it the broad policy to all homelessness leaves it vulnerable to being attacked the way it\u2019s currently being attacked,\u201d said Philip Mangano, a Republican who spearheaded the development of Housing First as the lead homelessness adviser to George W. Bush. \u201cThe truth is it\u2019s a mixed bag. For some people like those who are using substances, the evidence just isn\u2019t there yet.\u201d<\/p>\n Others say it has been ineffective in some places because of rampant misspending, abuse, and a lack of accountability<\/a>.<\/p>\n \u201cThis works when it\u2019s done right,\u201d said Marc Dones, a policy director for homelessness initiatives at the University of California-San Francisco, arguing that housing can save lives and lower spending on costly health care. \u201cBut I think we have been too polite and too nice for too long about some real incompetence.\u201d<\/p>\n Jeff Olivet, who succeeded Marbut at the U.S. Interagency Council on Homelessness under Biden, said Marbut and Trump\u2019s positions are misguided. He argues that Housing First has worked for those who have gotten indoors, yet the number of people falling into homelessness outpaces those getting housing. And he says there was never enough money to provide housing and supportive services for everyone in need.<\/p>\n \u201cHousing First is not just about sticking somebody in an apartment and hoping for the best,\u201d Olivet said. \u201cIt\u2019s really about providing stable housing and access to health care, mental health and substance use treatment, and to support people, but not forcing it on people.\u201d<\/p>\n This article was produced by <\/em>KFF Health News<\/em><\/a>, which publishes <\/em>California Healthline<\/em><\/a>, an editorially independent service of the <\/em>California Health Care Foundation<\/em><\/a>.<\/em>\u00a0<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n