The Poorhouse and the Asylum

He was barefoot when they took him. Just a plastic wristband, three black trash bags on the curb, and a psychiatric hold code: “gravely disabled, unable to care for self.” No charges. No consent. No visible path home.

His name was Derek. He lived in a tent behind a liquor store off Western Avenue in L.A. Neighbors said he played chess, helped fix flashlights, kept a plywood shrine to his mother lit with tea candles. His file said “resistant to treatment.” He disappeared in June.

Under California law, that code—5150—allows clinicians or police to detain someone for up to 72 hours if they appear mentally ill and a danger to themselves or others. A 5250 can extend that to 14 days. Consent is optional.

“He needed a place to rest. They gave him a case number.”

On July 24, 2025, President Donald Trump signed an executive order: Ending Crime and Disorder on America’s Streets. It directs federal agencies to incentivize the removal of unhoused people from public spaces—especially those labeled mentally ill or addicted—and funnel them into institutions. Civil commitment, once a narrow psychiatric tool, is recast as a matter of public safety.

The order calls current approaches “an abdication of duty.” It dismisses harm reduction as “taxpayer-funded narcotics,” and promises “compassionate institutional care”—without defining it, funding it, or requiring it.

It’s not a new idea. It’s an old American reflex dressed in new urgency: conceal distress, isolate disorder, call it compassion.

In the 19th century, poorhouses enforced moral correction through confinement. Residents scrubbed floors, wove brooms, broke rocks. Families were split. Meals were earned. The logic was deterrence: if relief is too easy, need will multiply.

Asylums carried the same design under a new name. Places like Worcester State Hospital in Massachusetts and Trans-Allegheny in West Virginia began as monuments to science and care. They became overcrowded holding pens. By the 1950s, tens of thousands were locked away, most without meaningful treatment.

The names changed. The blueprint remained.

“No new clinics. No new housing. Just more locks, fewer choices.”

Trump’s order follows that blueprint. “Endemic vagrancy,” “disorderly behavior,” and “violent confrontations” are cited as justifications for mass removal. Cities that show “measurable decreases” in visible homelessness will receive HUD funds. Those that fund housing-first or harm reduction may lose them.

But the institutions being asked to absorb this new influx are already fractured.

In 2023, more than 112,000 people were involuntarily committed in California alone—a 30% rise in ten years. A state audit found that nearly 70% of counties lacked adequate facilities. Nationally, 44 states report psychiatric bed shortages. There are fewer than eight per 100,000 people. Patients are routinely held in ERs or jails. Some are released in under 72 hours with no follow-up.

In Texas, lawmakers warned that new mandates would overflow jails and push people into unlicensed boarding homes. In Florida, psychiatric ER wait times average 18 hours. Arizona’s health director admitted the state has “no mechanism, no beds, no oversight plan” to execute mass detentions safely.

The demand is rising. The scaffolding to meet it doesn’t exist.

“The problem isn’t that he’s too sick. It’s that no one’s ready when he isn’t.”

Supporters argue civil commitment saves lives—that it’s the only way to reach people lost in psychosis. In Houston, Mike Nichols of the Coalition for the Homeless described a man who rocks violently outside their building, unable to speak. “We can’t communicate with him,” he said. “But we also can’t place him anywhere.” No conservator. No beds. No plan.

Trump’s order offers no answers to that impasse. It calls on states to broaden commitment definitions, empowers the DOJ to override rulings that restrict forced treatment, and encourages shelters to share health data with police “when legally permissible.”

In New York, Mayor Eric Adams has already authorized forced hospitalization of people unable to meet basic needs, even if not dangerous. Harvard psychiatrist Katherine Koh warned the policy risks “fueling distrust in systems already failing,” unless backed by housing and treatment—not just transport and intake.

This isn’t governance. It’s theater with real casualties. Like the man booked three times in a month, then discharged barefoot from an ER at 2 a.m., sent back to the same curb he left.

“It’s not reform. It’s removal with a clipboard.”

There is precedent. In 1987, Joyce Brown—known as Billie Boggs—was forcibly hospitalized under New York’s Project HELP. She won in court. A judge ruled she wasn’t a danger. Her case showed how psychiatric authority can be used to erase social discomfort.

In 2011, Kelly Thomas, a homeless man with schizophrenia, was beaten into a coma by six Fullerton police officers. His last words—“I’m sorry,” “Dad, help me”—were recorded. He died five days later. The officers were acquitted.

These aren’t exceptions. They’re signals.

The order discourages harm-reduction entirely. It encourages shelters to separate by sex—code for excluding transgender people—and reward those deemed “compliant.” LGBTQ+ individuals, long subject to psychiatric pathologization, face disproportionate risk in the very institutions meant to protect them.

