A headline in the March 11, 2026 edition of Stars and Stripes caught my eye recently: “VA plans to seek public guardianship for some veterans deemed unable to care for themselves.” According to the article, “The Department of Veterans Affairs, working with the Justice Department, plans to initiate legal steps to place into public guardianship veterans clinically determined to be incapable of making medical decisions for themselves. The effort will extend to veterans experiencing homelessness or at risk of homelessness.” The article further notes that approximately 33,000 veterans are considered homeless and up to 60% of the nation’s homeless veterans have a mental illness.
This plan to restrict the freedom of veterans who are homeless or “at risk of homelessness” follows a disturbing presidential order that seem to be flying under the radar (not surprising given the constant crises and chaos emanating from the Trump Administration). On July 24, 2025 Donald Trump signed an Executive Order aimed at “Shifting homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment” with the purpose of “restor[ing] public order”. Executive Order 14321 includes a “the reversal of Federal or State judicial precedents and the termination of consent decrees” that limit the use of civil (involuntary) commitment; using federal funding to ensure “that detainees with serious mental illness are not released into the public because of a lack of forensic bed capacity at appropriate local, State, and Federal jails or hospitals”; and a requirement that “recipients of Federal housing and homelessness assistance …. who suffer from substance use disorder or serious mental illness [to] use substance abuse treatment or mental health services as a condition of participation.” As of this writing, the Executive Order is still winding its way through government agencies (HUD and DOJ) and the Courts.
Taken together, these directives classify the inability to afford housing as a medical / criminal problem justifying coercion, punishment, and loss of freedom of movement and bodily autonomy for those who are homeless or “at risk” of homelessness.
Incarceration by Any Other Name
In 2014 I wrote an essay entitled Incarceration by Any Other Name: A Return to the Cuckoo’s Nest. That essay was intended to remind readers of the horrors of state mental and prison hospitals during the 1950s and early 1960s when hundreds of thousands of people were locked up, often permanently, and subjected to involuntary “treatments” including lobotomies. The 1962 book / 1975 film One Flew Over the Cuckoo’s Nest exposed the cruel and repressive practices common in these institutions in which patients lost all access to basic civil and human rights. The book and film were flashpoints for the deinstitutionalization movement of the 1960s and 70s which (correctly) argued that mentally ill Americans deserve the same rights as all Americans. In using the framework of inherent rights, the deinstitutionalization movement was part of the broader civil rights movement of that time.
As the United States moved into the era of mass incarceration during the 1980s, 90s, and 2000s, different ideologies drove public policies. “Tough on crime” and “War on Drugs” laws filled American jails and prisons with millions of people, disproportionately poor, Black or Brown, insecurely housed or homeless, substance users, and physically or mentally unwell. By the 2010s, experts began to describe jails such as Riker’s Island and the Los Angeles County Jail as the largest mental hospitals in the country. This description tended to be interpreted as a consequence of deinstitutionalization causing large numbers of mentally ill Americans to be without mental health services and housing. By 2014, many states including my home state of Massachusetts looked to expand the use of civil (involuntary) commitment (hence “A Return to the Cuckoo’s Nest) to address the situation.
We now understand that this interpretation — whether coming from a place of kindness (a desire to help people living with poverty and health challenges) or of bigotry — ignored key social and economic facts. The community mental health programs that were intended to replace state psychiatric hospitals never received adequate funding. At the same time, the public safety net of welfare was slashed first by the Reagan Administration and then the Clinton. The period of mass incarceration was further characterized by rapid escalation of housing prices, forcing many individuals and families into homelessness with the dual effects of increasing the likelihood of arrest and of impaired health. This coincided with mind-boggling increases in healthcare costs, preventing many individuals and families from accessing appropriate medical and preventative services, and rise of the new Jim Crow in reaction to the “threat” of racial equality articulated by the civil rights movement. By the 2010s the correctional and mental health care systems had become intricately intertwined.
Coerced Treatment is Ineffectual
It’s crucial here to clarify that whether the intentions are benevolent or malicious, coerced drug and mental health treatment do not work. Corderoy’s et al. 2024 review of quantitative research comparing involuntary inpatient groups with voluntary inpatients or other comparator groups found that “involuntary inpatient admission was associated with harms including increased subjective and objective coercion, increased cost and decreased patient satisfaction.” This review confirms Sered, Taft, and Russell’s 2021 review of 200+ studies that looked at the effectiveness of prison-based therapy for women. Despite assumptions and hypotheses to the contrary, the research shows little to no evidence that coerced treatment ameliorates trauma symptoms (the outcome most often tracked) or offers any benefit post-release. Most disturbingly, research indicates that people who are involuntarily committed to drug treatment are more than twice as likely to die by overdose after they are released as those who complete voluntary treatment.
The Trump Era
It is against this background that the policy orders with which I opened this post are highly troubling. We are now in a period of increased authoritarianism, extra-judicial arrests and abductions by a government agency – ICE – that seems to function as a semi-independent militia, and a movement by the federal government to buy up large warehouses for the purpose of incarcerating larger numbers of people. These actions are accompanied by rhetoric from a president who describes immigrants as “monsters” and people of color as “low IQ,” and of federal directives and budgets that cut housing assistance and healthcare services to poor and working class people.
A return to the cuckoo’s nest indeed. But this time, the capture nets are larger than ever.
Further Reading
Alexander, M. (2012). The New Jim Crow: Mass Incarceration in the Age of Colorblindness. New York, NY: The New Press.
Barsky, B., Caplan, A, Sisti, D. (2026). The Executive Order on “Crime and Disorder”: An Affront to Policy, Law, and Ethics. Psychiatric Services. https://doi.org/10.1176/appi.ps.202505.
Corderoy A, Kisely S, Zirnsak T, et al. (2024). The Benefits and Harms of Inpatient Involuntary Psychiatric Treatment: A Scoping Review. Psychiatr Psychol Law 32:734–781.
Gilens, M. (2000). Why Americans Hate Welfare: Race, Media and the Politics of Antipoverty Policy. Chicago: The University of Chicago Press.
Lipsitz, G. (2012). “In an Avalanche Every Snowflake Pleads Not Guilty”: The Collateral Consequences of Mass Incarceration and Impediments to Women’s Fair Housing Rights. UCLA Law Review 59(6):1746-1809.
Massachusetts Department of Public Health. (2017, August). An assessment of fatal and nonfatal opioid
overdoses in Massachusetts (2011-2015). https://www.mass.gov/service-details/chapter-55-overdose-report.
Sered, S., Taft, E., and Russell, C. (2011). Ineffectiveness of Prison-Based Therapy: The Case for
Community-Based Alternatives. Women and Incarceration Project, Suffolk University, Boston MA. https://cpb-us-e1.wpmucdn.com/sites.suffolk.edu/dist/1/1933/files/2021/11/Ineffectiveness-of-Prison-Based-Therapy-2021-1.pdf