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Justice

Recidivism: Reducing Non-Compliance or Victim Blaming?

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Court-mandated outpatient treatment in New York State, known as Assisted Outpatient Treatment (AOT), is a program designed to compel outpatient treatment and medication for individuals with serious and persistent mental illness who refuse to comply with treatment and become hospitalized or violent as a result.  However, this program fails to acknowledge the impact of mental health treatment shortages.

forcedmentalhealthThis error arises because the AOT program, and others like it around the country, falsely associates repeat hospitalization with treatment non-compliance. In many cases, treatment shortages, particularly housing shortages, are a major source of risk for repeat hospitalization. As such, thousands of individuals who struggle or are unable to secure limited mental health services are mischaracterized as dangerous, stripped of their rights to choose their treatment options, and are forced to submit to a court mandated treatment and medication regiment.

Since the creation of AOT in 1995, nearly 12,000 people in New York State have been subjected to court-mandated outpatient. As of 2012, approximately 3,330 people were currently compelled to the program. There are also major racial and geographic discrepancies in the implementation of the AOT program.

According to New York Lawyers for the Public Interest (NYLPI) (2005), African Americans and Latinos are subject to AOTs at five and two and a half times the rate of their Caucasian counterparts, respectively. Furthermore, people living in New York City were four times as likely to receive an AOT compared to those living in the surrounding state (NYLPI, 2005). These disparities indicate a major bias in the implementation of AOTs and suggest that other factors are influencing the application of this severely restrictive program.

Current Policy and Background

Assisted Outpatient Treatment was introduced in New York through the 1999 legislation known as “Kendra’s Law.” This law was named in memory of Kendra Webdale, a 32-year-old journalist who was killed when Andrew Goldstein, a man with a severe and persistent mental illness, pushed her front of a subway (Hartocollis, 2006).

Kendra’s Law provides the AOT mandate for people over the age of 18 suffering from a mental illness who are unlikely to survive safely in the community without supervision. AOTs can only be authorized by a judge and a hearing must prove either, A) lack of treatment compliance led to hospitalization at least two times in the last three years, or B) lack of treatment compliance led to threats or acts of serious violence to self or others in the last four years. In addition, the court must prove that the person’s mental illness makes them unlikely to participate in community-based treatment and that such treatment would be beneficial to prevent relapse and deterioration. (New York State Office of Mental Health, 2014)

600_subwayOnce approved, AOTs require case management services or an assertive community treatment (ACT) team. The person is required to follow a detailed treatment plan, which typically includes both services and medication.

If a person chooses not to comply with the treatment plan, they will be arrested and locked in a psychiatric hospital for 72-hours. After such time, the standard civil commitment process begins where it is determined whether they should remain hospitalized or be released into the community. (New York State Office of Mental Health, 2014)

Critique of Assisted Outpatient Treatment

Some advocates for the mentally ill consider the AOT program a positive step because it mandates providers to ensure care for the mentally ill and prevents people from falling through the cracks (Van Dorm, 2010). There have also been many documented benefits from the AOT program including a decrease in homeless, hospitalization, incidences of harmful behavior (New York State Office of Mental Health).

While the positive outcomes should not be overlooked, we must ask ourselves, at what cost are we accomplishing such feats? What are the unintended consequences of compulsory treatment and are there hidden victims behind the data?

A major critique of the AOT program is that it is likely applied to a wider rang of individuals than the intended population. Specifically, it is applied to individuals for whom services are scare. Recall that the first requirement for AOT is at least two hospitalizations within the last three years. While courts must prove these hospitalizations were caused by treatment non-compliance, it is often difficult to identify non-compliance when voluntary services are limited or substandard.

In a tragic and ironic example, Andrew Goldstein, Kendra Webdale’s assailant, was determined treatment non-compliant because he was not taking his medication when he pushed Ms. Webdale onto the subway tracks. However, this ruling was made despite the fact that Mr. Goldstein’s family and social worker had been fighting desperately for years to obtain medication assistance and supervised housing for him (Wineripe, 1999). Mr. Goldstein was countlessly denied treatment due to shortages and was on a waiting list for housing at the time of Kendra’s death. Mr. Goldstein had been hospitalized fourteen times in the two years preceding Ms. Webdale’s death and was given no priority access to community-based services upon his release.

