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Abstract

Although the health impact of patients' trust in physicians has been well documented, less is known about the possible health effects of trust in police or paramedics. Homeless people frequently interact with police officers and paramedics, and these experiences may affect their health and future willingness to seek emergency assistance. We examined homeless people's self-reported interactions with police and paramedics in Toronto, Canada, and their level of trust in these emergency service providers. In a sample of 160 shelter users, 61% had interacted with police in the last 12 months, and 37% had interacted with paramedics (P = .0001). The proportion of subjects who expressed willingness to call police in an emergency was significantly lower than those willing to call paramedics in an emergency (69% vs. 92%, P = .0001). On a Likert scale ranging from a minimum of 0 to a maximum of 5, trust levels were lower in police than in paramedics (median level 3 vs. 5, P = .0001). Among shelter users, 9% (95% confidence interval [CI], 5% to 14%) reported an assault by a police officer in the last year, and 0% (95% CI, 0% to 4%) reported an assault by a paramedic. These findings showed that homeless people have much lower levels of trust in police than paramedics. Reports of negative interactions with police are not uncommon, and homeless people's perceptions of the police may pose a barrier to seeking emergency assistance. Further research is needed for objective characterization of homeless people's interactions with police officers and the potential health implications of low levels of trust in the police.
Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 81, No. 4,
The New York Academy of Medicine 2004; all rights reserved. doi:10.1093/jurban/jth143
596
Homeless People’s Trust and Interactions
With Police and Paramedics
Tanya L. Zakrison, Paul A. Hamel, and Stephen W. Hwang
ABSTRACT Although the health impact of patients’ trust in physicians has been well
documented, less is known about the possible health effects of trust in police or para-
medics. Homeless people frequently interact with police officers and paramedics, and
these experiences may affect their health and future willingness to seek emergency
assistance. We examined homeless people’s self-reported interactions with police and
paramedics in Toronto, Canada, and their level of trust in these emergency service pro-
viders. In a sample of 160 shelter users, 61% had interacted with police in the last 12
months, and 37% had interacted with paramedics (P =.0001). The proportion of sub-
jects who expressed willingness to call police in an emergency was significantly lower
than those willing to call paramedics in an emergency (69% vs. 92%, P =.0001). On a
Likert scale ranging from a minimum of 0 to a maximum of 5, trust levels were lower
in police than in paramedics (median level 3 vs. 5, P =.0001). Among shelter users, 9%
(95% confidence interval [CI], 5% to 14%) reported an assault by a police officer in
the last year, and 0% (95% CI, 0% to 4%) reported an assault by a paramedic. These
findings showed that homeless people have much lower levels of trust in police than
paramedics. Reports of negative interactions with police are not uncommon, and home-
less people’s perceptions of the police may pose a barrier to seeking emergency assis-
tance. Further research is needed for objective characterization of homeless people’s
interactions with police officers and the potential health implications of low levels of
trust in the police.
KEYWORDS Emergency medical technicians, Homeless persons, Police, Trust.
INTRODUCTION
Police officers and paramedics have a highly visible presence in the urban environ-
ment. As the first responders in emergency situations, they play a vital role in safe-
guarding the health and safety of city dwellers. However, the effectiveness of these
services may be compromised by factors such as delayed response times or frankly
negative relationships with certain groups. Low levels of trust in the police are parti-
cularly widespread among urban youths and people living in high-crime urban
neighborhoods.
1,2
Research has consistently shown that individuals evaluate the
police primarily on the basis of how fairly they perceive the police treat the public.
3
Negative personal experiences can therefore lead to a loss of trust in the police and
reluctance to seek emergency aid, even in urgent situations.
Drs. Zakrison and Hamel are with the Faculty of Medicine, University of Toronto; Dr. Hwang is with
the Inner City Health Research Unit, St. Michael’s Hospital and the Department of Medicine, University
of Toronto.
Correspondence: Stephen W. Hwang, MD, MPH, Inner City Health Research Unit, St. Michael’s
Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. (E-mail: hwangs@smh.toronto.on.ca)
POLICE, PARAMEDICS, AND THE HOMELESS 597
A large body of literature has examined the conceptual frameworks and
empiric data related to trust and health. This work has focused almost exclusively
on patients’ trust in physicians, insurers, medical institutions, and the medical pro-
fession.
4–7
In this context and more generally, trust may be defined as “the optimis-
tic acceptance of a vulnerable situation in which the truster believes the trustee will
care for the truster’s interests.”
4
Thus, trust depends on the extent to which a
vulnerable individual has a positive “forward-looking evaluation of an ongoing
relationship” with another entity that is in a position of greater power.
