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Public health experts say Boston’s approach to Mass. and Cass is working. But push for more police involvement continues.

“People are demonstrably healthier and more engaged with treatment and are staying housed.”

In January, workers from the Newmarket Business Improvement District clean the streets at Newmarket Square in Boston. Craig F. Walker/Globe Staff

The number of people drawn to the streets in the area of Boston known as “Mass. and Cass” has once again swelled with the return of summer’s warm temperatures. 

The arrival of more individuals gathering on the city blocks surrounding the intersection of Massachusetts Avenue and Melnea Cass Boulevard is not new. The area — spanning across parts of the South End and Roxbury and dotted with services for those struggling with addiction, mental health issues, and homelessness — has been recognized for years by officials as the epicenter of the overlapping crises in the region. 

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Mayor Michelle Wu promised a public health approach to the humanitarian crisis when she took office last fall. Those working as service providers in the area, as well as some neighborhood residents, say so far she has delivered on that pledge. 

But there remains consensus on all sides that more must still be done as the number of people in the area increases and the need surges with the summer months. However, a divide remains over exactly what steps should be taken as elected officials, businesses, and residents of the surrounding neighborhoods continue to call out public safety concerns and point to how the crisis impacts their own communities. 

Some are pushing for greater utilization of law enforcement and one of the state’s involuntary commitment statutes, Section 35, in order to address ongoing public safety concerns. Others, including the city, say what is needed is more services in-line with the public health approach that is already underway. 

Data released last month by the state showed Massachusetts set a new record high for fatal overdoses in 2021; an estimated 2,290 people died from drug overdoses last year, an increase of about 9 percent from the year before. 

“Boston is currently experiencing its highest overdose incidents to date,” the Boston Public Health Commission (BPHC) said in a statement to Boston.com. “There is a very high demand for services at the moment. There is a need for accessible, low-threshold daytime services essential for reducing fatalities for those with substance use disorders.”

‘The public health approach that has been advocated is working’

Mayor Michelle Wu holds a May press conference to discuss the city’s response to the crisis at Massachusetts Avenue and Melnea Cass Boulevard. – Pat Greenhouse / Boston Globe, File

In recent years, the COVID-19 pandemic has exacerbated the overdose crisis and the conditions around Mass. and Cass. The number of tents and people living unhoused in the area surged into the hundreds in 2021, prompting an outcry from surrounding businesses and the neighborhood’s housed residents, who raised concerns about the open drug use, violence, vandalism of private property, trash, and human waste impacting their communities. Service providers called for more supports and low-threshold spaces to address the extreme need. 

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Officials working in law enforcement and public health pressed for ways to get people off the streets, and for a time last fall, a temporary court was opened in the Suffolk County Jail as part of an effort to get individuals with open warrants away from the area. The measure happened alongside the rollout of former Acting Mayor Kim Janey’s encampment protocols, which saw the quick removal of the sprawling encampments in the area. 

Both efforts faced significant pushback, and the special court session shuttered within a month

Facing pressure from advocates, Wu paused the removal of tents that began under Janey in the fall of 2021. But the breaking down of the encampments resumed in January after Wu set a deadline for individuals to be connected with appropriate services as part of a new “individualized” approach to the crisis. Utilizing newly opened low-threshold supportive housing sites, including at the Roundhouse Hotel and cottages on the grounds of the Shattuck Hospital, 83 people were initially moved out of encampments and into the temporary housing. 

According to BPHC, 320 people have used the low-threshold transitional housing sites since Jan. 12, the deadline for enforcing encampment protocols. 

“BPHC outreach teams continue to work with people in the area to connect them to housing and other resources to improve health outcomes, public safety, and cleanliness,” the commission said in a statement.

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Of that total number, 60 people moved into the low-barrier transitional housing set up at the Roundhouse Hotel that is being managed by Boston Medical Center with funding from the city, according to Dr. Miriam Komaromy, medical director of the hospital’s Grayken Center for Addiction. 

The move to offer the housing within the area of Mass. and Cass has faced community resistance, but Komaromy told Boston.com the experience has been “remarkable” for those involved. 

“The thesis of the Wu administration was that the way to address the encampments was not through arrests, not through forcing people to go into treatment that they weren’t ready to accept, but to instead provide housing that was actually acceptable and accessible to folks who were living in encampments,” she said. “And it has been highly successful.”

Not one of the 60 people who moved into the Roundhouse in early February when it opened has chosen to leave and go back on to the street, according to Komaromy. 

That fact, she said, disproves the “myth” that people who live on the street prefer living unhoused and won’t stay in housing. 

“We have a pretty compelling counterpoint to that,” Komaromy said. 

In addition, many people are engaging with treatment, including a substantial portion who say that they haven’t done so in the past, she said. 

