July 25, 2022
Dear Mayor Adams, Governor Hochul, Commissioner Jenkins,
As health workers we are dismayed by the mayor targeting New Yorkers experiencing homelessness through ongoing sweeps of street encampments, and are fervently opposed to the recently announced plan1 for increased police presence in the New York subway system and the renewal of sweeps of street encampments. Under the guise of safety and public health, these plans build on a pattern of criminalizing poverty without addressing the root causes of homelessness, and put the city’s most marginalized at increased risk. Coercion under police threat only temporarily moves people from one place to another. People experiencing homelessness will only permanently leave the subway system or street encampments when they are offered safe, accessible, and supportive housing.
We first resist the association between people experiencing homlessness and crime, as data has shown that people who are chronically unhoused are more likely to be victims of violent crime than perpetrators.2 That said, whether or not someone has had their behavior criminalized should have no bearing on their right to safe shelter. Increased enforcement of subway ‘rules of conduct’ and ‘end of the line’ policies are likely to lead to more police engagement with people experiencing homelessness, which has been shown both by advocates and in the literature to often have unintended harmful effects such as assaults on those experiencing homelessness and decreased trust of police and paramedics.3
Most importantly, forced removal of people from subways - which are often the only sources of acceptable shelter to people who are currently unhoused - does nothing to address the reasons why people are unhoused in the first place, such as the ever increasing cost of housing, fragmented and under-resourced mental health and social services, and inadequate pathways into a limited supply of housing. It furthermore places people at increased risk of poor health outcomes through environmental exposures, increasing risk of respiratory illness, infection, malnutrition, and complicated wounds.4
We further resist the use of encampment sweeps as an effective means for engaging unhoused persons on the street. Such sweeps have been going on for years through multiple mayoral administrations,4a and their continuation as the COVID19 pandemic sees another rise in infection rates stands in stark contrast to CDC recommendations.4b Encampment destruction–particularly when encampment residents themselves are not present–can lead to poor health outcomes. Vital medications and original health documents are often thrown away increasing the risk of acute health crises and burdening the healthcare system. Public health has been cited by the mayor and his deputies as a rationale for these sweeps.4c So we ask: public health for whom, and at the expense of whose personal health?
Among individuals experiencing homelessness, encampment sweeps are often considered no more than theater because many people return to these locations soon after city agencies move on. This is underlined by the fact that from March 18 to May 1st in the initial round of street sweeps, the city carried out 733 encampment sweeps across all five boroughs; however only 39 of the 264 people contacted accessed temporary housing5.
The result is a dehumanizing game of cat and mouse between city authorities and the most vulnerable members of our community. The fact is people who are forced out of one public space without being offered safe, affordable housing, end up in other public spaces. Finally, the end destination for individuals forcibly removed from public spaces are often emergency departments, where endless cycling not only impairs patient care and places an undue burden on a portion of the healthcare system not meant to be used as emergency shelter.
We call for clear data on getting people housed, not just sheltered temporarily, as a result of coercive actions like encampment sweeps and subway policing. We are interested in seeing these contrasted with the proven outcomes of these strategies. Case management and consistent outreach from social services teams do lead to positive outcomes and housing, but they have limited utility when there is no safe, affordable housing available for outreach workers and case managers to navigate people to. Put simply: there are not enough open safe haven beds and an inadequate supply of supportive housing; there are bottlenecks everywhere.6a,6b Troublingly, the mayor’s plan continues to rely heavily on police involvement in outreach, which is not conducive to building trusting relationships and perceived safety of people experiencing homelessness. The City has already implemented extensive outreach in the recent past under the prior administration, with the only outcomes being displacement of people experiencing homelessness, and limited accomplishments in terms of improving housing status. While the Mayor’s housing plan that was recently announced points to positive developments such as expedited pathways into housing and mechanisms to increase housing supply,7 specifics on how these interventions will be monitored and how success will be measured remain unclear.8
While more resources such as safe havens and stabilization beds are necessary, they should not be contingent on increased police presence and surveillance. While we are encouraged by the recent announcement of additional funding for safe haven bed9, it is uncertain if these services will be available in time to meet the thousands of individuals who currently need them, and whether there will be capacity to facilitate people accessing and using these services. The current Mayor needs to reverse the prior administration’s failures to follow through on its safe haven commitments.10a The City has grossly underperformed in implementing vouchers10b and the prior administration opposed State HONDA legislation (converting hotels and office spaces to housing)10c and instead moved people from hotels back to congregate shelters that people experiencing homelessness find to be unsafe and punitive in their rules. Rather than reinforcing outdated practices that center on policing and punishment, the mayor’s plan should be focusing its efforts on adequately funding and implementing more robust mental health and supportive services as soon as possible, and allowing for effective pathways into safe, affordable housing, which is the only true way to end homelessness. Instead of policing, the mayor should focus on his commitment to implementing HONDA and other mechanisms for permanent, supportive housing.10d
We support the voices of organizers and people directly impacted by homelessness in calling for:
In addition to expansion of safe havens and drop-in centers, dedicated expansion of case management within the city’s existing shelter system to facilitate pathways into housing
Alternatives to congregate shelters to allow for safe isolation and quarantine in the setting of COVID-19 risk and exposure
Transparent reporting on the impact of these new efforts, including shelter capacity, arrest rates, linkage to case work, and ED visits
Full passage of the Housing Access Voucher Program and Good Cause Eviction by the state legislature to help those at risk of eviction stay in their homes, and to create a path back to housing
City and State working closely together to expedite implementation of HONDA legislation
Adequately funding services integral to supportive housing so that operators can expand the number of available units
Increased funding, staffing, and tailored length of stay and services for inpatient psychiatric facilities to better serve people experiencing homelessness11
Increased policing and outreach without a dedicated expansion of resources is not only a retread of familiar, unsuccessful practices but will also put increasing numbers of the City’s vulnerable at risk. A true solution to homelessness requires dedicated expansion of services for supportive housing and legislation action to both keep people housed and create pathways into safe, affordable housing. We join with our partners across the city this Homeless Rights Month to urge both the city and state administrations to take such action if they are truly committed to the mission of ending homelessness.