4
These
concepts are clearly relevant to an individual’s relationships with police officers or
paramedics.
In the medical context, trust has significant health implications. Trust in physi-
cians is associated with greater adherence to treatment recommendations and improve-
ment in self-reported health,
4
and trust in the medical profession is correlated with
patients’ desire to seek care.
5
Trust in police or paramedics is also likely to have
health consequences, although this has been less well studied. The most likely adverse
health consequence of lack of trust in police or paramedics would be a tendency to
avoid or delay seeking assistance from these sources, even when urgently needed.
Among injection drug users in San Francisco who had witnessed a heroin overdose,
the most commonly cited reason for not calling 911 for an unconscious overdose
victim was fear of the police.
8
A similar study of heroin users in Sydney, Australia,
found that 24% of subjects had been present at an overdose, but had stopped or
delayed seeking help specifically because of fear of police involvement; 5% of all
overdoses in this study resulted in death.
9
Homeless people, like injection drug users, are a vulnerable and marginal-
ized urban population at high risk of morbidity and mortality.
10
Homelessness is
a growing problem in Canada: In Toronto, Canada’s largest city, the nightly
count of people sleeping in homeless shelters doubled over the last decade.
11
Currently, more than 30,000 individuals use shelters in Toronto each year.
11
Homeless people suffer from high rates of physical and mental illness
12,13
and
are therefore likely to use paramedic services at higher-than-average rates.
Homeless people also interact frequently with police. In both Canada and the
United States, homeless people have high arrest rates, and although some arrests
involve serious charges, homeless people are often charged with minor offenses
such as petty theft or entry into vacant buildings.
14–19
Some interactions with
police may also be related to prohibitions against loitering, camping, and pan-
handling.
20
The manner in which police and paramedics treat homeless people is therefore
an important issue. In addition to affecting homeless people’s trust and willingness
to seek assistance, these interactions can also have a direct impact on their physical
well-being. News accounts have described incidents in which police officers in vari-
ous Canadian
21–24
and US cities
25–29
reportedly used unjustified and excessive force
against homeless people. In some of these cases, the fact that the individual was
homeless appeared to be a factor contributing to their victimization. However, it is
unknown if these reports reflect rare and extreme cases, or if they are symptomatic
of a larger underlying problem.
We therefore conducted this study to assess homeless people’s trust and inter-
actions with emergency service providers in Toronto, which has a single police force
and a unified emergency paramedic service. We studied experiences with both
police and paramedics to provide comparative data on homeless people’s relation-
ships with these service providers.
598 ZAKRISON ET AL.
METHODS
Study Population and Recruitment Strategy
We interviewed a systematic sample of 160 persons at 18 of the largest shelters and
drop-in centers for homeless single adults and youths in Toronto, Canada, in 2001.
Interviewers approached every 10th person in sleeping quarters or common areas. If
an individual declined to participate, the next consecutive individual was
approached. Individuals were excluded if they were sleeping, frankly psychotic, or
severely intoxicated. Individuals were also excluded if they could not communicate
fluently in English. A convenience sample of 40 street dwellers was obtained by
approaching individuals at outdoor sites where homeless people congregate. Sub-
jects were told the study examined “homeless people’s perceptions of emergency
services.” Participants gave informed consent and received two public transport-
ation tokens. To ensure confidentiality, participants were not required to give their
full name. The Research Ethics Board of St. Michael’s Hospital approved this study.
Survey Interviews
In a face-to-face interview, we obtained information on demographic characteristics
and duration of homelessness. Subjects were asked whether they had interacted with
paramedics in Toronto during the past 12 months and, if so, the number of inter-
actions during that time. Subjects were asked to state how many of the interactions
were “good overall” and to describe what happened during the best interaction. They
were then asked to state how many of the interactions were “bad overall” and to
describe what happened during the worst interaction. Descriptions of these interactions
were recorded. What constituted a “good” or “bad” interaction was intentionally left
undefined to avoid prompting subjects to describe specific types of events. Subjects
could report both good and bad interactions in the last 12 months. Subjects were
asked to rate their trust in paramedics in Toronto on a Likert scale of 0 to 5, where 0
was defined as “no trust at all” and 5 was defined as “absolute trust.” They were then
asked: “In an emergency, would you call the paramedics?” An identically worded
series of questions was then asked about interactions with police in Toronto.
In an effort to avoid biasing subjects or prompting them to report assaults, the
issue of assaults was not mentioned until the final section of the interview. Subjects
were asked if they had been assaulted during the past 12 months, with assault
defined as a “sudden, violent physical attack.” If an assault was reported, the iden-
tity of the alleged assailant was determined. Finally, subjects were asked if they had
ever been assaulted by paramedics in Toronto, and if they had ever been assaulted
by the police in Toronto. The dates of reported assaults were obtained.