The assumption underlying the resulting legislation was that Mr. Goldstein was too ill to comply with treatment and should thus be striped of his rights in order to maintain public safety. This is an unfair and victim-blaming perspective. Mr. Goldstein was failed by the system.  He was denied services and then punished for not accessing them. This is not to say that people with mental illnesses never refuse treatment. Rather, it is to say that inadequate mental health services are a much greater cause of hospital recidivism than treatment refusal. Instead of addressing this problem by improving services, Kendra’s Law and the AOT program has focused on stripping the mentally ill of their rights.

Mr. Goldstein’s experience is not unique, as many mental health services in New York are limited. According to the National Alliance for Mental Health (NAMI, 2009), New York State is in “Urgent Need” of acute care facilities, mental health housing, and crisis intervention teams. According to a report by the U.S. Substance Abuse and Mental Health Services Administration (2013), only 38.5 percent of individuals with a mental illness in New York receive adequate treatment. The shortage of housing services for people with mental illnesses is particularly significance because, “Without appropriate housing in place, recidivism is especially high within this population” (NAMI, 2013). As of 2013, NAMI estimated that 21,000 additional housing units were required to adequately address the needs of the mentally ill.

Because of service shortages, two major distortions of the AOT program have occurred. First, hospital recidivism, rather than a history of violence, has become the dominant mechanism of AOT authorization. According to a comprehensive evaluation of the program commissioned by the state, 66 percent of all AOT cases were opened at hospital discharge to reduce recidivism (Swartz, et.al. 2009). They also found that the majority of AOTs were obtained before seeking an Enhanced Voluntary Service Agreement (EVS). Furthermore, only 15 percent of AOT participants were found to have any history of violence.

The second distortion of the AOT program due to treatment shortages is that court mandates have become the most reliable avenue for an individual in New York to obtain mental health services.  According to NYLPI (2005), because court mandates provide individuals with a “right to treatment” and priority access, AOTs are sometimes sought simply to get people treatment. This unfortunate and perverse distortion of the AOT program is of grave concern because it required the mentally ill to subject themselves to a subordinate legal status in order to be provided the care they need to live healthy, safe and productive lives.

Policy Recommendations

In order to improve the AOT system and ensure only those who are truly non-compliant are court-mandated treatment the following recommendations are provided. First, treatment shortages must be eliminated. This requires a significant increase in mental health financing and an increase in the number of supportive housing facilities, day program services, medication management, and intensive case management.

Second, individuals with a history of hospitalization should be provided priority access to community based services and a “right to treatment.” This includes creating Enhanced Voluntary Service Agreement (EVS) for all individuals who have been hospitalized at least two times in the last three years, rather an the current requirement that these individuals are prescribed AOTs. Third, AOT authorization for individuals with a history of hospitalization should be amended to include proof that non-compliance occurred in the presence of reasonably accessible services.

With these recommendations, the need for court-mandated outpatient treatment will be significantly diminished.  People with mental illness will have the resources that prevent hospitalization and those in critical conditions will have full-access to the services they need to get better.  Most importantly, mental health consumers will maintain their rights, dignity, and freedom to choose their providers, medications, and service-delivery methods. Treatment shortages should not be tolerated and neither should the further disenfranchisement of the mentally ill.

While there may be limited instances where court mandates are necessary, we should resist these mechanism whenever possible. Court-mandates are an oversimplified solution for a challenging program. Ultimately, the currently AOT system unfairly robs individuals of their liberties, dignity, and falsely blame the mentally ill for treatment shortages when the onus is on society.

References

Hartocollis, A. (October 11, 2006). Nearly 8 Years Later, Guilty Plea in Subway Killing. The New York Times. Retrieved from: http://www.nytimes.com/2006/10/11/nyregion/11kendra.html?_r=0

National Association of Mental Health. (2009). Grading the states 2009 report card: New York. Retrieved from: http://www.nami.org/gtstemplate09.cfm?Template=/contentmanagement/contentdisplay.cfm&ContentID=75312

National Association of Mental Health. (2013). Legislative agenda: the need for safe and affordable housing for people with mental illness. Retrieved from: http://www.naminys.org/advocacy/2013-advocacy/2013-action-agenda

New York Lawyers for Public Interest. (2005). Implementation of Kendra’s Law is Severely Biased. Available at http://www.nylpi.org/images/FE/chain234siteType8/site203/client/DLC%20-%20Report%20on%20Kendra%27s%20Law.pdf

New York State Office of Mental Health (NYOMH1): Summary of Kendra’s Law. Available at: http://www.omh.ny.gov/omhweb/Kendra_web/Ksummary.htm

