August 7, 2025 • 23 mins
August 7, 2025- In the wake of Gov. Kathy Hochul pushing to make it easier for New Yorkers to be involuntarily committed, President Donald Trump issued an executive order designed to promote more forced psychiatric institution of the country's homeless population. We unpack the significance of the action at the federal level, which could also hurt undermine harm reduction efforts in New York, with Patrick Wildes, director of the Government Law Center at Albany Law.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
This spring, state lawmakers, at the behest of Governor Kenfy Hochel,
approved language intended to make it easier for more New
Yorkers to be involuntarily committed, and in the wake of
this controversial decision, President Donald Trump signed an executive order
this summer directing federal agencies to explore how homeless people
with mental illness or substance abuse problems could be forcibly
hospitalized for longer periods. The initiatives by Hocheal and Trump
(00:25):
both stem from concerns about public safety, which advocates for
mental health and the homeless argue are misguided and can
be unproductive. To discuss these moving parts, we're joined on
the Capital pressroom by Patrick Wilds, director of Albany Law
School's Government Law Center, who in another life was assistant
Secretary to Governor Hokel for Human Services and Mental Hygiene.
Welcome back to the show, Patrick, Thanks goodness to you. Well.
(00:48):
Before we get into what's happening in Washington, d C.
I want to follow up on our conversation from May
when you discussed the language and the state budget dealing
with involuntary commitment, an interview that listeners can find at
Capitol Pressroom dot org, wherever you get your favorite podcasts.
Where are we in terms of the implementation of that
language nearly three months.
Speaker 2 (01:06):
Later as far as I can tell, right, I mean,
the budget finished in the middle of May, so the
law went into effect immediately. So as of right now,
there is a broader standard in New York State statute,
in the New York State Mental Hygiene Law when it
pertains involuntary commitment when it comes to that rationale for
both reason for transport and then potentially for admission for
a serious mental illness.
Speaker 1 (01:26):
So it's one thing to have a law, but often
those laws are incompanied by guidance or regulations. Has the
State Office of Mental Health put anything out to help
the stakeholders and partners understand what their responsibility is moving forward,
or provide any sort of clarity on how to enforce
this updated language.
Speaker 2 (01:44):
My understanding was that guidance either had gone out or
was going to go out regarding this in the last
week or two. So I'm not sure where that stands.
I haven't had a chance to read through it fully,
but I know that it was either going to go
out or should have been out.
Speaker 1 (01:56):
From what you saw of the guidance that was posted
with the caveat that we don't have it in front
of ourselves right now. Did it seem to be in
line with what was already on the books. Did it
represent a broad expansion, because that was sort of the
push from the governor was that what we have in
place isn't meaningful right now, and that we need to
update the law and what would think subsequently guidance to
(02:20):
ensure that it is being utilized more broadly.
Speaker 2 (02:22):
From what I saw, and like you said, I mean
I did see it, I haven't looked at it in
the last day or so, I believe it was really
trying to explain in more specific examples how this new
kind of broaden statutory definition would actually be would play
out in practice and kind of give some real world
examples of where someone who might need support and may
now be able to be transported and potentially admitted who
couldn't have been before. I think that was really the
(02:44):
ideas to try to spell it out in more finite terms.
Speaker 1 (02:47):
Well, that's definitely an area we'll have to keep an
eye on, but for now, we've only got the federal
changes to talk about, and thinking about what the Trump
executive order is trying to do here, there's often a
dis connect with his directives between what is in the
press release and maybe what's actually being substantively done. So
(03:09):
press release, the executive order is ending crime and disorder
on America's streets in reality? What do you think of
this executive order? What is the meat and potatoes of it?
What should listeners know?
Speaker 2 (03:20):
There's a lot of pieces, right, It's got five or
six subsections. I will say it definitely takes a public
safety heavy approach to addressing homelessness. I think that from
the outset, there's a major at the very least tie
to and a lot of instances, probably a conflation with
mental illness and substance use disorder. Almost assuming from the
outset that every person that is unhoused nationally or it's
(03:43):
very likely that each person has either slash and a
mental illness and or substance use disorder. So I think
that that's like an important kind of underlying theme to
it is that it seems to indicate that any addressing
of homelessness is going to have to be heavily based
on a public safety approach of looking at mental illness
and substance use.
Speaker 1 (04:02):
And another element of this, which I think means a
lot to the substance abuse providers in New York, is
the way the federal government, at the direction of the President,
would approach programs dealing with harm reduction. Those are typically
seen as evidence based and successful in keeping people alive.
(04:22):
What is the Trump administration's approach?
Speaker 2 (04:24):
Yeah, And I think it's important to also reference for
listeners that the executive Order came out on July twenty fourth,
I believe on July twenty ninth SAMPSO, which is the
Federal Substance Abuse and Mental Health Services Agency. I believe
I got the acronym right. Put out a Dear Colleague
letter kind of trying to explain, at least in regards
to the substance use treatment and harm reduction side of
(04:45):
the executive Order, what they mean and what their vision
is moving forwards. So if you don't mind, I can
get into that for a minute. Sure, the executive Order
speaks to kind of on broad terms, turning away from
harm reduction, and there's especially almost every time you see
harm reduction in there, there's also a mention and of
something of either safe consumption sites or overdose prevention centers
or something of that equivalent. So it's very clear that
the federal government is tying harm reduction very centrally into
(05:08):
that discussion and not thinking about it maybe more broadly.
Speaker 1 (05:11):
And for listeners, those safe consumption sites are the areas
two of which exist in New York City where you
can consume illegal drugs under basically the supervision of medical providers,
in addition to a range of other services being offered there.
