In the summer and early fall of 2020, as protests and riots swept across the United States, a new consensus began to emerge among progressive activists, writers and politicians. Given that black men, from George Floyd to Daniel Prude, were dying in drug and mental health-related altercations with law enforcement, perhaps police should not be handling these issues at all.

The writer Ta-Nehisi Coates, for instance, wondered whether “people with guns” should even be responding to mental health calls. Pilot projects were launched all over the country to replace police with civilian response teams for 911 calls involving mental health, drugs and homelessness. Congresswoman Katie Porter introduced a bill to pay states and cities to set up more such units, while her colleague Cori Bush introduced a bill that does much the same. In many cities, “decriminalisation”, long a rallying cry for progressive critics of policing, became standard operating procedure.

The activists are right that police cannot be the “solution” to mental illness and drug abuse, which overlap in about 50% of cases. But the programmes developed to replace law enforcement have had mixed results. That’s because in many of America’s progressive enclaves, the problem isn’t that it’s the police who are responding to these emergencies. It’s that there is little the police can legally do once they get there.

Lejon Butler is a tall, lean, black man who lives in Rodeo, a bedroom community in the North Bay Area. As a kid in the East Bay in the Eighties, he recalls going to school and being taught to “Just Say No” to drugs, then coming home and smelling the familiar chemical odour of freebased cocaine wafting through the air.

Lejon’s mother, Martin, who is now deceased, and his stepfather, Craig, were drug addicts. But Craig was such a high-functioning addict that he was able to conceal his use from his family for years. He ran a successful landscaping business while getting high every day, even trading services with one of his clients for Oxycontin. But a few years ago, he overdosed. After that, dementia set in.

By now Craig was living in Richmond, a working-class residential city in the East Bay. A few months before Lejon’s mother passed away, Craig had started to become violent towards her. When she died, in April 2021, he fell into a deep depression. He became aggressive and unpredictable. He threatened to kill his grandson with a samurai sword. He put a dagger to his own stomach and threatened to gut himself. On January 5 this year, he started a fire in his kitchen and then refused to leave the house, acting like nothing had happened. His family called 911.

The responding officer was Brian Lande, who, as part of the county’s Mental Health Evaluation Team, specialises in handling these sorts of calls. Officer Lande had spoken to Craig only a few days earlier. He makes a point of checking in on people with mental illness and addiction issues when they’re not in crisis. That way he’s able to get to know them as they really are, and not just when they’re sick.

When Lande arrived at Craig’s house, Lejon, his wife, and his niece Dnaya were already outside. Lande intended to put a psychiatric hold on Craig, which would allow a hospital to keep him for up to 72 hours. He also recommended that Dnaya fill out an application for a restraining order, which might help persuade the hospital to keep him there instead of just releasing him within a few hours.

The family had been through this drill many times before. Craig fell neatly through a gap in the system. He had dementia, but that didn’t count as a “mental illness” for the purposes of institutionalisation. He threatened his relatives’ lives, but he rarely actually attacked them, so the criminal justice system wasn’t inclined to take him seriously. “Someone’s going to have to get killed for them to do anything,” Lejon told me.

An ambulance pulled up, and the EMTs walked over to get a rundown from the cops. Then they went inside with two of the officers and came out with Craig on a gurney. Craig is in his seventies, and looks, if anything, older. He’s a small, stout Japanese-American man with sheet-white hair and an unkempt beard and moustache. His belligerence with the family stopped as soon as the first responders arrived. Suddenly he was compliant and reasonable.

This, according to Lejon, was a tactic of his stepfather’s. “He’s a very intelligent man,” Lejon said. His antics cease the moment he’s interacting with the authorities. Craig was deemed stable and released back to the family that evening, at which point the chaos flared right back up again.

It’s a pattern Officer Lande has seen time and again. “People have crises, they go to the hospital, they get stabilised,” he said. “They agree to a treatment plan. Then there’s no follow-up.” He continued: “Having a system of coercive mental healthcare that’s limited to emergency psychiatric crises that’s wedded strictly to voluntary participation — you’re condemning people to not getting the level of care they need. You’re condemning them to never get better.”

Craig is drug-addicted and psychologically debilitated, but he at least has a house to sleep in and a family to keep tabs on him. Hundreds of thousands of Americans suffering mental illness and substance addiction lack even that basic structure to their lives. In recent months, we’ve seen what happens when the most violent among them are left to their demons: America’s cities have been struck by a series of grisly, unprovoked murders of women committed by homeless men.