The people staying at the Roundhouse tell Komaromy and the staff that the reason why they are more willing to engage with services is because they feel safe — they’re not worried about being assaulted overnight, they know they have a place to shower, to take care of themselves. They’re not hungry. 

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That makes them ready to think about treatment, so Komaromy said a “substantial” number of the individuals at the Roundhouse have been connected to treatments for opioid use disorder, like methadone or suboxone, as well as other behavioral health interventions. 

“The public health approach that has been advocated is working,” she said. “People are demonstrably healthier and more engaged with treatment and are staying housed. The transition path to move them into permanent supportive housing is slow, but that’s not because the residents don’t want that. It’s because of the limited availability of the housing. All of them are working with housing case managers — every one of them, at this point — to try to establish a pathway to permanent housing. So our BMC experience is very positive about the public health approach — its impact and its success.”

What is needed, both Komaromy and Deb Goldfarb, a clinical social worker at BMC and the director of behavioral health in Population Health at the hospital, agreed is more time and more resources that are patient-centered and low-barrier — from housing to jobs programs. 

Such measures allow people the opportunity to meet their basic needs with dignity and gain self-efficacy, and confidence, which aids in the stabilization of their substance use disorder or other behavioral health issues.

“One of the things, too, that has struck me throughout this whole thing is I’ve always thought of individuals living on Mass. and Cass as our neighbors, as residents of this community,” Goldfarb said. “And I think that’s been challenged by some individuals who have owned businesses or houses in this area for a long time. But the individuals living in Roundhouse feel very much like this is their neighborhood and community. And they care about the space, and they care about how they feel safe and safety in their community.”

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And for many, what doesn’t necessarily make them feel safe is the presence of police, Goldfarb said.

It’s a point that was also echoed by Cassie Hurd, executive director of the Material Aid and Advocacy Program, a nonprofit that provides support to individuals experiencing homelessness.

“We know police are not part of any public health solution,” she said. “And that people are not dangerous or unsafe; it’s the conditions that people are surviving that are dangerous and unsafe and causing harm. So it would make people more safe, and our community more safe and free up resources to meet people’s needs, to offer long-term housing that meets people’s self-identified needs.”

Komaromy said the situation around Mass. and Cass is the perfect example of how housing, ultimately, is health care, a point often argued by the late Dr. Paul Farmer, a pioneer of global health. Experiencing at the Roundhouse how individuals gaining access to housing are then able to become stable has been powerful, she said.

The challenge facing the city — and the region — is the major dearth of affordable and low-barrier housing. 

“If we could help people to stabilize socially, then the substance use and the violence and all the things that are distressing to the community, it becomes clear that in many ways those are sort of by products of people’s traumatic and really difficult lives,” Komaromy said. “And if you can help make their lives more stable socially, a lot of these problems start to get better. … And we’ve tried arresting our way out of this, we’ve tried the war on drugs. And it’s been — not just unsuccessful — it has occured during the period we’ve seen the biggest runup of overdose deaths in history. So it’s not a successful strategy.”

‘Make a statement to those who are coming in’

In June, Wu and city officials released a “Warm Weather Planoutlining her administration’s steps for continuing to address Mass. and Cass with the arrival of the summer temperatures and the expected increase in need. The plan has the stated goals of improving public safety, improving health and cleanliness in the area, reducing overcrowding, and preventing encampments from forming. 

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The measures to achieve those goals include the planned opening this summer of day centers in other parts of the city, as well as efforts by Boston police and BPHC to work together on outreach in the area. 

BPD’s Lt. Peter Messina, assigned to the outreach team, said at a May press conference about the plan that the department remains committed to disrupting violence in the area by increasing the law enforcement presence, the continued enforcement of “all drug laws and all laws involving human trafficking, the apprehension of individuals with outstanding warrants, and the prevention and enforcement of property crimes and violent crimes,” and working with prosecutors and the courts. 

“We are focusing on continued diversion for individuals suffering from substance use disorder, mental illness, and homelessness while working towards enforcement for the criminal actors preying on these individuals,” Messina said. 

At a recent community meeting, Boston police reported that arrests in the area are up 84 percent compared to the same period last year, Boston 25 News reports

There are residents and officials who want to see more involvement from law enforcement to address the concerns about public safety. A letter, signed by Congressman Stephen Lynch, state Sen. Nick Collins, state Rep. David Biele, and four Boston city councilors — Ed Flynn, Michael Flaherty, Erin Murphy, and Frank Baker — calls on state, transit, and Boston police to undertake a “city-wide warrant sweep” and make greater use of Section 35 to address the issues raised by “concerned residents about public safety in South Boston and across the city.” 