Our definition of a reported assault by police in the last 12 months was a speci-
fied set of internally consistent responses to six survey questions. The responses
were (in order of their occurrence in the survey) as follows: (1) a report of inter-
action with police in the past 12 months, (2) a report of at least one bad interaction,
(3) a description of the “worst” interaction that was consistent with our definition
of an assault, (4) a report of having been assaulted in the past 12 months, (5) a
report of having ever been assaulted by police, and (6) a report that such an assault
had occurred within the past 12 months. The definition of a reported assault by
paramedics in the last 12 months used the same criteria. In subjects meeting these
criteria for a reported assault by police in the last 12 months, descriptions of the
interactions were examined for meaningful patterns. This exploratory effort did not
employ formal qualitative analysis.
POLICE, PARAMEDICS, AND THE HOMELESS 599
Statistical Analyses
Separate analyses were conducted for shelter users and street dwellers because of
differences in sampling methods. The sample size of 160 homeless shelter users was
selected to provide a 95% confidence interval (CI) of 5% for key events occurring
at a rate of 10%–20%. Confidence intervals were not calculated for responses by
street dwellers because this group was selected by convenience sampling. Compara-
tive data on the demographic characteristics of the general population of Toronto
were obtained from Statistics Canada.
The binomial test was used to compare dichotomous response items regarding
police and paramedics. The difference in trust in police compared to paramedics
was examined using the Wilcoxon signed ranks test. Differences in level of trust in
police among various subgroups of homeless subjects were examined using the
Mann-Whitney or Kruskal-Wallis test, as appropriate. Logistic regression analyses
were used to identify predictors of self-reported assault by the police or by anyone
in the last 12 months. Significant predictors were selected using backward selection.
RESULTS
Characteristics of subjects and their reported interactions with paramedics and police
are shown in the Table. Results are shown separately for the shelter-using and street-
dwelling samples. Shelter users had a mean age of 35.5 years, 73% were male, and
45% were non-white. By comparison, the general population of Toronto has a
median age of 36.9 years and is 48% male and 43% non-white. Among homeless
shelter users, interaction within the last 12 months was more common with police
than paramedics (61% vs. 37%, P=.0001). The proportion of homeless shelter users
who expressed willingness to call police in an emergency was significantly lower than
those willing to call paramedics in an emergency (69% vs. 92%, P=.0001).
Among 160 homeless shelter users, 15 (9%; 95% CI, 5% to 14%) reported
experiencing an assault by a police officer in Toronto in the last 12 months. The fre-
quency of such reports by street dwellers was 8%. No shelter user (0%; 95% CI,
0% to 4%) or street dweller reported an assault by a paramedic in the last 12
months. A remarkably large proportion of homeless shelter users (36%) and street
dwellers (50%) reported having been assaulted by police at some point in the past.
In the shelter sample, age was a significant predictor of self-reported assault by
police in the last 12 months (P =.01). Such reports were made by 26% of the shelter
users younger than 20 years, 11% of those 20 to 39 years of age, and 2% of those
40 years of age and older. Sex, race, and duration of the current episode of home-
lessness were not significantly associated with report of assault by police. Among
shelter users, age, sex, race, and duration of homelessness were not associated with
the likelihood of report of any assault in the last 12 months.
Homeless shelter users had lower levels of trust in police than in paramedics
(median level of trust =3 vs. 5, respectively, P =.0001) (Fig. 1). Not surprisingly,
individuals who reported ever having been assaulted by police tended to have much
lower levels of trust in police than individuals who did not report any such past
experience (median level of trust =1 vs. 3, respectively, P =.0001) (Fig. 2). To exam-
ine attitudes in a subset of subjects with limited personal experience with the police,
we focused on the 59 shelter users who stated they had never been assaulted by
police and who reported no interaction with police in the last year. Even in this
subgroup, trust levels in police were significantly lower than trust in paramedics
600 ZAKRISON ET AL.
TABLE. Characteristics of subjects and their reported interactions with paramedics
and police in Toronto
*Among subjects reporting any interaction in the last 12 months. Subjects could report both good and bad
interactions in the last 12 months.
†See text for definitions.
