Trump Order Sparks Concerns About Forced Institutionalization
President Donald J. Trump takes questions from reporters in the Roosevelt Room of the White House in July. (Yuri Gripas/Pool/CNP/DPA/Abaca Press/TNS)
A White House order calling for greater reliance on institutionalization threatens decades of precedent on disability rights, advocates are warning.
The executive order issued late last month by President Donald Trump is aimed at addressing homelessness, but could have implications for people with disabilities more broadly, according to multiple disability advocacy groups.
“This executive order appears aimed at upending decades of established Supreme Court precedent and eliminating basic protections that prevent the arbitrary confinement of people based on a disability,” said Jennifer Mathis, deputy director of the Bazelon Center for Mental Health Law.
With the action, Trump is directing the attorney general to seek “the reversal of federal or state judicial precedents and the termination of consent decrees that impede the United States’ policy of encouraging civil commitment of individuals with mental illness who pose risks to themselves or the public or are living on the streets and cannot care for themselves in appropriate facilities for appropriate periods of time.”
Trump’s order states that “shifting homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment will restore public order.”
The move to prioritize institutionalization is setting off alarm bells for advocates with The Bazelon Center for Mental Health Law, the National Disability Rights Network, the Center for Public Representation, the National Health Law Program, the Disability Rights Education and Defense Fund, The Arc of the United States and other groups.
Historically, people with disabilities were often confined to psychiatric hospitals with little to no reason. But in a 1975 case brought by Kenneth Donaldson, who was held in a Florida state hospital for 15 years, the Supreme Court ruled that “the mere presence of mental illness does not disqualify a person from preferring his home to the comforts of an institution” and that “a state cannot constitutionally confine, without more, a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.”
Advocates noted that the Supreme Court has repeatedly upheld these principles.
“We cannot go back to the times when people’s liberty could be taken away with no rhyme or reason, or for reasons like revenge or punishment,” Mathis said. “The executive branch has an obligation to abide by Supreme Court decisions rather than seeking to overturn them.”
As many as 40% of people with developmental disabilities have co-occurring mental health conditions and many lack the specialized services they need, advocates say.
Meanwhile, about 30% to 40% of those who are homeless have cognitive impairment, including autism or intellectual disability, and many wind up unhoused later in life after the death of a family caregiver, according to Michelle Uzeta, interim executive director at the Disability Rights Education & Defense Fund.
“This is a return to ‘ugly laws’ — and paves the way for the institutionalization and shuttering away of anyone this administration feels to be undesirable,” Uzeta said. “This is absolutely a slippery slope, and the product of an agenda infused with eugenic thinking.”
The new executive order says that federal officials should help state and local governments through technical guidance, grants and other means adopt and implement “maximally flexible civil commitment” standards.
It comes just weeks after Congress approved nearly $1 trillion in cuts to Medicaid, which is already fueling concerns that access to home and community-based services could shrink in the coming years. Sending more people to costly institutional settings, would put greater pressure on the system, advocates say.
“Rather than providing sufficient funding for community-based services and appropriate housing, this executive order takes us backwards and curtails the civil liberties of people with disabilities who need support, not institutionalization,” said Shira Wakschlag, senior executive officer for legal advocacy and general counsel at The Arc. “We call on the administration to uphold the law and support the humane care and treatment of people with disabilities.”