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President Trump wants far more homeless Americans with addiction and mental illness sent to institutions. The idea is spelled out in one of his executive orders. NPR's Brian Mann spent time with a family in Oregon that experienced this kind of forced medical care, and they say it can be lifesaving. They also fear that it could be misused.
JUDY THOMPSON: This is...
BRIAN MANN, BYLINE: Midmorning, Judy Thompson makes coffee in her tidy kitchen in St. Helens, Oregon, a small town near Portland.
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THOMPSON: How about a dove? I'll wash this off for you.
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MANN: Thompson, who's 73, takes me into her living room, which she's turned into a kind of headquarters. She's a leading activist in Oregon, lobbying for better services for people with mental illness - a campaign that began in the '90s when her son fell ill.
THOMPSON: He kept saying, you know who I am. You know who I am. And finally, he just said, I'm God. It was horrible. It was crushing.
MANN: Her son was diagnosed with bipolar schizoaffective disorder. I've come to meet Thompson because she testified this year in favor of Oregon's new civil commitment law, just enacted, which makes it easier for judges to force people facing severe addiction or mental illness into care, including institutionalization. Thompson says she came to believe government-mandated hospital care should be used more often. After her son's illness spiraled out of control in 2019, he began refusing to take his medication, and the episode ended in a car chase with police.
THOMPSON: He hit a car that hit another car - very totaled. He popped up out of the car and introduced himself as a U.S. marshal.
MANN: No one was killed. But Thompson says her son put other people in grave danger and wound up with a criminal record, all before a judge finally agreed to send him to a mental hospital.
THOMPSON: This thing where you have to wait till they've hurt themselves or they've hurt somebody else. We need some wiggle room before things collapse and end up in this big, horrific, horrible nightmare.
MANN: A lot of states have some form of civil commitment law. And Oregon's not alone in moving to expand its use. California and New York have also made it easier to mandate health care for addiction and mental illness. President Trump campaigned for a second term, in part on the idea that the U.S. should use this legal process more aggressively to force people living on the streets into institutions. Here he is speaking in 2023.
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PRESIDENT DONALD TRUMP: And for those who are severely mentally ill and deeply disturbed, we will bring them back to mental institutions where they belong.
MANN: Trump signed an executive order this summer urging state and local officials to ramp up use of long-term institutionalization as a way to reduce homelessness, crime and disorder on American streets. I asked Thompson what she thinks about Trump's idea. She says she's skeptical.
THOMPSON: It can be used for good or bad. It can be used to help or to harm.
MANN: She says her caution comes from her experience seeing this from both sides - fighting at times to have her son committed to an institution but also seeing up close what it's like to have the government take a person's freedom.
THOMPSON: I wouldn't want that, you know? So what's the medium? Where's the middle ground where people can meet?
MANN: Thompson takes me across the street to her son's apartment.
Nice to meet you. OK if I just come in?
ALTON AANDERUD: Sure.
MANN: Thank you.
They've been close neighbors now for years. Six years after that car crash that led to his last hospitalization, Alton Aanderud (ph) is 53, and he's doing well. His small home is even more tidy than his mother's. We sit, and he talks about a life redefined by mental illness.
AANDERUD: You know, I look at myself for a long time. And, man, I had this horrible, horrible illness.
MANN: At times, Aanderud's illness was so severe it left him homeless and led to repeated hospitalizations and run-ins with police. Now he lives with a lot of independence, thanks to medications and therapy. I ask if he agrees there were times when he needed civil commitment and institutional care.
AANDERUD: Yes. Primarily yes. But civil commitment is very scary because you don't know what you're getting into.
MANN: This is where their skepticism about Trump's executive order comes in. Aanderud and his mother agree civil commitment should be used only when absolutely necessary, after all other interventions have been tried, and hospitalization should be the shortest possible period of time. But the idea of using long-term institutionalization to reduce crime and homelessness, as Trump proposes, worries them.
AANDERUD: It's case by case, not, oh, just throw them all in an institution. That's wrong.
THOMPSON: It's like, throw the garbage away. And it's horrifying.
MANN: Trump has described long-term institutionalization as tough but compassionate - a way to protect the public while stabilizing people he describes as dangerously deranged. A senior White House official who spoke to NPR on condition of anonymity said Trump's executive order would be implemented by states in ways that respect people's rights. Aanderud worries the government could wind up forcing too many people into institutions for too long. His experience left him convinced civil commitment, even under the best circumstances, is traumatic. He says it left him isolated - his already fragile life in shambles.
AANDERUD: When I got out of Oregon State Hospital - I spent five months there, and I had nothing when I came home - no place to live, one pair of pants, one shirt, pair of shoes. It's disheartening when you just go, jeez, I'm going to be back at square one again.
MANN: With help from his mom, Aanderud was able to rebuild his life. But a lot of the homeless people who are Trump's focus don't have that kind of support. Aanderud says, if overused, civil commitment could damage Americans with addiction and mental illness, leaving them more vulnerable than before they were institutionalized.
Brian Mann, NPR News, St. Helens, Oregon.
(SOUNDBITE OF ANDREW GIALANELLA'S "TRY AGAIN") Transcript provided by NPR, Copyright NPR.
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