Trump would like to bring back mental institutions, but experts are skeptical

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A homeless encampment in Los Angeles in July 2024. / VCG via Getty Images

Donald Trump has promised a law-and-order approach to policy of all kinds — including the question of how to help people struggling with mental illness, substance use disorder and homelessness.

In a short video on his campaign website, Trump says cities in the U.S. have been surrendered to people who are unhoused, "drug addicted," and "dangerously deranged." To the American public, he promises, "we will use every tool, lever, authority to get the homeless off our streets."

His plan includes banning "urban camping," returning people to "mental institutions where they belong," and relocating people to government-sanctioned tent cities.

Experts say this law-and-order approach has already been tried, and failed.

"Independent of whether you think it's a good idea, I just don't see that happening," says Keith Humphreys, professor of psychology who studies addiction medicine at Stanford University.

It's been many decades since most states defunded mental hospitals and ended this practice. There's also legal questions around hospitalizing people indefinitely against their will – since a Supreme Court ruling on the issue more than 20 years ago.

Setting up tent cities run by the government can worsen problems with homelessness and substance abuse – according to Humphreys.

"It may make everyone else feel comfortable," says Humphreys, "but for the people who are in that one place, it turns into hell on earth."

Trump is not the first president to run on this kind of public safety message. Richard Nixon campaigned on a pledge to end street crime. But federal authority does not necessarily give presidents the tools to make meaningful change on these issues.

"From Washington, you actually don't have many law enforcement tools to affect street disorder in cities," says Humphreys. Federal agents, he says, "don't do things like grab a homeless person off a street corner in Chicago who's causing trouble because they're mentally ill or they're addicted or both."

During Trump's previous administration, he declared a public health emergency around the opioid crisis and signed legislation to boost federal funding for drug treatment the following year. Some criticized the response as poorly executed.

More recently, overdose deaths dropped for the first time in decades.

Humphreys notes that continued progress in this direction is possible, but the federal government would need to continue investing in known strategies around public health rather than a law and order approach, or destabilizing the Affordable Care Act, as some in Trump's party have proposed. If investment goes in that direction, Humphreys predicts, "these problems are going to get worse."