Signed,
Advancing Health Equity LLC
Callen-Lorde Community Health Center
Columbia University White Coats for Black Lives
Committee of Interns and Residents
Health Justice
Housing Works
Keith D. Cylar Community Health Center
Manhattan Central Medical Society
New York Doctors Coalition
Progressive Doctors
Abhishek Mogili, MD Candidate
Adrianna Meiering, MPH
Alana Engelbrecht, BS
Alejandro Hermida
Alexander Erickson, LMSW
Alexander Jordan, MD
Alice Beckman MD
Amelia Kidd, LCSW
Andrew Goldstein, MD, MPH
Angela Connors
Anna Guirguis, LMSW, MA
Arvind V Murali
Benjamin Asriel MD MGA
Benjamin Eckhardt
Betty Kolod, MD, MPH
Bhavana Patil, MD Candidate
Brian Hennessey, MPH
Bruce G. Trigg, MD
Caitlin Krenn, LCSW
Cameron Clarke, MSc/MPP
Cara Coren, MD MPH
Carol Kessler
Catherine Stratis, MD Candidate
Chidi Adeyemi, Patient Navigator
Chinmayi Venkatram, MD Candidate
Chris Ann Paternostro
Christopher Vo, MD
Danielle Spina, Managing Director of Justice Initiatives
Dara Walker, LCSW
David C Perlman, MD
David Himmelstein, MD
Deborah Herdan, RN
Deena Smith, LCSW
Glen McWilliams, MD
MaryLouise Patterson, MD
Edward Alcantara
Ellen Tattelman MD
Eric Whitney, MD
Ezequiel Ramos, MD Candidate
Farah Riazi, MPH Candidate and Hepatitis C Outreach Coordinator
Frances Whiting, LMSW
Galit Benoni, MD
Hannah Brooks, MSc, MD
Helen Ding, MD Candidate
Helen Dotterer, Outreach Specialist
L. Guichard, Eviction Prevention Program Supervisor
Janet Coleman-Belin, MD Candidate
Jennifer Johnson Avril, MA
Jennifer Sugijanto, MD Candidate
Jess Ho, MD Candidate
Joe de Jonge, MD Candidate
Jon Fricchione, MD
Julie M Byrnes, MD Candidate
Kai Russo
Katherine Cocca-Bates, NP
Kimberleigh Joy Smith, MPA
Lee Isaacsohn MD
Lipi Roy, MD, MPH, FASAM
Luis Camacho, Peer Navigator
Mara Lyn Leverett, MPH, RN
Marc Shi MD
Maria Ramos, Patient Navigator
Mariam Kwofie
Mariya Masyukova, MD, MS
Megan Dougherty, LCSW
Miao Jenny Hua, MD, PhD
Michael Zingman MD MPH
Miriam Fisher
Nasir Malim DO, MPH
Natalie Berger, MD Candidate
Natan Vega Potler, MD
Nathaniel Harvey, MPH
Oladimeji Oki, MD
Olivia Moscicki, MD Candidate
Oni Blackstock, MD, MHS
Oswald Perez
Paige Cloonan, MD Candidate
Rev Carol Kessler MD, MDiv
Rohan Viswanathan, MD
Samara Khan, MPH
Sandhya Kumar, MD MPH
Seth Congdon MD
Sherry L Baron, MD
Stephanie Tutak MD
Steven B. Auerbach, MD, MPH
Sunitha Malieckal, MBA
Susan Bonadonna, MD
Tamara Hofer, MPH
Terence Hughes, MD Candidate
Uche Blackstock, MD
Van Wells, MA, LCSW
William Jordan, MD, MPH
Yasmin Clark
Zainab Mabizari MD
Zoey Thill, MD, MPP, MPH
References
1. “The Subway Safety Plan.” https://www1.nyc.gov/assets/home/downloads/pdf/press-releases/2022/the-subway-safety-plan.pdf
2. Tong MS, Kaplan LM, Guzman D, Ponath C, Kushel MB. Persistent Homelessness and Violent Victimization Among Older Adults in the HOPE HOME Study. J Interpers Violence. 2021;36(17-18):8519-8537. doi:10.1177/0886260519850532 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8715865/
3. Zakrison TL, Hamel PA, Hwang SW. Homeless people's trust and interactions with police and paramedics. J Urban Health. 2004;81(4):596-605. doi:10.1093/jurban/jth143. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3455926/
