What Matters: Community Mental Health Programs Harm Homeless & Create More Displacement and Unhoused

This is the most controversial intervention in mental health—you’re deprived of liberty, can be traumatized and then stigmatized. – David Cohen, professor of social welfare at the Luskin School

Watchdog group documents a more than 50-year failure of psychiatric institutionalization and community mental health programs that harm and cause homelessness. Yet today, forcing displaced persons into dangerous mental health “treatment” is being relied upon to get the homeless off the streets.

By CCHR International
The Mental Health Industry Watchdog
April 4, 2022
Updated January 2023

The number of homeless in the U.S. is a national disgrace—a humanitarian debacle! Research shows that the primary cause of homelessness, particularly among families, is lack of affordable housing.[1] Living on the streets, individuals can lack access to food or clean water and sanitary conditions. However, often the solution offered to the homeless is “mental health treatment”—labeling their being displaced, deprived, and living in intolerable conditions as “mental illness.” A media opinion piece in 2019 suggested mental hospitals would be helpful. But this is exactly what helped cause the homeless problem in the first place.

Community mental health treatment and psychiatric hospitalization is a failed program that causes harm. It’s no more than a policy of herding the homeless out-of-sight into psychiatric institutions or forced into community “treatment” disingenuously couched as “compassionate care.”

Who profits from this? Not the homeless, but the mental health industry.

Since the 1980s, Citizens Commission on Human Rights, a watchdog group has documented the failure of the “Community mental health” program introduced in the 1960s. It started a wave of homelessness throughout the country. It was initially based almost entirely on the development of powerful neuroleptic (nerve-seizing) drugs, where patients were released from psychiatric institutions onto the streets dependent, especially, on antipsychotic drugs. Claimed to liberate patients from institutional harm, instead, they made them less able to deal with their circumstances, stripped them of their ability to work, and left them homeless.[2]

Anya Lawler, a policy advocate at the Western Center on Law and Poverty responded to California’s plans to push the homeless into “treatment. “We know that delivering those services in a forced, institutional setting—which this seems aimed at doing—actually has a very low success rate. It doesn’t result in people stabilizing over the long term,” she said.[3]

Today, Black or African Americans make up 13% of the general population but 40% (228,796) of the homeless population; 22.5% (130,348) are Hispanic/Latino; indigenous people account for 1% of the U.S. population, but 5% (18,935) of the homeless population. In contrast, 48% of all people experiencing homelessness were white compared with 74% of the U.S. population.[4] The Task Force Against Racism and Modern-Day Eugenics says labeling homelessness as a “mental disorder” and forcing “mental health treatment” on the homeless is just another form of eugenics—the psychological and psychiatric theory that falsely labels certain groups as inferior and denies them real help.

Bioethicist Carl Elliott, in an article titled, “The Best-Selling, Billion Dollar Pills Tested on Homeless People,” says neuroleptics cause “tardive dyskinesia, a writhing, twitching motion of the mouth and tongue that can be permanent.”[5] A patient survey of those taking neuroleptics found 90% felt depressed, 88% felt sedated, and 78% complained of poor concentration.[6] Elliot found that homeless populations have been used as participants in clinical drug trials.[7] He stated, “Many of the drugs that have been tested on the homeless are antipsychotics.”[8] Force the homeless onto psychotropic drugs and we will see diabolical abuse of this vulnerable group.

Psychotropic drug side effects can include violent behavior, aggression, paranoia, psychosis, dangerously high body temperatures, irregular heartbeat, and heart conditions, disorientation, delusion, lack of coordination, suicidal tendencies, and numerous physical problems.

In 2020, homelessness in New York City had reached levels not seen since the Great Depression (1929-1939) with more than 57,000 homeless people as of October that year.[9] Nationally, there were 580,466 people experiencing homelessness on the streets and in shelters in America.[10] 39% were unsheltered on the street, in abandoned buildings, in encampments, or other places not suitable for human habitation. On a single night in 2020, 34,000 people under the age of 25 experienced homelessness on their own as “unaccompanied youth.”[11]

California accounted for 30% of the country’s homeless population in 2022, despite making up less than 12% of the total population, according to figures released in December 2022. The U.S. Department of Housing and Community Development estimated that more than 172,000 Californians experienced homelessness in 2022. Nationally, the homeless population increased to more than 582,000.[12]

Yet in August 2022, California was said to have created more than 12,500 permanent and interim homes for people exiting homelessness. And $694 million was allocated for 35 projects that will create more than 2,500 new units in 19 communities throughout the state.[13] However, at the same time, California announced $1.1 billion to be given to keep vulnerable individuals “off the streets” and provide them the “mental health housing” and treatment—part of a $14 billion homelessness package. The governor also proposed so-called CARE courts, which sounded benevolent—dedicated to getting people with severe mental illness into treatment (whether they want it or not)—but which is a social policy of expanding on the existing California mental health laws for forced treatment. Unfortunately, that treatment is often damaging, if not deadly.

