The following is an extended version of the print edition
The idea, they say, is to set up teams to handle emergency calls about people dealing with mental health emergencies or substance use related crises, or requests for a welfare check on a potentially sick person, without sending armed police. The initiative is called Help Not Handcuffs, and New Orleans is among many U.S. cities exploring such programs. So what is the deal with this initiative that cops, prison reformists, and politicians all seem to love?
“Our goal is to make sure that when someone calls 911 for a mental health crisis, that they are met with support and not with cops who bear handcuffs, tasers, sirens, and scary uniforms,” said Orleans Parish Prison Reform Coalition (OPPRC) Executive Director Sade Dumas. “It’s to make sure that people do not end up in jail for being sick,” she said, broadly referring to individuals who have (or are perceived to have) mental health diagnoses.
Founded in 2004, OPPRC has been involved in several campaigns, with the longest and most resource-intensive one being the effort to stop the Orleans Parish jail complex from adding a new, massively expensive complex specifically designated for mentally ill people called Phase III. Instead, the group advocates building a “crisis stabilization center.” How different such a facility really would be from a jail isn’t yet clear.
The George Floyd uprisings of last summer made terms like “abolition” and “defunding the police” household conversation. The strength of that uprising, and the decades of organizing behind it, has catalyzed and reinvigorated what Chicago prison abolitionists Project NIA aptly call “one million experiments,” projects aiming to promote decarceration and reduce police violence through various avenues. Organizations all over the country—and all over the reform vs. abolition spectrum—are pushing, in particular, for non-police intervention options and alternatives to imprisonment for people experiencing (or perceived as experiencing) mental health crises.
It’s a life-and-death problem. People with mental illnesses make up more than one in five of those shot and killed by police, according to an oft-cited statistic based on Washington Post data. Some sources, like the nonprofit Treatment Advocacy Center, report even higher percentages. “Mentally ill” is a shaky, subjective term, one that evolves with culture. Accurate diagnoses can take years to determine even if one has access to excellent health care providers—so it is difficult to imagine how someone could make an on-the-spot assessment during an encounter with someone who seems distraught or disoriented.
Just as the category of “mentally ill” is nebulous, so too is another frequently conflated category—people who use drugs. In reality, most people use some kind of mind-altering substance with regularity, whether it is coffee, a prescription, or something considered recreational. Whether people are considered drug users (or “addicts,” with even stronger criminal connotations) has less to do with the substance itself, since it is possible to develop a chaotic or disruptive relationship with any drug, and more to do with how the substance is culturally perceived, medically regulated, or criminalized—and who is using the drug. Infamously, the sentencing disparities between crack and cocaine possession from 1986 to 2010 epitomize how prejudiced criminalization of drug use is. Given this quagmire of misunderstanding, stigma, and risk, like “the mentally ill,” people using drugs are often also wary of calling emergency services in crises.
Help Not Handcuffs, programs like it, and the discourse surrounding them must be understood within the context of this exact moment. Though the uprisings of last summer were generative, they didn’t actually succeed in defunding the police. Yet the mere suggestion of a less bloated, expensive, militarized police force—let alone the radical notion that perhaps we ought not have police at all—has resulted in a tremendous backlash (on the federal level, the Senate just passed a largely symbolic measure against defunding the police, opposed only by Bernie Sanders). In addition to the usual post-protest wave of laws criminalizing dissent and legalizing politically motivated vehicular manslaughter, the spectre of the “violent crime surge” is back big.
You can add “crime” itself to the list of hazy terms—civil rights lawyer and scholar Alec Karakatsanis, who co-founded Equal Justice Under Law and Civil Rights Corps, challenges the legitimacy of “crime” in his Yale Law Journal treatise “The Punishment Bureaucracy.” He writes that “choices about what is a crime and what is not are made by politicians and within the economic, social, and racial systems in which politicians exist. As a result, for better or worse, these choices reflect the logic of, promote the legitimacy of, and protect distributions of power within those systems.”
Put simply, the State has a monopoly on the concept of crime, and the police (in their function as the armed wing of the State) populate that definition via their decisions about where to police and who to arrest. This calls the usefulness and accuracy of crime statistics into question, even before considering that police are literally trained to lie and where those statistics aren’t available (or don’t serve the right narrative), the media falls back on “perception of crime” polling, which is even less useful and accurate. To make matters murkier, police don’t count or report their own crimes. So it makes sense that people in the prison abolition movement have for decades reframed social ills in terms of “harm,” which has a tangible meaning and more potential for solutions, rather than using the troubled concept of “crime.”
It is a little on the nose that the “violent crime wave” is occurring under the presidency of the author of the 1994 crime bill credited with hyper-accelerating mass incarceration and the vice presidency of California’s onetime top cop. Locally, the dual circumstances of widespread support for police reform and the backlash to it present a challenge to those seeking to obtain or retain elected positions during a big campaign season. “Tough on crime” is as reliable a platform as “if it bleeds it leads” is a reliable moneymaker for mainstream media, even with evidence that funding police typically doesn’t do much to actually stop violence. But politicians and candidates now also have to acknowledge, if not woo, voters who want to see big changes in policing and imprisonment. Help Not Handcuffs is being shaped within this tension—and this may be the key to understanding why the mayor, councilmembers, prison reform advocates, and the police are united in support of the initiative.
From Campaign to Task Force
Because people with mental illness are often punished rather than given medical treatment, some of the largest populations of people with mental illness are in jails, not hospitals. Help Not Handcuffs’ backers say they want to separate emergency mental health responses from policing.
OPPRC, along with groups like Help Not Handcuffs co-founders Court Watch NOLA, held informational sessions around the city about the idea this spring. In June, the City Council unanimously passed a resolution setting up what it calls a Crisis Intervention Strategy Task Force. That 13-member committee is intended to study the issue, hold public meetings, and within six months, make recommendations to the council on how to set up such a program. Dumas and OPPRC Deputy Director Lexi Peterson-Burge are among the members of the task force, and Peterson-Burge successfully nominated Dumas to co-chair the group at its first meeting on August 23.
Advocates say they want the process to move quickly. “We are committed to making sure that this happens in New Orleans and to make sure that it is not a performative measure by politicians during election year to get something started and leave it hanging,” Dumas said.