New York State Office of Mental Health (NYOMH2: Assisted Outpatient Treatment Reports: Outcomes. Available at: http://bi.omh.ny.gov/aot/outcomes

Swartz, M.S., Swanson, J.W., Steadman, H.J., Robbins, P.C. & Monahan J. (2009). New York State assisted outpatient treatment program evaluation. Durham, NC: Duke University School of Medicine (June, 2009). DOI: 10.1176/appi.ps.61.10.976

Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: New York, 2013. HHS Publication No. SMA-13-4796NY. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

Van Dorn, R.A., Swanson, J.W., Swartz, M.S., Wilder, C.W., Moser, L.L., Gilbert, A.R., Cislo, A.M., & Robbins, C.P. (2010). Continuing involuntary outpatient treatment: medication and hospitalization outcomes in New York. Psychiatric Services, 61(10) 1-6.

Winerip, M. (Nov 1999). Report faults care of man who pushed women onto tracks. New York Times. http://www.nytimes.com/1999/11/05/nyregion/report-faults-care-of-man-who-pushed-woman-onto-tracks.html?ref=andrewgoldstein

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Stephanie Pinsky is the Political Staff Writer for Social Work Helper. She recently completed her MSSW from Columbia University where she focused on Public Policy. She completed her field placement at the Center for the Study of Social Policy, where she worked on the Child Welfare Systems Change team. As a passionate social justice advocate and political fanatic, Stephanie writes on a wide range of social work policy issues including child welfare, immigration, public assistance, mental health, education, and race equity. You can read her blog Social Justice & Beyond at SocialWorker4Change.wordpress.com and follower her on Twitter @StephaniePinsky

          
5 Comments

Being in the front lines, for over the past 20+ years, I have witnessed the “shortage of treatment” allowed per individual, apparently, policy based on fiscal availability.

Early in my work, it used to be possible to get a person with m.i. into treatment if they were showing signs of decompensation, with appropriate documentation. Later, down the road, I found it was virtually impossible to get someone into treatment unless they had crossed the threshold of being a danger to themselves. It was apparent then (I’d say this was 2000) that the realm of treatment, now opposing most research, showing the value of early treatment, was out the window.

A sad state of affairs.

Human Rights

Increased Inmate Deaths and the Lack of Accountability

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Sandra Bland

One year after the death of Sandra Bland on July 13, 2015, the Huffington Post compiled a list of persons who died in jail. In the following twelve month period, there were 811 deaths, most of which were the result of suicide. In fact, 253 detainees committed suicide in the year after Sandra’s death, constituting 31% of all fatalities.

This heartbreaking statistic highlights a historical pattern; one of racial targeting and classism, poor management, health care oversight, and corruption. The criminal justice system fails our communities by allowing preventable inmate deaths while targeting the most vulnerable communities. These alarming trends in our prisons, jails, and juvenile detention centers have us wondering, why?

Experts examining suicide and death in our nation’s jails reveal disturbing trends across the most vulnerable communities. A recent New York Times article, for example, Preventing Suicide in America’s Jails, reveals in 2013 a total of 967 jail inmates died while detained in local corrections facilities. This statistic continued to grow the year after, even though the inmate population declined by 4%. Other authors and researchers cite poor management, inadequate health care, and perfunctory oversight as major culprits. Although these issues go mostly unresolved, they continue to institute a pattern of death and suicide.

Reasons Behind Inmate Deaths

Many jail fatalities are overlooked and underreported. Generally, jails are not required to disclose fatalities occurring within their facility to their community. Even the most egregious incarceration centers can go unnoticed by the community at large when they aren’t being held accountable for deaths occurring in their own institutions.

Different from prison, jail stays are shorter (approximately 21 days) and most of the inmates have yet to be sentenced. Jail inmates could also be under the influence of drugs, alcohol, or have mental or physical health issues that correctional staff might be unaware of. For these reasons, many jail suicides occur in the first week of incarceration as indicated below by the Prison Policy Initiative.

According to KyCIR’s reports in Kentucky’s Grant County Jail, rampant corruption, employee incompetence, ineffective staff preparation, and inmate maltreatment were all present in the jail’s culture. In an environment where accountability is minimal, inmates are more likely to be disregarded and mistreated, as is the case of Danny Ray Burden at Grant County Jail.

“Danny Ray Burden fell asleep mid-sentence as he was booked into the Grant County jail, toppling over on the bench where he sat. Prodded awake, he coughed, shook and pleaded for emergency medical attention. A blood test showed that the 41-year-old diabetic badly needed insulin. Instead of assisting with proper medical standards and medications, deputies put Danny Ray in a cell, where he was found unconscious just three hours after he had entered the jail on March 27, 2013. He died a week later.”

