A ‘Quiet Revolution’ Gains Momentum

Rev. Alexander E. Sharp Diversion

Diverting individuals from drug use to treatment rather than arresting them is becoming increasingly common in the United States. In this interview, Jac Charlier, co-founder of the Police, Treatment, and Community Collaborative (PTACC), describes this “quiet revolution” and brings us up-to-date on its progress. What are police diversion and deflection? Pre-arrest diversion is what happens when police direct individuals to treatment or other services when facing criminal charges that will be held in abeyance instead. Deflection is when police connect individuals into community-based treatment, housing, and services without involving the criminal justice system. Why did you start focusing on diversion and deflection? Diversion is the right thing to do. It’s hard to work in law enforcement and see that the tools we have on our belt — a gun and badge — aren’t solving the problem of addiction and mental health, the two largest drivers of justice involvement in the United States. Diversion is a way to say, “Let’s get these folks into treatment in the community, which will then stop them from having encounters with the justice system in the first place.” Should police ever arrest someone for low level drug possession? How often do we hear the phrase “We can’t arrest our way out of this.”  That’s the wrong statement. What we say in deflection is, “Do we really need to arrest in the first place?” Sometimes police drive away from someone when there are no other charges but they know the person needs help. They have compassion: Deflection says, “We need to be trained in how to work together with behavioral health to say, “I’m not driving away.  I know how to connect you up with treatment. No need to wait for a crisis to act.” What is PTACC? PTACC stands for Police Treatment and Community Collaborative. We are the national voice of the emerging field of deflection and pre-arrest diversion. PTACC represents a field that’s about seven years old, sitting at the intersection of law enforcement, first responders, community-based behavioral health, mental health, trauma, housing and other services. PTACC is made up of 31 national sponsoring organizations. When it comes to deflection, the vast majority are rural or medium-size departments, and so you’re getting 30 people a year, you’re getting 15 people, 10 people per department. We also still don’t have a lot of departments doing the deflection. 18,000 law enforcement departments, we think we’re at about 750 right now, up from 400 two years ago. What are your greatest accomplishments? We are demonstrating that police and drug treatment providers can work together. In the past they have had a kind of indifference to each other, not knowing that to reduce crime, they actually need each other. Police would go sit outside methadone clinics and wait for people. Those days are behind us and now police are carrying naloxone. The second big thing we’ve done at PTACC is to save lives, whether it’s in response to the opioid epidemic or to other mental health issues. Third, we have advanced the conversation at the federal level.  In 2019, for the first time, the Office of National Drug Control Policy included the words “deflection” and “pre-arrest diversion” as a formal strategies to combat drug use. That’s a big deal. You give police five pathways when they encounter drug users.  Which are the most successful? You have to look at what problem you’re trying to solve, and what resources you have. If you have opioid overdose, you’re going do Naloxone Plus.  Self- referral happens more in rural and medium-size area where the amount of investment needed to start deflection is light. Treatment is mostly what you need to get self-referral going.   Active outreach starts with the idea that we have a group of folks that our officers are running into over and over. About 10 percent in this group consume 80 to 90 percent of public health dollars in emergency room costs, repeat visits, and other chronic issues.  Under active outreach, you target proactively people to connect them to treatment. Officer prevention and officer intervention give officers what we call third option, which is the power of deflection while working their beat or on patrol. Everybody gets the first option: the power to arrest. They forget the second option, which is police can drive away and do nothing. In deflection, officers can instead take people directly to treatment, housing, and services. Since deflection started, how many people have actually been deflected? We estimate we are over 40,000 people. Aren’t we really just asking police to be social workers? About 80% of police calls have some amount of social service component to them. They’re not just getting called to go after the bank robbers. People are calling them because they don’t know what else to do. In officer training, I’ll say “We don’t want you to be drug counselors or social workers. We do want you and your counterpart in drug treatment and mental health and housing to know each other and know how to connect people between each other.” We want police out of the business of social services and into “Well, I don’t know. It’s not my thing, but here, wait five minutes. We’ll have someone come over, he’ll take you to drug treatment center.” The police would love that. They could get back to catching the bad guys. What are the barriers in getting police to divert and deflect? Police law enforcement is a paramilitary culture. You need the chief to give the command that the department is going to do this. You absolutely need leadership.  Number two is the broader culture, meaning the line officer and the sergeant. You need them saying, “This is what I expect you to do. I want to see what you’re doing on your shift.” The third thing is pressure from the public. They might say, Where did you take that guy? You got to take him to prison.” You have to learn how to respond to this so the crime reduction aspect of deflection is what happens. Much of this work depends on the availability of treatment.  How much treatment is available? Nationally, about 22 million people in the US are active users of drugs.  Against that, it is estimated that there are about 2.5 million drug treatment slots. My daughter is an emergency room doctor. She says she does not have any place to refer opioid overdose “deaths.” What are the pathways to address that? There is in the United States a huge and massive disconnect between emergency rooms at the hospitals and behavior health. The payment structure for services in hospitals includes a form that lists a discharge plan. But the case management to ensure that you do what the plan says is needed is rarely funded once you walk out of the ER. We need to find a way for hospitals to sit down at the table with local behavioral health, insurance companies, and the State Medicaid office, to develop a payment structure for follow-up to happen. We need specialized case management that bridges these worlds together. Are the five pathways confined pretty much to smaller cities and towns? San Francisco, New York, and even Chicago have small versions of it underway now. San Francisco has a small officer prevention approach that they are starting. New York City has someone.  Chicago has both mental health — down in Roseland, they have the mental health drop off center, and they have the west side triage and wellness center over on Madison and Pulaski. Baltimore has begun an officer prevention approach. Officers are trained to deflect in the high drug areas. Boston is underway with that. San Francisco. Spokane, Washington has a whole behavioral health unit fully integrated between officers and treatment. What impact does deflection have on communities? It can aid in police-community relations. Consider the normal scenario: Squad car drives down the street. Person is arrested, put in the squad car and driven away. Twenty-four hours later, he calls home from the jail and says he has been arrested. That cycle is repeated over and over. With deflection, squad car drives down the street, person goes in the squad car, two hours later he calls, he says, “Hey, mom and dad, I’m in drug treatment.  I’m in housing. I’m in a mental health center. Hey mom, I’m back home and Tomorrow at 10:00 a.m. I have to report to treatment.” Deflection changes the script on how police are viewed. We have anecdotal evidence, especially in high drug use areas, that that is in fact happening. The recovery community is beginning to come alongside police and say, “We’re spreading the word about what you’re doing.” That’s powerful. Can churches and faith leaders be helpful? What I really want churches to do is, first, be advocates for deflection and the funding of community-based treatment. Advocate for funding and resources.  Second, let’s recognize that congregations have people in recovery who could help others in recovery. If you had seven churches in a small community, those seven churches might have thirteen folks in those congregations who are in recovery.  What a calling in response to the Gospel it would be to say, “I’m going to use my recovery to help somebody else who is struggling. If you need someone, call me at 2:00 in the morning and we’ll set up a tree, we’ll figure out who to call and we’ll be there.”

