On July 24, 2025, the White House issued Executive Order 14321, “Ending Crime and Disorder on America’s Streets,” outlining a sweeping new federal approach to addressing unsheltered homelessness. The Order expands the use of civil commitment laws to institutionalize individuals experiencing homelessness who have mental health or substance use disorders, with a stated goal of restoring public safety. While the Order frames homelessness as a criminal justice issue, the implications for the health care are far-reaching and not yet fully defined. Providers may see a rise in emergency department visits, psychiatric admissions and length of stay if community supports are reduced. 

According to the White House fact sheet, the Departments of Health and Human Services, Housing and Urban Development, and Justice must work with state and local governments to ease restrictions on involuntary treatment and long-term institutional care. It also calls for increased enforcement of urban camping bans and encourages jurisdictions to implement mandatory treatment laws in exchange for federal funding. These changes appear to deprioritize community-based models like Housing First, which decades of research show can improve housing stability, reduce hospital utilization and improve behavioral health outcomes. 

The National Alliance on Mental Illness (NAMI) has cautioned that large-scale use of involuntary commitment (admitting an individual to a psychiatric unit against their will) can undermine patient autonomy and prevent people from seeking treatment in outpatient facilities that promote long-term recovery. Discharge planning could become more complex, particularly if new institutional settings lack clear criteria for admission, treatment duration or follow-up care. 

Adding to the uncertainty is the Executive Order’s lack of operational detail. There are no clear timelines or funding levels outlined, and it remains to be seen how states with different civil liberties protections will respond. Many behavioral health facilities are already at or near capacity. As noted by legal analysts, enforcement of the Order is likely to be difficult given the limited availability of treatment infrastructure and the requirement that any commitments comply with existing state laws and constitutional protections.  

The full implications of the EO remain unclear and no further guidance or regulation has yet been issued. Without meaningful investment in psychiatric workforce development, step-down care and supportive housing, the health care system may be tasked with implementing an expansive policy without the tools to do so effectively.