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Editorial & Opinion

Police violence as a public health crisis in RI: A call to healthcare professionals

It is beyond time for healthcare providers in Rhode Island to loudly join community members in speaking out against police violence and advocating for the defunding of statewide police departments to invest in much needed community resources and safer alternatives to policing.


Introduction

The persistent murdering of Black Americans tragically highlights that police violence and systemic racism are national public health emergencies. A key group of stakeholders has largely remained silent during recent statewide conversations around divesting from police forces and investing in community resources: healthcare providers. Policing and the carceral system in the state are actively harming our patients. Transformation must occur not only at the medical school and within our hospital systems; it must also permeate throughout the state of Rhode Island (RI). As future physicians, we realize that change is necessary, and the medical community has a significant role to play in calling for anti-racist practices. Inaction directly supports these harmful structures, and as a medical community, we are long overdue in speaking out and standing up for the safety and wellbeing of our patients.

As medical students at Alpert Medical School of Brown University, we compiled a report outlining the evidence behind police violence as a public health crisis in RI. In this commentary, we summarize key findings from the report.

Police Violence as a Public Health & Medical Crisis

Police violence has adverse impacts on health and development. Police brutality frequently results in severe physical injury and ongoing psychological trauma, not dissimilar to other forms of psychological or physical assault. Particularly among Black individuals, experiencing police violence is associated with higher rates of both chronic mental and physical health conditions. Given the ubiquitous police presence in predominantly Black communities, multiple encounters with the police compound to produce significant toxic stress, resulting in increased risk for chronic disease and shortened life expectancy.


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The link between mental health and the risk of police violence is evidenced by the fact that police violence also disproportionately affects individuals with diagnosed mental illness. At least 25% of fatal police encounters involve an individual with severe mental illness, and up to 50% of fatal police encounters may involve individuals with some form of mental illness. People with untreated mental illness are therefore exceptionally at risk for police-mediated violence, with a 16 times greater risk of fatality after being stopped by police than the general public. Psychiatric crises are inherently stressful and frightening experiences, yet roughly one-third of individuals who present to the emergency room in acute psychiatric distress are brought in by police.6 

The data highlight that many of the situations that police officers respond to would be better addressed by emergency behavioral health interventions. Given that such a large proportion of people stopped by police officers and involved in fatal encounters experience mental illness and are thus penalized, assaulted, or even killed due to their medical condition, it is imperative that physicians push for investment in crisis responders with specialized mental health training who are better equipped to address psychiatric emergencies.

Policing in Rhode Island

In healthcare, we have a long history to address in order to ensure that racism does not impact the quality of care that a patient receives. And yet, our Black patients are 9 times more likely to be killed by police than the general RI population, the second highest racial disparity in police killings in the nation. Furthermore, Black individuals are more likely to be arrested for nonviolent crimes. These racial disparities in enforcement extend beyond arrests, as racial disparities in traffic stops point to inappropriate policing as well. In 2016, 11.4% of motorists stopped by police were observed to be Black, despite being 6% of the RI population. Furthermore, officers are often unsuccessful in finding contraband during motorist searches involving minority drivers, implying excessive erroneous stops for racial minorities. This is not a mere inconvenience; people of color are more likely to be employed as essential workers at hospitals or grocery stores, where flexibility in working from home is not an option. Being stopped unnecessarily creates stress that may negatively affect employment, and as we have seen in the cases of Sandra Bland, Philando Castile, and Rayshard Brooks, among others, could even lead to death. 

In schools, policing is also detrimental to children. The presence of armed school resource officers (SRO) has led to instances of excessive force used against Black youth. Exposure to SROs correlates with adverse impacts on educational experiences, social growth, and overall brain development. Yet, in many RI schools, youth are more likely to interface with police than mental health counselors. In 2018, $2 million in funds matching was allocated by the state for SROs; two years later, a similar matching program for school mental health professionals offered just $1.5 million. 

Despite mounting evidence of law enforcement failings and countless acts of life-altering injustice, police unions have historically been resistant to addressing police misconduct. The state has only pushed for incremental reform, yet, there is little-to-no evidence that lauded police reform strategies – use of tasers, body cameras, community-oriented policing, implicit bias training – actually reduce police violence. The Minneapolis Police Department was touted as a model of progressive police reform, incorporating training on mental health crisis intervention and de-escalation techniques, in addition to the aforementioned strategies. And yet, George Floyd was unjustly profiled and murdered by officers. 

Instead of allocating additional funds to failed reform efforts as police unions are proposing, the American Public Health Association (APHA) outlines clear rationale for divesting from police departments entirely and reinvesting those funds in community-driven safety initiatives and social resources. These evidence-based practices work to reduce violence and increase access to crucial services. The Providence 2021 budget directly goes against this advice: the proposed $88 million police budget is significantly higher than all funds allocated for Economic Opportunity, Recreation, Health Services, Planning & Urban Development, and Human Services combined. To highlight the disproportionate spending on policing at the detriment of healthcare access, the Providence police budget is more than triple the charity care ($28 million) provided by Lifespan, one of the largest healthcare providers in the state. We are spending substantially more money on incarcerating and policing our patients than we are on providing them healthcare. 

National Alternatives to Policing

Government officials across the country are taking action against police violence. For example, Seattle, Portland, Boston, Minneapolis, and Los Angeles are implementing approaches that are in accordance with APHA’s recommendations: decriminalizing sex work and drug use, defunding police departments to invest in community-led safety initiatives, and removing police presence from schools. Cities across the country have also implemented community-led safety initiatives as alternatives to policing, many involving healthcare workers. For example, in Eugene, Oregon, the Crisis Assistance Helping Out on the Streets (CAHOOTS) program, which consists of medics and crisis workers specially trained to provide support for common 911 calls including behavioral health and psychiatric crises, successfully responds to 20% of 911 calls at just 3% of the city’s police department operating cost. 