4. National Healthcare for the Homeless Council. “Homelessness & Health: What’s the connection?”. February 2019. https://nhchc.org/wp-content/uploads/2019/08/homelessness-and-health.pdf
4a. https://twitter.com/SafetyNetUJC/status/1509236867392282634
4b. “Interim Guidance on People Experiencing Unsheltered Homelessness”. Center for Disease Control. Updated February 2022. https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/unsheltered-homelessness.html#facility-encampments
4c. “Transcript: Mayor Eric Adams Makes a Social Services Related Announcement”. https://www1.nyc.gov/office-of-the-mayor/news/169-22/transcript-mayor-eric-adams-makes-social-services-related-announcement
5. Bowman, Emma. “NYC homeless advocates say Mayor Eric Adams' street sweeps aren't working”. 13 May 2022. https://www.npr.org/2022/05/13/1097528966/nyc-eric-adams-homeless-sweeps
6a. Brand, David. “The City is Pushing Homeless New Yorkers Off the Streets and Subways. Where Will They Go?” City Limits. 30 March 2022. https://citylimits.org/2022/03/30/the-city-is-pushing-homeless-new-yorkers-off-the-streets-and-subways-where-will-they-go/
6b. Mascuch, Laura. “Opinion: A Focus on ‘Efficiency’ Will Keep Thousands of New Yorkers Needlessly Homeless.” City Limits. 4 February 2022. https://citylimits.org/2022/02/04/opinion-a-focus-on-efficiency-will-keep-thousands-of-new-yorkers-needlessly-homeless/
7. Office of the Mayor. “Housing our Neighbors: A blueprint for housing and homelessness”. June 2022. https://www1.nyc.gov/assets/home/downloads/pdf/office-of-the-mayor/2022/Housing-Blueprint.pdf
8. Brand, David. “ 7 July 2022. “Mayor’s Housing Plan Still ‘Thin on Details,’ Councilmembers Say”.
https://citylimits.org/2022/07/07/mayors-housing-plan-still-thin-on-details-councilmembers-say/
9. Office of the Mayor. "Mayor Adams Announces Unprecedented Investments in Safe Haven Beds and Resources for New Yorkers Experiencing Unsheltered Homelessness". 24 April 2022. https://www1.nyc.gov/office-of-the-mayor/news/244-22/mayor-adams-unprecedented-investments-safe-haven-beds-resources-new-yorkers#/0
10a. Murphy, Tim. “Is This New York City’s Moment to Convert Failing Hotels Into Services-Rich Housing for Homeless Folks?” The Body. 19 Aug 2021. https://www.thebody.com/article/new-york-city-convert-failing-hotels-services-rich-housing-homeless
10b. Brand, David. “NYC Slow to Issue Thousands of ‘Once-in-a-Lifetime’ Rent Vouchers for Homeless Residents.” City Limits. 22 March 2022. https://citylimits.org/2022/03/22/nyc-slow-to-issue-thousands-of-once-in-a-lifetime-rent-vouchers-for-homeless-residents%ef%bf%bc/
10c. Brenzel, Kathryn. “Mayor calls Cuomo’s office-to-resi plan “giveaway” to real estate.” The Real Deal. 11 February 2021. https://therealdeal.com/2021/02/11/mayor-calls-cuomos-office-to-resi-plan-giveaway-to-real-estate/
10d. Abraham, Roshan. “NYC Needs More Supportive Housing. Eric Adams Wants to Build It. Can He?” Next City. 18 November 2021. https://nextcity.org/urbanist-news/nyc-needs-more-supportive-housing-eric-adams-wants-to-build-it-can-he
11. BronxWorks, Center for Urban Community Services (CUCS). Improving Care Coordination for Homeless Individuals with Severe Mental Illness in NYC. February 2022. https://bronxworks.org/2022/02/10/improving-care-coordination-for-homeless-individuals-with-severe-mental-illness-in-nyc/