Speaker 2 (05:25):
Right right, And I think what you emphasize at the
end there is that there are a lot of other
services provided at an overdose prevention center than just the
ability to in theory, safely use illicit substances. The executive
order speaks to the idea of trying to really take
a close look at grant opportunities and funding that's coming
from SAMs as it pertains to addiction, and really make
(05:45):
sure that there's evidence based practices being used, but kind
of indicates that harm reduction isn't evidence based. The Dear
Colleague letter gets into kind of what they mean by that,
and they kind of rewrite their definition of harm reduction.
So in the Dear Colleague Letter they actually get into
it's almost lined out here are types of services and
programs that we think are permissible and that we don't
consider harm reduction. And here are the things that we
(06:06):
actually think are problematic. And when people think of harm reduction,
we think of you know, it's quite literally what it
sounds like, right. It is strategies or programs that are
designed to limit the risk of harm to people who
are doing a set activity. And here it's drug use,
so things like the lock zone or narcan people know
it by or fentyl test rips and xaladine test rips
and medication lock boxes and wound care kits. That's all
(06:30):
very standard harm reduction stuff, right. Everyone knows that it's
evidence based stuff. It works the executive order though, and
then by extension, the Dear Colleague letter really says a
lot of that's not harm reduction. Harm reduction is really
safe consumption sites. It's buying pipes for people, so we
don't want to do that anymore. But the test strips
and the lock zone, narcan, that's all fine. And they
even go as far as to differentiate in the Dearly
(06:51):
Colleague letter that the lock zone is and almaphine, which
is a whole other discussion. But these overdose reversal medications.
They're not really harm reducts at all. They're separate. So
the Dear Colleague letter spells out more finite terms what
they actually mean. But I think it's important for folks
to realize that there's broad strokes being painted in the
executive order. The Dear Colleague letters starts the signal or
(07:11):
they're actually trying to go with this.
Speaker 1 (07:13):
So Governor Hochele has been very clear that she is
not regulating the safe consumption sites in New York City,
she's not spending money on them. Given all that, though,
how do you envision the federal government approaching the existence
of those overdose prevention centers in New York City? Is
it possible that state funds still might get tied up
(07:36):
because they Trump administration says, this is happening on your watch.
I don't care if you're not giving it your blessing,
you're implicitly doing it by not shutting them down. So
if you're the Whopal administration right now, do you think
they should be worried about some of their discretionary grants
that either flow to the state or to nonprofits potentially
getting hung up because of the existence of these sites.
Speaker 2 (07:58):
That would be a very specific question and pertaining to
like the one organization that actually operates the two over
those prevention centers that you're referencing in New York City.
And I can't sit here right now and even tell
you if they receive any state.
Speaker 1 (08:08):
No, but I'm saying the other people. Could you say, Hi,
New York. Until you do something about these guys, your
other people aren't going to get money. Would that be
a legitimate fear for the state.
Speaker 2 (08:19):
I think it's a fair assumption to make from reading
this that there could be a lot of the hanging
this over your head. If you don't do X, then
maybe funding will flow your way the same way. I
wouldn't say it's that explicitly stated in here, from being honest,
but I do think there's like kind of an overall
kind of theme and flavor that would support there being
some concern there for sure.
Speaker 1 (08:38):
Obviously New York has not gotten behind the safe consumption sites,
including the two that are already in existence in New
York City, but there is not just a tacit endorsement
of something like a needle exchanges. I imagine there's actually some
money that flows towards ensuring that people aren't using contaminated needles.
So is that something that could we targeted by the
(09:02):
federal government here, Because when I think about something like,
you know, distributing drug paraphernalia, I could make the one
to one comparison there with a needle exchange program.
Speaker 2 (09:11):
I would say in shure that there should be concerns
in regards to that. Whether funding could be impacted definitely,
based on the way the executive order reads. I think
anything that is either endorsing or directly supporting the use
of illicited drugs seems to be in line for a
much closer scrutiny and potentially funding cuts or readjustments, etc.
Speaker 1 (09:29):
And after a quick break, we'll continue our conversation with
Patrick Wilds, director of Albany Law Schools Government Law Center.
Support for the Capitol Press Room is provided by New
York State United Teachers, a statewide union of nearly seven
hundred thousand professionals in education and healthcare. This is WCNYS
(09:54):
the Capitol press Room, and we're continuing our conversation about
an executive order from President Donald Trump directing federal agencies
to explore how homeless people with mental illness or substance
abuse problems could be more forcibly hospitalized for longer periods.
And our guest is Patrick Wilds, director of Albany Law
Schools Government Law Center, who in a previous life was
(10:16):
Assistant Secretary to Governor Kathy Hochel for Human Services and
Mental Hygiene. So this is a executive order targeting federal
agencies to figure out ways to basically increase the use
of involuntary commitment. When we think about who's actually doing
involuntary commitment, it seems like it's going to be the
people with the most direct contact with people, and not
(10:38):
necessarily federal government, which is, you know, levels removed. So
what other levers or powers do the federal agencies have
to increase the rate of involuntary commitment.
Speaker 2 (10:51):
One of the things that the executive order explicitly calls for.
Want to have it right in front of me. It's
actually a subsection two, so it's titled Restoring Civil Commitment,
and it really calls for the Attorney John role in
consultation with the HHS, the Federal Health and Human Services Secretary,
to really look at when I think what they say
is like we're applicable or we're appropriate but they really
say AG and HHS Secretary, you should look at applicable
(11:13):
federal and state judicial precedent consent decrees that speak to
involuntary commitment, and effectively, if it's not as flexible as
we want it to be, you should look to overturn
precedent and end consent decrees, which I think is pretty problematic.