The task force resolution calls for the group to “develop a strategy around establishing a mobile crisis team, staffed by specially trained personnel who are not members of law enforcement.” But the few details we learned about the initiative suggest that cops will be an intrinsic part of the program, maybe even its bottom line, though Council President Helena Moreno explicitly said she doesn’t believe the crisis team should be part of the New Orleans Police Department.
“I don’t think it’s appropriate to run it through NOPD,” she told ANTIGRAVITY. “I think it needs to be separate from that.”
That’s an opinion proponents say the police hold as well. “They are not trained behavioral health interventionists, and they don’t want to be, right?” said Dr. Jennifer Avegno, the director of the New Orleans Health Department, an emergency medicine physician, and a member of the task force. “That’s not why they got into doing what they’re doing, so they have been incredibly supportive.”
While politicians claim widespread support—”I have yet to hear anybody that thinks that this is a bad idea,” said District C Councilmember Kristin Gisleson Palmer—exactly what form the program would take in New Orleans remains to be seen until the task force report is in. “I always think it’s dangerous to have politicians weigh in on something in detail,” said Palmer. “My goal is still to listen to the experts in the field.”
Interrupting Criminalization (IC) are experts—they’re a group led by people who for years have been organizing to decarcerate, create new ways of responding to harm, defund the police, since long before defunding became mainstreamed. The principal researchers on the project are Woods Ervin of Critical Resistance and the Transgender, Gender-variant, Intersex Justice Project (TGIJP), police misconduct attorney and author Andrea J. Ritchie, and Mariame Kaba, a leading voice in the abolition movement, and member/architect of too many projects to list here. IC aims to “interrupt and end the growing criminalization and incarceration of women and LGBTQ people of color” via providing data based and best practice oriented resources.
One such resource is a guide to evaluating programs like Help Not Handcuffs through an abolitionist lens. The document is a checklist in the form of questions that establish guidelines to assess if a program might successfully address the problem or could be in danger of worsening it by expanding the police state.
Dumas is familiar with the resource, and said that OPPRC is advocating for “aspects from” it to be implemented, although she distanced herself from those standards, saying the specifics would ultimately be up to the task force—of which she is co-chair.
There’s a large gulf between the guidance of these seasoned organizers and the local initiative. Help Not Handcuffs leaders were united in saying that their program will be reached by calling 911, one of many discrepancies between the abolitionist checklist and the New Orleans plan. There are myriad ways the authors of the checklist suggest that using 911 would impede effectiveness and expand the police state. And in a majority Black city, where Black people are disproportionately targeted for criminalization, there’s a compelling argument that forcing Black people to interact with police or the 911 system that’s so entwined with police is itself state violence.
Black people comprising the majority of our city’s population and a hypercriminalized demographic raises another issue in medical interventions. Due to deep-seated racist misperceptions, Black people are more likely to be assigned diagnoses where criteria include aggression, which leads to a harsher approach from law enforcement and medical professionals, along with incorrect medication treatments. Health outcomes of racism aren’t limited to mental health diagnoses—intergenerational impoverishment and environmental racism are among causes of disproportionate breast cancer rates as well as maternal and infant mortality rates. New Orleans jazz pioneer Buddy Bolden’s early death may have been the result of medical racism. In that era, B vitamin deficiencies were detected via skin rashes, which care providers were not taught how to perceive on dark skin. The problem persists to this day.
The difference between prison abolition and prison reform is not about revolution versus incremental change, and neither is it semantic, although you will find people and organizations—like OPPRC—who use the terms interchangeably. There are significant tactical and ideological differences between the two, and in some cases they are positioned in opposition to one another. Abolitionism is not about purity politics, nor is reformism about pragmatism. They don’t share a vision for what that world would look like, and the paths toward that world are often incompatible. A recent example would be two campaigns that arose from last summer’s George Floyd uprisings. Prison reformist and activist celebrity DeRay Mckesson launched “8 Can’t Wait,” eight steps toward reforming police. Alarmed by the speed and extent with which hardwon radical ideals were diluted and derailed just as they were achieving national attention, abolitionists created “8 to Abolition.”
Perhaps all that needs to be said about the differences in the campaigns—and the difference between reformism and abolitionism—is that in response to 8 Can’t Wait, NOPD praised themselves, claiming to have already implemented the policies embraced by that reform campaign.
The Crisis of Policing
Currently, the NOPD maintains a Crisis Intervention Team (CIT), consisting of hundreds of officers who’ve received “40 hours of intense training from mental health experts” to “respond to and de-escalate mental health crises” in the city. Exactly what typically happens when this team arrives is hard to know, because the official statistics only track cases on calls classified after the fact as “disturbance, mental,” for which officers fill out a special crisis form. “For example, if an officer arrests an individual in crisis for a battery, the officer may not complete a crisis intervention form, so the arrest of a person in crisis may not be captured,” according to the most recent CIT annual report, a requirement of the NOPD’s consent decree with the Federal Department of Justice.
But we know its response to calls classified as “disturbance, mental” overwhelmingly involves taking people to the hospital, not onsite de-escalation: The report found 98% of such incidents “concluded with either voluntary or involuntary commitment to a psychiatric hospital” last year.
“They say half the time, I suspect it’s more, people are handcuffed,” said Meghsha Sqawsan Barner, who worked with OPPRC as a co-facilitator of the campaign.
Regardless of the exact numbers, few argue that police are the optimal response to people in crisis. An NPR report last year called police crisis intervention teams “largely ineffective,” citing a study that found they haven’t significantly reduced police violence and “only modestly helped reduce arrests of people with a mental illness.” After all, CIT officers don’t really have much training. “That’s a 40-hour training that does not compare to the hours that people study in school to become clinicians,” Dumas said.
And regardless of what people see as the role of police—historians often point to their longtime roles in enforcing first slavery, then other racial discrimination technically legal or not, and protecting the property of the wealthy while seizing possessions, including cash (even to the point of a citizen’s financial ruin) from people who cross their path—it’s fair to say there’s a consensus that police departments aren’t designed to help people in crisis situations.
Eugene, Oregon: New Orleans’ Sister City?
Help Not Handcuffs advocates say they’ve studied models from around the country, and a frequent point of comparison is the Eugene, Oregon, program called Crisis Assistance Helping Out On The Streets (CAHOOTS) that has been in place since 1989. But Eugene is strikingly different from New Orleans—it’s a college town, where the 21,000-student University of Oregon is one of the biggest employers, and as a Vera Institute of Justice report pointed out last year, it’s more than 80% white.
