Defund the police for public health, say doctors and nurses

The myth that people’s safety depends on police must be debunked
Photo: By Clay Banks on Unsplash
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In a Toronto shelter, a resident was in crisis. The Mobile Crisis Intervention Team, which brings together a specialized nurse and police officer to attend to people experiencing mental health issues, was called in to take the person for psychiatric evaluation.

But “the police came instead,” says Dr. Suzanne Shoush, who was working at the shelter, “and the threat of police violence to me was more significant than the [mental health] threat, so significant that I cancelled the [call] and asked the police to leave.”

“As health care providers, we’re doing mental calculations wondering what’s going to be more dangerous for my patient — the scenario in which I call 911 or the scenario in which I don’t call 911. The scenario in which I call 911 resulting in a patient’s death is very serious, very real, it’s very traumatic.”

The communities most afflicted by COVID-19 are also those most affected by poverty and police surveillance and interventions.

Dr. Shoush is a family physician at St. Michael’s Hospital in Toronto. She is also a founding member of Doctors for Defunding the Police, a group pressing to redirect money from the Toronto Police Services to the creation of non-violent emergency services.

Born to a mother from the Douglas First Nation in B.C. and a father from Sudan, she has seen the effects of policing from inside the communities most severely impacted. She also has children of her own, with a partner from Haiti — the world’s first self-liberated slave colony, she points out. As an Indigenous and Black mother, a doctor, and an advocate, Dr. Shoush wants Canadians to fundamentally rethink how to build health and safety for all communities.

And she’s part of a movement of doctors, nurses, and other health professionals across the country calling to defund the police.

Dr. Suzanne Shoush

Black and Indigenous people have a hyper-awareness of the threat posed by policing. In Canada and the United States, police brutality proceeds with calamitous regularity, year after year, with much of the violence targeted at Black and Indigenous bodies. Protests of varying intensity ensue, with those suffering the most carrying the weight. But now, in the tense and unsettling year of COVID-19, something remarkable is happening. A rebellion has sprung forth.

The communities most afflicted by COVID-19 are also those most affected by poverty and police surveillance and interventions. It all flows from the same source. “Systemic racism” now drops from the tongues of those in Canada’s upper echelons of power, whether they acknowledge its reality or not. They’ve been forced to grapple with the concept thanks to thousands of demonstrators who have come out — many in protective face masks — to support calls for police defunding.

The country is having a moment — but whether it will flourish into a true reckoning with its past and present remains uncertain.

Keeping order

Hundreds of people have died in police encounters in Canada in the past couple of decades alone.

From 2000 to 2017, the proportion of Black people and Indigenous people who died during police interventions far exceeded their representation in the country’s population, as revealed by a CBC investigation that recorded 461 total victims. Looking at the 362 cases where the race/ethnicity of the victim is known, Black and Indigenous people are roughly three times more likely to die at the hands of police than their presence in the overall population would indicate. Further, more than 70 per cent of people who died had mental health or substance use disorders. Most victims were killed by police gunfire.

The overlap between Black and Indigenous populations, mental health challenges, and police-involved fatalities is no coincidence.

Experiences of chronic racism contribute to higher risks for substance use and misuse, stress, depression, anxiety, and even psychosis.

The size of the racialized population in a municipality plays a central role in decisions about the strength of its police force. Researchers have found that Canadian cities with higher numbers of racialized people deploy a greater number of police officers per capita — regardless of crime rates, the total municipal population, and budgetary considerations.

This suggests that the dominant society, fearing and mistrusting minority groups, uses the police to watch and discipline them. The historical continuity is striking: the RCMP originated as a paramilitary police force in the late 19th century to subdue Indigenous Peoples in the west, modelled on the British approach to controlling the Irish. Before that, the slavery of both Black and First Nations people persisted in Canada for two centuries starting in the 1600s, a little-known and oft-denied part of history — in fact, the country is only now getting an institute devoted to the study of slavery within its own borders.

