The Treatment First Toolkit and the Bigger Picture 

What is the “Treatment First Toolkit”, and how did we get there? 

The United States Departments of Health and Human Services (HHS) and Housing and Urban Development (HUD), and the White House Office of National Drug Control Policy recently released a “Treatment First” toolkit to combat addiction and homelessness. This 40-page document outlines several recommendations for communities to reframe their homeless response system to prioritize treatment as a prerequisite for housing assistance. While the aspects around coordinating care and partnership may be helpful for providers, it is important to consider the bigger picture of federal government actions in this moment before taking their recommendations of “best practices” at face value. 

In July 2025, the Trump Administration published an Executive Order that misleadingly linked homelessness to crime and disorder. The false narrative and policy implications were built on an overall increasing hostility to those living in poverty. This includes a concerning trend of criminalization at the local level as politicians seek quick fixes to complex system failures. The Administration has since taken several actions across departments that focus on reducing the visibility of homelessness through tactics such as institutionalization and incarceration, rather than addressing the root cause of the crisis, which is a lack of affordable housing.  

People who have devoted their careers to ending homelessness know that this is not a zero-sum game. A system that pairs access to high-quality, voluntary treatment with stable housing leads to the best outcomes. Instead, the current narrow focus on institutionalization, incarceration, and treatment first overlooks the critical role that housing plays in ending homelessness. The Treatment First toolkit aims to expand civil commitment and create high barriers to housing that require strict compliance (even when recovery is not linear). 

Federal agencies across the government have worked in the last two years to implement harmful practices and dismantle the homeless response system that has been built on years of evidence, collaboration, and care. A few examples include:

• HHS launched a grant that rejects harm reduction and requires treatment participation in order to access housing. 
• The U.S. Department of Veterans Affairs (VA) and the DOJ announced a memorandum of understanding to increase capacity to pursue legal guardianship of homeless veterans, increasing pathways to forced treatment. 
• The U.S. Department of Justice (DOJ) released a $42 million grant opportunity focused on expanding civil commitment and institutional care as a homeless response plan. 
• HUD released several funding opportunities for the Continuum of Care program that reject the best practice of Housing First, rejects the prioritization of permanent housing solutions, and require programs to shift away from harm reduction and person-centered treatment towards mandates, high barriers, and transitional housing that prolongs experiences of homelessness.

The release of this new toolkit builds on these actions to target a crisis response system that has been deeply under-resourced but has effectively housed people experiencing homelessness for decades.  

Why Treatment First is Not the Solution to Homelessness 

People experiencing homelessness, like millions of other Americans, can struggle to access the behavioral health care and services they need. With rising health care costs, inaccessible health insurance, and a services shortage, behavioral and addiction related care is difficult for any American to voluntarily access. In 2027, the field will face additional burdens due to ineffective work requirements and increased administrative layers for vulnerable individuals with disabilities as they attempt to access Medicare. We will not connect more people to treatment by mandating pathways that do not exist at scale. We do so by expanding access to services and pairing them with stable housing.  

Extensive experience and research indicate that the administration’s punitive approach will ultimately keep people from accessing both housing and treatment. Services need to be both available and accessible – people seek and benefit more from services when they are person-centered, involve autonomy and decision-making, and are accessible from the dignity and security of stable housing.  

Our homeless response system wants a future where all individuals are housed and connected to the services they need to thrive. Getting there will require healthcare and homeless response systems to work together to make those connections easier, while recognizing the difficult realities communities face: too few affordable homes, rising costs of living, and insufficient access to community-based services.  

Housing provides the stable foundation from which people can pursue treatment. Our systems should work together to make sure that foundation is available to everyone.