Chronic Homeless Incarceration: Who, What, Where Why, When, How?

An aerial view of an old building four stories high
The Binghampton State Hospital, which was built in the 19th century. was originally called The New York State Inebriate Asylum. It was the first institution designed and constructed to treat alcoholism as a mental disorder in the United States.

A magical mystery tour is currently being considered by a few American jurisdictions. What percentage of the people experiencing chronic homelessness1 might benefit by involuntary committal to a psychiatric institution?

High. In more than one sense of the word.

And that’s never-minding the possible benefits to a squeamish, shoulder-rubbing public who are, or who feel, threatened by contact with these unfortunate health sufferers.

How might a possibly beneficial return to institutionalization ‘for your own good’ be implemented? Recently raising the issue has resulted in much goose-honking, wing flapping and confusion. So far there has been minimal professional guidance, at least for the benefit of a bewildered public.

America has been here before, and guidance in the form of laws and best practices has long been available for dusting-off and, if necessary, refurbishing. To help sort out practical, legal and ethical issues, The Conversation tapped the expertise of Katherine Drabiak, Associate Professor of Health Law, Public Health Law and Medical Ethics, University of South Florida.

Who might be helped by laws that snatch them off the streets? Studies show that as many as three out of every four people who are chronically homeless live with mental illness or drug use that can be life-threatening in a hostile environment (such as living outdoors in a North American climate.)

Drabiak introduces and explains that ‘civil commitment’ laws, which are different in every state, have been around for decades and are based on two key principles:

  • ‘Parens patriae’ — ‘parent of the nation,’ which invokes a state’s obligation to help those who cannot help themselves.
  • ‘Police power,’ which requires that states pass and enforce laws to preserve public health and safety.

Drabiak unpacks these principles and traces their use in law.

Looking at past periods of time when involuntary incarceration/treatment has been an active response to state responsibilities, how effective have these measures been? Over recent years, the efficacy of involuntary institutional treatment has been called into question. It has led to a long decline of both involuntary institutional treatment, as well as shrinking resources to administer/deliver this kind of mental health care.

A great deal more on this subject is covered in the following article. It is a useful doorway on issues surrounding involuntary committal. Don’t miss using the links in Drabiak’s article to learn more about issues such as the privatization of current institutional practice. Read more in The Conversation: The ethical dilemmas behind plans for involuntary treatment to target homelessness, mental illness


  1. Chronic homelessness means homelessness lasting for a long time (typically six months) or multiple episodes of homelessness over an extended period (such as homeless more than three times in three years).