President Trump’s recent executive order encouraging involuntary commitment of people with mental illness who are homeless provoked a swift response from infectious disease experts, who warned that such moves could disrupt care for conditions ranging from HIV to hepatitis C in already vulnerable communities.
The order — entitled “Ending Crime and Disorder on America’s Streets” — directs the U.S. attorney general, “in consultation with” the HHS secretary, to pursue civil commitment of people with mental illness who are deemed public risks or are “living on the streets and cannot care for themselves.”
“Shifting homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment will restore public order,” the executive order states. “Surrendering our cities and citizens to disorder and fear is neither compassionate to the homeless nor other citizens.”
Policy Without Input
“This is just another example from this administration of throwing out a policy without input from experts, without basing it on science and what we know works,” Colleen Kelley, MD, chair of the HIV Medicine Association (HIVMA), told MedPage Today. The order doesn’t engage the community that’s affected, she added, or the providers who work with that community and know what works to help them.
“It’s standing in the face of science, of facts, and of good, humane policies,” Kelley said.
“I am very appalled by this new executive order,” declared Monica Gandhi, MD, professor of medicine at the University of California San Francisco (UCSF) and medical director of the UCSF Ward 86 Clinic.
“Housing insecurity is a substantial problem for those living with HIV or at risk for HIV in the United States,” Gandhi told MedPage Today. “To criminalize homelessness is going to specifically affect those at risk for HIV or living with HIV.”
The threat extends to the broader field of sexually transmitted infections, explained Elizabeth Finley, senior director of communications and programs with the National Coalition of STD Directors in Washington, D.C.
“With sexually transmitted infections, it’s so important to get people the testing and treatment they need where they are,” Finley said. The threat of institutionalization or imprisonment could have a chilling effect on the willingness of people targeted by the executive order to seek care.
“Anytime you’re throwing a threat into the mix that someone’s freedom could be harmed, it’s going to make people shut down; they’re not going to show up for healthcare services,” Finley told MedPage Today.
Bark vs Bite
“There’s no clear way to implement this executive order,” Kelley said. “Are they planning to overwhelm our hospitals with people who are pulled off the streets involuntarily? Are they going to build ‘Alligator Alcatrazes’ for people who are mentally ill or those who are suffering from substance use disorder?”
The administration may continue its approach of defunding evidence-based practices, Kelley noted, or withhold funding from organizations that practice evidence-based harm-reduction activities.
“What we’ve seen over the last 6 months has already been frightening,” Kelley said, “and the possibilities in this case are also quite frightening.”
For clinicians, “we don’t know what this will look like in practice,” Finley noted. But providers should be wary of “preemptive compliance” with the executive order’s aims, she added. “With so much of what we’ve seen from this administration, there are executive orders that have very big aims — but there’s a long path to implementation.”
Despite that uncertainty, “our duty is to continue to provide compassionate care,” Gandhi said. “We have no obligation to cooperate, actually, unless there’s a warrant.”
To reach those in need despite the order, Gandhi recommends that healthcare providers take their services out of the clinic and into the community. For example, her clinic has delivered more mobile care to reach people living in San Francisco’s tent communities.
Mixed Messages
The executive order’s spirit runs counter to other recent Trump administration moves to support infectious disease prevention and treatment within the very communities that the order targets, observers told MedPage Today.
This month, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced a $100 million pilot program that aims to help eliminate hepatitis C. That pilot will fund programs to prevent, diagnose, treat, and cure cases of hepatitis C virus (HCV) in people with substance use disorder and/or serious mental illness.
“Through this pilot program, we are launching a comprehensive, integrated care model that not only cures HCV but also tackles critical risk factors like substance use, mental health challenges, and homelessness head-on,” HHS Secretary Robert F. Kennedy Jr. said in a statement announcing the initiative.
SAMHSA’s pilot debuted after Sen. Bill Cassidy (R-La.) and Sen. Chris Van Hollen (D-Md.) last month introduced S.1941, the ‘Cure Hepatitis C Act of 2025.’ The act would require the HHS secretary to work to eliminate HCV in the U.S.
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