Abstract

Excerpted From: Amanda Alexander and Toluloe Sonuyi, Reducing Community Violence & Incarceration: Insights from a Health-Justice Partnership in Detroit, 42 Yale Law and Policy Review 773 (Spring, 20240 (145 Footnotes) (Full Document)

In Detroit, community violence is the leading cause of death for young adults of all genders aged fifteen to thirty-four. Premature death and disability, in turn, often lead to the destabilization of families, economic disruption and poverty, a heightened chronic stress burden on communities, increased incarceration, widespread mental health issues, and more violence. Our community and others across the country desperately require solutions that center the needs of violence survivors and interrupt cycles of violence, reinjury, retaliation, incarceration, and premature death. As in other cities, gun violence in Detroit disproportionately affects Black and Latinx boys and men. While Black men and boys between the ages of fifteen to thirty-four make up two percent of the U.S. population, they comprised thirty-eight percent of shooting deaths nationwide in 2016.

Most cities have confronted the problem of community violence by deepening investments in punitive and carceral approaches, such as expanding police forces, surveillance infrastructure, jails, and prisons. In 2020, local and state governments spent $129 billion on police forces, $51 billion on court systems, and $86 billion on jails, prisons, probation, and parole. Yet these investments have not succeeded in stemming community violence, and often only exacerbate the problem and further destabilize communities. Here in Detroit, in late 2022, the National Institute of Justice gave a “no effects” rating to Detroit's Ceasefire and Project Green Light programs, two policing and surveillance strategies aimed at reducing youth gun violence, gang activity, and violent crime. The “no effects” rating means that “implementing the program is unlikely to result in the intended outcome(s) and may result in a negative outcome(s).” Recent public health studies point to the negative impact of policing, court involvement, and incarceration on the overall health, stability, and well-being of communities. As more and more members of the public call for a reallocation of police, court, and prison budgets, we must shift our resources toward community-led interventions that actually reduce violence and expand economic opportunities among some of the most vulnerable members of our community.

Over the past several years, various community-based and evidence-informed efforts designed to prevent community violence have come to be recognized collectively as necessary components of an effective Community Violence Intervention (CVI) ecosystem. Hospital-based violence intervention programs (HVIPs) are an important strategy within the CVI ecosystem as they leverage the trauma center as an access point for youth and young adults who have sustained acute physical injury from community violence. HVIPs have demonstrated the potential to “reduce exposure to repeat violent injury, help meet basic and mental health needs, improve psychosocial outcomes, and reduce exposure to the criminal justice system.” HVIPs also produce cost savings for the public sector and health care; every dollar invested in an HVIP returns between $10.07 and $15.11 worth of benefits through reduced reinjuries, hospitalizations, and convictions. In 2016, Detroit Life is Valuable Everyday (DLIVE) launched, establishing a violence intervention program at Detroit Medical Center's Sinai-Grace Hospital (SGH). SGH receives the greatest proportion of gunshot wounds and stabbings of any Michigan trauma center and, of the trauma centers in Detroit, is closest to the highest number of violent crimes. In 2018, DLIVE joined forces with the Detroit Justice Center (DJC) to form a health-justice partnership to provide holistic support to young people who have sustained acute injury from community violence, most often gun violence. So far, we have provided holistic support to 30 individuals through our health-justice partnership, furthering our shared goals of supporting participants in their healing processes, interrupting cycles of violence, preventing future incarceration, and actively facilitating pathways toward well-being and prosperity. In this article, we offer insights from the first five years of our partnership and point to promising areas for policy and practice interventions to improve health outcomes and reduce community violence and incarceration.

We partnered originally because we realized there were discrete elements of the carceral system (e.g., warrants, traffic tickets, court fines and fees, criminal records) that were adversely impacting the ability of violence survivors to meet their basic needs, meaning that the minefield of traffic stops and court involvement made it more difficult for them to heal and for communities to interrupt cyclical violence. When we met for the first time, we realized we were serving similarly situated people but in different moments of crisis in their lives--DLIVE was seeing them in the trauma center, while DJC's leadership was meeting them in courts, jails, and prisons. DLIVE has found that almost 60% of individuals they enroll have a history of being incarcerated at some point prior to DLIVE. Removing legal barriers for our participants has been transformational in their healing process, yet the health-justice partnership has expanded to encompass much more than civil and criminal legal services. By listening to our participants and doing everything in our power to support them, we have come to envision a wholly different means of addressing harms, fostering accountability, and achieving justice. The partnership has expanded to explore new supportive housing options for survivors of gun violence, non-law enforcement avenues for restorative and transformative justice, mechanisms for making crime victim compensation equitable and accessible for more people, and more. By sharing our learnings and challenges, we hope that our health-justice partnership can inspire efforts elsewhere to address violence with trauma-informed, abolitionist solutions and contribute to an overhaul of how we direct resources for public safety as a society.