Reflecting on the data, including the specific cases of Sandra Bland and Danny Ray Burden, who is at risk for jail fatality?

Vulnerable groups at correctional facilities include:

  • Persons booked for lesser crimes
  • Those without financial resources who are unable to post bond
  • Communities of color who are profiled by police and often receive harsher punishments
  • Sex offenders and those accused of vicious crimes

Why Death by Suicide?

For inmates whose lives were previously difficult, a brief jail sentence could prove traumatic. The most at-risk inmates may be experiencing withdrawal symptoms, a lack of access to prescriptions, and/or low availability of medical or mental health services. An inmate with a troubled emotional, mental, or physical state of inmates suffers even more while imprisoned, especially when our system neglects their basic needs.

Correctional facility detainees may have anxiety about unemployment, broken relationships, loss of residence, healthcare, or the inability to care for children. Without financial resources, these issues are compounded by the inability to pay a bond. And for black inmates, especially those in the 18 to 29-year age range, accruing considerably greater bail amounts than their peers in other racial groups isn’t uncommon.

Suicide Prevention Strategies for Correctional Facilities

In Matti Hautala’s article In the Shadow of Sandra Bland: The Importance of Mental Health Screening in U.S. Jails, the author examines the multifaceted environment of our American jail system and garners evidence-based recommendations for inmate suicide prevention.

The author suggests the initial entry procedure, including the preliminary psychological evaluation, acclimates the inmate to the criminal justice environment. This experience could have a lasting impact on the immediate future for that inmate; although alternative programs such as parole, probation, or mental health courts are recommended. Community supervision, rather than incarceration, is especially effective for those with psychological or mental health issues. Further recommendations include:

  • Psychological evaluation instruments and qualified evaluators
  • Proper procedures regarding medical records and treatment
  • Limiting the use of restraint and isolation
  • Frequent visual follow-ups, every 15 minutes, with suicidal or homicidal inmates.

The gross lack of culpability by local and state corrections personnel and increasing inmate deaths calls for advocacy and reform. Social workers, helping professionals, and concerned citizens must engage our political and community leaders in evidence-based dialogue and program development to reduce the number of inmate fatalities in our nation’s correctional facilities.

By engaging with our local communities and representatives, together, we can hold our system accountable. We can force our jail and correctional facilities to say “mea culpa!” and reform our policies to prevent tragic and unnecessary death.

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News

Brexit: Paradise Lost – or Have We Forgotten?

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For over a year now the UK has been wracked with a host of political scandals which rival the most intricate episodes of Yes, Prime Minister.

Yes, Britain is apparently leaving the European Union (a matter knife-edge enough). Yes, there are questions about the tenability of the Prime Minister’s position, and who will usurp her. Yes, the Paradise Papers have long ago told us what we already knew: the rich aren’t paying tax. Yes, our government is regularly implementing and justifying racist policies. But the hottest of the hot topics was, at least for a time, this:

Why has the sexual harassment and abuse of (mostly) women been prevalent in British parliament for decades?”

Our government has been dealing with everything from rape to groping and sexual assault, sexual harassment, and sexual or inappropriate comments. Women set up a WhatsApp group specifically to share information about whom to be cautious of.

The Secretary of State For Defence (that’s right, the person responsible for defending the United Kingdom against attacks) resigned on November 1st, 2017 before the full range of allegations was even made public.

The media has, of course, sought answers, ranging from It was the culture to Women need to toughen up to a disappointingly modest mainstream smattering of power, privilege and toxic masculinity.

Some outlets have linked this (to some, unsurprising) spurt of public revelations to the infamous Harvey Weinstein allegations. This is a man whom, for decades, sexually harassed and abused (mostly) women in Hollywood. His behaviour was known-yet-unknown, referenced in public but never revealed.

Given this, Hollywood responded with the full spectrum of shock, anger, feeling ‘sad’ and ‘bad for’ Weinstein, expressing renewed curiosity about women’s dress codes and naïveté of ‘the culture we live in’. This British Bank Holiday, on the 25th May 2018, he was finally charged, with rape, sex abuse, and sexual misconduct pertaining to two women. Two.

However, we now know about comedian Louis CK, actor Steven Segal, and the once-beloved Kevin Spacey. Morgan Freeman is on the list of those accused. Heartbreakingly, there will be others to come.

