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Give Police Tools to Reduce Arrest and Improve Community Health


NYPD training hall

(photo via @NYPDnews)


How do we respond to people in our society who might appear threatening, but who most urgently need medical help? Shortcomings in our community health and social services systems mean that many people who live in poverty, use drugs, and live with mental illness end up in our justice system.

In too many cases, a police officer’s response to someone experiencing a psychotic break or self-medicating with drugs involves an arrest, which can lead these medically-vulnerable people into a cycle of arrest and incarceration. Many of the issues that both public health and law enforcement agencies address in the communities they serve are rooted in health inequities, violence, trauma, racism, and poverty—problems that are often exacerbated by a stay in jail.

Of course, police officers should not be responsible for identifying social and medical needs in their communities, but they often serve as de facto street-corner psychiatrists and social workers for the people they encounter.

This is because they are called to respond to low level infractions that stem from people’s behavioral health needs. For instance, of all drug-related arrests in 2013, 83 percent were for possession of a controlled substance. Nearly 10 percent of all police interactions involve people with a mental health disorder—an interaction that too often leads to injuries and fatalities. In fact, it’s been estimated that more than 70 percent of people with mental health disorders in the justice system also have a substance use disorder. Currently, police lack alternatives to arrest for responding to these problems—officers report that they are more likely to arrest somebody displaying signs of a behavioral health disorder if they believe jail is the only option to provide basic medical services for that individual.

As gatekeepers between the community and the criminal justice system, police need to have the tools to appropriately respond to people who need treatment or services that do not require arrest, especially considering the long-term, steep collateral costs of justice involvement on individuals, communities, and taxpayers that include housing instability, underemployment, and reduced economic mobility.

Harm reduction and health promotion, two bedrock principles of the modern public health field, can serve as guiding approaches for police looking to minimize the negative impacts that too many low-level arrests have had on our communities—especially those of color. Though these burdens arise from the failures of current community health, justice, and social services, police officers can and should be an asset to public health work.

In contrast to abstinence-based interventions, harm reduction is a set of practical strategies that aim to minimize the negative impacts of drug use and other high-risk behaviors, even when people are not ready or able to give up these behaviors. And health promotion is designed to help people increase control over, and improve, their health.

Jurisdictions around the world have demonstrated that police who are able to incorporate a public health approach can not only reduce arrests of these medically-vulnerable groups, but also improve the health of communities.

Harm reduction-based interventions that deliver vital services to people engaged in drug use or sex work, such as condom distribution programs, overdose prevention training, or syringe exchange sites, can reduce the spread of infectious disease and prevent overdose deaths. And programs that incorporate health promotion principles, like Crisis Intervention Teams (CITs)—which consist of specially trained teams of officers who answer emergency calls where mental illness might be an issue—can leverage police training to equip officers to implement a safer response to people in psychiatric crises.

To ensure that vulnerable people are not driven underground and away from the services that benefit them and improve the health of communities, police should work with existing syringe exchange programs and local harm reduction advocates when possible to build trust and develop collaborative policies. Several harm reduction programs in New York City—like those of BOOM!Health, VOCAL-New York, and Washington Heights CORNER Project—have successfully worked with law enforcement agencies to develop policies and practices that don’t target people who utilize their services and that actively improve the safety of these clients as well as that of their communities.

Law enforcement agencies have also had success by reaching out to advocacy groups to increase their officers’ knowledge about harm reduction. The Harm Reduction Coalition has worked with police around New York State in a collaboration that resulted in the NYPD adopting their training manual. In the first year of this partnership, more than 5,000 officers were trained in using Naloxone, a life-saving antidote that prevents death when administered to somebody overdosing on opiates.

Many jurisdictions have also created collaborative diversion programs, where police departments partner with local health departments and behavioral health service providers to develop pre-arrest and pre-booking diversion programs. San Antonio’s Smart Justice programs provide CITs and two different kinds of drop-off centers—a short term crisis center and a longer term psychiatric center—where police can bring people instead of arresting them. It’s promising to see that New York City Mayor Bill de Blasio’s task force on behavioral health and criminal justice is adopting some of these strategies—the NYPD is increasing training for CITs and creating a drop-off center.

However, long-term impacts won’t be fully realized without an alignment of not only practices, but also metrics and incentives. Any review of police officers’ performance should include the number of their referrals to locally available community health and social services, metrics that reflect community perception and satisfaction with police encounters, and the number of lives saved through overdose prevention.