And what I will say is, you know, depending on
the state, and I don't have in my head a
(11:34):
rolodex of the you know, mental hygiene or equivalent laws
in every jurisdiction to know where they stand. And I
think with the changes that we saw in New York recently,
which kind of extended, at least in statute, the involuntary
commitment standard to someone being able to unable to meet
their own essential basic needs food shelter, et cetera, I'd
say that there's forty some states now that have that
(11:55):
on the books, and there's several that don't, so I
could see there being a lot of full becus on
those specific states. I would say if New York hadn't
just changed its laws in the last few months, we
might have also been under increased pressure now to do
what just happened.
Speaker 1 (12:11):
And what do you think of the landscape that's described
by the Trump administration, which argues that endemic vagrancy, disorderly behavior,
sudden confrontations, and violent attacks have made our cities unsafe.
Is there reason to believe that is widely the case
or is that sort of representative anecdotal experiences.
Speaker 2 (12:32):
I think there's a lot of stigmatizing language there that's
really I think what a lot of it comes down to.
I think most people who are walking down the street,
if you ask them in an anonymous poll, if they
think that the country's doing well enough when it comes
to homelessness, I think the majority of people would almost
undoubtedly say no. But I think, and I said this
at the outset, I think conflating serious mental illness and
substance use with homelessness and saying it's all the exact
(12:54):
same thing is problematic. And I think that there's some
pieces that are missing from the equation when it comes
to kind of solving almostests that aren't being talked about
at all in the executive order. And I think we
have to look much more broadly at the federal government's
approach to this issue since they've taken office. Right You've
looked at significant Medicaid cuts that are going to take
place over the next couple of years. So many people
who receive the types of services that we're talking about,
(13:16):
people who are on the kind of very far end
of the spectrum where they have profound disabilities. Frankly, whether
it be mental illness, substance use, or otherwise, some of
those people rely on Medicaid. So you're already kind of
on a big picture level, cutting a lot of funding
and services those people are going to have access to
over time. You also look at cuts to SAMSA, right,
And I'm not going to sit here and tell you
(13:37):
that SAMSA is the best federal agency ever. I don't
know the answer to that. But you're cutting SAMs You're
cutting staff there, you're cutting resources in nine eight eight,
you're kind of chipping away at this whole behavioral health
ecosystem and you're not coming back in with funding. And
the executive order here and there does allude to, yeah,
you know, we should re look at grant programming and
make it more flexible, and maybe there are more money
here and there, but I think it would be a
(13:58):
lot more comforting for people to see action dollars being
put down and saying we're going to put money towards
fixing this, especially when it comes to the community based
services side of it, which I wouldn't feel confident in
based on the executive order has written.
Speaker 1 (14:11):
The executive Order from the President puts a lot of
stock in the benefits of forcing someone into a long
term institutional setting. What are your expectations for the success
of something like that? And the critique is that this
is akin to prison by any other name. So what
(14:34):
do you think about those two fronts?
Speaker 2 (14:36):
Yeah, and I'm going to pull a quote directly from
earlier on in the Executive Order. I think it's actually
in their subsection one, which is shifting homeless individuals into
long term institutional settings for humane treatment through the appropriate
use of civil commitment, will restore public order. I think
when people, especially New Yorkers, hear the term institutionalization or
institutional they think back to places like Willebrook. They think
(14:58):
back to what our mental health system looked in the
nineteen fifties and sixties for those who are around for that,
and that represents dark times. And I would say as
a state here in New York, we've made a good
amount of progress moving away from that and towards making
sure people are in the most integrated setting imaginable. Of course,
following you know, Supreme Court President, like the om said
decision following the Americans with Disabilities Act. I think here
(15:20):
in New York that's going to strike a tone for
people that moving back towards institutionalization, which doesn't really get
spilled out in great detail throughout the executive Order, but
even kind of the ominous threat of that from the
very outset is very problematic.
Speaker 1 (15:33):
But what about the last part of that statement, which
is restore public order? Because to my years and I
think to other people who might be following the governor's
push here in New York for expanded involuntary commitment might say,
sounds exactly like what the governor has been talking about.
Seems like the same language New York City Mayor Eric
Adams is using. So from a philosophical point of view,
(15:57):
is there a big difference between what is being pushed
here in Albany and what's being pushed in DC.
Speaker 2 (16:03):
I would say the difference, certainly in New York versus
nationally is New York has over the last couple of years,
And I really wish this year's budget would have done
a lot more in this regard. Has invested in the
behavioral health workforce, which is still you know, very far
behind the times after not having had you know, increases
for many years. Minderstanding is that's actually a national issue.
I've talked to some friends or in different parts of
the country, and there's issues with the behavioral health and
(16:25):
human services workforce nationally. So at least as far as
that piece goes, I think New York has made some
progress versus nationally the federal government. I don't know if
they've they've infused money there, but look, at the end
of the days, it's a tough question. I'm not sure
if that's the best answer for you, But I think
that the idea of you know, ensuring public safety and
(16:47):
public order by involuntarily committing people in theory, I guess
sounds good to some people. But if you don't have
the whole system built out to actually support people as
they get transported in some cases admitted, it's not going
to work. Because at the end of the day, the
gold standard, even in cases where someone's involuntary admitted, is
not to keep them there right, It's to make sure
that they get the support and help that they need
in a humane fashion and help them get back out
(17:09):
into society as a functioning member of society as quickly
as possible. And if you're not investing in the actual
community based services and supports that are needed to ensure
that that happens, it's not going to work. So it
almost feels to me like you're taking people and some
instances off the street. In the short term that may
look better, but those people are actually not going to
get the help they need if the system's not built
(17:30):
out on the back end, and I don't think this
executive order speaks to that at all.
Speaker 1 (17:33):
Well, before we move on, let me reintroduce you for
listeners just joining us. This is the Capital Press Room,
and we're speaking with Patrick Wilds, who in a previous
life was Assistant Secretary to Governor Caffe Hochel for Human
Services and Mental Hygiene and is now the director of
All Any Law Schools Government Law Center. So there's another
section the Executive Order increasing Accountability and Safety in America's
(17:55):
Homelessness Programs, and part of the actions that they lay
out out here include, to the extent permitted by law,
ending support for so called housing first policies. What is
a housing first policy? Y.