Characteristic
Homeless shelter user
group (N =160), n (%)
Street dweller
group (N =40), n (%)
Age, mean ± SD 35.5 ± 12.8 37.1 ± 10.5
Sex
Male 117 (73) 29 (73)
Female 43 (27) 11 (28)
Race
White 88 (55) 25 (63)
Black 36 (23) 6 (15)
Aboriginal 11 (7) 7 (18)
Other 25 (15) 2 (5)
Duration of current episode of homelessness
Less than 6 months 72 (45) 12 (30)
6 to 12 months 45 (28) 10 (25)
More than 12 months 40 (25) 16 (40)
No response 3 (2) 2 (5)
Interaction with paramedics in last 12 months
Any interaction 59 (37) 17 (43)
Number of interactions (median and
interquartile range)* 2 (1–5) 2 (1–4.5)
At least one interaction rated good* 53 (90) 15 (88)
At least one interaction rated bad* 14 (24) 4 (24)
Would call paramedics in an emergency
Yes 147 (92) 34 (85)
No 8 (5) 4 (10)
Undecided 5 (3) 2 (5)
Interaction with police in last 12 months
Any interaction 97 (61) 32 (80)
Number of interactions (median and
interquartile range)* 3 (1–8) 5 (2–19)
At least one interaction rated good* 58 (60) 19 (59)
At least one interaction rated bad* 63 (65) 23 (72)
Would call police in an emergency
Yes 111 (69) 20 (50)
No 34 (21) 17 (43)
Undecided 15 (9) 3 (8)
Reported assault by anyone in last 12 months† 58 (36) 20 (50)
Reported assault by paramedics in last 12 months† 0 (0) 0 (0)
Reported assault by paramedics ever in the past† 1 (1) 0 (0)
Reported assault by police in last 12 months† 15 (9) 3 (8)
Reported assault by police ever in the past† 57 (36) 20 (50)
POLICE, PARAMEDICS, AND THE HOMELESS 601
0
5
10
15
20
25
30
35
40
45
50
0 1 2 3 4 5 don't
know
Level of Trust
%
FIGURE 1. Homeless service-users’ (N =160) level of trust in paramedics (white bars, median level
of trust =5) and police (black bars, median level of trust =3). Highest possible level of trust is 5.
P =0.0001 for the difference in trust.
0
5
10
15
20
25
30
35
40
45
50
012345don't
know
Level of Trust in Police
%
FIGURE 2. Homeless service-users’ level of trust in police. Black bars represent individuals who
reported any experience of assault by police in the past (N =57, median level of trust =1) and white
bars, those who reported no such history (N =103, median level of trust =3). P =0.0001 for the dif-
ference in trust.
602 ZAKRISON ET AL.
(median level of trust = 3 vs. 4, respectively, P =.01). Among all shelter users, age,
sex, race, and duration of the current episode of homelessness were not significantly
associated with level of trust in police in bivariate analyses.
Overall findings in street dwellers were similar to those in shelter users. Street-
dwelling subjects were more likely than shelter users to have interacted with police
at least once in the last 12 months (80% vs. 61%, respectively). The difference in
street dwellers’ trust in police compared to paramedics was large (median level of
trust = 1 vs. 4, respectively).
Of the 18 subjects in the entire study who reported an assault by police in the
last 12 months, 56% were male, and their age ranged from 15 to 44 years (mean 27
years). Review of these individuals’ comments showed that 4 assaults reportedly
occurred during the process of an arrest, and 8 reportedly occurred after an arrest.
Two individuals stated that after being arrested by police they were taken to
“Cherry Beach” (an isolated area of industrial land near downtown Toronto) and
assaulted. A third individual claimed that after he was arrested, officers threatened
to take him to Cherry Beach, but subsequently assaulted him at a different location.
DISCUSSION
In this study, homeless people in Toronto expressed significantly less trust in police
than in paramedics. A low level of trust in police was seen among homeless people
of all ages and races and was particularly common among homeless people with a
history of contact with the police. These findings were not entirely unexpected:
Paramedics have a clearly defined helping role, whereas the police serve a more
complex function in society that can result in significant conflict.
Previous studies have shown that minority group members and urban youths
tend to have low levels of trust in the police.
1–3
Further research is needed to assess
the possible health consequences of lack of trust in police, paramedics, or other
emergency service providers among disadvantaged urban populations. Such effects
could plausibly occur at the individual level, through chronic mental stress or delay
in seeking needed assistance, or at the neighborhood level, through a decline in
social capital.
30
A disturbing finding in our study was that almost 1 in 10 homeless individuals
reported experiencing an assault by a police officer in the last 12 months. Obvi-
ously, the accuracy of homeless people’s self-reports of assaults is a pivotal concern.
