Trump’s push to institutionalize unhoused people won’t solve homelessness, providers warn

The Northern Nevada HOPES community health center in Reno. (Photo: Northern Nevada Hopes)

A July executive order issued by Donald Trump that seeks to crack down on homelessness by pressuring cities to criminalize unhoused people or push them into institutions is riddled with “glaring contradictions” that ignore lack of mental health facilities and supportive housing, service providers say.  

In the meantime, states and cities that don’t comply with the order are at risk of losing federal funding, a consequence that has already prompted some providers to cut back on services.

Complicating the challenges, local officials and service providers in Nevada are also wondering how they’ll cope if health care and homeless program spending cuts in Trump’s fiscal 2026 budget requests are enacted into law later this year.

Trump’s July 24 executive order, which is also critical of harm reduction programs like providing clean needles, has already prompted Northern Nevada HOPES to end its safe syringe program.

“Because we get federal funding, we decided it was important to stop offering that service so we didn’t receive federal funding cuts,” said Sharon Chamberlain, CEO for Northern Nevada HOPES.  

Safe syringes have “proven to be the number one way to prevent the spread of HIV and Hepatitis C, prevent overdoses and get people into treatment,” Chamberlain said. 

For the White House to discourage the program by financially threatening organizations that provide it, Chamberlain said, “is really detrimental.”

The Change Point syringe service program that the health center provided for about a decade will instead be offered by Northern Nevada Harm Reduction Alliance, a nonprofit community organization, Chamberlain added. 

Homelessness across the country has risen in recent years, with Nevada seeing an estimated 17% increase in 2024, according to a December report from the U.S. Housing and Urban Development. 

Homeless advocates and service providers have long warned there isn’t enough affordable or  accessible housing to meet the needs of those experiencing homelessness or at-risk of entering homelessness.

Trump’s executive order contains no provisions to increase the amount of available housing, and in fact calls for “ending support for ‘housing first’ policies,” saying they “deprioritize accountability.”

Anti-homeless camping bans marked by procedural pitfalls and counterproductive criminalizing

Instead, the order calls for federal agencies like HUD to prioritize federal funding to local governments that enact anti-homeless camping bans or anti-squatting ordinances, push for stricter punishment for drug use, and force unhoused people into mental health or drug abuse treatment. 

Several Nevada jurisdictions have passed or enhanced anti-homeless camping bans in the last few years.

“Many of the items in this executive order really fly in the face of what we currently know to be the most successful treatment models and the most successful evidence-based practices, such as housing first and  harm reduction,” said Catrina Peters, the homeless services coordinator with Washoe County.

Clark County Manager Kevin Schiller said Nevada’s most populous county is in a “holding pattern” and waiting for guidance from agencies outlining how to comply in order to continue to receive federal funding. 

Trump also wants cities and states to push “homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment.”

Not only does the order use “archaic, outdated and charged language” against unhoused people, the approach of mass institutionalization wouldn’t work, said Benjamin Castro, the executive director of Reno Initiative for Shelter & Equality. 

“We’ve already demonstrated that it was not efficient or popular,” Castro said of institutionalizing unhoused people with mental health disorders. “To execute some sort of national program like that, we’re talking about hundreds of billions of dollars to create these facilities and then to staff them.” 

Trump issued the order calling on local officials to criminalize homelessness and push unhoused people into treatment the same month he signed his tax and domestic spending legislation, which includes steep cuts to Medicaid. 

Nevada homelessness, housing crisis will only get worse under Trump budget plans, providers warn

And in his pending budget request, Trump has proposed slashing HUD’s budget by more than 40%, which could decimate city and state funding for homeless assistance programs. 

“I think that’s one of the glaring contradictions of this order,” Castro said. “We’re talking about putting focus on institutionalizing people with mental health issues, but we’re not funding mental health facilities.”

‘We don’t have anywhere to put them’

Whether it is placing unhoused people in housing programs, like permanent supportive housing, or getting those who need it into mental health treatment beds, Castro said there is a capacity issue.

“You have people who are living out on the streets, and even if they wanted to get into the emergency shelter they couldn’t because the shelters were full,” he said. 