Speaker 2 (18:10):
Housing first by no means a housing expert, but housing
first is this concept that for people who are unhoused,
the most single most important thing is getting a roof
over their heads, a stable, permanent roof over their heads,
food on the table, before you start to tackle other
issues that they might also be facing. The housing first
model really focuses on saying, hey, this person's un housed,
(18:30):
let's get them into a permanent setting as soon as possible.
That may mean that that person still has ongoing mental
health challenges, ongoing and active substance use while they get housed,
and that those pieces kind of get addressed later. There
seems to be some talking points on the kind of
conservative end of the political spectrum that housing first is
ineffective because it doesn't actually require that people kind of
(18:52):
get clean, get sober before they go into housing. The
only problem with that assertion is that housing first time
and again has been proven to be a very very
effective evidence based model when it comes to housing people
who've been spending some time on the streets. You know,
it's very well established that getting a roof over your
heads is incredibly important before you address other issues in
life like employment and behavioral health issues, et cetera.
Speaker 1 (19:15):
And so what would be the ramifications for New York
of the federal government, say, de emphasizing housing first. Is
this another area where federal dollars that flow into the
housing world could be in jeopardy?
Speaker 2 (19:30):
Yeah, I mean, look, like I said earlier, I'm no
housing experts, So I think that the way that ecosystem
works in New York is probably very complicated. You know,
whether it's a relook at existing funding or if it's
going to impact how they put out grant opportunities moving forwards,
It's not quite clear yet, but it's probably something that
I think is going to raise a lot of people's
eyebrows and put their radar op As far as how
we're looking at, again, an evidence based program that's proven
(19:52):
to work. Amounts think it's perfect, but it's been proven
to work for people now being under some type of attack.
Speaker 1 (19:57):
And it also appears that the Trump administry wants to
tie federal housing and homelessness assistance to requirements that this
population is utilizing substance abuse treatment or mental health treatments
if they're diagnosed with those types of conditions. How successful
(20:18):
is that stick approach potentially going to be in getting
people to move to care who weren't already pursuing it.
Speaker 2 (20:27):
My sense is that you're going to say less people
be successful in getting housed if you require them to
be entirely clean and to have their mental health behavioral
health issues generally fully addressed by the time they go
into housing. Another thing, I'll just mention the executive order.
I don't know that it uses the word shelter once
in the entire thing. I'd have to double check what
(20:47):
I've read through it a couple of times. And not
that shelters are necessarily the gold standard when it comes
to helping the unhoused, but the reality is that the
shelter system, both here in New York and nationally is
part of the solution, and it's not even mentioned, which
makes me think that there's not even any suggestion that
that's part of the solution here, which I think is
concerning and maybe there's more forthcoming there, but I figuring
it's at least worth mentioning.
Speaker 1 (21:08):
And if there are funding cuts in the homeless space
or the substance abuse space or the mental health space,
with all of the other potential federal cuts, say, in Medicaid,
more broadly, what do you think as the state's capacity
to backfill there? I mean, how much money are we
(21:30):
talking about that could be at stake? Are we saying millions?
Are we saying billions? Too soon to tell?
Speaker 2 (21:37):
I mean too soon to tell? Especially being a lawyer,
that it depends. Answer is always the safe fallback.
Speaker 1 (21:41):
But in all seriousness, you could always say, to the
best of my knowledge, I could say another good caveat.
Speaker 2 (21:46):
That is a good caveat. What I'll say is, I
think it could be in the billions, right. I think
that you're looking at when it comes to the people
who are dealing with serious mental illness and you know,
significant substance just disorders, and are unhoused on the streets,
largely in New York City. I think you're looking at
at any given time a couple thousand people. But the
amount of money it can take and the resource it
can take to support those people is substantial. And I
(22:08):
think the Medicaid cuts, because you brought it up again,
has kind of broad application, right, that's not just specific
to this population, but it's inclusive of it. So I
think you're looking at a significant hole that this could
continue to cause in New York and a lot of
other states that are trying to help people who are
un housed.
Speaker 1 (22:22):
And finally, we're talking primarily from the federal perspective about
an executive order which doesn't necessarily carry as much weight
as a law from Congress, and that gets the blessing
of the President. So are there legislative changes from DC
that you're watching for as it pertains to the homeless
population or the ability to treat people's mental health or
(22:43):
substance abuse conditions.
Speaker 2 (22:45):
You know, legislatively, I'm not sure. I mean, that's kind
of a wait and see thing, but we'll certainly be
closely looking at that. I mean, very concerning to me
and I mentioned it a couple of moments ago. Is
just the suggestion that the Attorney General of the United
States would actually look at, you know, consent decrees and
consent orders and and existing both state and federal precedent
and looking to kind of either overturn those or right
size though so that they support the administration's interest of
(23:07):
making it easier to commit people civilly. And I think
that there are certain parts of the country where there
might be more of an appetite from state level leaders
to support that. I don't anticipate that being the case
here in New York, but it's a very concerning trend,
and I think it's just the emphasis on the wrong syllable,
if you will, when it comes to this overall issue.
Speaker 1 (23:25):
Well, we've been speaking with Patrick Wilds. He's the director
of All Many Law Schools Government Law Center and previously
served as an Assistant Secretary to Governor Kathy Hochel for
Human Services and Mental Hygiene. Patrick, thanks for visiting us
in the studio.
Speaker 2 (23:38):
Good to see you. Thanks again, and
Speaker 1 (23:42):
For more Capital Pressroom content, visit capitopressroom dot org or
wherever you download your favorite podcasts.