It is conceivable that some of these reports were fabricated, or that the actual events
involved police officers’ use of justified and proportionate force in the course of an
arrest. However, anecdotal evidence from cities in Canada
21–24
and the United
States
25–29
demonstrated that homeless people’s allegations of assault by police are
not inherently implausible. Our finding is also consistent with the results of a 1992
health survey in which 10% of 458 homeless people in Toronto reported having
been assaulted by a police officer in the last year.
31
It is interesting to note that three subjects in our study reported that assaults
after police arrest were associated with a specific site in Toronto known as Cherry
Beach. In 1996, a homeless man accused police of taking him to this location after
his arrest and beating him there.
22
The alleged victim filed a civil suit against
police officers that was settled out of court in 2003 for an undisclosed sum.
23,24
It
is unlikely that the publicity surrounding this case prompted our subjects to men-
tion this specific site because our interviews were conducted 5 years after the
attack allegedly occurred and 1 year before the civil suit came to trial and was
POLICE, PARAMEDICS, AND THE HOMELESS 603
ultimately settled. This raises the question of why three different study subjects
would mention the same location as a place where assaults took place after police
arrests.
Certain considerations have an impact on the generalizability of this study. The
race of our study population was about 55% white and 45% black, Aboriginal, or
other, which accurately reflected the racial composition of the adult homeless popu-
lation of Toronto.
13
In many US cities, however, a much larger proportion of home-
less persons belong to racial minorities.
32
Because non-white race is correlated with
lower trust in police,
2,3
a similar study of homeless people in a US city might find
substantially lower levels of trust in police. In addition, the relationship between
police and racial and ethnic minorities may vary substantially between countries
and from city to city within a single country.
This study had certain limitations. The exclusion of persons who did not speak
English may affect estimates of level of trust because non-English speakers (parti-
cularly those belonging to racial minorities) may have less trust in the police. How-
ever, 98% of homeless people in Toronto are able to communicate in English.
18
Our
study did not include efforts to objectively confirm subject’s reports of assaults or
the health consequences of alleged assaults. We did not formally assess subjects’
substance use or mental health. When subjects were asked whether they would call
police or paramedics in an emergency, we did not describe the type of circumstances
that might prompt such a call; in future studies, this question may be better posed
by providing specific scenarios. Finally, we did not use formal qualitative analysis in
this exploratory study. Future investigations should consider employing these meth-
ods in addition to attempting to characterize interactions between homeless people
and police officers objectively.
In conclusion, our study documents that homeless people in Toronto have a
much lower level of trust in police than in paramedics, and about 9% reported hav-
ing been assaulted by police in the last 12 months. Homeless people’s perceptions of
the police may pose a barrier that prevents them from seeking needed care in an
emergency. Our findings also highlight the need for independent investigation of
homeless people’s reports of victimization by police. Further research in this area of
urban health is clearly needed.
ACKNOWLEDGEMENT
Dr. Hwang is the recipient of a New Investigator Award from the Canadian Insti-
tutes of Health Research. The Inner City Health Research Unit is supported in part
by a grant from the Ontario Ministry of Health and Long-Term Care. The results
and conclusions are those of the authors, and no official endorsement by these orga-
nizations is intended or should be inferred. Preliminary results of this study were
presented at the Second International Conference of the International Society for
Equity in Health, Toronto, Ontario, June 2002, and at the 26th Annual Meeting of
the Society of General Internal Medicine, Vancouver, British Columbia, May 2003.
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... The above excerpts chart the lack of trust that participants have with local police (see also, Newburn & Rock, 2006). This is consistent with the findings of Zakrison et al. (2004) study of homeless people's trust and interactions with police and paramedics. In their sample of 160 shelter users, the authors found that their participants had much lower levels of trust in police than paramedics. ...
... Participants expressed their concerns about trusting statutory organisations during times of need. This finding is consistent with other research that charts most who sleep rough do not trust or have a declining trust in statutory services, except for healthcare professionals (Zakrison et al., 2004). According to Wen et al. (2007), a homeless patient's trust is not only motivated by a health care provider's technical and interpersonal competence, but also by the type of attitude projected by the provider, which is likely to be influenced by numerous characteristics specific to the homeless patient. ...
Article
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The rough sleeping homeless cohort is a marginalised population that has steadily increased over the past 10 years, across the United Kingdom (UK). Understanding this type of homelessness and the vulnerabilities associated with it is crucial, as it is often misconstrued due to policy ambiguity. This article examines rough sleepers as a vulnerable cohort and explores the precursors that lead to them becoming vulnerable and subsequently victimised. The key findings revealed that rough sleepers frequently endure implicit and explicit modes of exploitation. Their implicit exploitation puts them in a position of vulnerability that affects their ability to trust the public, statutory and third sector organisations. This questions their belonging in society and forces them to establish new ties and bonds, which exposes them to additional vulnerabilities. The explicit exploitation is the mere exposure of living in the streets, which puts them at greater risk of being victimised by the public, statutory bodies and criminal groups. This article concludes by offering practical recommendations of how the issue of rough sleeping can be better addressed via multi-agency, governmental, and academic work.