Diversion: A Landmark Bill

grygielny Diversion, IL

On May 31, the Illinois General Assembly passed legislation that will assist police in diverting individuals, including low level drug users and the mentally ill, into treatment programs rather than jails or prison. The bill is the first of its kind in the nation. Senate Bill 3023 formalizes a process called “diversion” which first gained national attention three years ago. The Police Chief of Gloucester, Massachusetts posted on Facebook that if drug users came directly to his office he not would arrest them but would steer them to treatment. The message went viral. Illinois’ legislation should serve as a roadmap for police and treatment providers. It authorizes them to establish diversion programs. It offers immunity from civil liability for participants and establishes eligibility for funding. It also requires the Illinois Criminal Justice Authority to gather program data and measure performance. Since then, Jac Charlier, National Director for Justice Initiatives at Illinois Treatment Alternatives for Safe Communities (TASC), has worked with police chiefs and social service providers to organize programs around the country based on this concept. Charlier helped to establish the PTAC Collaborative (Police, Treatment, and Community). This organization reports that over 500 out of 1,800 police departments in the U.S. are now practicing what he calls “deflection” in some form. Clergy for a New Drug Policy has been working to publicize and advocate for diversion programs since their inception. Progressive activists in the Quad Cities with whom we met last week expressed strong interest in advocating for this measure. They felt that the cost savings of treatment compared to incarceration should be persuasive to community leaders. The greatest obstacle to wider implementation is the lack of treatment facilities. In the May 24 issue of Chicago Reporter, Curtis Black wrote that “many existing programs… stabilize communities and prevent violence. But they are never brought to scale or funded sustainably. Instead we continue to pour money into arresting and imprisoning people.” Nationally, drug and mental health treatment is available for only about ten percent of those who need it. In the Chicago Reporter, Jack Charlier noted that “No community in the United States has sufficient behavioral health services.” About 1,300 police forces do not yet include deflection in their array of services. SB 3023 is intended to encourage them to do so. Reverend Alexander Sharp 