This spring, state lawmakers, at the behest of Governor Kenfy Hochel,
approved language intended to make it easier for more New
Yorkers to be involuntarily committed, and in the wake of
this controversial decision, President Donald Trump signed an executive order
this summer directing federal agencies to explore how homeless people
with mental illness or substance abuse problems could be forcibly
hospitalized for longer periods. The initiatives by Hocheal and Trump
(00:25):
both stem from concerns about public safety, which advocates for
mental health and the homeless argue are misguided and can
be unproductive. To discuss these moving parts, we're joined on
the Capital pressroom by Patrick Wilds, director of Albany Law
School's Government Law Center, who in another life was assistant
Secretary to Governor Hokel for Human Services and Mental Hygiene.
Welcome back to the show, Patrick, Thanks goodness to you. Well.
(00:48):
Before we get into what's happening in Washington, d C.
I want to follow up on our conversation from May
when you discussed the language and the state budget dealing
with involuntary commitment, an interview that listeners can find at
Capitol Pressroom dot org, wherever you get your favorite podcasts.
Where are we in terms of the implementation of that
language nearly three months.
Speaker 2 (01:06):
Later as far as I can tell, right, I mean,
the budget finished in the middle of May, so the
law went into effect immediately. So as of right now,
there is a broader standard in New York State statute,
in the New York State Mental Hygiene Law when it
pertains involuntary commitment when it comes to that rationale for
both reason for transport and then potentially for admission for
a serious mental illness.
Speaker 1 (01:26):
So it's one thing to have a law, but often
those laws are incompanied by guidance or regulations. Has the
State Office of Mental Health put anything out to help
the stakeholders and partners understand what their responsibility is moving forward,
or provide any sort of clarity on how to enforce
this updated language.
Speaker 2 (01:44):
My understanding was that guidance either had gone out or
was going to go out regarding this in the last
week or two. So I'm not sure where that stands.
I haven't had a chance to read through it fully,
but I know that it was either going to go
out or should have been out.
Speaker 1 (01:56):
From what you saw of the guidance that was posted
with the caveat that we don't have it in front
of ourselves right now. Did it seem to be in
line with what was already on the books. Did it
represent a broad expansion, because that was sort of the
push from the governor was that what we have in
place isn't meaningful right now, and that we need to
update the law and what would think subsequently guidance to
(02:20):
ensure that it is being utilized more broadly.
Speaker 2 (02:22):
From what I saw, and like you said, I mean
I did see it, I haven't looked at it in
the last day or so, I believe it was really
trying to explain in more specific examples how this new
kind of broaden statutory definition would actually be would play
out in practice and kind of give some real world
examples of where someone who might need support and may
now be able to be transported and potentially admitted who
couldn't have been before. I think that was really the
(02:44):
ideas to try to spell it out in more finite terms.
Speaker 1 (02:47):
Well, that's definitely an area we'll have to keep an
eye on, but for now, we've only got the federal
changes to talk about, and thinking about what the Trump
executive order is trying to do here, there's often a
dis connect with his directives between what is in the
press release and maybe what's actually being substantively done. So
(03:09):
press release, the executive order is ending crime and disorder
on America's streets in reality? What do you think of
this executive order? What is the meat and potatoes of it?
What should listeners know?
Speaker 2 (03:20):
There's a lot of pieces, right, It's got five or
six subsections. I will say it definitely takes a public
safety heavy approach to addressing homelessness. I think that from
the outset, there's a major at the very least tie
to and a lot of instances, probably a conflation with
mental illness and substance use disorder. Almost assuming from the
outset that every person that is unhoused nationally or it's
(03:43):
very likely that each person has either slash and a
mental illness and or substance use disorder. So I think
that that's like an important kind of underlying theme to
it is that it seems to indicate that any addressing
of homelessness is going to have to be heavily based
on a public safety approach of looking at mental illness
and substance use.
Speaker 1 (04:02):
And another element of this, which I think means a
lot to the substance abuse providers in New York, is
the way the federal government, at the direction of the President,
would approach programs dealing with harm reduction. Those are typically
seen as evidence based and successful in keeping people alive.
(04:22):
What is the Trump administration's approach?
Speaker 2 (04:24):
Yeah, And I think it's important to also reference for
listeners that the executive Order came out on July twenty fourth,
I believe on July twenty ninth SAMPSO, which is the
Federal Substance Abuse and Mental Health Services Agency. I believe
I got the acronym right. Put out a Dear Colleague
letter kind of trying to explain, at least in regards
to the substance use treatment and harm reduction side of
(04:45):
the executive Order, what they mean and what their vision
is moving forwards. So if you don't mind, I can
get into that for a minute. Sure, the executive Order
speaks to kind of on broad terms, turning away from
harm reduction, and there's especially almost every time you see
harm reduction in there, there's also a mention and of
something of either safe consumption sites or overdose prevention centers
or something of that equivalent. So it's very clear that
the federal government is tying harm reduction very centrally into
(05:08):
that discussion and not thinking about it maybe more broadly.
Speaker 1 (05:11):
And for listeners, those safe consumption sites are the areas
two of which exist in New York City where you
can consume illegal drugs under basically the supervision of medical providers,
in addition to a range of other services being offered there.
Speaker 2 (05:25):
Right right, And I think what you emphasize at the
end there is that there are a lot of other
services provided at an overdose prevention center than just the
ability to in theory, safely use illicit substances. The executive
order speaks to the idea of trying to really take
a close look at grant opportunities and funding that's coming
from SAMs as it pertains to addiction, and really make
(05:45):
sure that there's evidence based practices being used, but kind
of indicates that harm reduction isn't evidence based. The Dear
Colleague letter gets into kind of what they mean by that,
and they kind of rewrite their definition of harm reduction.