“You also have more progressive laws around drug use, for example,” said Mary Beth Campbell, a public health professional who grew up in the Pacific Northwest but now lives in New Orleans and volunteers with Trystereo Harm Reduction Collective (and is an ANTIGRAVITY contributor). “And there is more money put in mental health services in general.”
Avegno, a New Orleans native, acknowledged that the comparison isn’t quite intuitive. “While Eugene, Oregon, and New Orleans are not super similar, there were definitely some frameworks from this model that I think most other places are using to replicate,” she said, pointing to other cities that have set up such programs including Denver; Rochester, New York; San Francisco; and Austin.
In New Orleans, the organizational structure is largely yet to be determined: Moreno suggested the program could be managed through the Health Department, while Dumas implied a nonprofit could lead it. Where such agencies fall within administrations varies from city to city. In San Francisco, the newly created Street Crisis Response Team is run by the Fire and Public Health Departments with some staffing through California nonprofits; while in Rochester, the Person in Crisis Team launched this year falls under the Department of Recreation and Human Services, which also runs parks, an animal shelter, and a farmer’s market.
Exactly what types of calls the program would handle is also still up in the air, since there’s no firm decision yet on exactly how 911 calls would be routed to the new teams or who would make the decision on what the program’s territory is, versus the police versus EMS. But the program’s purview might go beyond what people traditionally think of as mental health crises or drug issues.
“What we’ve found by looking at other places is you can’t just say, we’re only going to go out for someone who’s having a psychotic break, right?” Avegno said. “That a lot of the calls, depending on where it is, are homelessness issues, substance abuse issues, and a variety of other social issues. So this team is going to have to be equipped to the best of its ability to at least assist with those sorts of things.”
But no decisions have yet been made about who’d staff the New Orleans teams. Moreno said she’d “leave that up to the task force,” and Dumas suggested “people who were previously bartenders and baristas” could be good candidates for training, since they already know how to de-escalate unpleasant situations. Avegno discussed the possibility of pairing behavioral health experts with people with so-called “lived experience,” not just professional experience, an approach also being taken in other cities including San Francisco.
Behavioral health experts like social workers aren’t typically armed like cops, although it’s not unheard of for them to carry personal weapons for self defense. It’s hard to say how much more trust they’d garner than the police. Social workers can wield considerable power over people, including bringing legal action that can tear apart families or involuntarily commit people to psychiatric wards, and these kinds of actions often fall disproportionately on Black people.
But even some social workers have said they’re already too involved in law enforcement. Given the history of police both preventing and involuntarily administering medical treatment to those deemed criminal, it is difficult to imagine them deferring to the lead of Helps Not Handcuffs teams on how to treat people they’re there to care for. Historically, cops have been alleged to prevent health care workers from treating patients they deem to be criminals, demand they administer drugs to subdue (sometimes lethally) children and adults, and enlist or coerce medical personnel into invasive procedures from blood draws to colonoscopies against the will of patients.
Directly Impacted People
A common refrain among Help Not Handcuffs organizers and supporters was that people directly impacted by mental health crises ought to have a core role in planning and executing the initiative. “It’s all about centering people who are closest to the problem,” Dumas told us. Among a potential dispatch team, LaToya Johnson, a social worker who worked with OPPRC as a co-facilitator of the campaign, said “You’ll have directly impacted people.” Barner concurred, saying it is important that the task force “specifically centers disabled people and native, Black New Orleanians.” We asked how organizers were ensuring that would be the case. “We’re just doing our best to forge relationships and invite more people to the table,” Barner answered.
But among the advocates and politicians we interviewed, nobody identified themselves as living with a mental health diagnosis. The task force resolution requires at least one person have such a background, but it’s not clear who fits the bill either. However, Palmer and Barner both referenced family members who live with—or died from—issues relating to dysfunctional drug use and mental health disabilities. Having loved ones struggle and suffer is no doubt deeply painful, and secondary trauma is real. Also very real is how people with mental health diagnoses, and other disabilities, are treated as burdens not just by society but by family members and friends. But being proximate to impact is not the same as being directly impacted. So we went looking for people who are.
The Depression Bipolar Support Alliance (also known as DBSA or DBSA New Orleans) is a peer-led support group for people living with mental health diagnoses. Over the years hundreds of people have attended their meetings, which, prior to the pandemic, averaged anywhere between 15 and 30 or so people. All are welcome; family and friends often attend to better understand the challenges their loved ones face and how to best support them. Woody, who has been a DBSA member for 15 years and volunteers as a facilitator, said that there is really no way to understand mental illness unless you’ve experienced it. “If you’ve never felt like killing yourself, you have no idea what that feels like,” he told us.
Woody has lived with Bipolar II disorder for 25 years, and at times it has debilitated him. But finding a diagnosis that fit his symptoms, and could thus guide treatment, was a long journey. It was an appointment with a psychiatrist at Metropolitan Human Services District, who he had to wait six months to see, that ultimately set Woody on a path to recovery—he said he has been in remission now for three years.
Metropolitan Human Services District (MHSD) did not return requests for comment, and was not acknowledged by Help Not Handcuffs organizers during interviews, who instead stressed that there is currently no alternative to calling the police when someone is experiencing a mental health crisis. In fact, MHSD does have a crisis response team, which can be reached 24 hours a day (at 504-826-2675) in the event of a “mental health, addiction or intellectual/developmental disability crisis.” Anecdotally, community members who did not wish to be identified told us that MHSD does not always dispatch police, but that it is not unheard of.
In August, the City also began a separate pilot program in NOPD’s Third District to involve MHSD in some mental health-related 911 calls.
Dispatchers can “conference in a mental health professional from Metropolitan” incalls about an “individual that is nonviolent and has no access or mention to weapons,” said Tyrell Morris, executive director of the Orleans Parish Communications District, which runs the city’s 911 system and co-chairs the task force, in an August 20 press conference.
“At that point, the mental health professional will determine what the next best thing is for the individual,” Morris said, adding that some urgent calls may be routed back to the 911 system. “That may be a response, it may be setting up an appointment with a crisis or a mental health professional or provide some more immediate care but it also provides another opportunity for us to make sure that we do not have a life-threatening emergency.”