... Heavy-handed approaches to homelessness thereby inspire adversarial relationships between police officers and a manifestly vulnerable population (Herring et al., 2020;Westbrook & Robinson, 2020; see also Zakrison et al., 2004). ...
... There is little research regarding the attitudes of people experiencing homelessness towards the police. For example, Zakrison et al. (2004) found lower trust in police than in paramedics for people experiencing homelessness. Another important factor is judgement of the fairness of police behaviour and procedures (Tyler, 2001). ...
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Homelessness is a serious social and health problem that is very important for community care and problem-oriented policing (POP). As this vulnerable population is difficult to reach, sound empirical data on psy-chosocial characteristics and contacts with the police are rare. This article reports a study of people experiencing homelessness from Berlin (Germany). Based on concepts of psychological and social functioning as well as social distance to the police we investigated their relation to reports of violent victimization to the police. A sample of 60 homeless males was contacted in the streets and anonymously answered interview questions and German versions of the Symptom Checklist 9, UCLA Loneliness Scale, and Perceived Social Distance Scale. Only participants who had experienced violent victimization within the last 5 years were included for the study. The results showed enhanced psychological problems and social isolation from the society, although there were some close relations to other people experiencing homelessness. Psychological problems and social distance to the police clearly differentiated between those participants who reported their violent victimization to the police and those who did not. Multivariate analyses stress the importance of social distance to the police, psychological functioning, and age as predictors of reporting victimization to the police. Moderator analyses suggested that if social distance to the police is low, people tend to report victimization independent of psychological functioning. The findings are relevant for POP and support the involvement of police in multi-agency-based community crime prevention. Implications for policy, practice , and research are discussed.
... Contemporary enforcement-focused policies address homelessness with police action, often by legally restricting behaviors endemic among the unsheltered, such as panhandling or begging, and in many cases, limit where people can sit, eat, or sleep (Snow & Mulcahy, 2001;Robinson, 2017). Enforcement-focused approaches have not proven successful; arrests and geographic displacement do not alleviate or reduce homelessness, and even when formal sanctions are absent, the adversarial relationships fostered by such policies exacerbate the harms associated with an unsheltered existence (Herring et al., 2020;Westbrook & Robinson, 2020; see also Zakrison et al., 2004). ...
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This article examines the relationship between criminality and housing among a population of formerly homeless adults by comparing arrest rates before and after placement in a supportive housing program. Jail entry records reflecting the period of chronic homelessness preceding housing placement were matched with post-intervention records for 87 adult men and women. In the studied population, a significant drop in arrest rates occurred after entry into the supportive housing environment. Findings support the assertion that supportive housing allows lifestyles to stabilize, which in turn leads to reductions in criminality. This study also reveals a transitionary period between the onset of the housing intervention and the observed decrease in arrests. Arrests do not instantaneously cease to accumulate. Instead, jail entries gradually decline over approximately twelve to eighteen months post housing placement. Explanations for the emergence of this transitionary period are discussed.
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Objectives Limited information exists about violent deaths among people experiencing homelessness (PEH) across the United States. Using data from a national reporting system, we describe characteristics of suicides, homicides, and other deaths classified as violent among PEH in the United States. Methods We obtained data on demographic characteristics, mechanisms of injury, and circumstances surrounding violent deaths from January 1, 2016, through December 31, 2018, in 31 states from the National Violent Death Reporting System. Results Of 122 113 violent deaths in 31 states during 2016-2018, 1757 (1.4%) occurred among PEH and 3952 (3.2%) occurred among people for whom homelessness status was unknown or missing. Of all violent deaths among PEH, 878 were suicides (1.1% of all suicides), 458 were homicides (1.6% of all homicides), 352 were of undetermined intent (2.8% of all deaths of undetermined intent), and 59 were the result of legal interventions (3.8% of all deaths due to legal interventions). Hanging/suffocation/strangulation was the most common mechanism of suicide among PEH (44.4%), followed by deaths due to firearms (21.6%). Firearms were the most common mechanism of homicide deaths among PEH (48.0%). Black PEH were more likely to die by homicide than by suicide, and White PEH were more likely to die by suicide than by homicide. Among the 843 suicide victims for whom additional information was known, 345 (40.9%) had a history of suicidal thoughts or plans, 245 (29.1%) had disclosed intent to die by suicide, and 183 (21.7%) were receiving treatment for a mental health condition. Conclusions Efforts to reduce mortality and improve health outcomes among PEH should consider the high rates of violent deaths in this population.
