Republished with permission from Daily Montanan, by Darrell Ehrlick
Social services leaders in Montana say a recent executive order from President Donald Trump would mark a complete reversal of the progress the state has made addressing the needs of people who are houseless and face addiction and mental health challenges.
For more than a decade, the State of Montana has tried to bring itself out of the era of institutions—where imposing buildings usually housed people who had few other options. Galen, Warm Springs and Boulder were all sites of state-run institutions, many of which had notorious stories of people being abused or forgotten, by being institutionalized, or as critics and historians called it “warehousing.”
However, in July, President Donald Trump embraced revamping the idea of large-scale institutionalization, this time targeting those with mental illness, addiction or those who are homeless. In fact, he signed an executive order that would mark a complete reversal of what state leaders have been attempting—to clear out and close statewide institutions and send those who struggle with mental health, addiction or chronic homelessness closer to the communities from which they came. While it’s unclear what effect the executive order will have on Montana—the order was one of many which have come from the White House since he took office—it could point to shift in funding, while the President has already proven he’s willing to leverage federal power to remove homeless people, as he has recently in Washington, D.C.
“The federal government and the states have spent tens of billions of dollars on failed programs that address homelessness but not its root causes, leaving other citizens vulnerable to public safety threats,” Trump wrote in his executive order on July 24. “Shifting homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment will restore public order.”
In Montana during the past two decades, taxpayers and leaders have spent millions on transforming a system of institutional-based care into one closer to communities and less formalized. The state’s largest psychiatric hospital in Warm Springs hasn’t been funded by the federal government of Medicaid in years after a series of abuses surfaced in 2022. Since its earliest days, the Gianforte administration has pledged to restructure, revamp and restore the care there, and officials with the Montana Department of Public Health and Human Services, which has oversight of the facility, says it may reapply for federal certification in 2026, after years of mostly state taxpayer support.
Furthermore, the Gianforte administration has also stressed that services need to be located throughout and across the state instead of in one location in order to help reintegrate residents struggling with mental health and addiction. Moreover, Gianforte created a special fund, the HEART Fund, which gives grants to communities throughout Montana to provide local or regional services.
“It’s disappointing to see because Montana has a clarity of vision for community-based services,” said David Carlson, the Executive Director of Disability Rights Montana. “People and leaders have been actually doing it.”
Despite Trump and most of Montana’s leaders sharing the same political party, they don’t necessarily share the same view of how to solve the increasing number of homeless people who also live with addiction or mental illness. And Trump’s move back to institutionalization concerns leaders.
The Daily Montanan reached out to the governor’s office about the executive orders and how they dovetail with the Gianforte administration’s plans, but it received no comment.
“Montana has been thinking hard about theses things, and we’ve inverted it. We’re in the de-institutionalization process. The Legislature gets it,” Carlson said. “You need to send someone from say, Sidney, all the way to Warm Springs. You shouldn’t have to send them that far from their community to get help.
“And Montana gets that.”
He said that shifting back to a long-term institutional model is “just not supportable as a policy.” He said that the state has seen too many horrible stories of abuse and neglect, and he can’t think of politicians on either side of the political spectrum who support the idea.
“The president can articulate it as an idea,” Carlson said. “But he is not a legislature of one.”
As an attorney and a leader, he said the president’s idea is not supported by the law. He said laws have evolved to add more protections for vulnerable residents, including due-process and health leaders have a much better understanding about mental illness and addiction.
Carlson said Trump’s executive order is a play for “warehousing”—or just herding those with chronic mental or addiction problems into a place that is out of the public’s eye. He said what’s even more concerning is that it could be providing an economic incentive for warehousing where buildings, institutions, jobs and programs are created by private industry to address the president’s executive order, creating a new cottage industry of institutions.
“I don’t think you get the most humane settings with institutional care,” Carlson said. “That model is living with 300 other people and being told what to do.”
Leaders are also concerned that as dangerous as the idea of returning to institutionalization can be, Trump’s order also creates an unwarranted fear of those who are unhoused.
“People who are unhoused are far more vulnerable than dangerous,” Carlson said. “But (the order) gives the impression that downtown Billings or Helena are scary places.”
He said that the growing concern about those who are unhoused or who are mentally ill isn’t necessarily a bad thing.
“If you’re disturbed because you’re seeing unhoused in the community, it’s because your compassionate and asking: Why does it exist in such a rich society?” Carlson said.
Brayton Erickson, the executive director of the Butte Rescue Mission, said that Trump’s suggestion wasn’t clear, and it worries him. His group works nonstop with an unhoused population, many of whom struggle with addiction or mental illness.
“If that means just rounding them and institutionalizing them, that’s not healthy at all,” Erickson said. “If we change some of the way to look at it differently than we did in the past, and we use it as a means to offer more services, then by all means.”
Erickson said he worries about the executive order failing if it’s attempted.
“You can’t outlaw tragedy,” he said.
He said that the federal government down to local leaders have to understand more about the causes of homelessness, addiction and mental illness. Furthermore, Erickson said that changing people’s lives is a matter of breaking a “vicious cycle” of events—from providing housing to more mental health.
“Housing, mental health and addiction is as complex as the individual,” Erickson said. He said while basic shelters may help alleviate pressure, there are other factors to ending homelessness. For example, is there mental health care to help stabilize individuals?
Erickson said that often the largest mental health centers in any city is the local jail.
He said with just a handful of beds for psychiatric needs, the state and federal government need to consider lifting the current cap on the beds so that facilities can support more patients and more resources for those struggling.
“A lot of mental illness starts with trauma. A lot of addiction starts with trauma. A lot of homelessness starts with trauma,” Erickson said.
Carlson said that much of the animosity against those who struggle with addiction, mental health or housing stability comes from underlying beliefs that people have about those populations, for example, that those who are unhoused are loafing or do not work hard.
“The national narrative is that homeless people are the problem—not the cost of housing and not the cost healthcare, not the access to mental health,” Carlson said. “There are so many different variables that are tied to homelessness.”
He said the solution isn’t warehousing or institutionalization, instead Carlson said that communities that have made positive strides in addressing homelessness have moved to a housing-first model, which stresses providing housing without so many administrative hoops or long prescriptive lists of rules.
“If the problem is the unhoused community, then the solution is to give them housing,” Carlson said. “But people get tied up in moral judgment: ‘Oh, they need to work.’”
He said that fiscally conservative Montana should welcome a housing-first model because it’s cheaper and less burdensome than building an entire institutionalized setting with staff and buildings.
“The infrastructure is very expensive. The operation is very expensive—as opposed to a community-based solution,” Carlson said, pointing out that when a person is institutionalized by the government whether that’s a facility or jail, the government then has the economic burden of providing housing, food and healthcare—a more costly endeavor.
He sees what is happening as example of history repeating itself, this time from the Gilded Age.
“The richest have opulent wealth while the rest have nothing,” he said. “It’s unnerving, and I think it has shocked a lot of people. There are not a lot of people that think this way. No one has suggested these as solutions for decades.”
Daily Montanan
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