Arrests averted, rather than arrests made, should be a core guiding principle for police.

Additionally, health agencies, interventions, and professionals need to consider arrest and incarceration metrics of success for their programs in addition to more straightforward health outcomes.

Accessing public health services for people with substance use and mental health disorders should not require an interaction with law enforcement or a jail stay. Until alternatives are provided, police can draw on harm reduction and health promotion principles to most effectively ensure public safety for everyone, especially those who are most vulnerable.

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Chelsea Davis is a Research Analyst in the Substance Use and Mental Health Program at the Vera Institute of Justice, and is co-author of its recent report, First Do No Harm: Advancing Public Health in Policing Practices.

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Have an op-ed idea or submission for Gotham Gazette? E-mail editor Ben Max: This email address is being protected from spambots. You need JavaScript enabled to view it.

Harmful Legal Reform Is Not an Ethics Solution


courthouse


Here's the lead I wish I could write: "Corporate groups join government watchdogs to push for a New York State ethics overhaul." Fortunately, it's partly right - watchdog groups like NYPIRG and Citizens Union are certainly doing so. But some corporate groups are responding to the ethics mess in Albany, well, differently.

Consider the Dec. 2 op-ed "After Silver: Legal Reform is Ethics Reform" from the Lawsuit Reform Alliance of New York or "LRANY." This group has seized on the ethics crisis to promote an incongruous agenda. With 90 percent of New Yorkers rightly believing that state ethics laws are too weak, LRANY's response would be to weaken the legal rights of 99 percent of everyone who lives here.

A big LRANY priority, for example, is undermining New York's common-sense scaffolding safety law. Currently, New York's law ensures that owners and contractors are exclusively responsible for limiting hazards like unsound scaffolding, ladders, and other equipment, as well as flooring and elevators. LRANY's proposal would substantially weaken the obligations of owners and contractors to ensure a safe worksite. As someone who lives in New York City, with active renovation and high-rise construction everywhere, I think I can speak for most in saying: Albany, please do not weaken this safety law.

Another LRANY priority is a bill that would delay and deny justice to people suffering from lethal asbestos-related diseases. The asbestos industry covered up the dangers of asbestos for over 50 years, more than 3,000 Americans still die from asbestos diseases annually, and asbestos is still not banned in the United States. The Lawsuit Reform Alliance proposal would essentially allow the asbestos industry to delay and avoid cases until the victims are dead. As Elihu Inselbuch, from the corporate firm Caplin & Drysdale, testified in Congress, such legislation, "has nothing to do with reducing fraud; instead, it is a gift to the asbestos industry, which continues to try and avoid accountability and decrease compensation to the victims of its past wrongs." Nor is this a bill about "transparency." Nothing in this legislation would stop the asbestos industry's continuing practice of hiding where asbestos is present and was used, and demanding secrecy from victims when they settle cases, as they routinely do.

Speaking of sick and injured New Yorkers, LRANY is also focused on medical malpractice. Medical errors are now the third leading cause of death in the United States. In New York, we actually have some experience solving this problem. When the labor and delivery unit at NY Presbyterian Hospital-Weill Cornell Medical Center implemented a comprehensive obstetric patient safety program, not only were catastrophic errors dramatically reduced, but also compensation payments fell by 99.1 percent. I think most New Yorkers would agree that the best way to reduce claims and lawsuits is to reduce injuries and deaths.

Unfortunately, this message seems completely lost on the medical and insurance lobbies, including groups like LRANY. Their focus continues to be stripping away the legal rights of injured patients after they've been hurt. Indeed, New York State doctors and hospitals already benefit from more liability protections than virtually any other industry or profession in the state. More specifically, in the mid-1980s, New York enacted three out of four "medical liability reform" agenda items pushed by LRANY's corporate partner, the American Tort Reform Association, all of which harm patients.

These laws added to legal obstacles that New Yorkers already faced, which residents in most other states do not. They include an archaic "wrongful death" law dating from the 1800s that does not allow compensation for emotional hardship in loss of a child killed by medical malpractice; and a restrictive statute of limitations law that prevents claims involving latent injuries, like a cancer misdiagnosis. In June, a bill to change that discriminatory law passed the Assembly and would have been signed by the Governor had it not been blocked by Senate Majority Leader John Flanagan, in cahoots with New York's powerful hospital lobby.