Compassion, when weaponized, becomes camouflage for control.

Some officials speak frankly: they’re overwhelmed. Emergency rooms clogged with behavioral health crises. Police pressured to clear sidewalks. News cameras fixated on tents. The political cost of visible inaction is higher than the moral cost of questionable action.

But urgency without infrastructure becomes force.

And history has seen it before.

In 1963, President Kennedy signed the Community Mental Health Act to replace institutions with neighborhood clinics. The asylums emptied. The funding never came. Reagan-era cuts severed what fragile systems remained. The idea of care wasn’t wrong. The execution was absent.

“Public order doesn’t begin with removal. It begins with presence.”

There are better models. Salt Lake City’s housing-first approach reduced chronic homelessness by 91% over a decade. In Vermont, mobile crisis teams now respond to mental health calls instead of police. These strategies work—but they require patience, dollars, and sustained leadership. None are offered in the current order.

Back on Western Avenue, someone locked the gate behind Derek’s plywood shrine. The candles are gone. The chessboard is still there. Two bishops and a pawn remain—an unfinished game no one’s coming back to finish.

He was barefoot when they took him.

We still don’t know where he is.

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Bibliography

1. Ovalle, David. “Trump Pushes Forcible Hospitalization of Homeless People with Order.” Washington Post, July 24, 2025. https://www.washingtonpost.com/health/2025/07/24/trump-homeless-forced-hospitalization-executive-order/. — Reports on Trump’s executive order encouraging civil commitment for the homeless and outlines reactions from experts and advocates.

2. Executive Office of the President. Ending Crime and Disorder on America’s Streets. Executive Order, July 24, 2025. — Full text of Trump’s executive order mandating institutionalization of the homeless for “public order.”

3. The White House. “Fact Sheet: President Donald J. Trump Takes Action to End Crime and Disorder on America’s Streets.” July 24, 2025. — Summary of the executive order’s key provisions and its political framing.

4. American Civil Liberties Union. “ACLU Condemns Trump Executive Order Targeting Disabled and Unhoused People.” Press release, July 24, 2025. — Civil rights organization’s response warning against forced institutionalization and privacy violations.

5. Substance Abuse and Mental Health Services Administration (SAMHSA). “Deinstitutionalization: Community Treatment and Civil Commitment in the U.S.” SAMHSA Background Brief. — Historical context on deinstitutionalization and the evolution of civil commitment standards.

6. Mathis, Jennifer. Statement in Ovalle, David. “Trump Pushes Forcible Hospitalization of Homeless People.” Washington Post, July 24, 2025. — Commentary on the legal and ethical problems with forced institutionalization.

7. Dailey, Lisa. Executive Director, Treatment Advocacy Center. Quoted in Ovalle, David. Washington Post, July 24, 2025. — Argues for earlier intervention to treat serious mental illness to avoid incarceration or homelessness.

8. Humphreys, Keith. Quoted in Ovalle, David. Washington Post, July 24, 2025. — Discusses political resonance and public frustration over visible homelessness.

9. “Confining the Poor: Poorhouses and Workhouses.” In Historical and Modern Institutionalization of Marginalized Populations, Part 1. — Documents the punitive logic of 18th–19th century poorhouses and their harsh conditions.

10. “Institutionalizing the ‘Insane’: Lunatic Asylums and Involuntary Commitment.” In Historical and Modern Institutionalization of Marginalized Populations, Part 1. — Describes the rise of asylums and legal laxity in 19th-century mental health commitments.

11. Bly, Nellie. “Ten Days in a Madhouse.” New York World, 1887. — Groundbreaking exposé on conditions at Blackwell’s Island Asylum and early journalism challenging institutional abuse.

12. Deutsch, Albert. The Shame of the States. New York: Harcourt, Brace, 1948. — A critical survey of postwar American mental institutions, exposing neglect and abuse.

13. Kennedy, John F. “Special Message to the Congress on Mental Illness and Mental Retardation.” February 5, 1963. — Introduced the Community Mental Health Act and began deinstitutionalization.

14. O’Connor v. Donaldson, 422 U.S. 563 (1975). — Supreme Court ruling that one cannot be involuntarily committed without clear evidence of danger or inability to survive independently.

15. Life Magazine. “Bedlam 1946.” Life, May 6, 1946. — Iconic photo essay documenting horrific asylum conditions in the U.S., helping galvanize public demand for reform.

16. Salt Lake County. “Final Report: Housing First Outcomes.” Salt Lake City, UT: Department of Human Services, 2024. — Provides data on long-term housing reducing chronic homelessness by over 90%.

17. Koh, Katherine. Quoted in Ovalle, David. Washington Post, July 24, 2025. — Harvard psychiatrist warning against expanding forced hospitalization without systemic support.