Mental Illness, Poverty, and Addiction Are Not Crimes

grygielny Diversion

Surely no reasonable person would assert that mental illness, poverty, and addiction are crimes, or that anyone should be sent to prison for being poor or afflicted with mental illness or addiction. But what should society do when those who, driven by their afflictions, repeatedly break the law? In 1971, President Richard Nixon gave us two potentially contradictory answers. He declared a War on Drugs—which President Ronald Reagan later intensified with relentless and mindless cruelty—that created militarized police forces and empowered them to arrest low-level drug users, mostly from poor, minority neighborhoods. Almost simultaneously Nixon created a program called Treatment Alternatives to Street Crime (TASC) to divert drug-involved offenders to treatment. In each program, it is the police who determine who goes to jail or who gets treatment, an authorization that this should give us pause. Police often handle a difficult job well. But for the most part they have not been trained in helping the afflicted, nor do they have the incentive to do so. Their rewards come from making arrests. “Law and order” and what might be called diversion, therefore, do not easily co-exist. While TASC programs have had occasional success, it is the War on Drugs that has dominated the national landscape, with tragic consequences: ruined lives, discriminatory law enforcement policies, and over one trillion dollars of national treasure squandered. In the last few years, however, this imbalance has begun to shift. The primary reason for this evolution is the opioid crisis, now a national epidemic, which claims over 65,000 overdose deaths annually. In the spring of 2015, the police chief in Gloucester, Massachusetts, stunned by five overdose deaths in five months in his town of 30,000, promised on Facebook that if addicts came to his office and turned in their drug paraphernalia, he would not arrest them but would instead help them locate treatment. The post went viral, and other police chiefs began to make the same offer. Together they formed the Police-Assisted Addiction Recovery Initiative (PAARI), which has grown to over 360 police chiefs nationwide. In 2017 they convened in Washington DC and decided to build a movement, broadening their base under the rubric Police, Treatment, and Community (PTAC). This larger collaborative, in turn, has just held the PTAC National Pre-Arrest Diversion Inaugural Conference. This collaboration enjoys creative and energetic leadership. One of the key organizers is a happy warrior named Jac Charlier, a nationally recognized expert in pre-arrest diversion who serves as National Director for Justice Initiatives at Illinois TASC. His enthusiasm was palpable as he opened the conference, declaring that for “the first time in the United States, all of us have realized that there is a newly emerging field and profession in the United States called pre-arrest diversion.” The numbers bear him out. PAARI’s executive director estimates that over 500 police chiefs are practicing diversion nationwide. Over 175 participants from communities across the country joined PTAC’s 26 founding organizations at the conference. Charlier has a compelling vision: “In three to five years, we will see the profession develop and we’ll start seeing job postings for pre-arrest diversion manager or counselor, just like the re-entry movement and how that started.” I believe this can happen, and that society will benefit when it does. We have come a long way in the last three years, when in this newsletter we described a police chief in Mundelein named Eric Guenther who was beginning to follow the Gloucester model by helping to find treatment for addicts that came to his police station. At that time I could not have imagined the scale of the response from police chiefs across the country, and the kind of vitality and commitment we saw at the first annual Police, Treatment, and Community conference. In this season that represents hope in difficult times, a ray of hope—indeed, of fundamental humanity—is more than welcome. It is an Easter blessing. Reverend Alexander Sharp 