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This mixed method study spotlights hardships and supportive factors for unhoused families led by single mothers who have successfully graduated from two transitional housing programs, one rural and one urban. Data collection consisted of entry and exit surveys (n = 241) as well as qualitative interviews (n = 11). Binary logistic regression results indicated education and social support as significant predictors of successful program completion. Qualitative findings further illustrate narratives surrounding supportive factors and program supports (i.e., assistance securing employment, education courses, sense of community), as well as policy implications. Implications stress the need for enhancing supportive factors (i.e., education and social capital) in early prevention efforts (e.g., schools and community centers), as well as an intentional integration of addressing socio‐emotional needs and resources within housing programs and services unique to rural and urban communities.
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Police are often called to address concerns about people experiencing homelessness, with arrests often resulting from low‐level, nonviolent crimes, and violations of minor nuisance ordinances. In Portland, Oregon, advocates lobbied for a new model of emergency response for 911 calls involving unhoused community members and people experiencing behavioral health crises. To ensure the program reflected the needs and perspectives of people experiencing homelessness, teams of researchers, community volunteers, and people with lived experience interviewed 184 people in camps, shelters, and parks. Teams asked unhoused people how the program should be designed, including who the first responders should be, how they should approach individuals in crisis, what resources they should provide, and how they should be trained. This article describes the methods, findings, and recommendations from our collaborative survey process aimed at ensuring that the voices of people experiencing homelessness informed the development of the Portland Street Response pilot program.
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At the front end of the policing process, contact with and detention of offenders is one of the most important tipping points in policing vulnerability. It is police action at this point that can do much to alleviate the vulnerability experienced by offenders. However, it is also the point at which police can exacerbate the offender’s individual vulnerability and create iatrogenic (or system-generated) vulnerability. The mismanagement of this important tipping point in the policing process is central to much of the recent protests against policing, especially as it relates to the use of force and officer-involved deaths of suspects and offenders. Policing history has highlighted how police actions disproportionately target vulnerable people, and the catastrophic consequences that could arise from taking action. In this chapter, we overview the research and practice in relation to working with vulnerable offenders, and consider the police caution and custody arrangements as critical tipping points where alternative policies and practice may alleviate vulnerability.
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Vulnerability has been conventionally operationalised in policy and practice as an exception despite evidence of its presence throughout criminal justice processes. Existing approaches to vulnerability in policing have focused on recognised (and recognisable) categories of disadvantage. In doing so, responses have been subject to a ‘competition of suffering’ (Mason-Bish, Disability, Hate Crime and Violence, Routledge, London & New York, 2013) that leave some vulnerable people without the assistance required in policing encounters. In our development of Gilson’s framework, we consider how existing approaches mistakenly present vulnerability as an exception rather than the norm (Gilson, E., The Ethics of Vulnerability: A Feminist Analysis of Social Life and Practice, Routledge, New York, 2014). In this chapter, we offer an alternative conceptualisation that accounts for the precariousness of social life and the situational vulnerability of policing encounters and outlines our universal precautions model to remedy the vulnerability that arises in policing.
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In order to document urban youth experiences of adults in positions of public authority, including police, educators, social workers and guards, a broad based street survey of 911 New York City-based urban youth was conducted in which youth, stratified by race, ethnicity, gender and borough, were asked about their experiences with, attitudes toward, and trust of adult surveillance in communities and in schools. In-depth telephone interviews were conducted with 36 youth who have experienced serious, adverse interactions with police, guards, or educators. Findings suggest that urban youth, overall, express a strong sense of betrayal by adults and report feeling mistrusted by adults, with young men of color most likely to report these perceptions.
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What is it about resident/police relations in poor urban communities that results in many community members' deep distrust in police? This question is addressed by applying a framework of the “four trust questions” to analyze the complexities of community members' perceptions of police and police action aimed at reducing youth violence in Boston's high-crime neighborhoods. To differentiate residents' multiple—and sometimes conflicting—expectations of police, trust is broken down into four questions about priorities, competence, dependability, and respectfulness. Based on more than 50 qualitative interviews with community members, findings reveal that many residents considered the police to meet their expectations of competence and dependability but not of shared priorities or respect. Respect, in particular, was important to residents, although they recognized a tension between police acting competently and respectfully.