So in the Dear Colleague Letter they actually get into
it's almost lined out here are types of services and
programs that we think are permissible and that we don't
consider harm reduction. And here are the things that we
(06:06):
actually think are problematic. And when people think of harm reduction,
we think of you know, it's quite literally what it
sounds like, right. It is strategies or programs that are
designed to limit the risk of harm to people who
are doing a set activity. And here it's drug use,
so things like the lock zone or narcan people know
it by or fentyl test rips and xaladine test rips
and medication lock boxes and wound care kits. That's all
(06:30):
very standard harm reduction stuff, right. Everyone knows that it's
evidence based stuff. It works the executive order though, and
then by extension, the Dear Colleague letter really says a
lot of that's not harm reduction. Harm reduction is really
safe consumption sites. It's buying pipes for people, so we
don't want to do that anymore. But the test strips
and the lock zone, narcan, that's all fine. And they
even go as far as to differentiate in the Dearly
(06:51):
Colleague letter that the lock zone is and almaphine, which
is a whole other discussion. But these overdose reversal medications.
They're not really harm reducts at all. They're separate. So
the Dear Colleague letter spells out more finite terms what
they actually mean. But I think it's important for folks
to realize that there's broad strokes being painted in the
executive order. The Dear Colleague letters starts the signal or
(07:11):
they're actually trying to go with this.
Speaker 1 (07:13):
So Governor Hochele has been very clear that she is
not regulating the safe consumption sites in New York City,
she's not spending money on them. Given all that, though,
how do you envision the federal government approaching the existence
of those overdose prevention centers in New York City? Is
it possible that state funds still might get tied up
(07:36):
because they Trump administration says, this is happening on your watch.
I don't care if you're not giving it your blessing,
you're implicitly doing it by not shutting them down. So
if you're the Whopal administration right now, do you think
they should be worried about some of their discretionary grants
that either flow to the state or to nonprofits potentially
getting hung up because of the existence of these sites.
Speaker 2 (07:58):
That would be a very specific question and pertaining to
like the one organization that actually operates the two over
those prevention centers that you're referencing in New York City.
And I can't sit here right now and even tell
you if they receive any state.
Speaker 1 (08:08):
No, but I'm saying the other people. Could you say, Hi,
New York. Until you do something about these guys, your
other people aren't going to get money. Would that be
a legitimate fear for the state.
Speaker 2 (08:19):
I think it's a fair assumption to make from reading
this that there could be a lot of the hanging
this over your head. If you don't do X, then
maybe funding will flow your way the same way. I
wouldn't say it's that explicitly stated in here, from being honest,
but I do think there's like kind of an overall
kind of theme and flavor that would support there being
some concern there for sure.
Speaker 1 (08:38):
Obviously New York has not gotten behind the safe consumption sites,
including the two that are already in existence in New
York City, but there is not just a tacit endorsement
of something like a needle exchanges. I imagine there's actually some
money that flows towards ensuring that people aren't using contaminated needles.
So is that something that could we targeted by the
(09:02):
federal government here, Because when I think about something like,
you know, distributing drug paraphernalia, I could make the one
to one comparison there with a needle exchange program.
Speaker 2 (09:11):
I would say in shure that there should be concerns
in regards to that. Whether funding could be impacted definitely,
based on the way the executive order reads. I think
anything that is either endorsing or directly supporting the use
of illicited drugs seems to be in line for a
much closer scrutiny and potentially funding cuts or readjustments, etc.
Speaker 1 (09:29):
And after a quick break, we'll continue our conversation with
Patrick Wilds, director of Albany Law Schools Government Law Center.
Support for the Capitol Press Room is provided by New
York State United Teachers, a statewide union of nearly seven
hundred thousand professionals in education and healthcare. This is WCNYS
(09:54):
the Capitol press Room, and we're continuing our conversation about
an executive order from President Donald Trump directing federal agencies
to explore how homeless people with mental illness or substance
abuse problems could be more forcibly hospitalized for longer periods.
And our guest is Patrick Wilds, director of Albany Law
Schools Government Law Center, who in a previous life was
(10:16):
Assistant Secretary to Governor Kathy Hochel for Human Services and
Mental Hygiene. So this is a executive order targeting federal
agencies to figure out ways to basically increase the use
of involuntary commitment. When we think about who's actually doing
involuntary commitment, it seems like it's going to be the
people with the most direct contact with people, and not
(10:38):
necessarily federal government, which is, you know, levels removed. So
what other levers or powers do the federal agencies have
to increase the rate of involuntary commitment.
Speaker 2 (10:51):
One of the things that the executive order explicitly calls for.
Want to have it right in front of me. It's
actually a subsection two, so it's titled Restoring Civil Commitment,
and it really calls for the Attorney John role in
consultation with the HHS, the Federal Health and Human Services Secretary,
to really look at when I think what they say
is like we're applicable or we're appropriate but they really
say AG and HHS Secretary, you should look at applicable
(11:13):
federal and state judicial precedent consent decrees that speak to
involuntary commitment, and effectively, if it's not as flexible as
we want it to be, you should look to overturn
precedent and end consent decrees, which I think is pretty problematic.
And what I will say is, you know, depending on
the state, and I don't have in my head a
(11:34):
rolodex of the you know, mental hygiene or equivalent laws
in every jurisdiction to know where they stand. And I
think with the changes that we saw in New York recently,
which kind of extended, at least in statute, the involuntary
commitment standard to someone being able to unable to meet
their own essential basic needs food shelter, et cetera, I'd
say that there's forty some states now that have that
(11:55):
on the books, and there's several that don't, so I
could see there being a lot of full becus on
those specific states. I would say if New York hadn't
just changed its laws in the last few months, we
might have also been under increased pressure now to do
what just happened.