Keisha Jefferies

“The prison industrial complex … is just almost an extension of the former enslavement era,” says Keisha Jefferies, a Black registered nurse whose practice in Nova Scotia led to her current research at Dalhousie University on the ways racism impacts the leadership opportunities and experiences of African Nova Scotian nurses. She is one of the authors of a letter from nurses calling for police and prison abolition.

“Society wasn’t built with Black people and Indigenous people in mind. It was built on the backs of these individuals and the lands were taken from Indigenous folks,” she says. Prisons and police are “used to control Black people, Indigenous people, and people of colour. That’s one of the main purposes, to reinforce this idea of control and surveillance and to keep order amongst this already extremely marginalized group of people.”

Dr. Shoush agrees. The country “was actually designed with the purpose of ignoring their humanity. So we didn’t build Canada around the needs of Indigenous people. We didn’t build Canada around the needs of Black people.”

Society creates circumstances where people are unwell through structural disenfranchisement, exclusion, and marginalization, she says.

“The health and wellness of people is a direct consequence of their political, social, and economic status.”

Decoupling police and mental health responses

“We know that most Indigenous or Black children are born into systems of exclusion that start as early as pre-K,” adds Dr. Shoush. “These systems of violence, these systems of anti-Black racism, anti-Indigenous racism, they start so young and carry through people’s lives.”

The consequences for mental health are severe. Experiences of chronic racism contribute to higher risks for substance use and misuse, stress, depression, anxiety, and even psychosis. Along with the heavy surveillance and policing of Black and Indigenous communities, this increases the likelihood of police encounters.

Dr. Tharuna Abbu, a family physician in Vancouver who launched a letter signed by doctors in support of defunding the city’s police department, works in the Downtown Eastside, an area with an intensive police presence. Their patients are “multiply oppressed” — mostly racialized people strained by issues like poverty and homelessness.

“Almost on a weekly basis I get some sort of personal account from someone or a report from the Emergency Department that has mention of a police encounter, often a negative or harmful one,” they say. Having moved to Canada as a young child from South Africa — their Tamil family goes back generations there — they see continuities with the apartheid regime, under which their parents attended medical school and witnessed police shoot rubber bullets, chase students with dogs, and take away their classmates.

Recently they received an automatically generated hospital report describing how one of their patients had been tasered by police after walking around and being reported for alleged aggressive behaviour. “It’s just very clear that people are harmed all the time by police.”

“The idea that this police force is the only thing that’s keeping us safe from catastrophe and violence and looting and anarchy and terror, that’s a critical myth to start to debunk.”

Police are not health professionals, nor are they well trained to deal with mental health crises. Some jurisdictions have established crisis response teams that pair mental health professionals with police, such as Toronto’s MCIT, Alberta’s Police and Crisis Teams, and Halifax’s Mental Health Mobile Crisis Team. But these teams usually don’t offer round-the-clock services and the police can ultimately take charge of the response.

In the wake of a recent series of wellness checks gone wrong — from bruising and bleeding to death after death after death — some have suggested expanding the police–mental health worker model.

But that’s not the solution, according to critics.

“Moving in that direction is still asserting this idea that police are a necessary part of our response to mental health and mental health crises, and I just don’t think that that’s true,” says Dr. Abbu. Numerous examples exist of people supporting each other “in the community without use of force or violence or that kind of coercion that the police embody.”

“Psychiatrists at CAMH don’t carry guns,” observes Dr. Shoush in reference to the country’s largest mental health hospital. But when she phones for police intervention in a mental health crisis, the main focus of the call is whether the person has weapons, knows how to make weapons, or has any military training — not what is required to de-escalate the situation and help resolve the crisis.

“As a physician you find yourself in a constant position of having to aggressively humanize a patient. You’re trying to basically pander to the police to make sure that they can see this person as a human being and not as just an object that should be hog-tied and brought down by force.”

