Municipalities can enforce laws and protect parks. But Oregon must finally confront the addiction and mental-health crisis that cities cannot solve on their own.
This past week I have been having conversations with my local candidates for Mayor and City Council, in the town I live, Albany, Oregon. One issue keeps resurfacing: homelessness, and the impact on public spaces.
What can Albany, or other cities actually do about it?
It is an important question because city government has responsibilities, but it also has limits. Oregon’s cities cannot rebuild Oregon’s mental-health system. They cannot create thousands of residential addiction-treatment beds. It cannot rewrite federal Medicaid rules, manufacture psychiatrists and counselors or repair decades of state and federal policy.
What local cities can do is govern, enforce the law, and keep parks clean.
That means maintaining parks for the public, enforcing laws against illegal camping, littering, dumping, theft, fires and destruction of property, removing abandoned camps and connecting people experiencing homelessness with available shelter, treatment and social services.
Those ideas are sometimes dismissed as addressing the “symptoms” rather than the “root causes.”
But that presents a false choice.
A city can insist that its parks remain parks while also believing someone sleeping in a tent and suffering from schizophrenia or fentanyl addiction desperately needs treatment. Compassion and accountability are not opposites.
And no candidate I have interviewed so far has proposed turning city parks into permanent campgrounds. If someone believes that your city should allow unrestricted camping in its parks, then propose that ordinance, debate it publicly and vote on it.
Until then, governments should enforce the laws they have.
Albany’s municipal code currently prohibits unauthorized overnight camping in city parks. The city also maintains policies governing the removal of homeless camps from public property.
The United States Supreme Court has also made clear that the Eighth Amendment does not prevent cities from enforcing generally applicable public-camping ordinances merely because the person violating them is homeless. In City of Grants Pass v. Johnson, decided in June 2024, the Court returned much of that policy discretion to elected state and local governments.
That does not mean every enforcement policy is wise. It means elected officials actually have to make decisions rather than pretending federal courts have tied their hands.
We Have Been Treating Several Different Problems as One
One of the biggest mistakes in America’s homelessness debate has been treating “the homeless” as though they were a single population with a single cause.
They are not.
A working mother evicted because her rent increased $500 is facing a fundamentally different problem than someone experiencing untreated schizophrenia, and both are facing a different problem than someone trapped in a severe methamphetamine or fentanyl addiction.
People who lose housing primarily because of a job loss, eviction, divorce or sudden increase in rent are an important part of the homeless population, but they are often experiencing a temporary economic crisis rather than the chronic street homelessness most visible in our parks and public spaces. Many retain the ability to work, seek assistance, stay temporarily with family or friends, use shelters or rental-assistance programs and eventually regain stable housing. The population most likely to remain chronically unsheltered is far more complicated. Severe mental illness, substance-use disorder, physical disability and overlapping behavioral-health problems are disproportionately common among people experiencing long-term homelessness. These are the people most likely to fall through the cracks because a rent subsidy or apartment key alone cannot address the illness or addiction preventing them from living independently. If we want fewer people living indefinitely in tents, our policy must distinguish between someone who simply needs help getting back into housing and someone who needs intensive treatment, structure and long-term support before housing can truly become sustainable.
It may be worth taking an hour to revisit KOMO’s controversial 2019 documentary Seattle Is Dying. It focused on the intersection of chronic street homelessness, addiction, untreated mental illness, repeat crime and a government increasingly reluctant to intervene—while critics rightly argued that it painted homelessness with too broad a brush. Seven years later, however, the question is worth asking again: Have we learned anything? Or have West Coast cities simply spent billions of dollars managing the same human misery while arguing over what we are allowed to call it?
UCSF’s behavioral-health analysis found that 48 percent of people experiencing homelessness in California had complex behavioral-health needs, defined by factors including regular drug use, heavy drinking, hallucinations or recent psychiatric hospitalization.
Thirty-five percent reported regular drug use.
And perhaps most troubling, 28 percent of those reporting regular drug use or heavy alcohol consumption said they had sought treatment during their current episode of homelessness but could not access it.
That is not simply a housing shortage.
That is a treatment shortage.
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Where Housing First Falls Short
Housing First grew from an understandable idea: stop requiring people to become sober, employed or psychiatrically stable before giving them a place to live.
A major systematic review published in the Journal of Epidemiology and Community Health found large improvements in housing stability but no clear difference in mental-health or substance-use outcomes compared with usual treatment.
