Commentary: Why Civil Commitment Is a Dangerous Solution to the Homeless Crisis

Photo by Fredrick Lee on Unsplash

By David M. Greenwald
Executive Editor

In California, a mental health treatment bond, Prop. 1, narrowly is holding on to a lead by about 41,000 votes at the moment.  Prop. 1 foreshadows what could be a long and drawn-out public debate over compulsory psychiatric care—or civil commitment.

In a relatively balanced commentary in Real Clear Politics, Kate Farmer asks, “Are Civil Commitments the Future in the War Against Homelessness?”

Despite the controversy, the trend seems to be headed that way because public officials don’t see another clear alternative and because the opposition’s voices are not loud enough.

That Prop. 1 is so close reflects a strange alliance of right wingers balking at additional state spending and progressives balking at the prospect of returning to the days institutionalizing people who are mentally ill.

As Farmer notes, “Recently, legislators presiding over cities with burgeoning homelessness have pushed to lower this threshold for commitment. California’s state legislature moved this year to broaden its commitment standards, expanding its prior requirement of ‘grave disability’ to include persons rendered unable to provide for their basic needs or protect their own safety. “

She added, “The law also widened its definition of mental health conditions to include substance use disorders, and established a new court system called CARE Courts exclusively for involuntary civil commitments.”

As noted, “Legislators and advocates argue that these changes are the only way to save individuals with severe mental illness from a pernicious cycle of streets, hospitals, and jails.”

California may be suffering the most from the homeless crisis, both because of its high cost of housing, perhaps its mild climate, and the fact that the majority of the unsheltered homeless population reside in the state.

But, Farmer notes, “The Substance Abuse and Mental Health Services Administration estimates that around 30% of the nation’s chronically homeless population suffer from a mental health condition. Many of this population cycle through jails, typically for ‘nuisance’ crimes like loitering and vagrancy. While in jail, their conditions are most often left untreated, and their recidivism rates are high. Others risk perishing in deteriorating street conditions, with cities like Los Angeles witnessing over a 50% increase in homelessness deaths from 2019 to 2021 alone.”

This puts mental health care, the carceral system and the housing crisis all on the same trajectory.

The status is clearly untenable.  The question is whether the cure will be worse than the disease.

And indeed, this solution is met with “staunch opposition” from a number of different sides.

Farmer cites, for instance, Disability Rights California, a progressive nonprofit.  They opposed the CARE Act, believing that “expanded civil commitments laws over-diagnose and misdiagnose severe mental health conditions, particularly among vulnerable populations and communities of color. “

Meanwhile, groups like the ACLU but also libertarian groups like the Cato Institute worry about the legacy of “America’s ugly history of forced institutionalization, condemning civil commitment expansions as unconstitutional deprivations of liberty, privacy, and the right to be left alone.”

Dr. Jeffrey Singer of the Cato Institute, a leading libertarian think tank, criticizes the policies: “You may have a mental health problem, but nobody has a right to force you, without your informed consent, to undergo change,” he says. “Civil commitments basically amount to other people deciding for you that you are not capable.”

This is where we are right now.  Clearly the homeless problem has reemerged as a vexing problem in America.

From my perspective it is worth asking why that’s the case. Has the problem of mental illness suddenly gotten that much worse in the last decade?  I find that proposition difficult to sustain.

Is it the drug epidemic?  It is actually not completely clear whether the opioid crisis is driving homelessness or whether homelessness is contributing to the opioid epidemic.

I tend to believe that the housing crisis is driving the homelessness epidemic.  That appears to be what the UCSF study concluded as well.  They were able to track people over time as they descended from housing insecure to outright homelessness.

People living on the margins with faltering support systems ended up getting sucked into homelessness.

That causes people with mental health issues and substance use issues to decompensate and their condition gets worse.

If we force civil commitment, are we actually solving the problem or are we removing the most obvious visual blight without addressing the core underlying issues?

I suspect if we asked Governor Newsom, he would argue that we need to get people off the streets, into treatment, and then put them into transitional and supportive housing.

And if we had the resources to do that and the guarantee that civil commitment doesn’t become a prison system by another name without the heightened due process of law, the plan might work.

But there are so many places where this approach is likely to fail—most notably the resources to provide the care, the safeguards to make sure that we aren’t just using this as a de facto prison, and the resources needed to transition people out of homelessness and into supportive housing.

I can see the allure of this solution for those who argue that the status quo is not tenable.  I can see the dangers if we are not willing to put the money and the safeguards into the system.

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