To what extent can we continue to suggest it’s women’s responsibility and women’s fault – when it’s happening to a whole spectrum of people? Let’s be clear: every single accused person is a man. And we are all – no matter our personal gender – at risk of the violence of male power.

As Judith Hermann writes in her seminal work Trauma and Recovery, “It is now apparent that the traumas of one are the traumas of the other. The hysteria of woman and the combat neurosis of men are one. Recognising the commonality of affliction may even make it possible at times to transcend the immense gulf that separates the public sphere of war and politics – the world of men – and the sphere of private domestic life – of women” (p. 32).

It should be noted here that Hermann’s usage of ‘hysteria’ was of hysteria a debunked and oppressive conceptualisation of women. She discusses  how a range of traumas, apparently so different, are linked  by the political – they are characterised by fear and threat, power and violence.

Her words ring true, except now the traumatic event is the same for both men and women. The personal world of child sexual abuse – largely perpetrated by men – has become political. And, unfortunately, that is meant both metaphorically and literally.

For Britain, however, this does not follow the Hollywood accusations as some have suggested. Its cultural foundations more likely rest on the ‘watershed moment’ of the British Jimmy Savile story.

Between 2011-2013 Jimmy Savile –  an English radio, TV, and media personality who was an avid charity fundraiser – was posthumously exposed as having perpetrated prolific sexual abuse.

Some of the abuse happened live on air, with cameras rolling. Some was with unconscious and disabled children. He was buried as Sir Jimmy Saville, just two months before the truth of his abuse was unearthed to the public.

This case was unprecedented; ghastly, shocking, unspeakable and yet the country could speak of little else. The grim reality of the tale started to unravel with one small thread: a ‘handful of cases’ in the 1960s.

At first, people couldn’t believe it.

Then, eventually, nobody could question it.

His final victim count – following a snowball effect of increased confidence in reporting, public attention, support and helplines – was around 500. At least, that we know of.

It is to the shame of Britain this happened. It is to the shame of Britain nobody listened until it was too late.

Consider now the current political mess. Consider the heated discussions about everything from consensual flirting to discomfort to harassment to rape. At once point, these discussions consumed the media as much as the media is consumed by its audience. Now, the attention has cooled in light of the scandal-machine that is our current government.

However, the sexual consent movement has been built upon the backs of those who were brave enough to stand up and say: this happened. It was real. It is also built upon the humiliation and isolation we heaped upon so many hundreds of thousands of others, by not believing them in the first place.

Arguably, such open discussions about child sexual abuse could not have happened before. They repeat an age-old story, except this time people are compelled and able to hear it.

The personal is political and the political is personal. The social and cultural context for victims, survivors and survivor-victims to finally unburdening their stories is ripe. And abuse is rife.

What does this tell us? It tells us we have a problem with how we teach our men. And it tells us we have a problem with power.

Judith Hermann predicts every few decades, society can acknowledge traumas and set the stage for action and reparation. However, the unspeakable nature of trauma begs that we push it back into our collective unconscious.

And we can’t. We simply can’t let that happen. Not in my country.

The original meaning of ‘watershed’ is an area of land which separates rivers which flow in two different directions. Politically, culturally, socially, morally, we need to make sure things flow in the right direction.

Crucially, we can’t let this stop with perpetrators who are famous, who have pockets of accusers sharing their stories together for their own safety. We need to support ordinary people (ordinary women, particularly), to share their stories outside of the limelight where the public’s support is less tangible. We need to support the poor, the less ‘credible’, the young, those of ethnic, gender and sexual minorities, those already in sex work, those with ‘bad reputations’.

Let’s continue to bring those in power to task.

Let’s support and donate to groups like Refuge and Broken Rainbow, the NSPCC, and other local charities in your area. Let’s protest the closure of women’s shelters. Let’s give our gratitude to groups like Sisters Uncut. And for goodness’ sake, for all that is healthy in this world…

Stop blaming women. Stop blaming victims. Start listening. Don’t let us forget what it felt like when these allegations and stories were fresh. Let’s turn the political back personal again.

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Justice

Is It More Than Just A Shooting?

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Several articles in response to the shootings in Minnesota, New Orleans, and Dallas point fingers at PTSD and mental illness. Although these issues are valid, there is a multitude of factors making this issue far more complex than a singular culprit like mental illness.

Underneath all these shootings and acts of violence is fear, an emotion we don’t often factor in when discussing shootings. Fear causes fight or flight reactions in humans, a strong, protective instinct which can, at times, cause reactions that aren’t typical of our normal behaviors.