Our partnership is an interdisciplinary team of lawyers, physicians, social workers, violence intervention specialists, paralegals, therapists, public health specialists, community legal advocates, community health workers, community navigation specialists, and people with other backgrounds and training. DLIVE and DJC are both Black-led organizations composed mostly of people of color who have experienced incarceration, the incarceration of a loved one, and the impacts of community violence firsthand. This proximity to the problems we are tackling is a large part of what fuels our commitment to addressing the root causes of violence and incarceration rather than just helping people churn through the trauma center, courtrooms, and jails. Our health-justice partnership is guided by public health and abolitionist principles that recognize that law enforcement and carceral systems are detrimental to healing, and that the most promising pathways for healing from violence, interrupting cyclical violence, and preventing future incarceration lie outside these structures. We are committed to working toward a world where policing and incarceration are obsolete, and where our services are no longer needed. As the DJC team puts it in their values, we seek a balance of “defense, offense, and dreaming” in our work. We must do what we can to alleviate present suffering and dismantle harmful systems, but it is not enough to focus on what we are fighting against; we must also focus on what we are fighting for. We are committed to dreaming of a better future and working to build it each day.

Across the country, intertwined health and violence prevention initiatives such as hospital-based violence intervention programs are becoming more common as communities search for solutions to gun violence, especially among young people. At the same time, health systems are seeking partnerships with legal providers to provide more holistic care to patients with significant civil legal needs (e.g., end-of-life planning, special education planning) through medical-legal partnerships (MLPs). Yet, on the issues where the civil and criminal systems overlap with healthcare, there has been surprisingly little work. MLPs tend to address civil legal needs, and health systems mostly have not sought partnerships to fill the criminal legal services gap for patients with potential criminal legal needs that act as barriers to health. Health-justice partnerships have an important role to play in reducing violence and incarceration, but to do so, they must address more basic criminal legal needs that typically go unmet, such as low-level traffic matters and warrants. These low-level matters can trap people in a vicious cycle of license suspensions, court debt, missed court dates, warrants for failure to appear, and jail time, which can lead to eviction, job loss, loss of educational opportunities, loss of custody, and other embedded consequences. Low-level traffic matters clog courts and jails and derail millions of lives across the country. The lack of accessible legal services for people suffering from low-level matters is a systemic problem: beyond individual patients and clients, at a macro level, policing and municipal courts have played a fundamental role in perpetuating segregation, wealth extraction, and poverty.

Prior to recent reforms, traffic offenses accounted for half of all Michigan criminal court cases in 2018 and driving without a valid license was the third most common reason that people went to jail in the state. In 2018, the state also suspended nearly 358,000 drivers' licenses for failure to appear or failure to pay court fines and fees. And yet, most people have no legal representation in these matters. Because of federal funding restrictions, legal service organizations funded by the Legal Service Corporation (LSC) cannot provide legal services in criminal cases, and public defender offices typically only handle more serious felony or misdemeanor cases. This means that someone with outstanding traffic-related warrants, a suspended driver's license, and hundreds or thousands of dollars in related court fines and fees, usually has nowhere to turn for assistance. In 2021, after a bipartisan task force was convened and various organizations led a statewide advocacy campaign (spearheaded by the Detroit Justice Center, Michigan Liberation, Safe & Just Michigan, Nation Outside, and others), Michigan enacted reforms aimed at reducing the state's jail population, including eliminating driver's license suspension as a penalty for unpaid court costs, tickets, or other issues unrelated to safe driving. The state took steps towards fixing the problem, but the reforms were not enough: thousands of people remain caught in the vicious cycle of tickets, fines and fees, and court debt without legal representation, even if their risk of jail time is lower today than it was before reforms were enacted.

The saga of inescapable criminal legal involvement doesn't just play out in the courts and on the streets. It is readily witnessed in the healthcare system, too. Nick Robinson, a participant of DLIVE and client of DJC through the health-justice partnership, woke up in the hospital after being shot to find that he was handcuffed to his hospital bed. “I was like locked, chained to my bed for the first two days,” he would later tell Michigan Radio. Like others in Detroit, he had many traffic tickets and there were warrants out for his arrest. He had five open misdemeanor cases, three of which were traffic offenses in warrant status. At the age of twenty-four, he had never obtained a driver's license. Mr. Robinson was building a music career and wanted to get a job at a factory to support himself while he worked on music, but his warrants kept him from gaining employment. With the assistance of DJC's Managing Policy Counsel, Erin Keith, Mr. Robinson was able to clear his warrants and get his license for the first time, which allowed him to find an apartment and a nine-to-five job at an auto supplier. He and his girlfriend welcomed their first child later that year. Clearing the warrants and getting a driver's license, along with peer support, mentorship, and holistic support from DLIVE, were essential to Mr. Robinson's ability to change the trajectory of his life.

