Defund, But Do It Right


By Alec Pruchnicki, MD

Recently, the Progressive Caucus of the New York City Council was ripped apart because of a demand that all members sign a pledge to decrease funding for the police and increase funding for alternative services to address public safety. The abuses by the police nationally, and sometimes lethally, are well known. I agree with the non-signers for a variety of reasons, but I think it can be done if done correctly.

In some respects, there is a rise in crime and in the public perception of crime. Some of this is mass media sensationalism and some is from mixed statistics on which crimes are rising, which falling, and which staying similar to pre-COVID levels. But, in a country where many citizens don’t believe in evolution, think the 2020 election was stolen, reject vaccinations, and believe in countless conspiracy theories, statistics from studies we’re not familiar with from sources we don’t know might not help much.

People do believe what they see. Horrible crimes, often with videos, are shown almost nightly on TV. Newspapers also highlight the most gruesome of cases. I find the least inaccurate reporting is in The Daily News. The Times is clueless about crime, except for an occasional “trend” piece. The Post is entirely partisan and can’t report a case without preaching against bail reform, Democrats, wokeness, or whatever. The News articles also report crimes in gruesome detail but they also, if you read to the very end of the articles, report the alleged criminals past record. A list of numerous arrests, often with significant psychiatric illness, makes the public question the whole legal system. And it doesn’t take a detailed article about shoplifting to educate a person when you can walk into your local Rite Aid and see the ice cream freezer under lock and key (like in the Hudson Street store).

The main reason I reject the plan to defund the police and use that money for alternative services, is that we did this before unsuccessfully. In the 1980s many of the state mental health facilities started to shut down due to several scandals about poor care, better outpatient medications, alternative community-based facilities and a desire to save money. Eventually, most, if not all, of the big state hospitals closed. But the community-based facilities never materialized in sufficient number to address the need. Outpatient clinics and residential facilities with psychiatric care, like the one that I have had my medical practice in for almost 20 years, were never numerous enough to meet the need. And, if community-based care isn’t available or doesn’t work, it is almost impossible to find an in-patient facility even if the person is a “threat to himself or others.” The result is the large number of people with inadequately or untreated psychiatric illness we see in crime reports on TV or in the papers, or in the subways, or on the streets, or in our prisons, or in our morgues. Kicking these people out of the state hospitals when alternative services weren’t widely available or effective didn’t do them any favors.

The failure of this approach over these decades has another aspect: the result is racist. Many types of crime are worst in poor neighborhoods which are overwhelmingly minority areas. Unequal services and outcomes in minority or poor areas versus White or wealthier areas has been documented in detail in the medical literature, including psychiatric services. A failed Defund Policy would hit these areas hardest.

If this approach has failed spectacularly over almost 40 years with psychiatric patients, what makes people think that this approach will succeed as an answer to part of the crime problem?

I do believe there might be one way of establishing a Defund Policy, but it will take more than a signed declaration to do it. Provide the services, get them running, evaluated, and publicized. Find two neighborhoods with similar levels of crime, income, and racial composition and provide violence interrupters, mobile and available mental health workers, social workers, emergency housing, and other services with police as back up in one neighborhood and traditional services in another. If crime is controlled, either by prevention or by enforcement, in the areas of intervention it should be publicized as aggressively as present day sensational crime stories are. If crime doesn’t go down, then other alternatives will be needed.

Also, don’t expect spectacular results. It might take a few years to see a drop in areas under this alternative approach. For 30 years, Eugene, Oregon has a program called CAHOOTS which does take this approach but it has replaced only 3-8 percent of police calls. Also, be prepared when the first mental health worker or social worker is harmed or killed and it ends up on the front page of every paper (maybe even The Times). Changing the entire law enforcement system might take time, money, and patience.

In other words, instead of “Defund the police and provide alternative services” maybe “Provide alternative services so we can defund the police.” If not, expect to wait around another 30 years for results.

Please direct all correspondence to or