Forced Involuntary Commitments Expand Nationwide

Group comforting a distressed person with hand on shoulder.

States across America are reviving controversial involuntary commitment laws targeting homeless addicts, despite mounting evidence that forced treatment increases overdose risks and death rates by 40 percent.

Story Snapshot

Over 25 states have expanded involuntary commitment statutes since 2015, with Massachusetts committing 6,000 people annually for substance abuse
Recent data shows involuntary patients face 1.4 times higher overdose risk after release, with one-third relapsing on their release day
Trump’s 2025 executive order pushes expanded involuntary psychiatric commitments nationwide without providing new funding
One-third of homeless Americans struggle with alcohol or drug problems, fueling political pressure for forced intervention despite poor outcomes

The Return of Forced Treatment

The pendulum swings back toward institutionalization as states grapple with visible homelessness and addiction. Massachusetts leads this charge, allocating $22 million to involuntary treatment facilities while spending only $7 million on harm reduction programs. This represents a dramatic shift from the deinstitutionalization movement of the 1960s and 1970s, which emptied state hospitals but failed to provide adequate community support.

The numbers tell a stark story. Current data shows 257,000 homeless Americans have severe mental illness or chronic substance use disorders. Among homeless populations, 38 percent abuse alcohol and 26 percent use other drugs. California’s recent survey revealed 32 percent of homeless individuals use methamphetamine regularly, while 11 percent have overdosed during their homelessness.

When Good Intentions Meet Harsh Realities

Massachusetts serves as a cautionary tale for other states considering similar approaches. The state’s Department of Public Health released damning data in 2024 showing involuntary commitment patients are predominantly young and white, with 80 percent under age 45 and 82 percent being white. More troubling, these individuals face significantly higher risks after treatment ends.

Stanford University researchers found that involuntary psychiatric holds double the risk of violent crime and suicide for patients deemed “judgment calls” rather than clear-cut severe cases. These borderline cases represent 43 percent of all evaluations, meaning nearly half of forced commitments may cause more harm than good. The disruption to patients’ lives often outweighs any potential benefits from brief involuntary treatment.

The Political Push Despite Evidence

Trump’s executive order targeting the “unhoused” represents the federal government’s entry into this debate, threatening to penalize Housing First programs that have shown superior cost-effectiveness. The order expands involuntary psychiatric commitments without providing additional funding, potentially pushing states toward criminalization rather than treatment.

This political momentum contradicts mounting evidence from public health experts. Dr. Margot Kushel from UCSF warns that forced commitment represents “a formula to worsen homelessness.” The data supports her concern: involuntary patients show decreased shelter use, reduced income and employment, and create revolving-door hospitalizations that drive up costs while delivering poor outcomes.

The Human Cost of Policy Failures

Behind the statistics lie real consequences for vulnerable Americans. Homeless individuals face victimization rates between 74 and 87 percent when severe mental illness goes untreated. However, forced treatment often traumatizes rather than heals, creating additional barriers to future voluntary engagement with services.

The current approach ignores proven alternatives. Housing First programs cost less and achieve better long-term outcomes than involuntary commitment, yet face federal penalties under new policies. Massachusetts exemplifies this backwards prioritization, spending three times more on coercive facilities than evidence-based harm reduction programs. The result perpetuates the cycle of homelessness rather than breaking it.