A recent report from the Drug Policy Alliance (DPA) explores the interrelated issues of addiction, mental health and homelessness, looking at how they can be addressed through health and social programmes and interventions.
“From Crisis to Care” is a reminder of how the most common challenges faced by everyone – from financial struggles, precarious work, to unstable housing – are exacerbated when someone has mental health disabilities or substance use disorders.
We spoke with Aliza Cohen, DPA’s Research Coordinator and the report’s author to understand more of the report and the motivations behind its publication.
How criminalisation prevents care
With around 21% of people experiencing homelessness in the US reporting serious mental health issues, and 16% report having substance use disorders, criminalisation is not addressing some of the root causes of issues people face. Instead, it’s diverting funds from essential health services towards incarceration, and choosing to lock people away from society rather than transform the environments that led to these outcomes in the first place. With half of all Americans aged 12 or older having used drugs at some point in their lives, and a quarter having used just in the past year, the potential number of people whose lives could be upended by continued drug criminalisation is immense.
While many who use drugs or have mental health struggles do not need or want treatment, for those that do, they continue to face practices that discriminate against, exclude, shame or dehumanise them because of these behaviours or issues. In health settings, this discrimination can be anything from denying people care (or providing a lower level of care), harassment or longer waits for treatment; this can lead to worse health outcomes, blocking access to resources, or even people being overall discouraged from seeking care.
Community and comprehensive care is needed
Care, available on demand, that is voluntary and tailored to people’s needs, is one of DPA’s outlined solutions. The report calls for the establishment of “community-based, scientifically-backed treatment and harm reduction programmes”. As Cohen told TalkingDrugs, “we know that investment in social services and health care improves the lives of people use drugs and improves public safety.”
There is growing evidence of the efficacy of community-based interventions like Assertive Community Treatment (ACT) in helping people with mental health disorders remain in treatment, employment and housing. ACT, which brings together a team of behavioural health, peer support and housing specialists help build people’s skills, deal with any emergency issues and keep people connected to their surrounding community.
“Instead of investing billions and billions of dollars in criminalisation, what would it look like to even put a small fraction of that amount into our treatment and harm reduction systems, into healthcare infrastructure, into housing?” Cohen asked.
Supportive housing – also known as housing first, where people faing homelessness are permanently housed as a priority, with access to support and treatment – is also recognised as critical for supporting people’s physical and mental health. This is due to the depth of evidence on how housing can be a game-changer for someone’s health, finances, and general wellbeing.
“Housing provides such a refuge for anyone. It provides emotional stability, physical stability, protection from external threats… Without housing, it’s so much harder to do just everyday tasks,” Cohen told TalkingDrugs.
The report underscores the evidence on how supportive housing is linked to reduced hospital use and health-related issues, decreases in arrests and increased health and social behaviours that are all key to someone’s recovery.
Harm reduction programmes should also be offered alongside drug treatment services. Harm reduction can ensure that people minimise risky drug taking behaviours, stay in contact with other people using drugs, access drug consumption rooms and sterile equipment, and a variety of other services.
Building community solutions works on many levels. Not only does it remove the need for constant policing of communities (and therefore reducing the justification for their continued funding), they are a way of tackling underlying social issues without resorting to punishment. Community solutions address resident concerns with lack of local safety, or missing political interest in resolving local issues. Funding ground-up programmes can benefit neighbourhoods’ health and social outcomes without the state’s physical presence.
Decriminalisation needed
Cohen spoke about decriminalisation as a broad spectrum of adaptable possibilities.
“Looking at decriminalization on a spectrum, it can look like the removal of criminal penalties for drug offenses, and it can also look like a prosecutor dismissing or declining to prosecute certain offenses like drug law violations, or sex work, loitering or trespassing.”
Recommending decriminalisation in America, given the backtracking and backlash against its trial in Oregon, is complicated. However, suggesting decriminalisation as a broad spectrum of possibilities is a useful way of highlighting the failures of prohibition: growing societal costs of incarceration, employment exclusion and the lack of treatment funding are all products of the continued criminalisation of drugs. Cohen acknowledges that “we shouldn’t look at decriminalization as a panacea,”, but that it can keep people out of the criminal system and in other structures of support that ease public suffering.
The report can be found here.