Re-evaluating safety

For people like Doug Ford, Ontario’s wealthy white premier whose father left him a multimillion-dollar company, defunding the police doesn’t make sense. Police budgets should only ever be increased, he said last month.

“People genuinely think the police keep them safe because they’ve never reflected on their privilege,” says Dr. Shoush, suggesting that if the police were abolished tomorrow, individuals like Ford would likely be fine because “they are well-resourced people who have been well resourced since birth.”

“When it comes to people of privilege and power, the police actually play probably a very small role in their safety.”

Television and movies boost misconceptions about policing. A report released at the beginning of this year, Normalizing Injustice, details how scripted television shows about police essentially serve as a public relations machine, misinforming people about crime, racial inequities, and the criminal justice system.

The development of unarmed response services should be a top priority.

“People are so scared of defunding because they’ve been tricked by media and very powerful police unions and culture that without police they will not be safe,” says Dr. Shoush. “The idea that this police force is the only thing that’s keeping us safe from catastrophe and violence and looting and anarchy and terror, that’s a critical myth to start to debunk. It’s a very powerful narrative and it’s a very false narrative.”

Jefferies says it makes sense that some people struggle with the idea of defunding police forces, given they haven’t felt the crush of policing.

“I’m Canadian so I understand Canadian values and the way we understand policing and prisons, but also being born and raised in an African Nova Scotian community I feel as though I’m able to see both [sides],” says Jefferies. “Growing up in the Black community you see the results of policing, you approach health and your understanding of health care and abolition from a very different vantage point compared to someone who hasn’t grown up with police in their community, coming into their homes, attacking their family, or arresting their family.”

The challenge is to re-evaluate what conditions contribute to safety — and understand that for many people, policing brings demonstrable harm.

Doctors and nurses interviewed for this article described police violence resulting in death, abuse, tasering, broken bones, and blindness. They also drew attention to psychological violence, from the intimidation and discomfort that people feel as police patrol their communities to the stress and trauma created by a police encounter.

Beyond mental and physical wellness is also family and community health, notes Jefferies. If a parent is arrested or killed by police, children can be placed into the foster home system, which starts its own cycle of harm.

“The list goes on,” she says. “There’s just a lot of ripple effects from this.”

Changing our investment portfolio

Police budgets have risen dramatically in the last two decades, in dollars and in the proportion of municipal spending they absorb. Commonly the largest line item in city budgets, they outstrip the amounts allocated to public goods such as libraries, social housing, and mass transit.

Under pressure from police-defunding advocates and protestors fighting to save lives, Canadian cities are facing intensified scrutiny of their police budgets. In light of shortfalls due to COVID-19, Vancouver, which spends about a fifth of its budget on policing, decided to cut police spending by 1 per cent, but, confusingly, the police board was somehow allowed to reject this change last month. Policing in Toronto runs over a billion dollars, yet city council voted down a motion for a 10 per cent reduction. In Winnipeg, where policing eats up 27 per cent of the city budget, the police chief has said that if social services were funded sustainably, he would be open to some police defunding. Edmonton just approved shifting $11 million over two years to social service areas to be determined by a task force — but that amounts to less than 3 per cent of the city’s police budget.

Martha Paynter

“As somebody who trained as an economist before becoming a nurse, it’s very clear to me what we invest in, and how we get return on those investments, and how we make very poor decisions that are rooted in white supremacy and not in evidence,” says Martha Paynter, a white registered nurse in Halifax who also coordinated the abolitionist letter. Her work focuses on supporting women and transgender/nonbinary individuals in pregnancy or parenthood who have experienced criminalization.

As police budgets have blown up, social assistance rates have stagnated. Social assistance payments are so low, in fact, that recipients can’t even take care of basic needs. While the idea of significant police defunding has often been treated as an impossibility by authorities, they’ve had few qualms about “stopping the gravy train” and slashing allotments for public education, health care, and social supports.

