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.) Continue reading “New Plan for Dealing With “Prolific Offenders” Substitutes Punishment for Harm Reduction, Advocates Say” →