Woody was not familiar with Help Not Handcuffs, and said DBSA was not approached by any individual or coalition related to it. He said there is no other group like DBSA in New Orleans that he is aware of. (The local chapter of the National Alliance on Mental Illness did not return requests for comment.) Having been on both sides of mental health crisis—as one in distress and also as a support to others—he has ample experience with the intricacies of those situations.
“The biggest challenge of any crisis situation,” he told us, “is, are you able to see it for yourself now?” If somebody is unable or unwilling to see that they are in a crisis state, there is a limit to how much one can help. If they do not agree that they are in crisis, Woody tries to find friends or family, basically anyone trusted and close, to assist. When Woody’s mood disorder symptoms were severe, his support system was key. “What I do is I surround myself with people and just made sure that I had somebody checking in on me all the time,” he said.
Woody cannot recall a time that he called the police when he or someone else was in crisis. “That would be like if I found a stray dog, the SPCA is the absolute last resort, it would be giving that dog a death sentence,” he said, referring to kill shelters. “We’re going to try to find a rescue organization first.” In practice, he said, this looks like finding and contacting therapists and other mental health professionals, calling friends in the healing professions, committing to difficult conversations with those in crisis, and connecting people with community. “I always felt that that was the key to life, being in community, in some kind of communal living situation,” he said, and though personally the pandemic hasn’t worsened his mental health, he observed that it had definitely worsened isolation for group members.
There was one occasion in which somebody (Woody isn’t sure who) called for a wellness check on him. A wellness check is when someone calls the police and requests that they visit a person to determine if they are a threat to themself or anyone else. Woody’s encounter with the police was brief and uneventful, but wellness checks can result in police brutality or even murder. In a dramatic incident earlier this year, Councilmember Jay Banks performed a wellness check on political rival and current mayoral candidate Belden “Noonie Man” Batiste that led to police being called (Banks declined to comment on the incident on the record). Batiste, who describes himself as “a grassroots community activist and just an ordinary person that wants what’s right,” is also a perennial presence on practically every local ballot.
In our interview with Banks, he said “If a person is in a mental health crisis, what good, what benefit can the police actually bring to them?” Batiste was surprised to hear that Banks was a vocal supporter of Help Not Handcuffs. “In the police report, he told them I was bipolar and mental,” Batiste, who does not identify himself as fitting that description, told us. “If he’s supportive, why did he come to my house? Why he didn’t call a crisis unit or doctor or anybody?”
The fallout wasn’t limited to just that night, Batiste said. “[Banks] went on TV trying to blast me, when none of that was true… At the end of the day if you serious about health and handcuffs, right? And then you call a man mentally crazy and everything? …if I was mental, you had a case on me and what did you do?” When asked how the City might fund an alternative approach, Batiste pointed to a centerpiece of his ambitious and detailed platform: de-privatizing Entergy.
None of the crisis intervention tactics Woody has found effective, together comprising what he describes as a “holistic approach,” could be accomplished in a single day. Which raises the question—what could a Help Not Handcuffs team, if dispatched, achieve in the space of a single incident? “I wish for a safe space,” Woody said. “What is a safe space though? Somewhere that you’re not locked in, you’re not blocked behind bars or doors or anything else… Maybe even animals like therapy dogs,” he said. “Just anything that’s going to make somebody feel safe and protected and seen and cared for. We need something that’s not the streets or the hospital or jail.”
Involuntary hospitalization—known to disability rights advocates as “psychiatric incarceration”—didn’t come up in our interviews, despite medical professionals being foundational to Help Not Handcuffs’ plan. “The jail is not a treatment facility and the police really aren’t equipped to be able to handle a medical emergency,” Banks said. The Disability Visibility Project offers a litany of similarities between mental hospitalization and jail: “an overrepresentation of BIPOC (Black, Indigenous, and people of color), disregard [for] the rights and safety of TGNC (trans and gender non-conforming) folks, use [of] law enforcement transport/response.”
Transport of people with mental health disabilities by law enforcement, which Dumas named as a feature of programs Help Not Handcuffs is using as models, can result in violence and death when performed by law enforcement officers. In 2018, during Hurricane Florence, two women who were prisoners of mental health facilities drowned in the back of a police transport vehicle in South Carolina. Both deputies survived. The police reported that scanner recordings demonstrated the deputies’ efforts to save the women, whose bodies ultimately had to be retrieved by divers, but one thing is certain—they died because they were prisoners.
The Disability Visibility Project’s inventory of commonalities between mental health hospitals and prisons continues: they both “use solitary confinement and seclusion in cells/’rooms,’ forcibly medicate folks (also known as chemical restraints), use physical restraints, offer extremely limited access to sunlight, fresh air, cell phones, news/media, and the outside world. In addition, sexual violence is routine, there is limited power to appeal legal/medical decisions, and the overwhelming majority of inmates are survivors of previous traumatic experiences.” A UN report from 2020 found that psychiatric hospitalization can be “tantamount to torture.”
On the topic of hospitals, the Abolition and Disability Justice Collective (ADJC) writes that we ought not “reproduce the very systems we are trying to abolish.” Their recommendations clash with “emerging proposals” like Help Not Handcuffs, which they say are “concerning because they suggest we should replace policing and prisons with social workers, mental health treatment, and hospitalization.” What’s wrong with that? ADJC writes: “The problem is, medical and psychiatric incarceration is part of the overall system of policing and incarceration that we need to dismantle. Medical and psychiatric authority is entangled with and part of the authority of police and prisons.”
Woody from DBSA said he was hospitalized once when he was experiencing a mental health crisis. He went voluntarily, was put on a 72-hour hold by the New Orleans coroner (which is standard even for voluntary admissions) but talked his way out of it, and was released in 48 hours. “My eyes were opened to the fact that the hospital environment is not a very therapeutic environment,” Woody said. “What I found out was they hospitalized people so they can be aggressive with medications.”
The practice of coercive medication is compounded by the cozy relationship between psychiatrists and the pharmaceutical industry. Pharma reps court doctors to promote their companies’ medications—usually new ones that are still under patent and therefore profitable. In the context of inpatient mental health hospitalization, this can result in patients finding relief on medications they cannot afford upon release. This enterprise is so pervasive and widespread that investigative reporting powerhouse ProPublica launched a thorough investigation and created a database so that patients can search to see what pharma affiliations their doctors have.
