Alliance Alert: A newly published study has shown strong bipartisan agreement that voluntary rather than coercive mental health policies should be prioritized — a rare point of unity in today’s polarized political climate.” This offers an especially significant contrast to the strong support for coercion put forward by conservative Republican-leaning groups like the Heritage Foundation, Manhattan Institute and Cicero Institute.
The study was posted online by the Journal of the Medical Association and found that nearly three-quarters of respondents (73%) supported expanding access to community-based services, with similar levels across party lines: 78% among Democrats, 72% among Republicans and 71% among Independents. Similarly, most respondents across party lines supported expanding peer-led services.
In contrast, support dropped for policies that would allow treatment to be forced on someone against their will. Just 40% favored forced psychiatric medication, 45% supported short-term involuntary hospitalization and 42% supported long-term hospitalization. Mandated substance-use treatment drew slightly more support, at 53%.
Yet, the Trump Administration recently issued an Executive Order that, according to the Kaiser Family Foundation, “seeks to widen the use of involuntary civil commitments for adults experiencing homelessness and serious mental illness, shifting away from deinstitutionalization efforts. Civil commitment is a legal process in which a court orders an individual with a SMI into involuntary treatment–either in a hospital or through supervised outpatient care (“assisted outpatient treatment“)—for a defined period.”
Advocacy groups that have strongly assailed the Executive Order include the Bazelon Center for Mental Health Law, our Alliance for Rights and Recovery, the Evangelical Lutheran Church in America, the American Civil Liberties Union, the American Bar Association, he National Alliance to End Homelessness, Mental Health and the National Disability Rights Network.
Americans Favor Voluntary Mental Health Care Amid Federal Push for Forced Treatment
By Deb Parker WashU Magazine September 17, 2025
Mental health needs are rising nationwide, yet millions of Americans still go without care. Recent data show that only about half of those with a mental health condition — and fewer than one in four people with a substance abuse disorder — receive care.
Policymakers have responded with efforts to expand care access, such as the national 988 crisis hotline, and to increase involuntary interventions like forced medications and hospitalization. A new study from the School of Public Health at Washington University in St. Louis explores how the public views expansions in behavioral health-care policies, finding strong support for voluntary care over forced hospitalization or medication against a person’s will. The research, “Public Attitudes Toward Mental Health Treatment Policy,” was published Sept. 17 in JAMA Network Open.
Community-based programs — such as 24/7 crisis hotlines, walk-in centers and peer-led services-aim to keep people close to home and out of hospitals.
“Community-based services, including those led by peers, are proven to improve population health and reduce reliance on costly institutional care,” said Morgan C. Shields, an assistant professor at the School of Public Health and first author of the study. “Our findings show strong bipartisan agreement that these services should be prioritized — a rare point of unity in today’s polarized political climate.”
Yet, even as Americans support community-based, voluntary care, recent federal actions are taking a different approach. In July, the federal government issued the executive order “Ending Crime and Disorder on America’s Streets.” This order directed federal agencies to reverse judicial protections and expand the use of civil commitment — a legal process that allows someone to be treated for mental illness without their consent.
The order specifically targets people experiencing homelessness and serious mental illness. This policy shift intensifies debates over how to balance public safety, individual rights and effective, evidence-based care.
Researchers surveyed 1,442 U.S. adults between Jan. 17 and Feb. 12 using a nationally representative online panel administered through Qualtrics. Quota sampling was applied for gender, age, race, ethnicity, income, education and region to reflect U.S. census population estimates. Participants rated their support for different mental health-care policies on a nine-point scale.
The survey examined several key areas: community-based services; peer-led services provided by individuals with lived experience of mental health conditions; treatment and recovery; forced medications; forced short-term inpatient psychiatric stays; forced long-term inpatient psychiatric stays; and forced treatment for substance use conditions. Researchers also collected information about political party affiliation to analyze differences across groups.
Nearly three-quarters of respondents (73%) supported expanding access to community-based services, with similar levels across party lines: 78% among Democrats, 72% among Republicans and 71% among Independents. Similarly, most respondents across party lines supported expanding peer-led services.
In contrast, support dropped for policies that would allow treatment to be forced on someone against their will. Just 40% favored forced psychiatric medication, 45% supported short-term involuntary hospitalization and 42% supported long-term hospitalization. Mandated substance-use treatment drew slightly more support, at 53%.
Democrats were slightly less supportive of policies involving forced treatment than Republicans, while Independents consistently reported lower support across all policies.
“At a national level, policies have swung back and forth between institutional, involuntary approaches and community-based solutions,” Shields said. “This research suggests a path forward: investing in community services that are both empirically and politically viable.”
She added that the team hopes these findings will guide policymakers and community leaders toward solutions that improve access to care while protecting individual rights. The paper was co-authored by Nev Jones, at the University of Pittsburgh, Shyamal Sharma, at Brandeis University, and Susan H. Busch, at Yale University.
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Public Attitudes Toward Mental Health Treatment Policy
Morgan C. Shields, PhD1; Nev Jones, PhD2; Shyamal Sharma, MPH3
JAMA Netw Open
Published Online: September 17, 2025
2025;8;(9):e2532344. doi:10.1001/jamanetworkopen.2025.32344
Introduction
Rates of mental health conditions are increasing, yet only about one-half of people with a mental health condition and less than one-quarter with a substance use disorder (SUD) received treatment in 2023.1 In response, policies have aimed to increase access to mental health care, including crisis services.2–4 One tension relates to support for community-based services vs increasing emphasis on involuntary interventions.5 To inform decision-making, it is important to understand public attitudes toward these policy choices.