“Change that portfolio,” advises Paynter in relation to state expenditures. “Whenever you are putting money towards almost anything that isn’t a violent police force, that’s abolition.”

In some situations, doctors are forced to involve police because they have no other options.

The development of unarmed response services should be a top priority. (In Dr. Shoush’s words: “Does this person passed out homeless on a bench deserve to be killed? If not, then why even show up with a gun? Does this person shoplifting deserve to be killed? If not, then don’t even show up with a gun.”) But police defunding also means ensuring people have access to basics, like food, housing, and health care. It means stabilizing funding and providing security to community programs and services that meet the needs of marginalized communities. It means changing laws and enforcement to help people avoid collisions with the police — for example, by decriminalizing sex work and drugs.

“Stop criminalizing behaviour and actions that have everything to do with poverty and health,” Paynter says.

Dr. Shoush also points to crimes of exclusion arising from anti-Black and anti-Indigenous racism. “We have to make sure that children feel belonging everywhere. That’s from the doctor’s office to the classroom to the library to the park.”

Decarceration is another beneficial investment, according to Paynter. An infectious disease like COVID-19 spreads easily among prison inmates and staff, then outside into the community. In Nova Scotia, 33 women were moved from a provincial jail due to COVID-19 and provided with wraparound support to live in the community. Months later, they are healthy, with no recriminalization, and cost savings compared to imprisonment have been demonstrated.

Given the range of societal needs, advocates say inflated police budgets are shameful.

Governments are “making the choice to allocate a limited resource to something they do not understand, that is not evidence based, that is not solutions based, and we know that community resources are a far superior intervention when it comes to safety of the community,” says Dr. Shoush.

“It’s power that provides safety in a community,” she says. “There can’t be safety in a community that doesn’t have a political voice and influence.”

Re-envisioning, not reproducing

Like other systems, health care has a racist history that runs through the present, and medical staff routinely collude with police and other surveillance systems.

In some situations, doctors are forced to involve police because they have no other options, such as when calling for a wellness check or an involuntary psychiatric assessment. The arrival of police, armed and ready to fight, often makes the situation worse.

Other times, health care workers participate with prejudice, overreporting Black and Indigenous patients to police and social workers. Dr. Shoush describes “highly offensive” instances where health care workers have called child protection because a Black parent has smoked marijuana, but paid no mind to white parents who drink wine. “That Blackness puts them at high risk of adverse interventions,” she says.

Health care workers need to become self-critical, according to Paynter. “We do harm when we perpetuate racism, when we do not intervene in racism and that intersection of racism and policing,” she says.

Long held in high regard, nurses and doctors have been hailed as heroes since the explosion of COVID-19. Given the respect their professions command, they have the space to speak, act, and lift up the voices of marginalized communities demanding changes. But in a simpler sense, insisting on police defunding is just a logical part of their jobs.

“As a nurse it only makes sense to examine this issue and to look for ways to better service communities that don’t involve brutalizing them,” says Jefferies. “Abolition is health care.”

“What keeps them safe is actually the fact that they are well-resourced people who have been well resourced since birth.”

Along with doctors and nurses, an array of health care providers — including dietitians, massage therapists, midwives, and counsellors — have supported calls to defund the police. “All health care providers are deeply impacted by the current structure of policing,” says Dr. Shoush, and it’s profound to see them re-envisioning policing, safety, and the intersection of health care and police services.

The public appears to be moving too: a recent poll of Canadians showed 75 per cent believe the RCMP is plagued by systemic racism. The question now is what will be done about it. Simply transferring money and power from police forces to health care or social work, as some have recommended, won’t do. It’s imperative to “avoid reproducing systems of surveillance and policing just under another name,” says Dr. Abbu.

Instead, the needs of communities must be addressed.

“Actually let people be well by having the resources they need to govern their bodies with pride and with self-sufficiency, with power and with joy,” says Paynter.

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