Speaker 1 (12:11):
And what do you think of the landscape that's described
by the Trump administration, which argues that endemic vagrancy, disorderly behavior,
sudden confrontations, and violent attacks have made our cities unsafe.
Is there reason to believe that is widely the case
or is that sort of representative anecdotal experiences.
Speaker 2 (12:32):
I think there's a lot of stigmatizing language there that's
really I think what a lot of it comes down to.
I think most people who are walking down the street,
if you ask them in an anonymous poll, if they
think that the country's doing well enough when it comes
to homelessness, I think the majority of people would almost
undoubtedly say no. But I think, and I said this
at the outset, I think conflating serious mental illness and
substance use with homelessness and saying it's all the exact
(12:54):
same thing is problematic. And I think that there's some
pieces that are missing from the equation when it comes
to kind of solving almostests that aren't being talked about
at all in the executive order. And I think we
have to look much more broadly at the federal government's
approach to this issue since they've taken office. Right You've
looked at significant Medicaid cuts that are going to take
place over the next couple of years. So many people
who receive the types of services that we're talking about,
(13:16):
people who are on the kind of very far end
of the spectrum where they have profound disabilities. Frankly, whether
it be mental illness, substance use, or otherwise, some of
those people rely on Medicaid. So you're already kind of
on a big picture level, cutting a lot of funding
and services those people are going to have access to
over time. You also look at cuts to SAMSA, right,
And I'm not going to sit here and tell you
(13:37):
that SAMSA is the best federal agency ever. I don't
know the answer to that. But you're cutting SAMs You're
cutting staff there, you're cutting resources in nine eight eight,
you're kind of chipping away at this whole behavioral health
ecosystem and you're not coming back in with funding. And
the executive order here and there does allude to, yeah,
you know, we should re look at grant programming and
make it more flexible, and maybe there are more money
here and there, but I think it would be a
(13:58):
lot more comforting for people to see action dollars being
put down and saying we're going to put money towards
fixing this, especially when it comes to the community based
services side of it, which I wouldn't feel confident in
based on the executive order has written.
Speaker 1 (14:11):
The executive Order from the President puts a lot of
stock in the benefits of forcing someone into a long
term institutional setting. What are your expectations for the success
of something like that? And the critique is that this
is akin to prison by any other name. So what
(14:34):
do you think about those two fronts?
Speaker 2 (14:36):
Yeah, and I'm going to pull a quote directly from
earlier on in the Executive Order. I think it's actually
in their subsection one, which is shifting homeless individuals into
long term institutional settings for humane treatment through the appropriate
use of civil commitment, will restore public order. I think
when people, especially New Yorkers, hear the term institutionalization or
institutional they think back to places like Willebrook. They think
(14:58):
back to what our mental health system looked in the
nineteen fifties and sixties for those who are around for that,
and that represents dark times. And I would say as
a state here in New York, we've made a good
amount of progress moving away from that and towards making
sure people are in the most integrated setting imaginable. Of course,
following you know, Supreme Court President, like the om said
decision following the Americans with Disabilities Act. I think here
(15:20):
in New York that's going to strike a tone for
people that moving back towards institutionalization, which doesn't really get
spilled out in great detail throughout the executive Order, but
even kind of the ominous threat of that from the
very outset is very problematic.
Speaker 1 (15:33):
But what about the last part of that statement, which
is restore public order? Because to my years and I
think to other people who might be following the governor's
push here in New York for expanded involuntary commitment might say,
sounds exactly like what the governor has been talking about.
Seems like the same language New York City Mayor Eric
Adams is using. So from a philosophical point of view,
(15:57):
is there a big difference between what is being pushed
here in Albany and what's being pushed in DC.
Speaker 2 (16:03):
I would say the difference, certainly in New York versus
nationally is New York has over the last couple of years,
And I really wish this year's budget would have done
a lot more in this regard. Has invested in the
behavioral health workforce, which is still you know, very far
behind the times after not having had you know, increases
for many years. Minderstanding is that's actually a national issue.
I've talked to some friends or in different parts of
the country, and there's issues with the behavioral health and
(16:25):
human services workforce nationally. So at least as far as
that piece goes, I think New York has made some
progress versus nationally the federal government. I don't know if
they've they've infused money there, but look, at the end
of the days, it's a tough question. I'm not sure
if that's the best answer for you, But I think
that the idea of you know, ensuring public safety and
(16:47):
public order by involuntarily committing people in theory, I guess
sounds good to some people. But if you don't have
the whole system built out to actually support people as
they get transported in some cases admitted, it's not going
to work. Because at the end of the day, the
gold standard, even in cases where someone's involuntary admitted, is
not to keep them there right, It's to make sure
that they get the support and help that they need
in a humane fashion and help them get back out
(17:09):
into society as a functioning member of society as quickly
as possible. And if you're not investing in the actual
community based services and supports that are needed to ensure
that that happens, it's not going to work. So it
almost feels to me like you're taking people and some
instances off the street. In the short term that may
look better, but those people are actually not going to
get the help they need if the system's not built
(17:30):
out on the back end, and I don't think this
executive order speaks to that at all.
Speaker 1 (17:33):
Well, before we move on, let me reintroduce you for
listeners just joining us. This is the Capital Press Room,
and we're speaking with Patrick Wilds, who in a previous
life was Assistant Secretary to Governor Caffe Hochel for Human
Services and Mental Hygiene and is now the director of
All Any Law Schools Government Law Center. So there's another
section the Executive Order increasing Accountability and Safety in America's
(17:55):
Homelessness Programs, and part of the actions that they lay
out out here include, to the extent permitted by law,
ending support for so called housing first policies. What is
a housing first policy? Y.
