Advocates for harm reduction took strong exception to a set of recommendations from a joint city-county “High Barrier Individuals Working Group”, arguing that several of the proposals are just extensions of the existing, punishment-based criminal justice system rather than the kind of programs that make meaningful, lasting change in the lives of people suffering from severe addiction and mental illness.

The four-pronged plan, which Mayor Jenny Durkan, King County Executive Dow Constantine, City Attorney Pete Holmes, and King County Prosecutor Dan Satterberg announced last week, came out of the recommendations of a work group assembled to respond to former city attorney candidate Scott Lindsay’s controversial “System Failure” report last year. That report looked at the records of 100 people with long lists of misdemeanor charges and determined that many of them had failed to comply with conditions imposed by the court, such as mandatory abstinence-based treatment, random drug and alcohol tests, and appearing regularly in court.

“We have too many people who’ve been cycling through the criminal justice system and we have not been able to design the right interventions for that,” Durkan said in announcing the proposals last week. “We had some of the highest-cost interventions that were also the least effective. We knew we needed to come together and bring people across jurisdictions to address this issue.” Satterberg described the proposal’s goals more bluntly: City and county officials needed a way “to manage what we see as obvious social disorder.”

The four pillars of the plan, which would be partly funded through Durkan’s upcoming budget proposal, are:

• Expanded probation. This would include a new “high-barrier caseload” model, in which probation officers (described in the recommendations as “probation counselors”) would meet with parolees outside the probation office and parolees would be required to show up in court more frequently; and a “high-barrier treatment” model, in which offenders would get reduced sentences in exchange for going to inpatient addiction treatment.

According to Durkan, “probation counselors” with “special training in harm reduction…will meet with individuals where they are in the field, have more frequent review hearings with judges, and give people that chance to spend less time in jail only if they agree to certain dependency treatment.”

Harm reduction advocates say adding more obstacles, such as additional mandatory court dates and coercive treatment,  represents a fundamental misunderstanding of the concept, which relies on non-coercive tactics to help people achieve better health, fewer arrests, and a better quality of life. This, in turn, reduces the harm they cause the community. They also argue that sending probation officers out into the field to track down clients and provide “counseling” will cause confusion and could lead to greater harm to people on probation, because probation officers (unlike real counselors) are obligated to tell the judge if a client is violating the terms of their probation.

“I’ve found in my clinical practice that clients start to get confused when parole officers start calling themselves ‘probation counselors’ because they start to think, ‘I can tell this person anything, and, I can tell them how I’m really doing,’ but [the probation officers] are still in this adversarial role,” says Susan Collins, co-director of the Harm Reduction Research and Treatment (HaRRT) Center at the University of Washington. For example, if someone on probation told their “probation counselor” that he was struggling to abstain from drugs and alcohol, the officer would have to report that to a judge as a probation violation, which could land the parolee back in jail.

Mandatory treatment is also contrary to harm reduction, because it makes sobriety, rather than improved outcomes, the goal. “Harm reduction doesn’t have to be at odds with serving protecting public safety. In fact, these goals would seem to be very compatible if we weren’t so fixated on abstinence achievement as a proxy for not committing crimes.” Moreover, it isn’t very effective, especially for people with severe drug and alcohol use disorders who are also facing other major challenges such as a criminal record and homelessness.

The “success” rate of short-term inpatient treatment, which is what the report recommends for parolees struggling with substance use disorders, is abysmally low already (about 9 out of 10 people with alcohol disorders who enter inpatient treatment, for example, relapse in the first four years), and the “success” rate for people with no support system or place to live when they get out is likely even lower. Although the work group’s report quotes an NIH pamphlet saying that “treatment does not have to be voluntary to be effective,” that pamphlet does not include links to actual research, which shows that although forced treatment can work, it usually doesn’t. The most recent research on the kind of severely addicted, chronically homeless people the probation proposal is supposed to address, Collins points out, actually showed that mandatory 28-day inpatient treatment was the least effective form of treatment.

“In addition to the nonexistent research foundation for coerced or mandated abstinence-based treatment for this population, the proposed approach is troubling philosophically,” Collins says. “It would be incongruous and disingenuous to train probation officers in harm reduction counseling if the judges—to whom the probation officers report—were to use coercion to force people into mandated and abstinence-based treatment and require abstinence in return for reduced sentencing. This is like a bait-and-switch for some of the most vulnerable folks in our community.”

Holmes, speaking last week, said expanded probation, with enforcement mechanisms like “random UAs [drug tests]” and consequences for noncompliance, would be complementary to LEAD’s “softer touch.” “We’re talking about a challenging population that does need the specter of a court intervention or revocation hearing [that] can follow when someone doesn’t comply with the terms of their probation. … We do have to [consider] public safety first, and a probation officer is going to be able to bring noncompliance to our attention so that probation can be revoked and sentencing reimposed as necessary.”

Collins, with the HaRRT Center, says “harm reduction”—like the Downtown Emergency Service Center’s successful program for people with alcohol use disorders at 1811 Eastlake— “doesn’t have to be at odds with serving protecting public safety. In fact, these goals would seem to be very compatible if we weren’t so fixated on abstinence achievement as a proxy for not committing crimes.”