And that's not the only damage the hospital lobby has done recently. In 2011, New York became the only state in the nation to enact a law providing that, if a baby suffers a catastrophic brain-injury at birth due to a doctor's negligence, the at-fault hospital is largely off the hook. Even if a jury finds the medical team at fault and awards the family compensation, the child's family cannot receive most of these funds. Instead, they are forced to go to a state program to pay for the child's care. Moreover, by law these children are condemned to a lifetime of suboptimal Medicaid care for any necessary therapies, no matter what a jury says they need.

Meanwhile, New York State law does not force insurance companies to disclose even basic information to lawmakers or the public about what they actually pay in claims, allowing them to price-gouge policyholders with virtually no oversight or regulation. In fact, New York State is one of the least transparent states in the nation when it comes to the insurance industry and claims data. Even Texas has better disclosure laws than New York. The impact of this goes far beyond simply harming public confidence in city and state government and major institutions. This secrecy also has serious public safety implications, allowing groups like Lawsuit Reform Alliance of New York to engage in fear-mongering, not facts.

What we do know is that New York is among the top states in the nation for physicians practicing in the "high-risk" specialties of OB/GYN and surgery. Last time NYPIRG examined this, New York State had the fourth highest number of OB/GYNs per capita in the country, second highest number of general surgeons, and the highest per capita number of surgical specialists.

Physician shortages that exist in New York's rural areas are longstanding and correlate to stagnating local economies and decreasing populations in those regions, not to insurance rates (which, in any event, are relatively low in those areas). LRANY claims in its article that "at least eight New York counties have no OBGYN services at all," suggesting that women and injured babies should give up even more of their legal rights as a result. When a lobby group made spurious allegations like this a few years ago, we decided to check the counties about which these claims were made. By making a few simple phone calls, we found that those counties indeed either had obstetricians practicing within the county or had obstetrical services available from doctors very nearby. The entire argument was bogus, not to mention unethical.

History is clear on one thing: taking away the rights of the most seriously injured New Yorkers has been and continues to be failed public policy. Our laws should hold accountable those who commit harm. And if insurance companies are engaged in price-gouging, the solution to that problem lies with the insurance industry and stricter insurance regulation and disclosure laws. Transparency and oversight are the only way to stop corporate lobbies from abusing their economic influence here, and promoting a legislative agenda that severely harms New Yorkers.

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Joanne Doroshow, Executive Director, Center for Justice & Democracy at New York Law School; on Twitter @centerjd.

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Have an op-ed idea or submission for Gotham Gazette? E-mail editor Ben Max: This email address is being protected from spambots. You need JavaScript enabled to view it.

City's Rezoning Plans Won't Improve Affordability or Quality


Berman protest flickr

Andrew Berman, the author, at a rally 


The Mayor's 'Zoning for Quality and Affordability' (ZQA) and 'Mandatory Inclusionary Housing' citywide rezoning initiatives, released jointly this fall, are finishing the first stage of public review at the city's 59 community boards. They're receiving a resounding thumbs down, by a 7-to-1 and 3-to-1 margin respectively. Why are measures aimed at increasing affordability and quality in new construction getting such a cold shoulder?

Perhaps because they would do little or none of either, and possibly more harm than good. The central tenet of ZQA is that if you increase the allowable height of new buildings, quality and affordability will improve.

For purely market-rate buildings, to which many of the proposed height limit increases would apply, this premise is almost laughable. The City's main contention is too many new buildings have 10- or 11-foot-tall ground floors instead of a more generous 13.5 feet, and new buildings should set back from the street to make room for planters in front. Neither is a concern I have heard a single New Yorker raise about new construction, but to achieve this, the City is willing to give developers an additional 5-20 feet in height for new buildings.

Never mind that many new buildings already have 13-foot-high ground floors, and sometimes more modestly-scaled ground floors are actually preferable. Or that setback buildings with planters make no sense on the large commercial streets where the new rules would often apply, and developers would get the extra height ZQA offers whether or not they set their building back and provide the planters anyway.

Such folly aside, the city's argument for raising height limits for 'affordable housing' is more insidious. In certain zoning districts, market-rate developments are now encouraged but not required to set aside 20 percent of units as affordable housing by offering additional market rate square footage if they do. There are height limits for these and all other new developments, to ensure that they fit in with their surroundings.

