Pillar IX: Provide Safe and Secure Communities so All Americans Can Live Their Lives in Peace

Address Homelessness and Mental Health Issues that are Plaguing Our Streets

An increasing number of individuals and communities are struggling with homelessness in America today. Approximately 580,000 homeless individuals are scattered across the Nation, according to a Department of Housing and Urban Development 2020 survey. Four in 10 of these individuals are currently in unsheltered locations on the street or in other unhabitable areas.

Substance abuse and mental illness play a major role in this issue. Fifty percent of unsheltered homeless individuals report that mental health conditions contributed to loss of housing, and 51% report that substance abuse conditions contributed to their situation. Furthermore, at least 3 in 4 unsheltered homeless individuals self-reported mental health or substance abuse conditions, with the majority reporting both.

The rising number of mentally ill and substance- abusing individuals pose a danger to themselves and others, and this situation must be addressed. All around the country, the data show that neighborhoods next to street camps have higher levels of rape, armed robbery, and aggravated assault than those that are not. Additionally, diseases such as typhus and Hepatitis A have spread through homeless encampments in California.

Once vibrant cities such as San Francisco have allowed drug paraphernalia, human excrement, homeless encampments, and tent cities to proliferate in the name of “compassion,” hurting the local economy and lowering the quality of life for law-abiding taxpayers. For these reasons, approximately 8 in 10 voters in the city want their legislators to ban street camping.

Solving problems associated with mental health and homelessness requires appropriate and flexible treatment options for severe mental illness. Medicaid has excluded federal payments to institutions of mental disease (IMD) for care provided to most Medicaid-eligible adults since 1965, which has limited access to care for low-income patients with severe mental illness. In 2018, the Trump Administration sought to address this issue through CMS-issued guidance that allowed states to apply for Section 1115 waivers to pay for some short-term treatment in IMDs for serious mental illness. It also issued guidance allowing waivers to cover short-term treatment for substance use disorders in 2017.

Addressing the root causes of homelessness must be prioritized by policymakers through the alignment of funds and resources. The Left has long advocated for a “Housing First” approach that provides homeless individuals with housing without addressing the underlying problems that cause homelessness. Evidence has shown that this approach is ineffective.

An America First solution requires addressing the mental health and substance abuse crises contributing to the homelessness crisis, empowering law enforcement to act in defense of their communities and public spaces, and deregulating local housing markets. Allowing homelessness to grow unabated is not the “compassionate” solution for the homeless themselves nor for the broader public. Instead, the problems of this vulnerable population must be addressed so they can be empowered to live as productive American citizens in clean, safe communities.


  • Unsheltered homelessness increased by more than 50,000 individuals during the last 5 years.
  • Sheltered homelessness has decreased each year since 2014.
  • 60% of crimes in Los Angeles involving homeless individuals are violent, while just 32% of all crimes in the city are violent.
  • 4 people die in Los Angeles’s homeless camps every single day.
  • At least 3 in 4 unsheltered homeless individuals self-report mental health and substance abuse conditions.
  • Approximately 8 in 10 voters want their legislators to ban street camping.


At the federal level, support policies that:

  • Combat drug addiction and the opioid epidemic by ending the flow of drugs into the country from our open borders, creating harsher punishments for drug trafficking, and increasing treatment availability.
  • Allow modifications of the IMD exclusion in Medicaid based on evidence from Section 1115 waivers for short- term treatment for severe mental illness or substance abuse disorders.
  • Empower states and communities with the flexibility and resources needed to develop treatment programs for homeless individuals.

At the state level, support policies that:

  • Apply for Section 1115 waivers for modifications of the IMD exclusion in Medicaid for short-term treatment for severe mental illness or substance abuse disorders.
  • Empower local police to enforce all public order laws.
  • Abandon the failed “Housing First” philosophy. Instead, address the underlying causes of homelessness first and then empower individuals to succeed on their own.
  • Address overregulated local housing markets.
  • Challenge the 9th Circuit’s ruling in Martin v. Boise, which held that cities could not enforce anti-camping ordinances if they do not have enough homeless shelter beds available for their homeless populations.


2020 Annual Homeless Assessment Report (AHAR) to Congress, U.S. Department of Housing and Urban Development (Jan. 2021).

Brief Visuals on Reducing Homelessness, The Cicero Institute (Nov. 2021). Crime Data from 2020 to Present, City of Los Angeles. Ending Chronic Homelessness in 2017, United States Interagency Council on Homelessness (2017).

Fiscal Year 2019 Budget of the U.S. Government, Office of Management and Budget (Feb. 2018).

Health Conditions Among Unsheltered Adults in the U.S. by Janey Rountree, Nathan Hess, and Austin Lyke, California Policy Lab (Oct. 2019).

Housing First is a Failure by Judge Glock, The Cicero Institute (Jan. 2022). 

Medicaid’s Institutions for Mental Disease (IMD) 

Exclusion, Congressional Research Service (July 2019).

‘Medieval’ Diseases Flare as Unsanitary Living Conditions Proliferate by Anna Gorman, Scientific American (March 2019).

Million-Dollar Murray by Malcolm Gladwell, The New Yorker (Feb. 2006). 

Putting America’s Health First – FY2021 President’s Budget for HHS, U.S. Department of Health and Human Services (Feb. 2020).

SMD # 17-003 RE: Strategies to Address the Opioid Epidemic, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services (Nov. 2017).

SMD # 18—011 RE: Opportunities to Design Innovative Service Delivery Systems for Adults with a Serious Mental Illness or Children with a Serious Emotional Disturbance, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services (Nov. 2018).

The “Housing First” Approach Has Failed: Time to Reform Federal Policy and Make it Work for Homeless Americans by Christopher Rufo, The Heritage Foundation (Aug. 2020).

The State of Homelessness in America, Council of Economic Advisers, Executive Office of the President (Sept. 2019).

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