Five Forms of Diversion

grygielny Diversion

At the recent Inaugural Pre-Trial Diversion Conference of Police, Treatment and Community in Florida, I (Al Sharp) was privileged to hear presentations on five forms of diversion for non-violent drug offenders away from the prison industrial complex and into treatment and support programs. Below, we offer descriptions of these programs, excerpted from the presenters at the conference. Statements have been edited for length. Self Referral In this model, the individual initiates contact with law enforcement to seek a treatment referral, without fear of arrest. Allie McDade, Executive Director of the Police Assisted Addiction and Recovery Initiative in Gloucester, Massachusetts, presented about the program. The Gloucester Angel program was started in June 2015 after a series of overdose deaths in that community. Gloucester is a small fishing community about an hour north of Boston, so one overdose death per month was a lot for them. The police departments decided to do something different. The idea was that they would open the doors of the police station and anybody who wanted to come in, 24 hours a day, could just walk into the station and ask for help and they would figure out how to get you into treatment. It didn’t matter where you lived, whether or not you had insurance, what your drug of choice was. The goal was to prevent overdose deaths. The self-referral pathway, as the name suggests, is for people who are ready for treatment. It’s reaching people outside of the criminal justice system before any violation occurs. Anybody can walk in and ask for a direct referral. Some of the programs, including Gloucester’s, are going to address the barriers to treatment and create linkages, for example, between detox and a longer-term care and advocate. We also do a lot of reentry support, so once someone returns to the community after treatment, we help them get connected to housing and employment. This pathway—and all the other pathways really—would not work without collaboration. Obviously, as a department, you need [a program] to refer someone to, and you need to be familiar with all the different recovery support services in your community. So, collaboration and linkages are very, very important to this pathway. Active Outreach In this approach, law enforcement identifies individuals and hands them off to a treatment provider. John Tharp, Sheriff of Lucas County, Ohio, described the program and its origins. In 1973, my partner and I responded to a call. When we arrived, there were three people dead from overdose in an apartment. We made out a half-page report and contacted the coroner, who came and got the bodies, and that’s all we did… .We were thinking, “We should be doing more.” So we decided that when we got calls for an overdose we would take those individuals straight to detox when they were released from the hospital. We called Ohio Attorney General DeWine and explained the situation to him, and he brought us $800,000 to pay for more officers and for detox beds. Since the inception of the unit, we have responded to over 2,600 overdoses, so we’re averaging right around 79% success of getting people into detox beds and getting people to agree to go to detox beds. It’s very, very tough to respond and get people to go with us, because first of all, they’re afraid of cops. They just overdosed, and the last person they want to see is law enforcement. So, we talk them into going to detox with us, and they will do so. We actually deputized park rangers and brought them in. We have certified peace officers who work security in public libraries, and we deputize them. We now have 17 officers who are aggressive and responding. We know that relapse is part of recovery. They relapse. Once they’ve relapsed, we don’t wash our hands of them. We continue to go back and work with them. Naloxone Plus This option involves engagement with treatment as part of a response to an overdose or a severe substance use disorder at acute risk for opioid overdose. Tom Fallon, Commander, Amberley Village Police Department, Hamilton County, Ohio; Dan Meloy, Director of Public Safety, Colerain County, Ohio; and Kelly Firesheets, Coordinator, Interact for Health’s Preventing Opioid Misuse and Safety Network described their communities’ applications of this approach to addiction.’ Meloy: I was talking to people in recovery: “What if we showed up at your door after you overdosed? What would you say?” And the young man happened to be a firefighter. He had fallen off a roof in the line of duty, had surgery, was prescribed Percocet, and addiction followed, then crime; he was facing prison and got probation. He just looked at me and he cried…. “Why would police and fire care? I’ve overdosed so many times. I turned into a criminal. Why would police and fire care about me?” I sat down with the CEO of the Greater Cincinnati Addiction Services Council and laid out the model: “We have the information; we’re going to go out and proactively find them. What do you think?” The CEO looked at me: “It’s going to work. I’ve been doing street-level social work for over 30 years. You’re breaking down barriers by being there.” Fallon: You have to locate the victim, which a lot of times is very difficult. These people are nomadic. You knock on the door, you get them, and you turn them over, and you just say, “How can I help you?” Our role is to locate the victim and turn them over to the behavioral health people. They figure out the best place to place them, whether in intense outpatient or detox, or whatever they need. What we see is a collaboration between first responders, usually police, fire, EMS in some shape, form, or fashion and then public health and treatment. More and more, we’re integrating peer recovery coaches and peer recovery counselors, which is a fantastic addition to the work. Firesheets: These naloxone-plus interventions literally are the bridges in that huge systems gap between the sidewalk where people are dropping and the treatment facilities. So, we’re building those bridges to get people across the gaps. Officer Intervention Law Enforcement initiatives treatment: charges are held in abeyance or citations issued. Greg Frost, President of the Civil Citation Network of Tallahassee, Florida, described this approach. Basically, we are casting a very broad net for individuals who’ve never been