But the City claims the height limits prevent developers from including the affordable units, leaving no way to cram in all the extra space for the affordable and additional market-rate units, at least not without cramped, substandard spaces.

However, the facts don't bear this out.

About 50 percent of the new developments in such zoning districts in our area, Greenwich Village and the East Village, include the affordable units and the generous dimensions the City says we want in new developments. At the same time, we've seen many developers who had ample room to add the affordable units within the current height limits, but simply chose not to. The height limits were not an impediment; within this voluntary program, these developers simply decided it wasn't worth their while.

Nevertheless, the Mayor is proposing to lift the height limits for such developments by 25 feet or more, or up to 31 percent, though there is little or no evidence that it will result in a single additional unit of affordable housing being built. What it will do is increase out-of-scale construction in residential neighborhoods, and eliminate hard-fought-for height limits which were often delicate compromises that took years to craft and achieve.

While ZQA would do little or nothing to help affordability, making the current voluntary affordable housing program mandatory clearly would.

Many people think Mandatory Inclusionary Housing (MIH), the companion to ZQA, will do that. But under the Mayor's plan, it won't.

MIH would require that new residential developments include 25-30% affordable units. But under the Mayor's plan, MIH would only be applied in areas where rezonings also allow a large increase in the allowable size of market-rate housing development.

But many areas of the city will probably never see MIH because such large increases in the allowable size of development, especially market-rate development, are just not tenable. This will likely include many of the more affluent parts of the city with the strongest real estate markets, which are most lacking in affordable housing, and where the city's own studies say new housing is most likely to be produced.

So why limit MIH only to areas where you're substantially increasing the size of development allowable?

The Mayor claims he's doing this because if the program is too onerous, developers just won't build at all.

But this argument does not seem credible. In strong real estate markets of the city, developers are opting into the affordable program about half the time, which shows they are willing to build under these conditions (and the other 50 percent probably would if required to). And clearly developers are making money when doing so, meeting the legal requirement for allowing a "reasonable return" which zoning must meet.

By contrast, linking MIH to large-scale increases in the allowable amount of market-rate development might undermine the supposed goal of increasing affordability, to say nothing of maintaining neighborhood character and livable communities.

Cases in point: the Williamsburg/Greenpoint waterfront and West Chelsea/Hudson Yards. These are the two areas of the city which have seen the largest production of affordable housing in recent years, through programs similar but not identical to MIH.

But the price for the affordable housing in those neighborhoods was the tsunami of large-scale, market-rate housing to which it was attached. This resulted from zoning changes significantly increasing the amount of market-rate housing which could be built, which the city says would also be a prerequisite for using MIH.

The result: two of the most rapidly gentrifying, unaffordable neighborhoods in New York, with a scale and sense of place more like Hong Kong or Miami than New York. While the percentage of affordable housing under MIH might be slightly different (in those cases 27-28 percent was promised, as compared to MIH's commitment of 25-30 percent), the net effect would be pretty similar.

So why would the Mayor so aggressively pursue ZQA, which has little or no likelihood of increasing affordability, and choose to significantly diminish the effectiveness of MIH, which would?

It seems the Mayor is intent upon staying on the good side of the real estate industry, and thus far he has succeeded. As has been widely reported, industry players have been his biggest financial backers, and generous to the "Campaign for One New York," the nonprofit fund which supports the Mayor's 'affordable housing' and other initiatives. The Mayor seems to be trying to make his plans as palatable to big real estate as possible, regardless of how it affects the outcomes.

A further example: right now we are pushing the Mayor to rezone a 12-block area of Greenwich Village that allows 300-foot-tall towers, and guarantees they will be 100 percent luxury housing, hotels, or dorms. We want reasonable height limits for new development while keeping the allowable square footage the same, elimination of incentives for dorms and hotels, and incentives (or requirements, if the City agreed) for including affordable housing.

The administration's response: an adamant no. De Blasio wants to keep the existing luxury tower-only zoning. ZQA and MIH as proposed may please the Mayor's real estate backers, but won't accomplish their purported goals of increasing affordability and quality. Community Boards and groups across the city appear to be getting that. It remains to be seen if the City Council and others that will decide these measures' fate will as well.

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Andrew Berman is Executive Director of Greenwich Village Society for Historic Preservation. On Twitter @GVSHP.

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Have an op-ed idea or submission for Gotham Gazette? E-mail editor Ben Max: This email address is being protected from spambots. You need JavaScript enabled to view it.



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