Skip to main content
PMC home page
Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2004 Dec;81(4):596–605. doi: 10.1093/jurban/jth143

Homeless people’s trust and interactions with police and paramedics

Tanya L Zakrison 1, Paul A Hamel 1, Stephen W Hwang 1,2,✉
PMCID: PMC3455926  PMID: 15466841

Abstract

Although the health impact of patients’ trust in physicians has been well documented, less is known about the possible health effects of trust in police or paramedics. Homeless people frequently interact with police officers and paramedics, and these experiences may affect their health and future willingness to seek emergency assistance. We examined homeless people’s self-reported interactions with police and paramedics in Toronto, Canada, and their level of trust in these emergency service providers. In a sample of 160 shelter users, 61% had interacted with police in the last 12 months, and 37% had interacted with paramedics (P=.0001). The proportion of subjects who expressed willingness to call police in an emergency was significantly lower than those willing to call paramedics in an emergency (69% vs. 92%, P=.0001). On a Likert scale ranging from a minimum of 0 to a maximum of 5, trust levels were lower in police than in paramedics (median level 3 vs. 5, P=.0001). Among shelter users, 9% (95% confidence interval [CI], 5% to 14%) reported an assault by a police officer in the last year, and 0% (95% CI, 0% to 4%) reported an assault by a paramedic. These findings showed that homeless people have much lower levels of trust in police than paramedics. Reports of negative interactions with police are not uncommon, and homeless people’s perceptions of the police may pose a barrier to seeking emergency assistance. Further research is needed for objective characterization of homeless people’s interactions with police officers and the potential health implications of low levels of trust in the police.

Keywords: Emergency medical technicians, Homeless persons, Police, Trust

Full Text

The Full Text of this article is available as a PDF (90.3 KB).