The deceased in these homicides were not the only victims. The acutely mentally ill and drug-addicted are prisoners of their sicknesses, and despite all the money we’ve thrown at homelessness, our policies have amounted to a wholesale abandonment of these broken people to their grim fates.

In San Francisco, that chronic failure has become the city’s official policy. An entire downtown neighbourhood, right in the heart of the city, has been effectively ceded to drug dealers, addicts and the mentally ill, all in the name of compassion. Users in the Tenderloin smoke fentanyl and shoot heroin on the sidewalks in broad daylight. When it rains, the train station there becomes a huge underground shooting gallery.

Following the spectacular failure of the War on Drugs, the prevailing ideology in the addiction treatment world became “harm reduction”. Harm reduction aims to respect the rights and dignity of drug addicts by destigmatising their drug use; to minimise the social harms that accompany drug addiction such as crime, incarceration and discrimination; to save lives by providing safeguards against overdoses; and to offer detoxification but not to require it as a condition for social services and subsidies. The motto of harm reduction is “meeting people where they’re at”, rather than compelling abstinence as a one-size-fits-all-solution.

But the approach has its critics, who view it as well-intentioned but ineffective. “There are aspects of harm reduction that I support, and there are aspects that blur the lines between harm reduction and enabling,” said Tom Wolf, a former addict in San Francisco. “The most important thing is to have a full continuum of care that focuses on recovery, not an indefinite maintenance of one’s addiction.”

“Out of thousands of people I saw maybe two get clean,” said Ginny Burton, a former addict in Seattle, describing her work as a case manager employing the harm reduction model. “What I’ve seen actually work, and experienced myself, is separation. Separate the person from the destructive environment. Maintain that separation long enough for the person to get clarity. Then implement services based on priority of need.”

This is how she got clean. “Thank God I was arrested,” she said. But in cities like Seattle and San Francisco, the enforcement policies that resulted in her arrest don’t exist anymore. “If I was loaded today, I wouldn’t be able to pull myself out,” she said. “I wouldn’t be arrested.”

Tom Ostly, who was a prosecutor under the former San Francisco District Attorney, agrees that the state’s coercive powers are what are needed to jolt drug-addicted people into making the commitment to go clean. He once prosecuted a man who had walked up to a random man on the street, punched him in the face and broke his nose. The whole assault was caught on video. With his priors, the defendant was facing 12-15 years in prison.

It turned out the man’s son had died, and the grief had turned the father into a drug addict. The day of the assault was the anniversary of his son’s death. He had been on a self-destructive spiral. Facing 15 years in prison, he agreed to go to intensive drug rehab instead, where he received counselling for PTSD. He’s now taking classes to be a drug counsellor and will soon graduate from college.

Those kinds of prosecutions just don’t happen anymore in San Francisco, where it’s considered more humane to allow people to continue killing themselves with drugs than to force them to stop. “The current administration lets everyone out and gives them no services,” said Ostly. “It’s bullshit.”

Jail is a lousy place to get clean, and drug use in and of itself should not be treated as a crime. Those lessons have come across loud and clear from the failed War on Drugs. But in rejecting the politics of mass incarceration, we’ve also thrown out the very idea of coercion. And without that, we’re empty-handed in the struggle against addiction and the rampant crime that it engenders.

Drug addiction itself is coercive. Giving an addict the “choice” to continue to use or to voluntarily get clean is as illusory as pushing someone off a roof and giving them the choice to either fall or fly. The current approach in cities such as San Francisco, Officer Lande said, “assumes people exercise full voluntary volition over their behaviour, and they don’t”. The decision to get clean has to be as non-optional as an addict’s “choice” to continue using. It has to be forced.

That doesn’t have to mean jail — in fact, it shouldn’t. Ginny was incarcerated repeatedly, but she finally got clean not through the criminal justice system but through her diversion to drug court and mandated rehabilitation. Nevertheless, coercion was an indispensable element in that successful intervention. The certainty of consequences is what finally broke through the fog of addiction.

“You don’t want to overly criminalise people,” said Officer Lande. “But you have to have some non-carceral way. Some judicial process beyond what the current system has.”

“Right now it’s very black or white,” he continued. “You’re either a psychotic or you’re not. You’re either a grave danger to others or you’re not. We don’t have anything in that grey area. We just have to wait until people are hitting rock bottom before we can do something.”

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