My older brother has schizophrenia. He’s never believed he’s sick, refuses treatment, and has spent years bouncing between emergency rooms, jail cells, and the streets of Los Angeles. To the system, he’s“unhoused” and “noncompliant.” We doctors call it anosognosic, pathologically unable to recognize his own illness. That isn’t defiance. It’s brain disease.
That’s why I support President Trump’s recent executive order on crime, homelessness, and serious mental illness. It directs federal action to remove people with untreated psychiatric conditions from public spaces and into care, including, if necessary, through involuntary treatment. Some call this controversial. I call it compassionate.
I’m a neurologist. I’ve treated patients who arrive in the hospital with stroke, dementia, or seizures and no insight into their condition. They might deny their paralysis or hallucinate loved ones long gone. They’re confused, disoriented, and sometimes combative.
But we don’t leave them on the curb. We don’t wait for them to “want help.” We treat them — urgently, respectfully, and often without their immediate consent, because the brain has temporarily robbed them of the capacity to choose.
Schizophrenia and other serious mental illnesses are no different. It’s time we stop pretending otherwise.
The idea that civil liberties mean leaving people to deteriorate in public, untreated, is not progressive. It’s paralyzing. For decades, we’ve tiptoed around this reality, prioritizing theoretical rights over lived outcomes. My brother’s “freedom” to refuse care has cost him everything: his housing, his health, his future. That’s not liberty. That’s neglect.
Trump seeks to make it easier for people with mental illnesses to be involuntarily committed
I’ve navigated the system from both sides, as a physician, scientist, and drug developer, and as a brother watching someone I love disappear into delusion. I’ve seen how current civil solutions like California’s CARE Court offer legal choreography without teeth. These programs often drag on for months or years, with no enforceable treatment, no dedicated resources, and no real ability to intervene. They create the illusion of reform without actual care.
The uncomfortable truth is that Reagan-era deinstitutionalization simultaneously went too far and not far enough. We closed psychiatric hospitals with the promise of community care, but never built the infrastructure to support it. The result is what we see today in every major city: people with untreated psychosis living and dying on the streets, surrounded by the public but profoundly alone.
Trump’s executive order could signal a willingness to reverse course. But if the U.S. acts only to remove people from view and not to heal, it will repeat the worst mistakes of the past. This moment demands more than commitment laws. It demands commitment to care.
That means creating real facilities with trained staff, not just more jail beds. It means funding long-term psychiatric housing with structured, evidence-based treatment, not short-term crisis beds that discharge people back to the sidewalk. It means empowering families and clinicians to act early, before tragedy, while ensuring rights are protected and recovery remains the goal.
Critics warn of coercion. But there’s nothing more coercive than untreated brain disease. My brother is not living freely. He is trapped by a mind that cannot perceive reality. When he talks to himself, yells at the sky, and dumpster-dives to avoid being “poisoned,” that is not choice. It’s illness. And it’s entirely treatable.
I’ve spent much of my career developing novel treatments for serious mental illnesses like schizophrenia, bipolar disorder, treatment-resistant depression, and severe substance use. I believe in the power of innovation in medicine. But no treatment, no matter how advanced, can reach someone who lacks insight and declines all contact. We need a legal and medical framework that allows us to reach them, to treat not just the willing, but the vulnerable.
We don’t hesitate to treat a stroke patient who denies their deficits. We don’t wait for someone with Alzheimer’s to “consent” to safety precautions. We understand that brain diseases impair autonomy. Psychiatry must be granted the same clarity and the same clinical urgency.
The executive order gives us an opening. I am optimistic that the Trump administration will follow through with the resources, infrastructure, and policy needed to make this work because safer, healthier communities depend on it. If we seize this moment with real reform, we can finally confront the humanitarian crisis of untreated serious mental illness. But if we let political discomfort override moral responsibility, we will continue to abandon those who cannot advocate for themselves.
After a long inpatient stay years ago, my brother briefly emerged from the grip of his illness. “I don’t feel like me anymore,” he said. For the first time, he glimpsed what the disease had taken from him. It was treatment that made that moment possible — not hope alone, but medical care that dialed down the psychosis enough for him to see himself again. That version of him is still there. He deserves a system willing to bring him back, even when he can’t ask for it.
We must act, not out of fear, but out of reason, responsibility, and compassion. Refusing to treat the most vulnerable is abandonment.
Shaheen E. Lakhan, M.D., Ph.D., is a board-certified neurologist and pain physician, former department chair and curricular dean of a medical school, and multiple first-in-class therapeutics developer whose family has been profoundly impacted by brain diseases.