Housing First may succeed at answering Where will this person sleep tonight?
It does not automatically answer how do we help this person recover from schizophrenia, alcoholism, methamphetamine addiction, fentanyl dependence or profound behavioral deterioration?
Housing is part of the solution. It cannot become a substitute for treatment.
Yet in too much of West Coast policy, those concepts became blurred together. Build subsidized housing. Move people into housing. Measure success by whether someone received housing, then hope everything else improves. For many people it does, for most it doesn’t.
Someone suffering from severe untreated psychosis may not suddenly become capable of managing medications, maintaining an apartment, paying bills and living safely simply because we hand them a key.
Someone in the depths of severe addiction may need detoxification, residential treatment, months of structure, medication-assisted treatment where appropriate, counseling, accountability, employment assistance and long-term recovery support.
Putting a severely impaired human being alone in an apartment and calling that compassion can sometimes amount to little more than relocating the crisis behind a door.
Oregon Expanded Coverage. It Did Not Build Enough Treatment.
Oregon provides an especially frustrating example.
The Affordable Care Act dramatically expanded Medicaid eligibility here. By June 2014, Oregon Health Plan enrollment had increased by more than 357,000 people since the beginning of that year, largely because Oregon expanded Medicaid under the ACA.
That expansion gave hundreds of thousands more Oregonians health coverage.
But an insurance card is not a treatment bed.
For years, federal Medicaid’s so-called IMD exclusion prevented Oregon from using ordinary Medicaid funding for residential substance-use treatment in facilities with more than 16 beds. Oregon eventually obtained a Section 1115 waiver in 2021 allowing Medicaid financing for those facilities. OHA itself acknowledges that most Oregon residential treatment facilities exceeded the old 16-bed threshold.
While coverage expanded, Oregon failed to build anything resembling adequate treatment capacity.
Oregon’s own 2024 Behavioral Health Residential+ Facility Study estimated that the state needed approximately 2,357 additional residential substance-use-treatment beds beyond projected capacity.
It also identified needs for approximately 571 additional withdrawal-management beds, 198 secure residential treatment beds and 486 additional inpatient psychiatric beds, depending upon the capacity methodology used.
OPB summarized the conclusion rather plainly: Oregon was years away from having enough inpatient substance-use and mental-health capacity and would need at least $500 million over five years just for facilities and beds — not including ongoing operating expenses.
Meanwhile, addiction accelerated.
OHA reports that fentanyl-related unintentional overdose deaths nearly quadrupled between 2020 and 2022, from 223 to 843. In 2024, Oregon recorded 1,544 drug-overdose deaths. More than 90 percent involved fentanyl, methamphetamine or some combination of the two.
There has been encouraging progress — overdose deaths declined in 2024 after years of increases — and that should also be acknowledged. But 1,544 dead Oregonians is hardly a victory lap.
Measure 110 Exposed the Hole in the System
Then came Measure 110.
Oregon attempted an extraordinary social experiment: reduce criminal consequences for possession of hard drugs while steering people toward voluntary treatment.
There was one rather significant problem.
We didn’t have enough treatment.
The state eventually poured hundreds of millions of dollars into Behavioral Health Resource Networks and other services, and some of those investments are worthwhile. But Oregon’s own Secretary of State concluded in a December 2025 audit that Measure 110’s implementation suffered from instability, weak coordination and an inability to demonstrate clear results. The audit also noted that Oregon remains among the states with the nation’s highest levels of substance-use disorder and illicit-drug use.
The Legislature ultimately recriminalized possession through HB 4002 in 2024 while preserving and modifying the treatment network.
The lesson shouldn’t be that treatment was a bad idea.
The lesson should be that voluntary treatment is meaningless if treatment isn’t available — and sometimes voluntary treatment is insufficient for someone whose illness has destroyed the capacity to recognize that they need help.
We Need to Talk About Institutional Care Again
America also needs to become willing to discuss something politicians have treated as nearly unspeakable for decades: Institutional mental-health care. Not the abusive warehouses of a century ago where involuntary mass confinement trapped people in poorly ran asylums. We can provide compassionate inpatient institutes without stripping people of constitutional rights because they are eccentric, poor or inconvenient.
I am talking about modern psychiatric hospitals, secure residential treatment facilities, long-term inpatient addiction programs and carefully regulated civil commitment for people whose illness leaves them genuinely incapable of caring for themselves.