When we experience fear, whether real or perceived, our adrenaline increases and as an act of self-preservation. Our reactions to fear may cause us to act in ways our “normal” brain might not have. Unfortunately, it can also cause us to react in a way which can take the life of someone in the name of self-protection or justice.

So, imagine the stress of living in a neighborhood where people are killed, gunshots are heard regularly, and those around you are involved in nefarious activities. Long-term stress can have severe consequences – such as physical health issues and problems with cognitive thinking. For children, toxic stress results in behavioral and development issues.

Living in a state of constant fear never allows an individual to care for themselves, always on the alert for potentially dangerous situations. Living in fearful conditions where a community’s needs aren’t met and their safety is questionable, a physically and mentally harmful lifestyle is already enough to deal with. Now, factor in racial profiling, police bias and brutality, and classist targeting.

In low-income neighborhoods, police are not always responsive. The police don’t often know you or your family and tend to approach certain neighborhoods with harmful preconceived ideas. Whether it’s internalized hate, racial profiling and learned bias, classism or just plain ignorance, many police officers are not educated about communities different from their own and only have reference points from television and media, which reinforce harmful stereotypes. If this is the basis from which police are viewing the public, it’s highly likely police will target certain groups out of fear.

It is important as a society, we do not downplay the personal responsibility we have for our actions nor the sheer horror of violence. But we are not born disliking people of color, women, immigrants or cultures different from our own.

Through our learned experiences with family, school, media, or religious institutions, we learn to be separate and fear groups who are not like us. We look around and see people who only look like us and learn to live in a comfortableness rather than question the status quo which oppresses certain groups more than others.

So, how do we get past this fear? Education, compassion, and empathy are key. As a community, we need to be more responsible to one another and have difficult conversations about race, gender, and class while challenging our own internalized biases.

Speaking to our legislators, media representatives, friends, and family is a power to hold ourselves and others accountable for racial profiling, classism, abuse of power, and internalized fears. We need to put our foot down and refuse to settle for superficial conversations or answers to large, complex problems.

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Environmental Justice

How Should Social Work Respond To The United States Leaving The Paris Agreement?

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“Logic clearly dictates the needs of the many outweigh the needs of the few” – Dr. Spock (Star Trek)

This quote is at the heart of a complex political debate; Dr. Spock doesn’t think it’s that complex.  Social justice is one of the tenants of social work practice. This often places social work on the wrong side of Dr. Spocks quote.

Frequently, social workers are providing for or advocating for the needs of the few. Dr. Spock had some help in posing this quote. The question originates from the philosophy of Utilitarianism. John Stewart Mill argued that society is a collection of individuals and that what was good for individuals would make society happy.

You can see this gets messy… and quick. This philosophy was recently put to the test with President Donald Trump’s decision to withdraw from the Paris Climate Accords. A 195 country agreement to reduce carbon emissions and offer assistance to developing nations to do so as well. Mr. Trump makes a case for economic justice that our involvement in the Paris Accord forces us to over-regulate businesses. He also argues it places an unfair burden on The United States contribution to developing nations. Trump asserts both factors create undue pressure on some of the most economically vulnerable areas in the country. Taking a strict stance stating he “Does not represent Paris…I represent Pittsburgh”. He believes the needs of local Americans outweigh the need to cost-share climate change with the globe.

Should the United States share in the cost of global warming at the cost of our local economies? The economic impact is up for significant debate. The best analysis of this complex issue is provided by FactCheck.org. I’ll let you read it but the economic rationale for leaving the Paris Accord seems questionable. The report he cited on the economic impact ignores many factors including the growth in the renewable sector.

From the social work perspective, this creates an interesting dilemma. The virtues of Globalism versus the “America First” Populism will remain a challenge. How do the local needs of the “Rust Belt” and “coal country” interact with the global energy economy impacted the Paris Accords?

The issue of Global Warming challenges social work to think about where our “systems thinking” begins and ends. Is our profession concerned for the global good or just the area’s they serve? In a recent speech, the UN Secretary-General argued the poor and vulnerable will be hit by climate change first.

Also, what is not in question is the economic impact in the Rust Belt and Coal Country of the United States. This also depends on where you are placing “The needs of the many”. The loss of manufacturing and energy jobs has had a significant impact on services in these areas.  These voters were activated by a hope of a potential change in their economic future. These parts of the country who rely on manufacturing and energy have been economically depressed. There is fear further government regulation and lack of money in these areas will make this worse.

