On July 24, 2025, President Donald Trump signed an executive order to move those living in homeless encampments around the United States into treatment facilities with both mental health and substance use services (1). This executive order marks an abrupt change in direction and policy.
The Housing First Program
Beginning in the 1990s, an accepted idea on how to deal with the chronic homelessness crisis was a program called “Housing First.” This program offered the homeless, including people living rough outside, free housing with no strings attached. The program could be found in many communities throughout the United States and Canada.
For many, the Housing First approach was a huge success. People who had bad luck, lost employment, had medical bills to pay, or dealt with other unexpected problems (often without a serious mental illness or substance abuse issues) were able to get a new chance at life, and many successfully went back to work and financial independence. I’ve met a number of these people through my church in downtown Cincinnati, which offers Housing First-based programs, and have donated to their excellent mission over the years.
There were also reports of what happened to another population of people—the mentally ill homeless and those living with a drug addiction, often outside—who were also served by Housing First. Fortunately, once they were housed, many of these people were found to voluntarily seek professional services (even though Housing First did not require it) and work on their addiction and/or mental illness. In treatment, many began to successfully rebuild their lives.
Rejection of Housing
However, the main underlying problem with Housing First was unexpected. Many persons living on the streets rejected comfortable, clean, and generous living arrangements, preferring to live rough outside.
One of the most famous cases of this was the situation of Nathaniel Ayres, whose life story is documented in the film “The Soloist” (2). After being offered a beautiful and comfortable apartment for free, paranoia, anxiety, and hallucinations led him to reject any prospect of housing. At the end of the movie, after repeatedly and adamantly refusing housing, preferring to live under a bridge, a journalist who refused to give up on Nathaniel changed Nathaniel’s mind.
You would think that anyone who is living under a bridge or in a tent in subzero temperatures would be “crazy” to not accept a comfortable, indoor living arrangement. But perhaps that’s the problem.
When I chose to begin sleeping in a churchyard in January 2006, where I would live for 13 months, my mind was ravaged by schizophrenia. I always thought I was special, one in a million, who would someday be a billionaire. Today, I understand I had become just a statistic, a nameless face, and that even my delusions of becoming rich are widespread among people with schizophrenia.
I never used drugs, but today I understand that of those choosing to live rough, outside, for weeks, months, or years, almost every one of them is either severely mentally ill and/or abusing substances. These people are badly in need of help, but often too ill to seek services. A complete lack of insight into one’s mental illness, preventing the mentally ill from accepting treatment, is called “anosognosia,” and it is common in those with psychosis and schizophrenia. In 2006, I was delusional, hallucinating, and paranoid while living outside, but I thought I was very mentally healthy and saw no reason to ask for help. I suffered every day, but accepted my homeless lifestyle, as though it were normal.
While homeless, I had a number of people I could have contacted who had offered to let me live with them, free of charge, and in nice places (read the whole story in my memoir Mind Estranged [3]). But I always said no. And had I been housed through Housing First, I would surely have lost my housing. I cannot imagine my neighbors would have tolerated me when I was screaming back at the voices day and night, at the top of my lungs (something no one seemed to notice for months while I lived outside).
Today, I ask, if a person is too mentally deficient to be able to accept clean and comfortable living arrangements (as I was not able to), shouldn’t this decision be made for them?
I think it is also important to note that, like many others, I did eventually accept housing while taking antipsychotic medication for my schizophrenia. On medication, and because of my restored sanity, the idea of living outside no longer made sense to me. I have lived in private housing now for more than 18 years, and during this time, I have taken my antipsychotic medication every day. Housing and medication have stabilized my life and helped me to thrive. They have also enabled me to graduate from college with honors, work, and become financially stable.
Psychosis Essential Reads
Plans for Utah’s Facility
This idea, that those who refuse a nice, comfortable, and clean place to live should have the choice of where they should live made for them, I believe, is the driving force behind President Trump’s Executive Order. And Utah is the first state to make an effort to turn the Executive Order into a reality (4).
With a quick look at the plans for the facility, and considering the history of psychiatric facilities, it seems obvious that this effort could be a huge success or perhaps an equally big failure, depending on the specific details of their plan and ongoing, long-term support.
In my next few posts, I will dive into the details of this facility in more depth. I will discuss plans and details I am hearing from the facility builders themselves (including the governor of Utah’s office), as well as from those opposed to this project. I will discuss the commitment to cleanliness and comfort in this facility, its location, and its services to the sickest people it serves. I will also discuss their plans to serve those without mental disorders and/or substance abuse problems, ensuring that those without a mental illness are never given unnecessary medication or treatment.