At the heart of DLIVE and DJC's partnership is a recognition that individuals can avoid reinjury and, as a result, communities can reduce violence by taking a health-centered approach to target the drivers and structural causes of community violence. High levels of community violence are embedded within a broader context of structural violence; communities with perpetually poor indices of well-being do not occur naturally, but instead are the result of political choices that deny resources to some communities and subsidize the well-being of others. As in other major cities, Detroit's poorest residents face systemic barriers to economic opportunity, dwindling access to affordable housing, and crises related to criminalization and policing. For decades, the city experienced job cuts, home losses, increasing segregation, and rising incarceration; now Detroit--nearly eighty percent Black--is the poorest major city in the US. Detroiters are heavily impacted by incarceration: each year, twenty-five percent of people released from Michigan prisons return to Wayne County, or roughly two hundred people a month. Some Detroit school teachers and social workers estimate that half of their students have an incarcerated parent or parental figure. This accords with national data which shows that, among Black children of fathers without a high school diploma, fifty percent will experience parental incarceration by age fourteen. A growing literature makes clear what many families and communities have long known: criminalization and incarceration impoverish families, hinder economic development, and cement concentrated poverty. Recognizing that criminalization, court involvement, incarceration, and legal barriers directly contribute to the destabilization of individual and community health, DLIVE and DJC launched the health-justice partnership to advance the health and well-being of DLIVE participants. Before describing the partnership in more detail and discussing its policy implications, we will discuss the connection between community violence and the social factors contributing to health that is central to our work.

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My freedom dream is my kids going to school and wanting to ... go to college, preparing for it in high school. Like that's what they're doing-- wanting to. So when they want to, that's my freedom dream right there. - Chuck Anderson, Health-Justice Partnership participant

At the Detroit Justice Center, we talk a lot about freedom dreams. We ask ourselves about our wildest dreams for the work we are doing; we ask Detroiters about what a just, liberated city would look and feel like. Hearing our health-justice partnership participants dream about their futures and set goals for how to get there has been the very best part of this work. In March 2023, we aired an episode of the Freedom Dreams podcast where we spoke with Chuck Anderson, a participant who was working to put his life together after being shot and spending periods incarcerated. He read his DLIVE goal sheet--education was first on the list. He was working toward a GED so that he could move onto a paid four-year apprenticeship program to be a carpenter, electrician, and contractor. Then he wanted a house for himself and his family, including his two young children. Next, he wanted to build his own business. But beyond his goals, his freedom dream was for his kids to go to school and to want to go to college, preparing for it while they were in high school. He said he could picture his kids growing up and running an even better business than his. Mr. Anderson had come a very long way since waking up in the Emergency Department the year before. He said that it felt impossible to go back to the place he had been; he's “super dad” now. He especially credited the support of other DLIVE participants, explaining that it was hard to feel negative with so many positive people around. And it helped that he was getting a driver's license for the first time with support from his DJC attorney.

We long to live in communities where the legacies of historical and generational trauma have dissipated and where people can explore their dreams, passions, and pursuits unmitigated by their environment or where they grew up. At the end of the day, that is what the social determinants of health are about. Creating this world will require overhauling what systems are available to provide healing and accountability, revolutionizing how we address trauma, and attending to how we care for every member of our society. We get there by having the courage to break with the punitive logics of our existing systems and experimenting with other ways of holding each other through crisis and supporting each other's healing.

The past five years of the DJC-DLIVE health-justice partnership point to what is possible when we center the needs of people who have survived violence and work relentlessly alongside them, following their lead. They also point to an underlying need in our society to shift prevailing ideas about who crime victims are and what they need and care about. Too often, policy is made consistent with skewed societal perceptions of who tends to be the victims and perpetrators of crime--often in the name of imagined white, frequently female victims of crime. Instead, we must be guided by those who have experienced the brunt of community violence and structural violence and developed safety strategies in the face of it: Black people, Indigenous people, Latinx people, transgender and gender non- conforming people, and incarcerated and formerly incarcerated members of our communities.

With all the resources flowing into communities from federal and state governments for violence intervention and prevention--and with powerful calls from organizers, survivors, and activists to cut police and prison budgets--we have an opportunity to build and fortify community-led solutions that actually interrupt cycles of violence. To do so, public funding must be directed to community-led solutions through funding mechanisms that recognize violence as a public health issue, not a “law and order” one. Rather than doubling down on destructive policies, we can follow the lead of collective efforts that are ending cycles of community violence, reducing incarceration, supporting survivors' ability to heal and dream, and creating healthier and safer communities. We hope our collaboration can inspire efforts elsewhere to address the root causes of community violence with trauma-informed, abolitionist solutions and contribute to an overhaul of how we direct resources for public safety as a society.

Amanda Alexander is a Senior Research Scholar at University of Michigan Law School and the founder and former Executive Director of the Detroit Justice Center (DJC).

Tolulope Sonuyi is an Assistant Professor of Emergency Medicine at Wayne State University and a practicing Emergency Medicine Physician.