Even if the move out of the Paris Climate Accords does fix local economies, it creates another complex systemic problem. Again thinking about where does our “systems” thinking end? I touched on this in my post about Facebook’s global vision for the world. The debate on globalism is a complex one, but The United States leadership on climate change is not.  Have we put ourselves at disadvantage by not being a leader willing to partner in climate change?

Are countries going to want to “make a deal” with us about innovation and technology in the energy sector? How will the impact on the global economy affect our local economy? Seems like this blog post has more questions than answers.

To attempt to answer this, I again consult the National Association of Social Workers Code of Ethics.  Section 6.04 in social action says…

(c) Social workers should promote conditions that encourage respect for cultural and social diversity within the United States and globally. Social workers should promote policies and practices that demonstrate respect for difference, support the expansion of cultural knowledge and resources, advocate for programs and institutions that demonstrate cultural competence, and promote policies that safeguard the rights of and confirm equity and social justice for all people.

No easy answers when thinking about dedicating United States funds which may help globally but detract from the local action. This also brings about thoughts of our core value of competence. That whatever we do to help the most vulnerable citizens in the Rust Belt, I hope it based on sound evidence.

Those policies are based on science and evidence-based practices to try to help these local economies. Whatever we do globally it places the people we serve in the healthiest and most prosperous situation.  It’s not just social workers who are thinking about the impact but physicians are weighing in as well …

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Business

Work Together to Prepare for the Next Big Storm

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Year by year, hurricanes are growing stronger and more frequent. We are witness to these changes as we watch two catastrophic storms devastate the southeastern United States in as many weeks.

This month, Hurricane Michael slammed the Florida Panhandle, southern Virginia, and the Carolinas. The massive storm killed at least 16 people, flooded cities, highways, and rivers, and reduced much of the region to rubble.

Barely two weeks ago, Hurricane Florence killed at least 36 people in three states, forced thousands to evacuate their homes, dumped record floodwaters on North Carolina, created power outages for hundreds of thousands, and killed millions of farm animals. The most recent damage estimates put the economic toll at a staggering $100 billion, once accounting for property damage, medical costs, and lost wages.

Natural forces emboldened by climate change continue to overwhelm our outdated stormwater management practices and inadequate urban planning, putting us in a precarious position. Short-term economics have often driven development where considering long-term environmental impact was needed instead. When it comes to handling the effects of more storms, we’re not as prepared as we think.

As we assess the damage done by Michael, Florence, and other storms, the shrewdest move is to prepare for the next big storm — and the one after that. Municipalities, businesses, and individuals can brace for the next storms by focusing on the following areas:

Additional Pollution Prevention

Florence and Michael disrupted two of North Carolina’s biggest industries: coal power and hog farming. This created environmental trouble and the potential for health problems. Duke Energy officials in North Carolina said slope and landfill erosion caused stormwater with coal ash — containing heavy metals such as arsenic, lead, and mercury — to spill into Sutton Lake. Watchdog groups have expressed concern about the effect on water quality.

Floodwaters also breached multiple hog lagoons, designed to keep solid waste from polluting sources of drinking water, in at least two North Carolina counties, causing varying degrees of damage. The North Carolina Pork Council says the state’s other 3,000 hog lagoons are holding up, but the state’s Department of Environmental Quality will have to perform inspections.

The landfills, dams, and lagoons containing pollutants need to be stabilized and reinforced. Cities can reduce landfill washout by using gravel stabilizers, terracing, drainage diversions, and other measures to safeguard their slopes against erosion. To avert overflow of detention ponds like hog lagoons, companies can add pond depth, secure the perimeters, and place impervious barriers around the site.

Adjusted Damage Estimates

Because of climate change, we can count on heavier rain and shorter intervals between storms increasing flooding risk. Data is still being gathered for Michael, but we know that for Florence, greenhouse gas emissions and warmer weather made for more intense rainfall. When Hurricane Harvey hit Houston last year, the city matched its annual rainfall (typically 50 inches) in a matter of days.

Cities, businesses, and infrastructure planners need to set new damage expectations, as 500-year storms” arise with increasing regularity. Adequate planning and preparation may seem expensive overall, but it’s more expensive to deal with damage in the aftermath of flooding. It’s important to remember there’s no immediate fix or silver bullet. Instead, we need long-term solutions first acknowledging the problem and then planning for it.