References

  • 1.Stoutland SE. The multiple dimensions of trust in resident/police relations in Boston. J Res Crime Delinquency. 2001;38:226–256. [Google Scholar]
  • 2.Fine M, Freudenberg N, Payne Y. “Anything can happen with police around”: Urban youth evaluate strategies of surveillance in public places. J Soc Issues. 2003;59:141–158. doi: 10.1111/1540-4560.t01-1-00009. [DOI] [Google Scholar]
  • 3.Tyler TR. Public trust and confidence in legal authorities: what do majority and minority group members want from the law and legal institutions? Behav Sci Law. 2001;19:215–235. doi: 10.1002/bsl.438. [DOI] [PubMed] [Google Scholar]
  • 4.Hall MA, Dugan E, Zheng B, Misra AK. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. 2001;79:613–639. doi: 10.1111/1468-0009.00223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Balkrishnan R, Dugan E, Camacho FT, Hall MA. Trust and satisfaction with physicians, insurers, and the medical profession. Med Care. 2003;41:1058–1064. doi: 10.1097/01.MLR.0000083743.15238.9F. [DOI] [PubMed] [Google Scholar]
  • 6.Ahern MM, Hendryx MS. Social capital and trust in providers. Soc Sci Med. 2003;57:1195–1203. doi: 10.1016/S0277-9536(02)00494-X. [DOI] [PubMed] [Google Scholar]
  • 7.Boulware LE, Cooper LA, Ratner LE, LaVeist RT, Power NR. Race and trust in the health care system. Public Health Rep. 2003;118:358–365. doi: 10.1016/S0033-3549(04)50262-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Davidson PJ, Ochoa KC, Hahn JA, Evans JL, Moss AR. Witnessing heroin-related overdoses: the experiences of young injectors in San Francisco. Addiction. 2002;97:1511–1516. doi: 10.1046/j.1360-0443.2002.00210.x. [DOI] [PubMed] [Google Scholar]
  • 9.Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: II. Responses to overdose. Addiction. 1996;91:413–417. doi: 10.1111/j.1360-0443.1996.tb02290.x. [DOI] [PubMed] [Google Scholar]
  • 10.Hwang SW. Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000;283:2152–2157. doi: 10.1001/jama.283.16.2152. [DOI] [PubMed] [Google Scholar]
  • 11.Hwang SW. Homelessness and health. CMAJ. 2001;164:229–33. [PMC free article] [PubMed] [Google Scholar]
  • 12.Padgett DK, Struening EL, Andrews H, Pittman J. Predictors of emergency room use by homeless adults in New York City: the influence of predisposing, enabling and need factors. Soc Sci Med. 1995;41:547–556. doi: 10.1016/0277-9536(94)00364-Y. [DOI] [PubMed] [Google Scholar]
  • 13.Goering P, Tolomiczenko G, Sheldon T, Boydell K, Wasylenki D. Characteristics of pe who are homeless for the first time. Psychiatr Serv. 2002;53:1472–1474. doi: 10.1176/appi.ps.53.11.1472. [DOI] [PubMed] [Google Scholar]
  • 14.Gelberg L, Linn LS, Leake BD. Mental health, alcohol and drug use, and criminal history among homeless adults. Am J Psychiatry. 1988;145:191–196. doi: 10.1176/ajp.145.2.191. [DOI] [PubMed] [Google Scholar]
  • 15.Fischer PJ. Criminal activity among the homeless: a study of arrests in Baltimore. Hosp Community Psychiatry. 1988;39:46–51. doi: 10.1176/ps.39.1.46. [DOI] [PubMed] [Google Scholar]
  • 16.Martell DA, Rosner R, Harmon RB. Base-rate estimates of criminal behavior by homeless mentally ill persons in New York City. Psychiatr Serv. 1995;46:596–601. doi: 10.1176/ps.46.6.596. [DOI] [PubMed] [Google Scholar]
  • 17.Desai RA, Lam J, Rosenheck RA. Childhood risk factors for criminal justice involvement in a sample of homeles people with serious mental illness. J Nerv Ment Dis. 2000;188:324–332. doi: 10.1097/00005053-200006000-00002. [DOI] [PubMed] [Google Scholar]
  • 18.Tolomiczenko G, Goering P. Gender differences in legal involvement among homeless shelter users. Int J Law Psychiatry. 2001;24:583–593. doi: 10.1016/S0160-2527(00)00068-6. [DOI] [PubMed] [Google Scholar]
  • 19.Benda BB, Rodell DE, Rodell L. Crime among homeless military veterans who abuse substances. Psychiatr Rehabil J. 2003;26:332–345. doi: 10.2975/26.2003.332.345. [DOI] [PubMed] [Google Scholar]
  • 20.Graser D. Panhandling for change in Canadian law. J Law Soc Policy. 2000;15:45–91. [Google Scholar]
  • 21.Kalogerakis G. Cop’s trial starts in Lizotte death: vagrant’s beating in 1999 caused uproar. Montreal Gazette. April 29, 2002;sect A:A3.
  • 22.Duncanson J, Welsh M. Eight Metro officers suspended as assault probed. Toronto Star. August 28, 1996;sect A:A1.
  • 23.Pron N, Deverell J. Kerr claims victory in beating case. Toronto Star. January 25, 2003; sect A:A23.
  • 24.DiManno R. Police payoff to Kerr speaks for itself. Toronto Star. January 25, 2003; sect A:A01.
  • 25.Cooper M. Squeegee man gives account of shooting by police officer. New York Times. June 19, 1998;sect B:1.
  • 26.Chen DW. Amtrak police officer indicted in assault case at Penn Station. New York Times. July 16, 1998;sect B;2.
  • 27.Newton J. Shooting broke LAPD’s rules, inspector finds; report: police commission official’s conclusion about the death of a homeless women could intensify the conflict between Chief Bernard Parks and the civilian board. Los Angeles Times. February 12, 2000;sect A:1.
  • 28.Castaneda R. One officer guilty, one acquitted in Prince George’s dog attack. Washington Post. August 16, 2001.sect A:A01.
  • 29.Berry S. Ex-officers face jail in assault; LAPD: the two plead no contest in an attack on a homeless man. Critics say plea deal too lenient. Los Angeles Times. August 2, 2002;sect California Metro, part 2:4.
  • 30.Kawachi I, Berkman LF. Social cohesion, social capital, and health. In: Berkman LF, Kawachi I, editors. Social Epidemiology. New York, NY: Oxford University Press; 2000. pp. 174–190. [Google Scholar]
  • 31.Crowe C, Hardill K. Nursing research and political change: the street health report. Can Nurse. 1993;89:21–24. [PubMed] [Google Scholar]
  • 32.Homelessness: Programs and the People They Serve. Findings of the National Survey of Homeless Assistance Providers and Clients. Washington, DC: Interagency Council on the Homeless; 1999.

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine

RESOURCES