Methods
This cross-sectional study was approved by the institutional review board at Washington University in St Louis. We followed the STROBE reporting guidelines for cross-sectional studies. We conducted a national internet-based survey of US adults (January 17 to February 12, 2025) through Qualtrics using quota sampling on gender, age, race, ethnicity, income, education, and region to reflect census population estimates. Participants provided consent electronically through the survey. Participants were asked to indicate their support for expansions in broad mental health care policies on a 9-point Likert scale, including community-based services, peer-led services, and involuntary services; we created binary variables from responses that capture support for those with values 6 to 9 on the scale (see the eAppendix in Supplement 1 for survey details).
To examine differences by party, we asked people what political party they identify with. We used χ2 tests to examine unadjusted differences between Democrats and Republicans and linear probability regression models to examine adjusted differences across parties, reporting statistically significant differences at 2-tailed α = .05. Descriptive statistics were weighted on the characteristics used in quota sampling to account for remaining differences in representation, as well as political party affiliation; these same variables served as controls in regressions, with the addition of rurality and history of using behavioral health services. Data were analyzed with Stata statistical software version 18 (StataCorp).
Results
Of 1442 participants, 849 (58.9%) were female, and 292 (20.3%) had annual household income less than $25 000. In unadjusted weighted estimates, 72.64% (95% CI, 68.81% to 76.47%) supported policies to expand access to community services, and most participants supported policies to expand access to peer-led services (65.10%; 95% CI, 61.09% to 69.11%) (Table). We found no evidence that levels of support differed between Republicans and Democrats. These trends persisted in adjusted models (Figure)…
All linear probability models controlled for the following categorical variables: region, rurality, income, education, age, gender, race, ethnicity, prior experience receiving mental health or substance use treatment and used robust SEs to account for potential heteroskedasticity.
In contrast, fewer participants supported policies that make it easier to force a person against their will to take medication (39.90%; 95% CI, 35.71% to 44.09%), be hospitalized for a short-term stay (45.05%; 95% CI 40.88% to 49.21%), be hospitalized for a long-term stay (42.32%; 95% CI, 38.21% to 46.43%), or to receive SUD treatment (53.07%; 95% CI, 48.91% to 57.23%) (Table). There were no statistically significant differences between Republicans and Democrats in unadjusted analyses. In adjusted analyses, Democrats were less supportive of involuntary inpatient care for short-term stays (−10.4%; 95% CI, −16.7% to −4.0%), inpatient care for long-term stays (−7.4%; 95% CI, −13.7% to −1.1%), and SUD treatment (−7.3%; 95% CI, −13.7% to 0.9%) (Figure). Independents and other party affiliation consistently reported lower support for all policies in both unadjusted and adjusted analyses. The full regression models are available from the authors upon request.
Discussion
National policy has vacillated over time in its focus on involuntary and community-based interventions5,6; it remains unclear how these priorities will evolve. The findings of this cross-sectional study indicate that the public largely supports policies that expand voluntary, community-based services, a position shared by members of all political parties. In comparison, the public is less supportive of involuntary policies, although Republicans report more support than others. As with all surveys using quota sampling, we cannot eliminate potential biases inherent in these surveys. Community-based services are evidence-based ways to improve population health and reduce reliance on costly institutional care. During public polarization on health policy issues, strong bipartisan support and empirical evidence suggests that these policies are politically viable.
Article Information
Accepted for Publication: July 15, 2025.
Published: September 17, 2025. doi:10.1001/jamanetworkopen.2025.32344
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2025 Shields MC et al. JAMA Network Open.
Corresponding Author: Morgan C. Shields, PhD, School of Public Health, Washington University in St Louis, One Brookings Dr, St Louis, MO 63105 (mshields@wustl.edu).
Author Contributions: Dr Shields had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
References
1. Substance Abuse and Mental Health Services Administration. 2023 NSDUH annual national report. July 30, 2024. Accessed August 8, 2025. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report
2. Beronio K, Glied S, Frank R. How the Affordable Care Act and mental health parity and addiction equity act greatly expand coverage of behavioral health care. J Behav Health Serv Res. 2014;41(4):410-428. doi:10.1007/s11414-014-9412-0PubMedGoogle ScholarCrossref
3. Maclean JC, Wen H, Simon KI, Saloner B. Institutions for mental diseases Medicaid waivers: impact on payments for substance use treatment facilities. Health Aff. 2021;40(2):326-333. doi:10.1377/hlthaff.2020.00404PubMedGoogle ScholarCrossref
4. Suran M. How the new 988 lifeline is helping millions in mental health crisis. JAMA. 2023;330(11):1025-1028. doi:10.1001/jama.2023.14440
ArticlePubMedGoogle ScholarCrossref
5. Oreskes B, Newman A. Will New York force more mentally ill people into treatment? New York Times. February 21, 2025. Accessed August 8, 2025. https://www.nytimes.com/2025/02/21/nyregion/kathy-hochul-nyc-homeless-involuntary-commitment.html
6. Substance Abuse and Mental Health Services Administration. Civil commitment and the mental health care continuum: historical trends and principles for law and practice. 2019. Accessed August 8, 2025. https://www.samhsa.gov/sites/default/files/civil-commitment-mental-health-care-continuum.pdf