None of the Help Not Handcuffs organizers conveyed knowledge of what hospitalization here is like, but walking step-by-step through a scenario is instructive—if you’re trying to build something that isn’t quite jail and isn’t quite the hospital, you have to identify the harms associated with each.
One experience of voluntary hospitalization in New Orleans by a community member highlights several troubling aspects, despite what was essentially the best case scenario for a bad situation: a white person bearing detailed notes on their medical history, accompanied by a professionally-comported friend to advocate for them. They asked to remain anonymous, and we will refer to them as “the patient” and use gender-neutral pronouns. They were experiencing debilitating delusions as a result of medical neglect—their psychiatrist had gone missing for months, causing a lapse in medication management, and the patient struggled to find another prescriber. Louisiana consistently ranks among the worst states in the country for mental health services and outcomes. Like Woody, this patient was placed on a 72-hour hold, despite voluntary admission and lack of suicidal ideation or self-injurious behavior.
After an emergency room intake in New Orleans, a hospital social worker locates an inpatient facility that has an open bed, and the patient is transported to that location (depending on the social worker, they may or may not take into account patient preferences when selecting the location). Following an evaluation by staff at the inpatient facility, the coroner extended the patient’s involuntary hold to 12 days without informing the patient, and the friend ended up having to break the upsetting news.
At that point, there is little one can do but wait it out. It is possible to appeal such a decision, but doing so requires knowing you have the right to, knowing how to obtain a lawyer, being able to afford one or find a pro bono advocate, and securing a hearing. By the time a patient has done all that, using the limited phone access they are afforded and the limited capacity they might have to advocate for themselves in their condition, 12 days could easily elapse.
Who paid for the involuntary stay? Health insurance. In what’s known as “the Florida shuffle,” after a state where it’s prevalent, patients seeking care for mental health disabilities, particularly substance use disorder, are held for periods longer than medically necessary, may be moved from facility to facility, and may even be forced into unpaid labor as part of their treatment. Inpatient treatment has proven to be a golden goose.
The patient was given no rationale for the extended hold, though a comment a nurse made upon their release suggests one possible explanation. Though the patient had sought care for psychotic delusions, and was not seeking and didn’t receive help with drug use issues (which they do not have), and though the nurse had been supervising the patient throughout their stay, during discharge the nurse commented: “Well, at least you aren’t on those drugs you were addicted to anymore.”
On the discharge form, next to “Accompanied by,” the nurse wrote “Uber,” the form of transportation the patient took home after being released with too little notice to arrange a ride from—or even inform—a friend. Upon release the patient was feeling better than when they had sought help, in spite of being held against their will. They attributed their improved mood to their freedom, but also to the medication regimen they were put on while inpatient. Only problem? The core medication that had eased symptoms was a patented drug that came with a $600 co-pay—even with Medicare coverage. In the face of so much demoralizing treatment, one might understandably give up, go off their medication, become unwell once more. It took an advocate aggressively calling the medical director of the inpatient center for the patient to receive an alternate prescription.
So how would a Help Not Handcuffs stabilization center differ from a hospital? Since such a center is as of yet theoretical, it is impossible to know. But asking further questions illuminates issues that will surely arise. Would such a center offer, mandate, or encourage medication? Is corruption and influence from monied pharma interests preventable? Many public services in New Orleans are provided by contractors, in every field from housing to sanitation to, of course, our charter school system. Privatization creates additional barriers to transparency and thus accountability to the public.
In Orleans Parish Prison, medical services are provided by a national contractor called Wellpath. Wellpath has been the subject of harsh criticism and legal complaints alleging inadequate care here and throughout the country. Would the stabilization center be staffed by contractors? City employees? Some other entity? In this pandemic, Wellpath and the Sheriff’s Office have been responsible for protecting imprisoned people from contracting the coronavirus and becoming ill with COVID-19. Ultimately, it is impossible to know how successful they have been, because they are the sole arbiters of that data and it is in their best interest to attribute cause of death to anything but COVID-19.
Who would monitor conditions related to the pandemic in a stabilization center? Though measures like sanitizing surfaces are commonplace, they are merely hygiene theater, ineffective against a virus that we have known for over a year is airborne. Revamping air circulation, the solution that better addresses the actual method of transmission, is more expensive, and there are no regulations requiring that businesses or public facilities take any action to address that yet. At a center designated for a population that society treats as disposable, could people expect better air conditions than are available in freeworld settings?
And, as Michel Foucault, author of seminal history of prisons Discipline and Punish wrote in 1975: “Is it surprising that prisons resemble factories, schools, barracks, hospitals, which all resemble prisons?”
Harm Reduction, or Harm Production?
Interviewees involved in the planning of Help Not Handcuffs often used “drug users” and “people living with mental illness” interchangeably. Mental illness, drug use, and criminality are commonly conceived of as being not only linked but used in the creation of an imagined other—the unhinged, drug-addicted criminal lowering your property value.
Cities have been known to use police to “clean up” the streets of people that fit that bill, especially before events that draw tourists. Speculation about political support for a stabilization center aside, in a city like New Orleans, dependent on a tourist economy, it is conceivable that unhoused people, or anyone who hangs out on the street and might have a Help Not Handcuffs team dispatched to them, could be wary or suspicious of underlying motives.
Drug criminalization has long justified racist policing and violent police tactics. Even jurisdictions that have decriminalized some drugs, or have Good Samaritan laws protecting people reporting overdoses, often include confusing loopholes and broad discretion that can be disastrous, even deadly, in encounters with police.
We decided to find out what the “directly-impacted” drug-using community of New Orleans had to say about the initiative. Trystereo Harm Reduction Collective had never heard of and hadn’t been approached about joining Help Not Handcuffs, despite there being no comparable group in the city. But drug users are no strangers to being excluded from plans to save them.
Harm reduction is an ideology and practice created by and for people who use drugs in order to keep each other alive. Given that Louisiana saw a steep increase in overdose deaths these past few years, the worsening of the opioid crisis—harm reductionists call it the preventable overdose crisis—during the pandemic, and the specific vulnerabilities New Orleanians face during hurricane season, the mission is urgent.