On January 26, 2023, a coalition of disability and civil rights advocates filed a lawsuit asking the California Supreme Court to block the rollout of Governor Gavin Newsom’s “far-reaching” Care Courts, alleging it is unconstitutional to compel treatment for thousands of people, as reported by The Los Angeles Times.

In their filing, representatives from three organizations—Disability Rights California, Western Center on Law and Poverty and the Public Interest Law Project—asked the state’s high court to strike down the program. The governor’s plan is to ramp up funding to $215 million by fiscal year 2025-2026.

The law enacted to compel this allows family members, first responders, medical professionals and behavioral health providers, among others, to petition a judge to order an evaluation of an adult with a “diagnosed psychotic disorder.”  If a person qualifies, a CARE plan could include forced drugs and treatment services.

Critics argued that CARE Court was a misguided approach to solving an issue that needed more significant investments in permanent housing and voluntary treatment services.[13A]

Beware the groups supporting such measures such as the National Association for Mentally Ill. They say treatment models and antipsychotic drugs have changed significantly since people were warehoused in institutions in the 1960s.[14] That is not true. Antipsychotics are among the most debilitating drugs given in the mental health system. NAMI received $23 million in just two years from pharmaceutical companies and Eli Lilly, the manufacturer of the antipsychotic Zyprexa, was NAMI’s biggest donor.[15] NAMI’s philanthropic partners in 2019 included at least 15 pharmaceutical companies. Of these, 14 had been exposed for some type of notorious conduct or criminal or civil misconduct, with those sued or coming under Department of Justice investigation often settling their cases, while admitting no liability. Fines and settlements were a combined total of $22 billion between 2010 and 2020.[16]

Imagine how many homeless could be helped with $22 billion?

The cost of institutionalizing a percentage of the homeless would be better spent on housing and food. Forced hospitalization costs several times more than the actual solution to homelessness. “Many homeless people…have spent time in hospitals and other emergency services that have failed them; they might be hospitalized for a few days but then where do they go after that?” says Laura Grund of Harlem United, a New York City-based organization providing housing support to the homeless.[17]

According to the NYC Independent Budget Office, emergency shelters cost $138 a day on average for single adults, or more than $50,000 a year. Supportive housing costs between $25,000 and $36,000 per person per year. Cost estimates for a forced night in a hospital, meanwhile, range from about $1,100 to more than $3,000 equal to an annual expense of $400,000 to $1.1 million per person.[18]

The rate at which Americans are already held against their will and forced to undergo mental health evaluations and state-ordered confinement—lasting anywhere from a few days to years—has risen sharply over the past decade, according to a November 2020 study by researchers at the UCLA Luskin School of Public Affairs.[19]

Involuntary psychiatric detentions outpaced population growth by a rate of 3 to 1 on average in recent years. “This is the most controversial intervention in mental health—you’re deprived of liberty, can be traumatized and then stigmatized,” said David Cohen, a professor of social welfare at the Luskin School, who led the research.[20]

Recently, the World Health Organization and the United Nations Human Rights Council have both called for an end to forced psychiatric hospital detention, and forced “treatment,” calling these practices dehumanizing and torture.[21] As such, psychiatric treatment given to the homeless without their consent constitutes torture.

Forcing such practices into the community—rather than in a “hospital”—is simply a change in geography and the mental health industry profits from it. Since being implemented, the federal Community Mental Health Center budget soared more than 160% from $143 million in 1969 to a projected $372 million in 2025. Medicaid plans to spend $7.5 billion toward expanding community behavioral health services over the next 10 fiscal years.[22]

The late Dr. Thomas Szasz, Professor of Psychiatry Emeritus, warned that Community Mental Health Centers were touted as “providing the least restrictive setting for delivering the best available mental health services. Such were the claims of psychiatrists to justify the policy of forcibly drugging and relocating their hospitalized patients. It sounded grand. Unfortunately, it was a lie.”[23] The bottom line he pointed out, was that psychiatrists were the last people to turn to solve the problem of our homeless.[24]

Providing housing, food and jobs for the homeless is a priority and the most altruistic approach. With such housing should come protections against any forced mental health treatment.