• The expansion of a recently opened shelter in the decommissioned west wing of the King County jail by 60 beds, which Durkan suggested could be reserved for “high-barrier offenders.” Durkan claimed last week that the shelter would be a “comprehensive place-based treatment center” with “on-site treatment for mental health and substance abuse disorders… something that doesn’t exist” yet in the city.

This statement—repeated by the Seattle Times, which described the shelter as a “60-bed treatment center”—is inaccurate.

“It’s going to be a shelter,” says DESC director Daniel Malone. “So, just to be really clear—it’s not going to be licensed as a treatment facility, but we will bring behavioral health treatment resources there. … What we do in a lot of our locations is have a regular, often scheduled, presence of different kinds of behavioral health specialists there to engage with people, form relationships, and help them access services.” (City officials were apparently asked to stop referring to the shelter as a treatment center prior to Durkan’s remarks last week.)

Malone says the shelter, like other shelters the organization operates, will offer medication-assisted treatment induction for people who have opiate use disorder—prescriptions for suboxone, a lower-harm opiate that can replace and reduce cravings for harmful drugs with high overdose potential like heroin. However, there is no similar drug to address the upsurge of methamphetamine use, which is increasingly common among the “high-impact” group last week’s proposals are supposed to address.

There also appears to be some tension between city and county officials over whether shelter beds would be reserved for people referred directly by a court, which is tantamount to compulsory treatment. Constantine emphasized repeatedly that “no one is going to be compelled or forced to reside there,” but Durkan said that the shelter would be a place “specifically designed” as “a place “for those high-barrier individuals to go” as an alternative to jail.

“Instead of being locked in jail cell, [offenders will] actually be in a wing of the county jail that is providing services,” city attorney Holmes added. “That has to yield better results because that’s a resource that doesn’t exist now. It gives our prosecutors one more option to suggest to the court, and if we can get the defense counsel and the courts to come along with this … [it’s] going to be more effective, less expensive and ultimately have better outcomes.”

Malone confirms that DESC’s programs, including the future shelter expansion, are all voluntary, not court-compelled. “We run voluntary programs, so we aren’t looking to mix in some kind of required treatment components to the work that we’re doing with people, and I believe that is consistent with the county’s intent for this program,” he says. For example, “We will not be administering urinalysis at the shelter.” Leo Flor, the director of the King County Department of Community and Human Services, confirmed last week that the shelter will “follow the same model as the original shelter, which is, let’s go out and find the clients we need and see what they need.”

• A “rapid reentry connector” within the jail to direct people who have been in jail for less than 48 hours to existing housing, shelter, and treatment.

Public Defender Association director Lisa Daugaard, whose organization runs the Law Enforcement Assisted Diversion (LEAD) program in collaboration with local law enforcement agencies, says that without intensive case management and dedicated shelter or housing and services to refer people to, adding a new jail referral staffer will be “largely futile, because whatever someone, no matter how skilled, can do in six to 12 hours, it’s not building a relationship. It’s not connecting them with something that they have a set-aside right to. It’s just a referral service.” The analogy that comes to mind is the Navigation Team, which is made up mostly of police officers who are charged with doing “outreach” to people living in tents at the same time as they are removing their encampments.

LEAD was not asked to sit on the work group or help develop the recommendations. But King County Department of Public Defense director Anita Khandelwal was, and she said in a statement that the new jail coordinators beg an important question: “Why are we booking people for periods of 12-48 hours” in the first place? “Research shows that even short jail stays like this are destabilizing,” she said.

• “Case conferencing,” in which law-enforcement officials and case managers will meet to share information about offenders and collectively come up with the best strategies for keeping them out of jail. This program would be similar to existing case conferences that are done through LEAD, except that it would be operated through the criminal legal system, meaning that (unlike LEAD), it could result in jail time for people who fail to comply with conditions set by the group.

And there’s an ongoing tension between privacy protections and information sharing between prosecutors, police, and case managers. Under federal law, case managers “can only share information with ongoing permission form their clients, and they’re only going to get that permission if that discussion does not happen in a way that is going to blow up on people”—by, for example, being used against them in a court or probation hearing, Daugaard says. “Once that failure happens a few times”—for example, once prosecutors throw a few people in jail over information revealed in case conferencing—”it will be the end, and they will not share information with case managers anymore.”

Daugaard notes that a set of recommendations that came out of the county’s Familiar Faces initiative several years ago recommended a “single plan of care” that was based on intensive case management and building relationships between service providers and people who cycle in and out of the jail system. The idea was that by building trust, people would become more receptive to services and case management. “One of the key observations” from that group, Daugaard says, “was that, all things being equal, the less justice system involvement the better, because it interrupted other aspects of care, exacerbated trauma and made things worse.” 

In announcing the new plan last week, city attorney Pete Holmes, who prosecutes misdemeanor cases, said, “we are not going to be held back by the fact that some of the ideas we’re trying have not been tried before. We’re not going to be held back by the fact that some people might object to us going in a new direction.”

Advocates who work with this population say that’s just the issue—these proposals have been tried before, and haven’t worked. Khandelwal, in her statement, said that “mitigating the crushing effects of poverty, homelessness, past trauma, and behavioral health disorders is an enormous challenge that does not yield to quick fixes. We know that when we look to the criminal legal system to provide answers to those issues, we end up only compounding the problem and harming the very people who most need our help.”