Scenes from the aftermath in Oakland:
stories of victims, survivors and healers.

Saturday, February 13, 2016

Made in Oakland: the good, the great and the victims

This is from a draft of a report I'm working on for Youth ALIVE!, with a few contributions from my colleagues.
Sherman Spears founded Caught in the Crossfire

The city of Oakland produces many good and great people. Oakland also produces victims. According to Oakland Police Department crime statistics, since 2011 there have been over 33,600 violent crimes here, including 2,343 shootings and 930 homicides. Consistently, Oakland's violent crime rate has been 3 to 4 times that of the state of California; its homicide rate has been 3 to 6 times higher. Consistently as well, the highest concentration of homicide victims has been young African American men ages 18 and 34. These violently wounded suffer not just physical but mental trauma that often becomes a forbidding barrier to the business of everyday life. There is help available, but these victims require individual, knowledgeable, energetic and sensitive guidance if they are to access the services and care necessary to return to their lives. Unfortunately, economic, cultural and even gender barriers exist between the victims and the help they need.

Each year, over 1.5 million victims of violence are treated in hospitals nationwide for nonfatal gunshot, stabbing, and other physical assault injuries; nearly 63% are male, and 41% are males of color. In Oakland, each year hundreds are shot but not killed. Since 2011, Oakland has suffered nearly 400 shootings per year, among over 5,000 violent assaults annually. The vast majority of victims are male. In fact, according to the California Department of Public Health, 1066 of 1189 – an incredible 90% – of firearm assaults treated by Alameda County emergency departments between 2011 and 2014 were male victims.

They were also young: 1,189 victims of violent assaults, including gunshot victims, both fatal and non-fatal, were cared for at Alameda County emergency department between 2011 and 2014. Nearly half, 512, were under the age of 25. You could say those were the lucky ones. They survived, although their ordeal of trauma and healing and their need for services and aid was only just beginning. Precise demographic statistics on overall shooting victims can be difficult to gather. But homicide demographics are instructive. Since 2006, Oakland has suffered an annual average of 103 homicide. Each year, the largest percentage of homicide victims, 34% on average, tend to be between 18 to 25. In 2015 alone, according to the Oakland Human Services Department (HSD), 54 of the city's 87 homicide victims were under the age of 30; 34 victims were aged 25 or younger. An analysis by California Safe Communities, of 171 homicides occurring between January of 2012 and June of 2013, showed that 74% of victims were under the age of 35. 36% were under the age of 24. Most of them would have lived their short lives, and lost them, in the city's highest stress neighborhoods, in police beats in East and West Oakland that ranked 1 through 6 for highest crime rates.

They are of color: A majority of victims are young people of color. Just as an example, from July 2014 to June 2015, in a city with an overall population just over 50% African Americans and Latino, 95% of clients in Youth ALIVE!'s Caught in the Crossfire program, which provides case management to young victims of violent crimes in Oakland, were African American or Latino. Amazingly, 86% of victims of violence, including gunshot wounds, under the age of 24, cared for at county emergency departments between 2011 and 2014, were African American or Latino.

The wounded begin the process of recovery in shock, suffering from a dissociative numbness that inhibits decision making just at a time when there are many decisions to make and much business to take care of. Their trauma causes symptoms such as sleep problems, paranoia and hyper-vigilance that can lead to further victimization, exploitation and violence. Most of these victims are men, who have been socialized not to seek help or even admit to their symptoms. When they do, they tend to be perceived as anti-social, even delinquent, as opposed to depressed and traumatized. African Americans are also adversely impacted by the diagnoses and treatments they receive. Specific to mental health services, African Americans tend to be over-diagnosed with psychotic disorders, like schizophrenia, and under-diagnosed with affective disorders, like depression and anxiety. For a group of people already less likely than whites to seek mental health services, misdiagnosis and inappropriate medications can lead to continued or increased symptoms and erode trust in treatment. This is a lonely, lost, confused and even embittered population in dire need of order, direction and aid; this is a young, vulnerable, at-risk group of victims who deserve but often do not get help.