Oregon State Hospital operates campuses in Salem and Junction City with capacity for roughly 700 patients. Its mission includes caring for people civilly committed because severe mental illness makes them dangerous to themselves or others or incapable of meeting basic health and safety needs.
But much of Oregon’s state psychiatric capacity has become consumed by the forensic system — people involved with criminal courts who require competency restoration or other court-ordered treatment. Independent analysis by the Treatment Advocacy Center found that in 2023 roughly 93 percent of Oregon’s staffed state-hospital beds were occupied by forensic patients, leaving remarkably little traditional civil capacity.
Oregon has actually begun recognizing the problem.
Changes enacted in 2025 allow courts examining civil commitment to consider whether serious harm is reasonably foreseeable in the near future even when it is not literally imminent, along with patterns of deterioration, inability to provide basic needs and certain chronic mental disorders.
That is movement in the right direction.
California, hardly a bastion of conservative social policy, is moving in a similar direction with its CARE Court system, which allows family members, first responders, behavioral-health professionals and others to petition courts for structured treatment plans for certain people suffering from severe psychotic illnesses. The program is now operating statewide.
Perhaps the political pendulum is finally moving away from the absurd proposition that watching someone psychotic, addicted, filthy, victimized and slowly dying under a tarp is somehow respecting their freedom.
Sometimes intervention is compassion.
What Albany Can — and Cannot — Do
That distinction also matters when deciding what Albany city government should reasonably be expected to accomplish.
The Albany City Council cannot rebuild Oregon’s psychiatric system, create thousands of residential treatment beds or solve the shortage of behavioral-health professionals. It cannot repair Medicaid reimbursement policy or create a statewide system of long-term addiction recovery. Those responsibilities extend far beyond a municipal government, and Albany taxpayers should not be expected to backfill decades of state and federal failure through the city’s general fund.
What Albany can control is the condition of Albany’s public spaces and how consistently its laws are enforced.
That means maintaining parks for their intended public use, responding to illegal camping, littering, dumping, abandoned property, dangerous fires, theft and destruction of public facilities while continuing to direct people toward shelter, treatment and other available services. Those are ordinary responsibilities of local government, and performing them does not require pretending that enforcement alone will end homelessness.
In fact, enforcement without somewhere for people to go can simply move the problem from one location to another. That is why outreach, shelter and treatment matter. But the reverse is also true: refusing to enforce reasonable standards does not create another apartment, open a treatment bed or make an addicted person sober. It simply transfers the consequences of a broken system onto parks, neighborhoods, businesses, police officers, public employees and everyone else who uses those spaces.
There should be nothing controversial about saying that someone experiencing homelessness deserves dignity and help while also being expected to follow the same basic laws governing public behavior as everyone else.
If Albany residents want public parks to become authorized camping areas, then someone should propose that policy openly, amend the ordinances and let elected officials vote on it. So far, none of the candidates I have interviewed has advocated for that approach.
Until the law is changed, however, selectively declining to enforce it is not a homelessness strategy. It is simply allowing prohibited conduct because government has become uncomfortable confronting it.
And that brings the responsibility back to Salem.
Albany can manage the local consequences of homelessness. It cannot cure the conditions driving the most difficult cases of chronic street homelessness. Oregon needs enough detoxification beds that someone asking for help doesn’t encounter a waiting list. It needs residential addiction programs capable of treating people for months rather than merely stabilizing them for days. It needs psychiatric facilities for people too sick to safely care for themselves, transitional programs that reconnect recovery with employment and community, and a civil-commitment system that protects individual rights without requiring society to watch someone deteriorate almost to the point of death before intervention becomes possible.
That is a statewide behavioral-health system. It cannot be recreated city by city.
Oregon has spent years expanding eligibility, benefits, housing programs and homelessness spending while its underlying treatment infrastructure remained inadequate. The state’s own capacity studies now document the shortage. The question is no longer whether Oregon needs more behavioral-health capacity. The question is whether our political leadership is willing to admit how badly we allowed that capacity to deteriorate and how aggressively we are prepared to rebuild it.
The goal should not be to return to the institutional warehouses of the twentieth century, nor should it be to continue the twenty-first-century alternative of leaving profoundly sick people in tents along sidewalks and riverbanks.
