Arizona disability advocate says Trump order is an attack on people with serious mental illness

President Donald Trump signed an executive order last month that marks a major change in the way the United States handles homelessness and serious mental illness.

It targets homeless encampments, expands involuntary civil commitment and pushes for people to be put into mental health or addiction treatment.

Many see it as a move backward toward forced institutionalization of people with mental illness. But others say the system we have now has gone too far the other direction — and it isn’t working.

Disability advocate J.J. Rico, CEO of Disability Rights Arizona, says this order is a blatant attack on people with serious mental illness.

Full conversation

J.J. RICO: Call it institutionalization, we'll call it warehousing, but that, that's a concern and where I think we're, we're failing on this executive order and also for our community is what the root cause of these problems are. And that's needing more affordable housing, needing more independent, accessible and community-based services, or wraparound services for people with serious mental illness that maximizes their treatment and most importantly, you know, their ability to live independent lives.

LAUREN GILGER: You mentioned, you know, the ability for people to live independent lives. A lot of this, I think has to do with the concern about the loss of liberties, individual liberties, and the question of how widespread, with an order like this, involuntary treatment will become for someone with serious mental illness.

RICO: Most definitely, that's going to be the result. I mean, once someone's institutionalized or court ordered, they lose those liberties, those independent choices. Oftentimes there's misdiagnosis. There's folks who have co-occurring disabilities or multiple disabilities that aren't effectively treated in environments like mental health hospitals.

So there's a lot of layers here that the executive order is very broad at this point, seeing how it's implemented, seeing how it's enforced, or to what extent law enforcement might be involved. There's a lot of concerns at this point from our office.

Disability Rights Arizona

GILGER: Yeah. Let me ask you about the flip side of that and some of the people who are glad to see this executive order. Without these institutions in place, we've seen a whole lot of people with serious mental illness end up on the streets. And you know, that's not safe for them. It's not good for society. Is there enough of an alternative that has been put into place — since these institutions were dismantled — to treat these folks?

RICO: I mean, the short answer is no, there has not been enough investment in these community-based services, and that's where I think we have an issue. So I'm not gonna act like there's not an issue related to proper and adequate home and community-based services for people with serious mental illness. But the solution is not what's outlined in this executive order.

So proper investment in housing wraparound services, we may not be having this discussion if we did effectively fund those programs. And this current administration seems to be cutting the very programs that could serve these folks, the recent passage of the cuts to Medicaid. I mean, we're cutting Medicaid that does provide a lot of services to people with serious mental illness. So, it just doesn't seem like they're addressing the root of the problem and instead trying to find a quick solution. Which there is no quick solution to this issue.

GILGER: You bring up the cuts to Medicaid, which makes me think about the cost of this, right? And concerns about the cost of mass commitment of creating a place for folks with serious mental illness to go to be treated involuntarily or otherwise. I mean, where would that money come from?

RICO: Yeah, I would ask that, right? I mean, if we're cutting Medicaid and then we're thinking that, I mean, there's hospitals. I mean, if we just look at Arizona, I mean, there's only one Arizona state hospital right now, and that does not have beds adequate for even the current residents that are there. So, I don't know where they anticipate treating these individuals, helping these individuals. I mean, what we've been left with is our Department of Corrections, which is also failing people with serious mental illness and people with other disabilities.

So, ultimately, I think, again, that's why you go back to the term of warehousing. Because there is not a place at this point to actually provide treatment. So, you can sign an executive order, but you don't have anything in place — and every state is different. So if, if some states have beds, then will they get treatment, but Arizonans might not? I mean, this is concerning nationwide.

GILGER: Does this mark a turning point for you, J.J., in terms of the country's approach to serious mental illness and disability rights?

RICO: Yes and no. I mean, it's shocking that an executive order from the president of the United States would have this as a solution or this as an agenda item. So that's surprising. We just passed the 35th anniversary of the Americans with Disabilities Act. We're 50 years removed from the Rehabilitation Act. We're 50 years removed from programs like our protection and advocacy programs that allow us as an agency to go into institutions and make sure folks are free from abuse and neglect.

So, it's surprising that it's coming from the president when Congress has clearly, and the Supreme Court, has clearly stated, you know, that people with disabilities have rights. And so it's concerning that it's coming from that office. But I'm also confident that the community will mobilize against this. I'm also confident that there's probably a series of laws that this would violate if and how this is enforced.

GILGER: Is there a middle ground, J.J.? I know you can get people in treatment for, you know, a couple of days. There's usually like a 72-hour hold and then they're released. We see lots of criticism of this street, treat, repeat cycle, right? Someone goes into a short amount of treatment is held for a couple of days, they get put back on the street and then they end up back in the same cycle again with, you know, jail being a part of that at some point as well. I wonder if you're looking at the possibility of a shift in this and institutions being part of the future of this system. Is there a way to do that well?

RICO: I might not be the right person to answer that, because I don't think when we say institution, I envision a locked secured facility. And I don't think that's the solution. So I envision where again, as I call wraparound services. So that if somebody does have, as you describe a 72-hour hold, we're not just releasing them back on the street in the same circumstances that will just create a cycle and pattern.

Do we have adequate programs or services to really help them successfully transition back, you know. And again, if this person is unhoused because that's a big part of this executive order also. Are we just then putting them literally back on the street? Which lends itself to a number of problems, exposure to a lot of things that, you know, could exacerbate their mental illness, could lead to harm, etc.

So, you know, in my mind, if we're gonna do hold, obviously involuntary commitment has been increasing. We need to also make sure that if we are committing our folks, which we are not in support of, that we're also making sure that they have services when they return to the community. And that's, you know, intersects with all areas of life, you know, if we're trying to return into our community and be an active participant, we need supports and services and not cutting those various services and programs that do serve this community.

GILGER: So, your answer is no, there's not a good way to do that. But it sounds like for you it's really it's about funding the systems that we have in place. And the reason that they're criticized for not working the way they're supposed to, you say, is because they're underfunded.

RICO: Right, I mean, we need to invest in those programs that work. I mean, these are not, you know, the last administration programs. These started back with George Bush. This is, you know, been found to be also when you talk about earlier, I think you had a question about maybe funding.

I mean it costs more to institutionalize folks or incarcerate people. If we're talking about waste fraud and abuse, we should really invest in programs that work, which are community-based services. But they have to be adequately funded, not just, oh we have we have one or we have a program that has has limits. There needs to be a lot more investment in them to make sure that they're successful.

I don't think we as a community ever want to go back to the out of sight, out of mind times. And so I'm hopeful, and I hear a lot of loud voices and I can hope that they continue to be louder, especially with the idea that institutionalization is an option — and it shouldn't be.