Trystereo volunteer Jonah summarized the work the group does: “We distribute sterile syringes and naloxone and safer injection equipment throughout the drug-using community in Southeastern Louisiana.” Public health professional and Trystereo volunteer Campbell expanded on that description. “I help with the Monday night drop-ins in the Lower Ninth,” she said. “We supply people with clean points, safer injection kits, Narcan, fentanyl test strips. I also help with [overdose reversal] trainings. I also help write articles for ANTIGRAVITY to promote harm reduction.”
Campbell provided a history lesson: “Harm reduction was created by drug users in collaboration with the AIDS activist movement in the 1980s. Because people who use drugs were contracting HIV, dying of AIDS. They were dying of overdoses… And so a lot of activists risked their lives to get supplies to keep people healthy and alive.” Though the phrase “harm reduction” has gained popularity in recent years, harm reduction services, like needle exchanges, used to be—and in many places still are—outright criminalized.
Along with the mainstreaming of terms like harm reduction comes the dilution of those concepts. Campbell, wondering how Help Not Handcuffs would be funded, says that funds for harm reduction groups have been creeping away along with the concept itself. On one hand, she said, “There are drug users’ unions advocating for health and housing and other rights,” the kind of work harm reductionists have been doing for decades. “But now because of where we’ve gone, [the powers that be] co-opted all these funds… And we’re starting to see that they’re going to go to these groups who are using the language, but not actually practicing harm reduction.”
Campbell said that Trystereo, founded in 2011 but only considered legal by New Orleans since 2017, is one of many groups nationally who have been “doing this work every day, who were villainized, who now have a little bit [of] legitimacy.” Their methods are recognized by the CDC as being effective, best practices for preventing and reversing overdose deaths, along with treating other hazards, like injection-related infections.
People from all stations in life use drugs, but participants in Trystereo, particularly at drop-ins, tend to be living in precarious circumstances. We asked if the group ever had what they’d consider mental health crises at community events. “There are instances,” Campbell said. “People who aren’t quite talking about suicide but you can tell that they’re on the edge of it.”
But she was hesitant to characterize those incidents as crises, and so was Jonah. Both described the situations more as heightened emotion deescalated by the presence of community. “I’ve seen like 10 situations defused by the presence of friends,” Jonah said. Intervention, Campbell said, can look a lot more low key than the way it is depicted on television. “It’s more listening to people and talking to people and connecting them with resources, letting them know that what they’re feeling is totally valid and what they’re going through is totally valid.”
Campbell told us that involving the police in those situations would damage, perhaps irreparably, trust between volunteers and participants. Neither she nor Jonah could think of any possible situation in which a Trystereo volunteer would call the police. “We know that the police hate drug users,” Campbell said. “That’s the reality that we are up against.”
New Orleans, a town whose economy relies on people from all around the world coming over to get wasted, has been slow and selective in making the city safer for its drug-using residents. Just this year the City decriminalized fentanyl test strips, a life-saving tool that Trystereo had already been providing. And District Attorney Jason Williams announced his office would no longer prosecute drug possession charges—except those involving heroin and fentanyl. The City has yet to remedy its archaic and convoluted paraphernalia ordinance. Suboxone, a medication people use to taper off of opioids like heroin, remains difficult to access and criminalized when not prescribed—a recent death at OPP involved a man who’d been booked for possession of the medication.
Of the stabilization center, Palmer suggested that “if somebody is picked up for public intoxication or potentially drugs they can be dropped off there instead of jail.” That sympathetic view is out of step with other recent comments she has made. While pushing for a resolution to expand police access to private properties, she said drug users hold entire blocks “hostage” in her district. Harm reductionists wondered why, if Palmer was concerned about drug users not having safe places to consume substances, she wasn’t a vocal proponent of evidence-based solutions like safer consumption sites (SCS).
Campbell described an SCS a little like a stabilization center, but not exactly the way Help Not Handcuffs seems to envision it. “It’s a space where people decide, ‘Hey, I want to be here just in case I overdose.’ They go there for community, to get sterile supplies. A lot of sites provide a safe, warm place to be, there’s toilets to use depending on how much funding they have, maybe food. They also have people there who can link you to services like health care services later with clinics.”
The key, Campbell explained, is that accessing the site is voluntary, not coercive or punitive. “I think you’d be hard-pressed to find any human being who responds well to that approach,” she said. “And this is one of the reasons why these punitive treatments and laws don’t work, because people need agency, people need respect.”
Campbell is disturbed by the dissonance between politicians supporting Help Not Handcuffs and their inaction on other drug and mental health related issues. She has the same criticism of the involvement of nonprofits that don’t engage with drug-related causes in their other work. “You know, it’s great lip service,” she said. “Maybe, being cynical here, it will help people get elected… But if you actually want to enact change and actually help people, you need to understand what’s going on and then do the work.”
The treatment of drug users and people with mental health issues also frustrated her. She said organizers and politicians were displaying “a lack of understanding about the nuance with mental health and with substance use,” and that it is a spectrum, not a dichotomy.
Harm reductionists are wary of labelling people “addicts,” and true to their ethos that there are no inherently “good” or “bad” drugs, instead use more nuance with phrases like “people who feel their drug use is dysfunctional or chaotic.”
Campbell said, “Addiction tends to occur because people have other traumas they are dealing with in their lives.” In her view, there is no bandaid solution, and she was not optimistic that this initiative was set up to tackle those issues. “That takes time, and it’s uncomfortable,” she said. It also means accepting, as a society, that we have failed on some level. “It takes a reckoning. Our society does not like that. And people in power don’t like that.”
Campbell, who disclosed that she lives with depression and anxiety, was skeptical about the idea of a stabilization center borne of a campaign that did not include the drug-using community and other impacted populations. “The less you generally do engage with people who are going to be directly affected and have drug users and have sex workers weigh in… it’s going to be just another prison,” she said. “It sounds like a new name or maybe a different color paint on the walls, but it’s still jail.”
OPPRC and Moreno also spoke at length about “stabilization centers.” The term can mean different things, but they’re generally mental health facilities where people are intended to be treated quickly—sometimes more quickly than they’d be seen with the same symptoms in an emergency room—and often stay for (at most) a few days.
“We would still have to make that determination as to who goes there,” said Moreno. “But what I do know is that there are many people in crisis and family members have really no place to turn. And maybe this could be an opportunity for some of those family members to get some assistance when their family member is in that crisis mode, through a center like this.”