There is a better middle ground: modern psychiatric care, long-term addiction treatment, supportive and transitional housing, due process, personal accountability and intervention appropriate to the severity of the person’s condition.
That is not abandoning Housing First. It is recognizing that sometimes housing is the answer, sometimes treatment must come with housing, and sometimes a person is simply too sick to live independently without intensive intervention.
A civilized society should be capable of recognizing the difference.
Housing Is Housing. Treatment Is Treatment.
Perhaps the biggest course correction we need begins with intellectual honesty about what we are actually trying to solve.
Homelessness is not a single condition with a single root cause. High housing costs and inadequate supply clearly matter, particularly for working families and people living on the financial margins. But homelessness can also follow job loss, disability, family breakdown, domestic violence, untreated mental illness, substance-use disorder or some combination of these problems. Once someone is living on the street, the instability and isolation of homelessness can make addiction, psychiatric illness and physical health dramatically worse.
That means the appropriate response depends upon the person.
Someone who is working and loses an apartment because rent has outrun income may primarily need affordable housing, rental assistance or simply a housing market with greater supply. A family experiencing a temporary financial crisis may need emergency shelter and short-term assistance. Someone capable of independent living but struggling with a disability may benefit tremendously from supportive housing and case management.
But the person cycling between a tent, emergency room and jail while suffering from severe addiction or psychosis presents a fundamentally different challenge. That person may need detoxification, residential treatment, medication, psychiatric care, months of structured recovery and eventually transitional or supportive housing. In the most severe cases, intervention may have to occur before that person is capable of independently choosing or maintaining treatment.
We should stop pretending these circumstances are interchangeable merely because everyone involved currently lacks permanent housing.
Housing policy should address housing problems. Behavioral-health policy should address mental illness. Addiction policy should provide meaningful pathways into recovery. And when these problems overlap—as they frequently do among the chronically unsheltered—our response has to address all of them rather than selecting whichever diagnosis is politically most convenient.
That is where the Housing First debate has too often gone wrong. Housing can provide the stability from which recovery becomes possible, and for many people it may be the most important first intervention. But housing should be the foundation for treatment when treatment is needed, not a substitute for it.
A studio apartment cannot detoxify someone from fentanyl. A housing voucher cannot stabilize untreated schizophrenia. And a monthly rent subsidy cannot replace the structure of a long-term recovery program.
Those aren’t arguments against housing. They are arguments for matching the intervention to the human being who actually needs help.
The Course Correction
Oregon did not fail because we were unwilling to spend money or provide health coverage. We have done plenty of both. The deeper failure was assuming that eligibility for services meant services would actually exist when someone needed them.
We confused coverage with capacity, housing with treatment and tolerance with compassion.
Albany’s responsibility is considerably narrower: protect public spaces, enforce reasonable laws consistently and connect people with whatever assistance is available. The state bears the much larger responsibility of making sure meaningful assistance actually exists.
That means rebuilding detoxification capacity, residential addiction treatment, psychiatric care and long-term recovery infrastructure while continuing to address housing affordability and supply. These policies are complementary, not competing philosophies.
We do not need to recreate the asylums of the past. We need to build the treatment institutions of the future—humane, professionally staffed, evidence-based, accountable and protected by due process.
Because a tent is not housing, a jail cell is not a psychiatric hospital, and an insurance card is not a treatment bed.
It is time for Oregon to make the course correction.
That’s my viewpoint.
Sources and Further Reading
Documentary – Seattle is Dying
Oregon Health Authority — Behavioral Health Residential+ Facility Study, 2024: OHA Behavioral Health Residential+ Facility Study
Oregon Health Authority — Medicaid Substance Use Disorder 1115 Waiver: Oregon SUD 1115 Waiver
Oregon Secretary of State — Measure 110 Lacks Stability, Coordination & Clear Results: Oregon Measure 110 Audit
UC San Francisco — Behavioral Health and Homelessness: UCSF Behavioral Health and Homelessness Study
Pew Charitable Trusts — How Housing Costs Drive Levels of Homelessness: Pew housing-cost research
Oregon Health Authority — Oregon Overdose Data: Oregon overdose report
U.S. Supreme Court — City of Grants Pass v. Johnson: Supreme Court opinion
Oregon Legislature — ORS Chapter 426, Civil Commitment: Oregon civil-commitment statutes
City of Albany — Park Regulations: Albany park regulations
California Courts — CARE Act Implementation: California CARE Court data and implementation
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