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The National Survey of Homeless Assistance Providers and Clients (NSHAPC) was conducted to provide information about the providers of homeless assistance services and the characteristics of homeless clients who use them. This survey was conducted for use by federal agencies and other interested parties responsible for administering homeless assistance programs. The NSHAPC selected a sample of 76 geographic areas to represent the entire Untied States, including the 28 largest metropolitan statistical areas (MSAs), 24 small and medium-sized MSAs, and 24 groups of rural counties. Information was gathered on 16 types of homeless assistance programs. Fifteen percent of homeless clients are part of family households, with one or more children under age 18. Thirty-four percent of homeless service users are members of homeless families, and 23 percent are minor children. Of homeless families with children, 52 percent received benefits from the Aid to Families with Dependent Children program. Forty-five percent of homeless children of preschool age attend preschool, and 93 percent of homeless children attend school regularly. This report presents detailed information about homeless clients and the availability of services. One appendix lists the sampling areas, and the other describes the 16 types of programs studied. (Contains 41 figures, 24 tables, and 31 references.) (SLD)
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A sample of 329 heroin users were interviewed about their experiences at other peoples' heroin overdoses. The overwhelming majority (86%) had witnessed a heroin overdose, on a median of six occasions. Heroin users were reluctant to seek medical attention, with an ambulance being called on only half (56%) of the most recent overdose occasions. At only 17% of most recent overdoses was calling an ambulance the first action taken. Males reported taking significantly longer than females to call an ambulance. Nearly half (44%) of subjects reported that there were factors that had delayed or stopped them seeking medical assistance, the most common impediment being a fear of police involvement. The importance of interventions to encourage help-seeking at overdoses are discussed.
To illuminate the role of criminal activity among the homeless, particularly the homeless mentally ill, the author compared 634 arrests of homeless persons with 50,524 arrests in the general population that were made in Baltimore in 1983. Significant differences were found in the demographic characteristics of the two groups of arrested persons and in the types of offenses prompting the arrests. Among the homeless, those arrested were more likely to be male, white, and over age 45 and to have committed trivial, victimless crimes. Evidence suggests that ostensibly serious offenses such as assault, larceny, and burglary charged to homeless persons tended to involve petty thievery, entry into vacant buildings, and other acts aimed at maintaining subsistence in the absence of housing.
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As part of a community-based survey of 529 homeless adults, the authors analyzed factors associated with their use of mental health services. Homeless persons who had had a previous psychiatric hospitalization were the least likely to sleep in an emergency shelter, had been homeless nearly twice as long as the rest of the sample, had the worst mental health status, used alcohol and drugs the most, and were the most involved in criminal activities. The majority had not made an outpatient mental health visit in 5 years. It is suggested that diverse systems of care are needed for homeless persons.
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Employing data from a 1987 shelter survey of 1260 homeless adults in New York City, multivariate models of emergency room (ER) use are developed which include an array of risk factors for visiting a hospital ER including health and mental health problems, victimization and injuries. The study's primary goal is to identify factors that predict ER use in this population. Multivariate logistic and linear regression models were tested separately for men and women predicting three outcomes: any use of the ER during the past 6 months, use of the ER for injuries vs all other reasons (given any ER use), and the number of ER visits (given any ER use). Lower alcohol dependence, health symptoms and injuries were strong predictors for both men and women; other significant predictors differed markedly by gender. Both models were highly significant and produced strikingly high risk profiles. A high prevalence of victimization and injuries underlies ER use among the homeless. Based upon the findings, we recommend expanded health and victim services as well as preventive measures. Until primary care becomes available for this population, we advise against policies that discourage ER use by the homeless.
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The study aimed to estimate the prevalence of homelessness among mentally disordered offenders entering the criminal justice and forensic mental health systems, to compare base rates of arrest for violent and nonviolent criminal charges among homeless and domiciled persons with mental illness, and to examine patterns in the categories of victims chosen by these two groups. The authors analyzed data from structured psychiatric interviews and criminal and psychiatric records of 77 homeless defendants and 107 domiciled defendants referred for psychiatric examination by the criminal and supreme courts in Manhattan over a six-month period. Mentally disordered defendants had 40 times the rate of homelessness found in the general population, and 21 times the rate in the population of mentally ill persons in the city. The overall rate of criminal offenses was 35 times higher in the homeless mentally ill population than in the domiciled mentally ill population. The rate of violent crimes was 40 times higher and the rate of nonviolent crimes 27 times higher in the homeless population. Homeless defendants were significantly more likely to have been charged with victimizing strangers. Homeless mentally ill persons appear to be grossly overrepresented among mentally disordered defendants entering the criminal justice and forensic mental health systems and to have a higher base rate of arrest for both violent and nonviolent crimes than domiciled mentally ill persons.