Those details could determine if constitutional due process rights could be violated by the program. We asked Simone Levine, executive director of Court Watch NOLA if that was a concern. We presented her with a theoretical scenario: Somebody is having what is perceived to be a mental health crisis and a Help Not Handcuffs group is dispatched. That group decides that the person in crisis should be taken to a stabilization center for evaluation or treatment. Presumably there is some police presence at that center—it’s difficult to imagine there wouldn’t be—but we don’t know what level, or more importantly to what extent the visit is voluntary versus involuntary. It’s not clear if at some point people have an advocate or representation. When you’re arrested and charged, eventually you get sentenced. If you get hospitalized, you can be involuntarily held, for an indeterminate length of time.
Levine said constitutionality would hinge on “whether [the person in crisis] would be considered to be detained, regarding if due process would be what they were losing. And I don’t know enough, honestly, about the potential center to be able to respond, I think. It’s a really interesting question and something that I will go back and ask my team member that’s actually doing this work.”
Palmer, who touted the City’s “low-barrier homeless shelter” and currently-closed “sobering center” described the proposed center as a “a soft shelter” or “drop in place” where people could stop by when in need.
“If there’s mental health issues or if somebody is a victim of domestic violence and needs to get away for a minute, or if there’s a sex worker who’s in a bad situation and needs to drop in someplace and know that it’s safe, with no questions asked,” said Palmer, who previously faced criticism from sex workers for her staunch support of strip club raids in 2018, which purported to seek victims of human trafficking but turned up none, intimidating and roughing up strip club workers in the process. “I’m a huge believer in creating safe spaces [where] there are no questions asked and people can get the resources that they need.”
And like the crisis response teams, exactly where the resources would come from to fund a stabilization center is still very much in question. Most jurisdictions do fund crisis response programs and, where they exist, stabilization centers (at least in part) with “municipal funds,” Avegno said. In East Baton Rouge Parish, for instance, voters approved a property tax millage in 2018 to fund The Bridge Center for Hope, a stabilization and treatment center that describes itself as an alternative to taking people with mental illness to “expensive emergency rooms or parish prison.”
But one other possibility, Avegno suggested, is that as Help Not Handcuffs-style programs develop here and elsewhere, insurers including Medicaid may become more willing to pay for their services, especially if they’re cheaper than emergency rooms and traditional inpatient stays. Already, Medicaid has a trial program letting states get funding for short in-patient stays if they also pursue community-based treatments, including “crisis stabilization services.” The pandemic relief bill provides funding for crisis response teams, as well as other potential federal money for mental health treatment and “crisis intervention services.” But here, too, the details remain to be solidified.
Can We Afford to be Safe?
In a city perennially straining against manufactured budgetary limits, nobody has come to a firm decision about how to pay for the program. “All of this stuff is up in the air,” Banks said. “This is all discussions at this point—none of the money has been identified.”
Initially, some proponents had said the funds could come from the NOPD budget: In a June email, the New Orleans chapter of Democratic Socialists of America (DSA) described the Help Not Handcuffs effort as “a campaign to take $10 million dollars out of the New Orleans Police Department budget and direct those funds to a non-police crisis response program.” (DSA didn’t respond to multiple inquiries sent between June and August.)
But amid national and local concerns about a supposed rise in violent crime—a claim that experts have repeatedly debunked and attributed to sensationalist reporting and police alarmism—the general appetite for defunding the police seems to be waning.
“I’m not hearing about any reductions to NOPD,” Moreno said, though she suggested the program could lead to jail population cuts that could free up money.
Palmer, who is campaigning for an at-large council seat (“I will win,” she told us) on a platform that includes taking on “violent crime,” said the program could free up more police resources to focus on crime. An NOPD representative is also on the task force, as required by the council resolution that set it up, and multiple supporters have emphasized that police back the program. “They love it,” Palmer said. “The officers I’ve spoken to love it.”
Similarly, Banks told us that the program would free up police time and funds for fighting “more violent offenders and the threat to all of us.”
If anything, it appears that Help Not Handcuffs would increase police funding. Organizers with OPPRC, along with the politicians who support their efforts, all mentioned that no matter what form the initiative ultimately might take, the police need more training—a reform that abolitionists emphatically caution inevitably expands the budget and reach of policing.
“That will also look like NOPD continuing to get their 40-hour training, sure, but also training 911 dispatchers specifically to know how to catch these calls, like what to look for in these calls, how to figure out what they need, what particular questions to ask,” said LaToya Johnson.
NOPD didn’t provide a statement in time for our print deadline, and the Police Association of New Orleans didn’t respond to multiple inquiries. But in the August 20 press conference announcing the pilot program with MHSD, NOPD Superintendent Shaun Ferguson said the department was “excited” about that program.
“This will allow us as a department to focus more on what we need to focus on, and right now we all know that violent crime is our number one priority,” he said, though just days earlier the department had prioritized a traffic stop initiated by concern over high-tint windows, then initiated (along with State Police) a high speed chase that left an infant passenger injured.
Some Help Not Handcuffs organizers say the program could be good for the mental health of the police by pulling them off of crisis response work. “It’s also traumatizing for police officers,” Barner said. “There’s a lot of research that shows [that] being in these particular kinds of incidents, it’s vicariously traumatic for them.” Dumas cited concern for the welfare of officers as incentive to restructure. ”There’s trauma on both sides, because these are two groups who don’t know how to deal with one another,” she said, seeming to draw an equivalency between the most disenfranchised, vulnerable members of society and a heavily armed, lavishly funded force that can legally act without consequence.
Though pandering to the Blue Lives Matter bloc is required of politicians, it’s unusual to see organizers, particularly those who occasionally identify as abolitionists, express such concerns. Still, Barner and Dumas are onto something: an article in the Journal of the American Academy of Psychiatry and the Law from September 2019 evaluated the effectiveness of police crisis intervention training programs and concluded that the only measurable positive outcome was “increased officer satisfaction and self-perception of a reduction in the use of force.”
But even if a case is initially handled by the crisis response program, the police might still arrive on the scene. In existing programs around the country, including Eugene’s much-touted CAHOOTS, teams can and do call for police backup. “EPD rates of CAHOOTS requesting backup are higher than what has previously been reported in the news media,” according to a Eugene Police Department report from last year. “It is when CAHOOTS is dispatched to a traditionally police-centric call, like Criminal Trespass, that the instances of CAHOOTS requiring backup from the police jumps significantly.”