arrested before. It’s their first contact with law enforcement or one of the first where they are a suspect in committing a certain eligible misdemeanor. Be honest with yourselves. Look back on your life. How many of you, besides me, have done something in your past for which you could have been arrested? Raise your hand. Okay. Now, look around at who didn’t raise their hand. You’ve got it. You’ve got it. It’s us, folks. It’s us. People make mistakes. It’s you and me on a bad day. It’s the person who is a lawyer, a doctor, a student at Florida State University, and they make a mistake, and they end up breaking the law. Every year in Florida, 65,000 people are arrested for the first time on misdemeanor charge. There are serious consequences to that arrest. There hasn’t been a lot of research done on that first-time, low-level, nonviolent misdemeanor offender, because there’s been kind of a, “Yeah, okay, that’s not a big deal.” Well, it is a big deal. And it’s costing us all a lot of money. We’ve got three large schools, colleges, in Tallahassee. These kids are losing their federal funding because they were 20 years old and got caught with a can of beer in their hand. They’re losing their student loans, having to drop out of school. Access to some housing programs. Negative impact on child custody. If you lose your job, what’s the impact on some of the minority communities where you have such a high arrest rate? Entire neighborhoods are being destabilized economically, just because the criminal justice system doesn’t provide law enforcement officers with that curve tool. Here’s the basic process: You have a misdemeanor and a call for service. An officer responds. Let’s just say it’s two guys in a bar and they’re arguing over the tab and somebody pushes the other guy. There’s probable cause. Rather than arresting the person, the officer can issue a civil citation. The person doesn’t have to take it. They can say, “No, I have my constitutional right, I want to go stand before a judge.” If they choose the civil citation, then for the next 72 hours, they report into a behavioral health agency. They have a full biopsychosocial assessment, there’s a drug screening, and then from there, there’s an individualized intervention behavioral health plan put together to address their specific issues. If the person is successful, then they’ll have counseling, they’ll have additional drug screenings, they will go through some educational modules, they’ll have their community service hours. So once they complete all of those successfully, then there is no arrest record. I’ve talked to a lot of chiefs and sheriffs who have said, “Wait a minute now, this is soft on crime.” No, it’s not. They’re going to have community service hours, they’re going to pay a fee for their behavioral health services. It’ll be basically the same as if they went through the criminal justice system. So a person is being held accountable, one way or the other. We’ve got approximately an 84% success rate. Those that go into the program, 84% of them successfully complete the program. Officer Prevention In this approach, law enforcement initiates treatment as part of an enforcement action, and no charges are filed. Kris Nyrop, LEAD National Support Director; Co-founder, first LEAD project, Seattle, and Brendan Cox, Director of Policing Strategies at the LEAD National Support Bureau; and Chief (ret.) Albany, NY Police Department, described this approach. Nyrop: LEAD grew out of incredibly contentious, over-a-decade-long debate that was played out in court, in civil litigation, over massive racial disparity in black arrests. So in a city [Seattle] where 8% of the population was African-American, about 60% of those who were being arrested for drug possession and sales were black. And it was not in response to opioids; the emphasis here was on crack. This was the motivation behind LEAD. What we’re seeing in other cities is that the motivation is quite different. But the common theme in all of the places that have adopted LEAD so far, is that the status quo around behavioral health conditions is absolutely broken. Police are routinely coming in contact with individuals with behavioral health conditions, either substance abuse or mental health. Or poverty, in some cases. And the only choice the police have at that moment is to arrest that person. That’s the handcuff that the police are in, that the option they’re given is either to ignore what’s going on or to arrest the individual. So, LEAD was designed to give officers a third option. LEAD exists in both pre-arrest and post-arrest formats. It can be adapted to local situations. Some areas are doing only pre-arrest diversion, others are doing it only post-arrest. Many areas are doing both. The range of offenses that are eligible for LEAD also varies by jurisdiction. For example, in Seattle, the driver of racial disparity in drug arrests was really around drug sales. So for us it was absolutely critical that drug sales be a divertible offense. When we first started, our initial eligibility criterion was possession or sales of up to three grams of drugs. That was a big leap for the Seattle Police Department to make. Since then, after six years of successful operation, they’re willing to include a much wider range of offenses. We’re now up to possession or sales of seven grams. Basically, drug possession arrests have ceased in Seattle as a result of doing LEAD. Cox: There are people who need to be in jail or in prison. We know that. Somebody kills somebody, …

Lessons from Portugal

Rev. Alexander E. Sharp Diversion

As we celebrate the second year of Clergy for New Drug Policy, this is a good time to bring us all up-to-date on the central issue that lies at the heart of our work. Our mission is to seek a “health not punishment” response to drug policy. We will be successful when all non-violent, low-level drug users are not treated as criminals and steered to treatment if they are struggling with addiction. One nation does this with great success. Sixteen years ago, Portugal decriminalized all drugs, not just marijuana. Police refer all non-traffickers to “dissuasion commissions”, consisting of a doctor, social worker, and a lawyer. Selling drugs is still against the law. If the user is deemed a recreational user, the commission issues a small fine, or perhaps community service; in other words, a civil sanction.