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Calling the conditions around Andrew Square — a mile east from the Mass. and Cass intersection — and along Southampton Street “dangerous, inhumane, and unacceptable” in the letter dated June 15, the elected leaders said the “public health and safety crisis requires urgent action to both help those who suffer from substance use disorder and preserve quality of life in our communities.”

“In addition to executing outstanding warrants, we ask that you use your authorities under Section 35 of Chapter 123 of the Massachusetts General Laws to intervene with those suffering from mental health and substance abuse with a likelihood of serious harm to themselves or others,” they wrote.  “It is for these reasons, we write to support and request a city-wide warrant sweep so that any and all outstanding warrants be executed prioritizing those individuals with a history of violence or human-, gun-, and drug-trafficking.”

Dave Procopio, a spokesman for state police, said Col. Christopher Mason had received the letter and “is discussing it” with the state’s public safety secretary, the Boston police commissioner, and the chief of transit police.

Sgt. Det. John Boyle, a spokesman for BPD, told Boston.com the department does not have plans for a “city-wide warrant sweep.”

“We on a daily basis are out enforcing services for the courts and arresting individuals with warrants as well as assisting other agencies in the apprehension of individuals that have Section 35s,” he said. 

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Asked about the letter, BPHC said in a statement that the commission and “City of Boston are focused on addressing the crisis in this area through equity-focused, public health policies that address the needs of the individuals experiencing homelessness, substance use disorders, and behavioral health issues.”

“BPHC is working collaboratively with BPD on this effort to ensure 24/7 coverage with multiple units in the Mass and Cass neighborhood,” the statement read.

Murphy, who is chair of the City Council’s committee on public health, homelessness, and recovery, told Boston.com the letter was prompted by a meeting with residents of South Boston. She said she drives through the area of Mass. and Cass on her way to work and it “still takes [her] breath away” to see how the crisis has evolved. 

She described seeing more than 200 people congregating in the area in late June, and said she frequently fields calls and emails from constituents raising concerns that crime is proliferating out from Mass. and Cass. 

“I am a believer that we have to approach those struggling in an empathetic, holistic way, but at the same time, if you drove through, it’s very clear that there are criminals and drug dealers and sex trafficking going on around those who are struggling,” Murphy said. “And the police know that. So I think the warrant sweep would be the way to make a statement to those who are coming in and preying on those down there.”

‘Everything should be on the table’

David Stone, president of the Blackstone Franklin Square Neighborhood Association in the South End, told Boston.com he supports the role police have in the city’s Warm Weather Plan and is in favor of greater law enforcement involvement, like the measures being called for in the letter from elected officials. 

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“Things have been allowed to get too far out of control in the past few years, which has been a major part of the problem,” he said. 

Another resident of the area, Marla Smith, who lives in Roxbury near Mass. Ave. and Clifford Park, told Boston.com that while she has appreciated seeing the Wu administration follow through on promises to address the encampments, she’s convinced that nothing in the area will fully change until the city addresses the “open air drug market.”

Even with police and the city doing a “reasonable” job in their work to handle the encampments, she said she continues to have safety concerns. She thinks the number of people in the area seems to be back to the levels of last fall, but that instead of using tents, she said people are creating temporary shelters out of structures — like patio umbrellas — to avoid the city’s encampment protocols. 

The situation makes it “complicated” for people who need to move around the area, she said.

“It doesn’t feel like a safe area, I wouldn’t walk through there by myself. … But people do still live here, people do still work here,” she said. 

It’s a point that Murphy stressed, emphasizing that businesses in the area are hurting — a concern that the business leaders and owners themselves have been raising since last year.

But advocates and those working in harm reduction say that addressing the underlying issues is key to addressing the public safety concerns.

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The narrative, Hurd said, that people are “unsafe” or “preying upon” each other is untrue. People are “experiencing and surviving a scarcity of resources and support,” she said.

“If people were to have solutions that they identified as necessary and supportive toward their goals, police would not be needed,” she said. “The city has not fully invested in public health. It has invested to a point. But instead of pivoting, those funds are being used for the substations for bicycle police, for so-called police outreach, instead of investing those in harm reduction services and voluntary treatment on demand and housing.”

Murphy said time will tell if the city’s approach using low-threshold housing will work. But the at-large councilor said she’s not sure the city “can afford to keep up with always giving permanent housing to people in this situation.” 

She said there needs to be another plan and everyone should be working toward solutions. In her view, that includes options like warrant sweeps, the use of Section 35, and proposals like the one from Suffolk County Sheriff Steve Tompkins to open a treatment facility on his South Bay correctional campus where people in the area of Mass. and Cass with open warrants could be directed by the courts for treatment.

Murphy noted that she understands, given her own family’s experience with the “recovery world,” that not everyone staying in the area of Mass. and Cass is ready for treatment.

