Deinstitutionalisation

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Deinstitutionalisation 

The former St Elizabeth's Hospital in 2006, closed and boarded up. Located in Washington D.C., the hospital had been one of the sites of the Rosenhan experiment in the 1970s.

Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late 20th century, it led to the closure of many psychiatric hospitals, as patients were increasingly cared for at home, in halfway houses and clinics, in regular hospitals, or not at all.

Deinstitutionalisation works in two ways. The first focuses on reducing the population size of mental institutions by releasing patients, shortening stays, and reducing both admissions and readmission rates. The second focuses on reforming psychiatric care to reduce (or avoid encouraging) feelings of dependency, hopelessness and other behaviors that make it hard for patients to adjust to a life outside of care.

The modern deinstitutionalisation movement was made possible by the discovery of psychiatric drugs in the mid-20th century, which could manage psychotic episodes and reduced the need for patients to be confined and restrained. Another major impetus was a series of socio-political movements that campaigned for patient freedom. Lastly, there were financial imperatives, with many governments also viewing it as a way to save costs.

The movement to reduce institutionalisation was met with wide acceptance in Western countries, though its effects have been the subject of many debates. Critics of the policy include defenders of the previous policies as well as those who believe the reforms did not go far enough to provide freedom to patients.

History

19th century

Vienna's Narrenturm—German for "fools' tower"—was one of the earliest buildings specifically designed for mentally ill people. It was built in 1784.

The 19th century saw a large expansion in the number and size of asylums in Western industrialised countries. In contrast to the prison-like asylums of old, these were designed to be comfortable places where patients could live and be treated, in keeping with the movement towards "moral treatment". In spite of these ideals, they became overstretched, non-therapeutic, isolated in location, and neglectful of patients.

20th century

By the beginning of the 20th century, increasing admissions had resulted in serious overcrowding, causing many problems for psychiatric institutions. Funding was often cut, especially during periods of economic decline and wartime. Asylums became notorious for poor living conditions, lack of hygiene, overcrowding, ill-treatment, and abuse of patients; many patients starved to death. The first community-based alternatives were suggested and tentatively implemented in the 1920s and 1930s, although asylum numbers continued to increase up to the 1950s.

Origins of the modern movement

The advent of chlorpromazine and other antipsychotic drugs in the 1950s and 1960s played an important role in permitting deinstitutionalisation, but it was not until social movements campaigned for reform in the 1960s that the movement gained momentum.

A key text in the development of deinstitutionalisation was Asylums: Essays on the Social Situation of Mental Patients and Other Inmates, a 1961 book by sociologist Erving Goffman. The book is one of the first sociological examinations of the social situation of mental patients, the hospital. Based on his participant observation field work, the book details Goffman's theory of the "total institution" (principally in the example he gives, as the title of the book indicates, mental institutions) and the process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor," suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of "institutionalizing" them.

Franco Basaglia, a leading Italian psychiatrist who inspired and was the architect of the psychiatric reform in Italy, also defined mental hospital as an oppressive, locked and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents, and patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism. Other critics went further and campaigned against all involuntary psychiatric treatment. In 1970, Goffman worked with Thomas Szasz and George Alexander to found the American Association for the Abolition of Involuntary Mental Hospitalisation (AAAIMH), who proposed abolishing all involuntary psychiatric intervention, particularly involuntary commitment, against individuals. The association provided legal help to psychiatric patients and published a journal, The Abolitionist, until it was dissolved in 1980.

Reform

The prevailing public arguments, time of onset, and pace of reforms varied by country. Leon Eisenberg lists three key factors that led to deinstitutionalisation gaining support. The first factor was a series of socio-political campaigns for the better treatment of patients. Some of these were spurred on by institutional abuse scandals in the 1960s and 1970s, such as Willowbrook State School in the United States and Ely Hospital in the United Kingdom. The second factor was new psychiatric medications made it more feasible to release people into the community and the third factor was financial imperatives. There was an argument that community services would be cheaper. Mental health professionals, public officials, families, advocacy groups, public citizens, and unions held differing views on deinstitutionalisation.

However, the 20th Century marked the development of the first community services designed specifically to divert deinstitutionalization and to develop the first conversions from institutional, governmental systems to community majority systems (governmental-NGO-For Profit). These services are so common throughout the world (e.g., individual and family support services, groups homes, community and supportive living, foster care and personal care homes, community residences, community mental health offices, supported housing) that they are often "delinked" from the term deinstitutionalization. Common historical figures in deinstitutionalization in the US include Geraldo Rivera, Robert Williams, Burton Blatt, Gunnar Dybwad, Michael Kennedy, Frank Laski, Steven J. Taylor, Douglas P. Biklen, David Braddock, Robert Bogdan and K. C. Lakin. in the fields of "intellectual disabilities" (e.g., amicus curae, Arc-US to the US Supreme Court; US state consent decrees).