As Marilyn Harris once said to me, "Oakland is strangling its young Black men."

But how did they get to this point? Shooting victims in Oakland tend to receive excellent emergency care. Many survive their shooting because of that care. But they are then thrust into an entirely new post-shooting life. New, but with one exception: whereas wounded soldiers, for example, are sent home from the battlefield, wounded and traumatized young Oaklanders tend to return to the very same place, the same neighborhood, street or school where their assault occurred.

The story of the founder of Youth ALIVE!'s Caught in the Crossfire program, the first of what are now upwards of 30 hospital-based violence intervention programs in the U.S., is illutrative of the crossroads they find themselves at. As a young teen, Sherman Spears got into the gang and drug-dealing life in Oakland as a way to make money. He quickly became his group’s enforcer, with a reputation for winning fights and putting off challenges. But as he grew older, the dangerous life lost its appeal. Despite the money, cars and local fame, he found he craved safety and peace. He tried to leave the life. He got a job as a painter, moved out of Oakland, got an apartment and settled down. But the life found him; not everyone knew he was out of the game. One day some old enemies tracked him down, shot him and left him for dead. Spears survived but today is confined to a wheelchair. Back then, lying in his hospital bed, he felt alone, he was alone, lost in the fearful, paranoid, angry new world of the victim of violence. He was determined to heal, but he was also vulnerable, impressionable. There in the hospital, weak and in pain, his friends, who loved and cared for him, offered him the only solace they knew: they asked Spears to identify his assailant so they could retaliate. He could have chosen that, or, if an alternative presented itself, he could try something different. Especially if that alternative was healing, if it came in the form of someone who had been there, who understood who he had been, what he had done and why, what he was up against, how hard it was going to be to change, what the challenges of his past had been and what the challenges would be to move forward toward peace. This was the place and time to choose the past or choose healing, but it was not something that could be done on his own. He needed someone who has been there, who perhaps has been a victim of violence; or has had a loved one injured or lost to violence, who knows the cost of being wounded, the struggles that lead to and away from an assault, who knows that healing is possible. All too often that help doesn't come.

At 39% White, 31% African American, 25% Latino and 12% Asian, Oakland can appear remarkably integrated in its public places and at public events. But it remains segregated in its neighborhoods, whose contrasting environments and cultures create a tainted geography that informs life here. In Oakland, white people live in the highlands and people of color in the flatlands and rarely does the one visit the other. It is the same with services, commerce and civic attention. Crime in the flatlands breeds fear which affects the willingness of commercial and service enterprises to serve this community whose needs are so fundamental. That is the problem at large. Gunshot victims face all of this intensified. They are stigmatized by association as probable criminals themselves, often blamed by law enforcement, health professionals, even neighbors, for somehow “getting themselves shot.”

They are themselves in shock and suffering from debilitating fear, paranoia and a bitterness with what they perceive as an apathetic city, one they are reluctant to seek help from. And there are strong cultural and gender barriers to accessing services or even returning to life after being the victim of a violent assault. Research indicates that, in particular, victimized men and boys of color -- and the majority of victims are men and boys of color -- do not admit their symptoms or seek out the help and services they need. And when they do seek help, their trauma often goes undiagnosed or is misdiagnosed. Consequently, they must be sought, in a sensitive and culturally-aware way. Most existing systems do not currently provide services nor do they have the cultural competency, capacity, or ability to engage, respond to and treat this population.

And so, there are very clear reasons why this victim population is underserved, despite the existence of a few dedicated, culturally diverse and trauma-aware organizations. The primary gap these organzations encounter is one of capacity. In 2014, Oakland Police reported 663 shootings. The California Department of Public Health reported 384 intentional firearm assaults treated in Alameda County. And yet, with a proven, well-known, widely-replicated program, based in the county’s primary hospital trauma centers, case management organizations had only the capacity to provide case management for 68 gunshot victims, as well as for another 14 victims hospitalized for stabbing or physical assault. Unattended, the trauma will continue to fester. Many victims will remain fearful, bitter and disaffected. This is a call to take them by the hand and help them make a comeback. Or to start anew.