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“I know there are people working and there are things happening,” she said. “But if you were for the first time or for the 20th time driving down that street, you would think nothing is happening. That’s what it looks like right now. We need to step in and do something. So I would say everything should be on the table.”

While Smith said she also thought “everything” should be considered in tackling the complex issues in the area, the Roxbury resident said she goes back and forth over whether she supports the use of warrant sweeps or Section 35.

She said she thinks individuals, who may have warrants for low-level or non-violent crimes, should be diverted for treatment. But she said she also knows that people do better in their recovery when they are able to choose treatment themselves, rather than when it is forced on them. 

“There’s been a lot of success in the area when people are treated like humans and treated with respect and you try to make them see that they’re worth it,” Smith said.

Smith knows that service providers have been seeing success at sites like the Roundhouse with people engaging with treatment. 

But the problem, she said, is that it’s not doing anything to “stem the number of people who are still coming to Boston” looking for services. 

“There’s just not enough to service everyone who’s here,” she said.

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Smith said her concern about public safety extends to those who have come to the area, as well as those who live and work in the neighborhood. But as it is, the residents and businesses who have been in the area for years, she said, don’t have a choice with what’s going on. 

They can’t just pick up and move, she said.

You deserve the same safe streets and safe roads that other people in other parts of the city enjoy,” she said. “Public safety is my primary concern, and it probably will always be my primary concern as a resident. I should be able to move around my neighborhood safely. Period.”

‘It can be fatal if you’re not receiving the right treatment and health care’

A man crosses the street across from the Roundhouse Hotel near the intersection of Massachusetts Avenue and Melnea Cass Boulevard in May. – Craig F. Walker / The Boston Globe, File

Those providing care to the people struggling at the center of the crisis continue to argue that the options on the table should not include threats of “sweeps” or use of Section 35. 

Both Komaromy and Goldfarb said involuntary commitment under that state statute is problematic for many reasons, one of the primary being that decisions about an individual’s health should be made by health care experts and professionals, not law enforcement or the courts. Unlike Section 12, which can be used to involuntarily hold people with mental illness who are a risk to themselves or others, Section 35 does not include a clinical component that sees clinicians making a determination about whether a person should be held. 

“There are a number of structural problems with Section 35 that promote its use for control of people who others may see as undesirable, as opposed to its primary focus being to promote the wellbeing and health of the individual,” Komaromy said. “And that’s where it feels problematic, when it’s enforced that way as more in the crowd control kind of approach.”

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Goldfarb stressed that there’s also no evidence to show that sweeps or executing 35s have a positive impact. In fact, she said, exposure to the criminal/legal system can have a really negative impact on health outcomes for those struggling with substance use.

If the goal is housing, she said, involvement in the legal system can also be a “huge barrier” to getting people stabilized into long-term housing.

“It really sort of works against what I think we’ve all agreed is the long-term goal, which is to get individuals the resources they need and get them into housing,” she said.

The social worker acknowledged that law enforcement, being a part of the city and the community, does have a role to play. It’s a part Komaromy pointed out is already in action, since police do pursue people who have warrants for serious violent crimes. 

“That’s their job, and they take that seriously,” she said. “So when we start to talk about a sweep, it is much more of a dragging the net and catching everyone in its wake.”

Komaromy said she and her colleagues have seen that threats of a sweep or moves toward more policing result in a “chilling effect” where people are afraid to engage with treatment systems or go into housing. People become afraid of making a wrong step, getting caught up in a sweep, and ending up incarcerated. They worry that being in stable housing will make them more locatable or an easier target for such a sweep. 

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In addition, the doctor and social worker said that a focus on the criminal and legal system can have other harmful consequences. Being picked up on a warrant and spending a single night in jail can lead to job loss, child custody loss, and disconnection from treatment, among other impacts.

“We’ve seen in some cases it can be fatal if you’re not receiving the right treatment and health care, both on a Section 35 or being picked up on a warrant,” Goldfarb said.

Before moving in that direction, she and Komaromy said officials have to look at what the impacts and potential consequences are down the line before rushing into action just to “get everybody off the street.”

That includes examining whether any of the actions could increase racial inequities, Komaromy said. 

“We know that a Black person who uses substances is multiple times more likely to be arrested and charged for that than a white person and similarly more likely to have a harsh sentence and be treated violently by police — the list goes on and on,” she said. 

Goldfarb said she doesn’t want to see the city “backstep” on the headway that’s been achieved by increasing an approach through law enforcement. 

She emphasized that the city’s “messaging” on the issue matters. 

“Individuals who are living down there that are worried about being picked up in sweeps if they are to happen — [the] messaging can be interpreted that those individuals are being less prioritized or cared for than other individuals in the community,” Goldfarb said. “That’s a pretty strong message that perhaps the city doesn’t care about your long-term wellbeing.”