For further information:


[1] https://www.dailymail.co.uk/news/article-9045585/Pandemic-driving-homelessness-NYC-record-levels-20-000-single-adults-shelters.html; https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness/

[2] https://journalofethics.ama-assn.org/article/deinstitutionalization-people-mental-illness-causes-and-consequences/2013-10; https://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html

[3] Editorial: “Forcing homeless people into mental health treatment isn’t the way to solve homelessness, Los Angeles Times,” 28 Jan 2022, https://www.latimes.com/opinion/story/2020-01-28/homeless-people-mental-health-treatment-homelessness

[4] https://my.neighbor.org/demographics-statistics-homelessness/

[5] Susan Perry, “Recruitment of homeless people for drug trials raises serious ethical issues, U bioethicist says,” MinnPost, 11 Aug. 2014, https://www.minnpost.com/second-opinion/2014/08/recruitment-homeless-people-drug-trials-raises-serious-ethical-issues-u-bioet/; https://medium.com/matter/did-big-pharma-test-your-meds-on-homeless-people-a6d8d3fc7dfe

[6] Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, (Perseus Publishing, 2002), p. 256

[7] “Exploitation of Homeless Populations in Phase One Drug Trials,” The ethics and society blog, 9 July 2020, https://ethicsandsociety.org/2020/07/09/exploitation-of-homeless-populations-in-phase-one-drug-trials/

[8] Op. cit., MinnPost, 11 Aug. 2014

[9] https://www.dailymail.co.uk/news/article-9045585/Pandemic-driving-homelessness-NYC-record-levels-20-000-single-adults-shelters.html

[10] https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness/

[11] https://my.neighbor.org/demographics-statistics-homelessness/

[12] https://calmatters.org/newsletters/whatmatters/2022/12/california-homeless-count-2/

[13] https://www.gov.ca.gov/2022/08/24/in-los-angeles-governor-newsom-announces-694-million-in-homekey-awards-to-create-more-than-2500-new-homeless-housing-units-statewide/

[13A] Hanna Wiley, “Civil rights groups file lawsuit to block Newsom’s plan for treating people with mental illness,” Los Angeles Times, 26 Jan. 2023, https://www.latimes.com/california/story/2023-01-26/disability-advocates-lawsuit-care-court-newsom-mental-illness-addiction-homeless

[14] https://www.foxnews.com/us/gov-newsom-approves-court-ordered-mental-treatment-homeless

[15] Martha Rosenberg, “Are You Mentally Ill? NAMI Hopes So,” Dissident Voice, 11 Oct. 2014, https://www.cchrint.org/2014/10/13/are-you-mentally-ill-nami-hopes-so/

[16] https://www.cchrint.org/issues/psycho-pharmaceutical-front-groups/

[17] Annalisa Merelli, “NYC’s new plan to forcibly hospitalize homeless people is a waste of taxpayer money,” Quartz, 3 Dec. 2022, https://qz.com/nycs-new-plan-to-forcibly-hospitalize-homeless-people-i-1849843872

[18] Ibid.

[19] “Study finds involuntary psychiatric detentions on the rise,” UCLA Newsroom, 3 Nov. 2020, https://newsroom.ucla.edu/releases/involuntary-psychiatric-detentions-on-the-rise

[20] Ibid.

[21] https://www.cchrint.org/2021/06/11/world-health-organization-new-guidelines-are-vital-to-end-coercive-psychiatric-practices-abuse/, citing: “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” World Health Organization, 10 June 2021, https://www.who.int/publications/i/item/9789240025707

[22] “Total expenditures … by type of mental health organization: Untied States, selected years, 1969-1983,” Mental Health, United States, 1987, U.S. Department of Health and Human Services, p. 5; https://bhbusiness.com/2022/03/28/white-house-budget-proposes-to-transform-mental-healthcare-allocates-4-8b-to-related-initiatives/

[23] Thomas Szasz, M.D., Cruel Compassion, (John Wiley & Sons, Inc., New York, 1994), p. 160

[24] Thomas Szasz, M.D., The Manufacture of Madness, (Harper & Row, New York, 1970), p. 15