The nonprofit Castro operates, RISE, is one of the few places in Northern Nevada that provides housing for people going through substance abuse treatment. 

When it comes to getting anyone, in particular those on the streets, into treatment, one of the first obstacles case managers face is figuring out who pays for the services. 

For people who rely on Medicaid, “there are very few providers that will actually provide the services that are needed, because Medicaid is complicated,” Castro said.

 “It doesn’t pay much,” he said, adding it’s a challenge for providers to get reimbursement for services in a timely manner. “Most service providers don’t want to deal with it.”

If a person who is unhoused is experiencing a mental health crisis, “they end up going to the hospital, but usually they end up going to jail because we don’t have anywhere else for people to go,” he added 

For all its flaws, Castro said Medicaid currently helps people get connected to mental health treatment options. 

That could soon change when the Medicaid provisions Trump’s spending cuts and tax cuts bill signed into law last month take effect in 2027.

The law is estimated to kick  17 million Americans off Medicaid or Affordable Care 

Act coverage, with about 114,500 Nevadans at risk of losing their health care. There are nearly 738,000 Nevadans enrolled in Medicaid, including 15% with chronic conditions, according to KFF.  

Trump’s order is “saying we want to push people toward treatment,” said Peters, the Washoe County homeless services coordinator. “But when we’re removing a payer source, we’re just removing opportunities for people to be able to access that resource.”

“Substance abuse treatment for people experiencing homelessness needs to be provided in a dignified and humane way,” Peters said, “and forcing people to institutions is the exact opposite of that, and has shown to not be a successful strategy.” 

While Trump’s order calls for  unhoused people to be swept off the streets and into treatment facilities, it does not detail where they could go or how those facilities  would be funded. 

“Is it implied that we are supposed to put them in jail?,” Castro asked. “Most of these executive orders are a lot of rhetoric that’s full of a lot of charged language that’s meant to rally a voting base. It doesn’t have a practical application.” 

Social service providers, who endorse the housing first model, agree that someone having a roof over their head is paramount to helping people address mental health or substance abuse needs.

“We can’t address all these other issues until we get people out of survival mode,” Castro said. “Survival mode means they know where they’re going to sleep tonight.”

Then the challenge is finding a place for them to go when they are ready to move on to permanent supportive housing, Castro said, “because we don’t have anywhere to put them.”

Washoe County alone lacks an estimated 1,100 permanent supportive housing units, said Peters, citing an analysis by the Corporation for Supportive Housing.

In some cases, social services providers are able to successfully get a client qualified for the Housing Choice Vouchers, commonly referred to as Section 8. 

Castro said getting clients a voucher is “half the battle.”

“The other half of the battle is finding somebody who will take it or finding a landlord who will actually accept it,” he said, adding Nevada doesn’t have laws to prohibit landlords from refusing to house people whose rent is paid by federal assistance. 

‘Deaths, I think’

Chamberlain with Northern Nevada HOPES said there has been a growing emphasis in the state for more than a decade to rely on harm reduction tools alongside substance abuse treatment.

The tools, she said, are evidence-based and backed by numerous scientific and health agencies, including the Centers for Disease Control and Prevention. 

Trump’s executive order calls for an end to funding for “so-called ‘harm reduction.’”

The Southern Nevada Health District said the Substance Abuse and Mental Health Services Administration sent a letter July 29 to agencies clarifying some harm reduction tools still allowed under Trump’s EO.

The list includes fentanyl test strips, HIV treatment, and opioid overdose reversal supplies like naloxone. 

But the letter underscores that no federal funding can be used for“syringes or needles used to inject illicit drugs.”

Clean needles and safe syringes help prevent the spread of other infections, including HIV.

For now, the Southern Nevada Health District doesn’t anticipate “any immediate changes to the harm reduction services” it currently provides. 

“The Health District remains committed to providing harm reduction services and resources to the community,” the district said in an email. “We will continue to monitor federal guidance and policy changes to help ensure the continuity and accessibility of these vital public health services.”

Though there are still many unknowns to the impact of Trump’s order, Chamberlain worries that the order will have a dire impact on unhoused people.

“From a health perspective, it’s going to result in deaths, I think, and significant health care needs that will go untreated because there won’t be access to services.”