If the program is then unlikely to be paid for by NOPD reductions, there are funds available through this year’s federal pandemic relief law for “mobile crisis intervention services” for the next five years, as cities increasingly test such programs. It’s unknown, and ultimately likely up to a future Congress, if that money will be earmarked forever or be sufficient to fund the program.
“I think we’ll have to have another conversation in a few years about how to sustain this,” Dumas said.
Will Help Not Handcuffs Help?
Since at least 2016, OPPRC has been mobilizing its base to oppose the proposed “Phase III” of the Orleans Parish jail complex, which would house people with perceived mental illness and other medical issues. A federal judge has ordered the City to build that facility, which officials have argued is unnecessary. An OPPRC web page about the proposal lists two goals: “Stop the City from building a $100 million+ new jail facility” and “Work with stakeholders and community members to build a crisis stabilization center that would provide care outside of a carceral setting for people with serious mental illness.”
Prison abolitionist and Critical Resistance co-founder Dr. Ruth Wilson Gilmore writes that “prisons are geographical solutions to social and economic crises.” If a person is removed from their community involuntarily and held elsewhere involuntarily, it becomes very difficult to distinguish a stabilization center from a jail. What if, in such a center, a person is forced or coerced to take medication—say, if they are told they will be released if they comply? This seems like a blatant expansion of state power, evoking the concept of “biopower” wherein populations are controlled via literal, direct interference with their bodies. Already in community treatment centers, patients may be required to submit to medication not just while held at the center but even upon their release, a practice that critics call “chemical incarceration.”
Unanswered questions abound. What happens to a child if a parent or caregiver receives a visit—or multiple visits—from a Help Not Handcuffs team? If the caregiver is taken to a facility? Standard operating procedure would require involvement from the Department of Children & Family Services, Louisiana’s version of what’s often called Child Protective Services, a type of agency accused of overreach, racism, and classism. Children who end up in the foster care system are far more likely to develop mental health issues and poor life outcomes. Court Watch NOLA’s Levine highlighted the cyclical nature of crime, arrest, imprisonment, and trauma, identifying social neglect as the underlying problem. “When survivors [of harm] do not receive trauma care, and children of crime survivors do not receive trauma care,” she said, “they go on to be arrested for [things including] substance abuse related crimes—because that is how they are attempting to deal with their trauma.”
Where is the line between monitoring someone for their safety and surveilling them? Recent trends like predictive policing have blurred the line, in the name of protecting people and promoting public safety—two goals Help not Handcuffs shares. Predictive policing is one controversial scheme wherein data about populations is plugged into an algorithm, producing suggestions about who might be likely to be involved with crimes. These measures are billed as free from the biases that plague us flawed mortals, but are of course also created by said mortals, using inherently biased data—think back to the way “crime” is constructed. Data only exists for populations police target. A recent program from the Pasco County’s Sheriff’s office in Florida used “criminal histories, social networks and other unspecified intelligence” to select “prolific offenders” for frequent visits from deputies. The same agency also has a program that uses “schoolchildren’s grades, attendance records and abuse histories” to identify future criminals. These dystopian programs aren’t aberrations, they’re common and live here in this city with us already.
The patronizing message underlying tactics like predictive policing—the idea that the authorities know your risk level better than you do, know you better than yourself—appears at odds with the principles of autonomy and dignity associated with prison reform and abolition movements. The same can be said within the context of involuntary hospitalizations. We don’t yet know how data related to Help Not Handcuffs intervention will be collected, stored, or used, but history shows us that when authorities monitor civilians, they can’t always be trusted to steward what that yields. That this program is explicitly tied to health raises further questions about health confidentiality laws.
People (and the policies they make) reflect varying definitions of crime, violence, and mental illness. Not all people with mental health diagnoses are violent, and not all violent people have mental health diagnoses (people with mental health diagnoses are actually 10 times more likely to be the victims of violence than those without). Despite increasing popular conflation of the two categories, “mental illness” and “violent behavior” are more of a venn diagram than two discrete circles, but our conversations with Help Not Handcuffs supporters did not always reflect that. Instead, sick people in need of help and violent people in need of containment were usually treated as separate categories.
Councilmember Banks acknowledged the overlap—and the reality that even after implementation of the program, police will continue to be dispatched. “Now they’re all going to be instances, obviously, where a trained police officer will be called on a mental issue,” he said. “Somebody is out there hurting somebody or shooting somebody doing something like that… but if someone’s out there, just say running through the neighborhood naked or doing something not threatening to other people, but clearly doing something that is not normal, then police resources should not be spent on that,” he elaborated. It’s unclear how the program would define ”’normal” and allow for discretion.
For an initiative like Help Not Handcuffs to function according to its stated values, every detail will matter. But at this stage not many are known, and the ideas and plans around which there seems to be consensus already contain complex contradictions. A cynical view is that, intentionally or not, this program would be an enormous gift to a police department in perpetual need of rehabbing its image, politicians curating their stances during election season, and a prison reform nonprofit that would benefit from political currency—and needs wins in order to court funders. But maybe there is cause for optimism, too, if taken in good faith, in the unanimity that the status quo does not do right by people living with mental illness.
Will Help Not Handcuffs fundamentally change the way this city treats its most vulnerable residents, or will it merely be an expansion of the already vast punishment bureaucracy? Will OPPRC have spent years mobilizing people to fight against Phase III, only to back a replica? Perhaps some avenue still remains for the project to make good on its pledges: to center directly impacted people, to offer a real alternative to arresting people in crisis, to create a safe haven for people to find their footing—and then some. With so few details available, it’s difficult to assess how OPPRC’s membership, base, and sympathizers might respond to a reform that does the opposite of defunding the police. New Orleans, a city where children show symptoms of post-traumatic stress disorder at four times the national average, deserves no less.
We asked Trystereo volunteer Jonah how a mental health crisis would ideally be addressed. “Access to stable housing, a sense of security in life. So… not being poor,” he said.
We asked Woody from DBSA what the one thing he wishes readers who don’t live with mental health disabilities would know. He answered without hesitation: “That compassion and empathy are paramount.”
Disclosure: Co-author Beck Levy occasionally participated in and did contract work for OPPRC between 2017 and 2020.
Illustrations by Hyena Hell