In my orthopedic surgery practice, I regularly see patients whose medical recovery is derailed by housing instability. A patient discharged after hip surgery needs a safe place to rest, take medications on schedule, and attend follow-up appointments. Without stable housing, surgical outcomes suffer and patients end up back in emergency rooms–costing the healthcare system far more than the initial surgery.

This is why Utah’s proposed $75 million “homeless services campus” for up to 1,300 people, with 800 beds for involuntary psychiatric and substance use treatment, alarms us as healthcare providers. As a surgeon and a family nurse practitioner who completed doctoral research on healthcare in detention settings, we can tell you: the promised care won’t materialize, the fiscal math doesn’t work, and patients will suffer worse outcomes.

The workforce doesn’t exist

Utah already faces a severe shortage of psychiatric beds and mental health professionals. Where will the workforce come from to staff a 1,300-person facility with 800 beds designated for intensive psychiatric and substance use treatment?

Confined populations require more healthcare resources per person, not less. The promised “integrated care” requires teams of specialists–physicians, nurse practitioners, psychiatrists, addiction specialists, and case managers working in coordination.

The state is simultaneously cutting Medicaid, which funds mental health services for these populations. State Senator Jen Plumb called the promise of quality care “pie in the sky.” Without massive new funding–which isn’t proposed–this becomes what she warned: “a prison or a warehouse.”

Medical recovery requires community integration

As a trauma surgeon, I treat patients who need months of recovery, physical therapy, and follow-up care. Housing isn’t separate from medical treatment–it’s the foundation that makes treatment possible.

The proposed campus is two miles from the nearest bus stop, an hour’s walk with no sidewalks, in an industrial area near the airport. How do patients get to specialist appointments or access pharmacies and physical therapy?

Effective healthcare requires continuity. When patients are isolated from community resources, outcomes worsen. This is especially true for mental health and substance use treatment, where research shows community-based care with voluntary engagement produces better results than institutional settings.

The evidence contradicts involuntary approaches

Research published in JAMA Network Open found that Housing First with intensive case management is cost-effective and produces better outcomes than treatment-first models. People in stable housing show up for appointments, take medications consistently, and can focus on recovery rather than survival.

Meanwhile, people involuntarily committed for substance use disorder are more likely to experience fatal overdoses compared to those who complete voluntary treatment. Coercion doesn’t improve outcomes–it often makes them worse.

As a family nurse practitioner who worked with diverse patient populations, I saw that patients who succeeded were those given stable support and respect for their autonomy–not those forced into treatment.

The fiscal math doesn’t work

The proposal estimates $75 million in construction costs plus $34 million in annual operating expenses, with no identified funding source while the state cuts Medicaid.

The plan proposes redirecting $17 million in federal housing grants currently used for permanent housing — meaning people already housed would lose their homes. As Josh Romney, chair of Shelter the Homeless, warned: “If you start fiddling with that money, you’re going to be pulling people out of housing into homelessness.”

Utah’s own data shows that 95% of people placed in permanent housing stay housed. Building expensive institutional facilities that research shows produce worse outcomes isn’t good medicine or good fiscal policy.

What Utah County residents should demand

As healthcare providers who live and work in Utah County, we understand the community’s frustration with visible homelessness. But frustration shouldn’t drive us toward expensive solutions that research and clinical experience show won’t work.

The 4,600 Utahns experiencing homelessness — including seniors, working families, and people with medical needs — deserve evidence-based care. As medical professionals, we don’t prescribe treatments proven ineffective.

Utah County residents should demand that state legislators answer basic questions: Where will the healthcare workforce come from? How will Medicaid cuts be reconciled with increased treatment promises? What happens to people currently in housing when funding is redirected?

The state should invest in what works: permanent supportive housing, community-based mental health care, and voluntary treatment services. That’s not just good medicine — it’s responsible use of taxpayer dollars.

Jordan P. Barker, MD, is an orthopedic trauma surgeon at Intermountain Health in Provo and Clinical Adjunct Assistant Professor at Noorda College of Osteopathic Medicine. Celeste C. Barker, DNP, BSN, RN, is a family nurse practitioner whose doctoral research focused on healthcare delivery in detention settings. They live in Utah County with their four children.