Broader Public Education

Weathering the next storm requires a public education process that touches all sectors on the solutions available to help protect communities against floodwater. In my hometown of Houston, the community has come together with a discussion on the web, in public forums, and in community meetings.

The Houston Green Building Resource Center provides a public resource at the permitting building, providing engineers, architects, contractors, and homeowners with techniques on how to reduce flooding on the macro and micro levels, including information on building codes, permeable and sustainable materials, and engineering technologies to incorporate. Examples include elevated construction, or raising buildings above the rising floodplain, and permeable paving techniques that can reduce the extreme weather’s impact on the earth’s surface. Both are cost-effective improvements worthy of broader public education.

The intensity of storms like Michael and Florence raise the bar for planning and preparation. Governments, businesses, and communities must plan ahead and work together during the quiet times before the storm returns.

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Justice

Brett Kavanaugh’s Hall Pass for Police Misconduct

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Brett Kavanaugh

On July 9, 2018, Brett Kavanaugh was nominated for a lifetime appointment to the highest court of the land, the Supreme Court of the United States (SCOTUS). Since Kavanaugh’s nomination, opponents are extremely concerned his addition to the court will skew the court to a conservative majority resulting in the rollback of rights and protections for women and minorities

Although Brett Kavanaugh’s stance on Roe v. Wade has been widely discussed, the latest allegation of sexual assault levied by Dr. Christine Blasey Ford has added yet another layer of angst among Democrats and women advocacy groups opposing his confirmation.

Observers can’t help but notice the historical parallels between the Kavanaugh hearings and the installation of Justice Clarence Thomas despite the testimony of Anita Hill in 1991. Thomas is currently the longest serving conservative justice on the current court. Most importantly, it is likely his impact will be felt for decades to come which is why its imperative the mistakes of the past are not repeated.

As the spotlight shifts from Kavanaugh’s stance on Roe to allegations of sexual assault, little attention has been paid to Kavanaugh’s position on the exclusionary rule which may drastically change how law enforcement wield its governmental power. The exclusionary rule is “a law that prohibits the use of illegally obtained evidence in a criminal trial” presented by police to prosecutors.

Last year, Kavanaugh gave a speech where he commended the late Chief Justice William Rehnquist’s view that the exclusionary rule “was beyond the four corners of the Fourth Amendment’s text and imposed tremendous costs on society,” and that it was not “required by the constitution.” Kavanaugh was referring to Rehnquist’s originalist approach to the constitution and his belief that the court should not go beyond its text.

The exclusionary rule was created to deter law enforcement from performing unreasonable searches and seizures as defined by the 4th amendment of the United States Constitution. This limit on law enforcement power is so intrinsic and engrained in our culture that it is almost taken for granted.

The rule simply says that evidence unlawfully obtained by police cannot be used against a suspect at trial. The rule also provides an important check on a criminal justice system that is already skewed against poor people and people of color.

A recent study found that the majority of innocent people who are wrongfully convicted and later exonerated are African American. In regards to murder convictions, African Americans are seven times more likely to be wrongfully convicted than white people. The disparity is even more pronounced with regards to drug offenses; African Americans are twelve times more likely to be wrongfully convicted than whites.

The stock argument in opposition to the exclusionary rule is that it inevitably allows guilty persons to go free. According to Judge Benjamin Cardozo, “The criminal is to go free because the constable blundered.” However, those in favor of the exclusionary rule remaining intact believe without it, the protections guaranteed by the Fourth and Fifth Amendments are nothing more than empty promises.

The exclusionary rule has been chipped away at with various exceptions since the Rehnquist Court. Currently, the Supreme Court has four conservative justices; Clarence Thomas, Neil Gorsuch, Samuel Alito, and John Roberts. With the addition of Kavanaugh our protections under the exclusionary rule, and Roe for that matter, will be in jeopardy.

The public has already witnessed Officer Michael Slager on video attempting to plant evidence on Walter Scott after fatally shooting in him the back while he was running away from a traffic stop for a broken taillight violation in Charleston, South Carolina. Communities of Color already fear and mistrust the police, and unchecked police power will further widen the divide.

If police are allowed to illegally enter into a home or seize property without securing a warrant and are able to present this evidence in court despite being obtained illegally, many fear this move will reward illegal behavior by the police.

The hypocrisy of government benefiting from its own unlawful conduct leads to a lack of trust in it and further diminishes the idea of equal protection under the law. Most importantly, when a court permits the use of illegally obtained evidence, the court not only sanctions the misconduct but also encourages it.

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