Speaker 2 (18:10):
Housing first by no means a housing expert, but housing
first is this concept that for people who are unhoused,
the most single most important thing is getting a roof
over their heads, a stable, permanent roof over their heads,
food on the table, before you start to tackle other
issues that they might also be facing. The housing first
model really focuses on saying, hey, this person's un housed,
(18:30):
let's get them into a permanent setting as soon as possible.
That may mean that that person still has ongoing mental
health challenges, ongoing and active substance use while they get housed,
and that those pieces kind of get addressed later. There
seems to be some talking points on the kind of
conservative end of the political spectrum that housing first is
ineffective because it doesn't actually require that people kind of
(18:52):
get clean, get sober before they go into housing. The
only problem with that assertion is that housing first time
and again has been proven to be a very very
effective evidence based model when it comes to housing people
who've been spending some time on the streets. You know,
it's very well established that getting a roof over your
heads is incredibly important before you address other issues in
life like employment and behavioral health issues, et cetera.
Speaker 1 (19:15):
And so what would be the ramifications for New York
of the federal government, say, de emphasizing housing first. Is
this another area where federal dollars that flow into the
housing world could be in jeopardy?
Speaker 2 (19:30):
Yeah, I mean, look, like I said earlier, I'm no
housing experts, So I think that the way that ecosystem
works in New York is probably very complicated. You know,
whether it's a relook at existing funding or if it's
going to impact how they put out grant opportunities moving forwards,
It's not quite clear yet, but it's probably something that
I think is going to raise a lot of people's
eyebrows and put their radar op As far as how
we're looking at, again, an evidence based program that's proven
(19:52):
to work. Amounts think it's perfect, but it's been proven
to work for people now being under some type of attack.
Speaker 1 (19:57):
And it also appears that the Trump administry wants to
tie federal housing and homelessness assistance to requirements that this
population is utilizing substance abuse treatment or mental health treatments
if they're diagnosed with those types of conditions. How successful
(20:18):
is that stick approach potentially going to be in getting
people to move to care who weren't already pursuing it.
Speaker 2 (20:27):
My sense is that you're going to say less people
be successful in getting housed if you require them to
be entirely clean and to have their mental health behavioral
health issues generally fully addressed by the time they go
into housing. Another thing, I'll just mention the executive order.
I don't know that it uses the word shelter once
in the entire thing. I'd have to double check what
(20:47):
I've read through it a couple of times. And not
that shelters are necessarily the gold standard when it comes
to helping the unhoused, but the reality is that the
shelter system, both here in New York and nationally is
part of the solution, and it's not even mentioned, which
makes me think that there's not even any suggestion that
that's part of the solution here, which I think is
concerning and maybe there's more forthcoming there, but I figuring
it's at least worth mentioning.
Speaker 1 (21:08):
And if there are funding cuts in the homeless space
or the substance abuse space or the mental health space,
with all of the other potential federal cuts, say, in Medicaid,
more broadly, what do you think as the state's capacity
to backfill there? I mean, how much money are we
(21:30):
talking about that could be at stake? Are we saying millions?
Are we saying billions? Too soon to tell?
Speaker 2 (21:37):
I mean too soon to tell? Especially being a lawyer,
that it depends. Answer is always the safe fallback.
Speaker 1 (21:41):
But in all seriousness, you could always say, to the
best of my knowledge, I could say another good caveat.
Speaker 2 (21:46):
That is a good caveat. What I'll say is, I
think it could be in the billions, right. I think
that you're looking at when it comes to the people
who are dealing with serious mental illness and you know,
significant substance just disorders, and are unhoused on the streets,
largely in New York City. I think you're looking at
at any given time a couple thousand people. But the
amount of money it can take and the resource it
can take to support those people is substantial. And I
(22:08):
think the Medicaid cuts, because you brought it up again,
has kind of broad application, right, that's not just specific
to this population, but it's inclusive of it. So I
think you're looking at a significant hole that this could
continue to cause in New York and a lot of
other states that are trying to help people who are
un housed.
Speaker 1 (22:22):
And finally, we're talking primarily from the federal perspective about
an executive order which doesn't necessarily carry as much weight
as a law from Congress, and that gets the blessing
of the President. So are there legislative changes from DC
that you're watching for as it pertains to the homeless
population or the ability to treat people's mental health or
(22:43):
substance abuse conditions.
Speaker 2 (22:45):
You know, legislatively, I'm not sure. I mean, that's kind
of a wait and see thing, but we'll certainly be
closely looking at that. I mean, very concerning to me
and I mentioned it a couple of moments ago. Is
just the suggestion that the Attorney General of the United
States would actually look at, you know, consent decrees and
consent orders and and existing both state and federal precedent
and looking to kind of either overturn those or right
size though so that they support the administration's interest of
(23:07):
making it easier to commit people civilly. And I think
that there are certain parts of the country where there
might be more of an appetite from state level leaders
to support that. I don't anticipate that being the case
here in New York, but it's a very concerning trend,
and I think it's just the emphasis on the wrong syllable,
if you will, when it comes to this overall issue.
Speaker 1 (23:25):
Well, we've been speaking with Patrick Wilds. He's the director
of All Many Law Schools Government Law Center and previously
served as an Assistant Secretary to Governor Kathy Hochel for
Human Services and Mental Hygiene. Patrick, thanks for visiting us
in the studio.
Speaker 2 (23:38):
Good to see you. Thanks again, and
Speaker 1 (23:42):
For more Capital Pressroom content, visit capitopressroom dot org or
wherever you download your favorite podcasts.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
The Clay Travis and Buck Sexton Show
The Clay Travis and Buck Sexton Show. Clay Travis and Buck Sexton tackle the biggest stories in news, politics and current events with intelligence and humor. From the border crisis, to the madness of cancel culture and far-left missteps, Clay and Buck guide listeners through the latest headlines and hot topics with fun and entertaining conversations and opinions.