There is no reason that similar efforts, specifically led and designed by and for directly-impacted community members, would not work in our state. 

Conclusion

Police violence and underlying systemic racism undoubtedly affect the health and wellbeing of our patients. While many medical professionals may believe that we do not have a role to play in this movement, the current state of law enforcement throughout the state produces explicit risk to patient health. As future physicians, it is imperative that we no longer turn a blind eye to the adverse health impacts of police violence. It is beyond time for healthcare providers in RI to loudly join community members in speaking out against police violence and advocating for the defunding of statewide police departments to invest in much needed community resources and safer alternatives to policing.

References

  1. Code Switch. A Decade of Watching Black People Die. National Public Radio. Published May 2020. https://www.npr.org/2020/05/29/865261916/a-decade-of-watching-black-people-die
  2. Against Racism in Medicine, Code Black Rhode Island, White Coats for Black Lives at Alpert Medical School. Police Violence as a Public Health Crisis: Supporting Calls to Defund the Rhode Island Police. Code Black Rhode Island website. Published July 2020. https://www.codeblackri.com.
  3. APHA Policy Statement 201811: Addressing Law Enforcement Violence as a Public Health Issue. American Public Health Association website. Published November 13, 2018. Updated  January 29, 2019. Accessed June 7, 2020. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/29/law-enforcement-violence
  4. Bor J, Venkataramani AS, Williams DR, Tsai AC. Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. The Lancet. 2018;392(10144):302-310. doi:10.1016/S0140-6736(18)31130-9
  5. Toxic Stress. Center on the Developing Child website. Accessed June 9, 2020. https://developingchild.harvard.edu/science/key-concepts/toxic-stress/
  6. Overlooked in the Undercounted. Treatment Advocacy Center website. Published December 2015. Accessed June 16, 2020.
  7. Police Violence Map. Mapping Police Violence website. Updated June 30, 2020. Accessed June 9, 2020. https://mappingpoliceviolence.org/
  8. Rhode Island Arrest Data Shows Larger Racial Disparity Than In Ferguson, Missouri. Rhode Island ACLU website. Published November 19, 2014. Accessed June 9, 2020. http://riaclu.org/news/post/rhode-island-arrest-data-shows-larger-racial-disparity-than-in-ferguson-mis
  9. Traffic Stop Data Analysis and Findings, 2016. Rhode Island DOT website. Published March, 2018. Accessed June 9, 2020.
  10. Gelb-Bicknell, Corey. R.I. Department of Health data shows people of color are overrepresented in positive test cases for COVID-19. Brown Daily Herald. Published May 2020. https://www.browndailyherald.com/2020/05/01/r-department-health-data-shows-people-color-overrepresented-positive-test-cases-covid-19/
  11. ACLU says it is representing girl, 13, arrested by Pawtucket school resource officer. Published January 20, 2020. Accessed June 9, 2020. https://turnto10.com/news/local/aclu-says-its-representing-girl-13-arrested-by-pawtucket-school-resource-officer
  12. Governor proposes SRO funding include mental health professionals. WJAR10 website. Published January 22, 2020. Accessed June 9, 2020. https://turnto10.com/i-team/schools-in-crisis/governor-proposes-sro-funding-include-mental-health-professionals
  13. Fiscal Year 2021 Budget Proposal. State of Rhode Island website. Published January 16, 2020. Accessed June 10, 2020.
  14. No More Money for the Police. New York Times website. Published May 30, 2020. Accessed June 9, 2020. https://www.nytimes.com/2020/05/30/opinion/george-floyd-police-funding.html
  15. FY2021 Proposed Expense Budget. City of Providence website. Updated April 28, 2020. Accessed June 9, 2020. https://data.providenceri.gov/Finance/FY2021-Proposed-Expense-Budget/gw2q-3yqc
  16. Lifespan Facts & Statistics. Lifespan website. Accessed July 9, 2020. https://www.lifespan.org/about-lifespan/lifespan-facts-statistics
  17. Natapoff A. Misdemeanor Decriminalization. Vanderbilt Law Review. 2019;68(4):1055-1116. https://scholarship.law.vanderbilt.edu/vlr/vol68/iss4/2
  18. Minneapolis City Council announces intent to disband police department. KARE website. Published June 8, 2020. Accessed June 9, 2020.
  19. Portland superintendent says he’s ‘discontinuing’ presence of armed police officers in schools. Oregon Live website. Published June 5, 2020. Accessed June 9, 2020.
  20. Crisis Assistance Helping Out On The Streets. White Bird Clinic website. Published 2018. Accessed June 18, 2020. https://801975b9-a44a-41cd-9055-22057cdd1cb7.filesusr.com/ugd/154589_363bbe58f4a847fb8c74a456f49b3f5a.pdf

Acknowledgment 

We would like to acknowledge the support and contributions of members of Against Racism in Medicine (ARM), Code Black RI, and White Coats 4 Black Lives at Alpert Medical School (WC4BL@AMS) in drafting and informing this commentary. Additionally, we would like to acknowledge the important work of community organizations and individuals in Rhode Island working to alleviate disparities and advocate for equitable policies in our communities. 

Disclaimer 

The views expressed herein are those of the authors and do not necessarily reflect the views of Brown University or the Warren Alpert Medical School of Brown University.