Last week, the current Presidential administration released an executive order with a noble title, “Ending Crime and Disorder on America’s Streets.” Here is the opening paragraph of this problematic memo:

Endemic vagrancy, disorderly behavior, sudden confrontations, and violent attacks have made our cities unsafe. The number of individuals living on the streets in the United States on a single night during the last year of the previous administration — 274,224 — was the highest ever recorded. The overwhelming majority of these individuals are addicted to drugs, have a mental health condition, or both. Nearly two-thirds of homeless individuals report having regularly used hard drugs like methamphetamines, cocaine, or opioids in their lifetimes. An equally large share of homeless individuals reported suffering from mental health conditions. 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.

There are misconceptions and factual errors throughout this order. (There are errors and twisting of facts in that single paragraph alone.) Dear reader, I’m just one finite person, so I will only address one problem today.

This order conflates homelessness with mental illness, substance misuse, and crime. This is wrong.

The Venn diagram below is an approximation of the reality of the intersections of homelessness, mental illness, substance misuse, and crime:

Most people are not homeless, which is why the green circle is small. Here in King County (the county Seattle is in), over 97% of people will sleep indoors tonight. Are there people who are homeless with mental illness and/or substance misuse? Of course. Did some of these people have such issues before losing their housing? Yes. Did some of them develop these problems after becoming homeless? Indeed.

Then there are all the people with a place to call home who also have mental illnesses and substance use disorders (yellow circle). In fact, many people with mental illnesses (including schizophrenia and bipolar disorder) and substance use disorders (like alcoholism, which kills more people each year than opioids) are not homeless. Furthermore, they will never be homeless.

Likewise, many people who do criminal things do not have mental illnesses or substance use disorders (red circle). If they are incarcerated, they go home when they are released from jail. Psychiatric “beds” make up only a small fraction of all jail beds. Most people who are incarcerated do not behave in ways that warrant psychiatric intervention while they are there.

The blue dot represents civil commitment, or forcing someone into an institution for psychiatric reasons. The vast majority of people with mental illnesses and/or substance misuse will never be hospitalized, let alone involuntarily committed. Some people end up in jail when they would be better served (i.e., get treatment) in a psychiatric institution.

This seems to be the worldview of the current Presidential administration:

The language of the executive order suggests that if someone is homeless, then they must have a major mental illness and/or substance use disorder. (Hence the green “homeless” circle is completely surrounded by the yellow “mental illness, substance misuse” circle.) This is wrong. It does not reflect reality.

However, as a result of this cognitive error of conflating homelessness with mental illness and substance misuse, they offer the solution of civil commitment:

Notice that the blue dot of civil commitment has transformed into a bigger blue circle that surrounds the green circle of homelessness. The memo also argues for “maximally flexible” civil commitment, which is a convenient way to keep people off the streets if homelessness equals mental illness and substance misuse (which, again, it does not).

To be clear, I am not cool with people being homeless. I ended up in public health psychiatry because there are people who are homeless because of debilitating mental illnesses and substance misuse. They get better with treatment. Then they escape homelessness — and all the challenges that come with it.

If you look at that first diagram, though, the overlap between homelessness and mental illness and substance misuse is limited. And a number of people — often people in their late teens and early 20s — don’t have any major mental health or substance use problems when they become homeless. (They are often fleeing unsafe and untenable situations in their homes.) Not knowing where you will sleep tonight is stressful. Trying to appear “normal” and “fine” makes you anxious and depressed. Worrying about unwanted attention and personal safety while outside, unsheltered, when it is dark is exhausting. No one, as a kid, thinks, “When I grow up, I want to be homeless, have a drug or alcohol problem, and need psychiatric services.” That is literally no one’s ambition.

This administration wants you to believe it’s humane — offering treatment to people with mental illness and substance use disorders. But that’s not what it’s about. It’s about hiding people who are so poor they have nowhere to live.

If this were really about providing mental health and substance use disorder support and treatment — you know, actually helping people — then the Presidential administration would not have cut $1 billion (yes, billion with a B) from the Substance Abuse and Mental Health Services Administration. The administration would not have gutted Medicaid, which is the primary funder of mental health and substance use disorder support and treatment to people who are poor, including those who are homeless.

Don’t be fooled. Pay attention.