Community organizing and development regarding the fields of mental health, traumatic brain injury, aging (nursing facilities) and children's institutions/private residential schools represent other forms of diversion and "community re-entry". Paul Carling's book, Return to the Community: Building Support Systems for People with Psychiatric Disabilities describes mental health planning and services in that regard, including for addressing the health and personal effects of "long term institutionalization". and the psychiatric field continued to research whether "hospitals" (e.g., forced involuntary care in a state institution; voluntary, private admissions) or community living was better. US states have made substantial investments in the community, and similar to Canada, shifted some but not all institutional funds to the community sectors as deinstitutionalization. For example, NYS Education, Health and Social Services Laws identify mental health personnel in the state of New York, and the two term Obama Presidency in the US created a high-level Office of Social and Behavioral Services.

The 20th Century marked the growth in a class of deinstitutionalization and community researchers in the US and world, including a class of university women. These women follow university education on social control and the myths of deinstitutionalization, including common forms of transinstitutionalization such as transfers to prison systems in the 21st Century, "budget realignments", and the new subterfuge of community data reporting.

Consequences

Community services that developed include supportive housing with full or partial supervision and specialised teams (such as assertive community treatment and early intervention teams). Costs have been reported as generally equivalent to inpatient hospitalisation, even lower in some cases (depending on how well or poorly funded the community alternatives are). Although deinstitutionalisation has been positive for the majority of patients, it also has shortcomings.

Criticism of deinstitutionalisation takes two forms. Some, like E. Fuller Torrey, defend the use of psychiatric institutions and conclude that deinstitutionalisation was a move in the wrong direction. Others, such as Walid Fakhoury and Stefan Priebe, argue that it was an unsuccessful move in the right direction, suggesting that modern day society faces the problem of "reinstitutionalisation". While coming from opposite viewpoints, both sets of critics argue that the policy left many patients homeless or in prison. Leon Eisenberg has argued that deinstitutionalisation was generally positive for patients, while noting that some were left homeless or without care.

Misconceptions

There is a common perception by the public and media that people with mental disorders are more likely to be dangerous and violent if released into the community. However, a large 1998 study in Archives of General Psychiatry suggested that discharged psychiatric patients without substance abuse symptoms are no more likely to commit violence than others without substance abuse symptoms in their neighborhoods, which were usually economically deprived and high in substance abuse and crime. The study also reported that a higher proportion of the patients than of the others in the neighborhoods reported symptoms of substance abuse.

Findings on violence committed by those with mental disorders in the community have been inconsistent and related to numerous factors; a higher rate of more serious offences such as homicide have sometimes been found but, despite high-profile homicide cases, the evidence suggests this has not been increased by deinstitutionalisation. The aggression and violence that does occur, in either direction, is usually within family settings rather than between strangers.

Adequacy of treatment and support

Common criticisms of the new community services are that they have been uncoordinated, underfunded and unable to meet complex needs. Problems with coordination arose because care was being provided by multiple for-profit businesses, non-profit organizations and multiple levels of government.

Torrey has opposed deinstitutionalisation in principle, arguing that people with mental illness will be resistant to medical help due to the nature of their conditions. These views have made him a controversial figure in psychiatry. He believes that reducing psychiatrists' powers to use involuntary commitment led to many patients losing out on treatment, and that many who would have previously lived in institutions are now homeless or in prison.

Other critics argue that deinstitutionalisation had laudable goals, but some patients lost out on care due to problems in the execution stage. In a 1998 study of the effects of deinstitutionalisation in the United Kingdom, Means and Smith argue that the program had some successes, such as increasing the participation of volunteers in mental healthcare, but that it was underfunded and let down by a lack of coordination between the health service and social services.

Reinstitutionalisation

Some mental health academics and campaigners have argued that deinstitutionalisation was well-intentioned for trying to make patients less dependent on psychiatric care, but in practice patients were still left being dependent on the support of a mental healthcare system, a phenomenon known as "reinstitutionalisation" or "transinstitutionalisation".

The argument is that community services can leave the mentally ill in a state of social isolation (even if it is not physical isolation), frequently meeting other service users but having little contact with the rest of the public community. Fakhoury and Priebe said that instead of "community psychiatry", reforms established a "psychiatric community". Julie Racino argues that having a closed social circle like this can limit opportunities for mentally ill people to integrate with the wider society, such as personal assistance services.

Thomas Szasz, a longtime opponent of involuntary psychiatric treatment, argued that the reforms never addressed the aspects of psychiatry that he objected to, particularly his belief that mental illnesses are not true illnesses but medicalized social and personal problems.

Medication

There was an increase in prescriptions of psychiatric medication in the years following deinstitutionalization. Although most of these drugs had been discovered in the years before, deinstitutionalisation made it far cheaper to care for a mental health patient and increased the profitability of the drugs. Some researchers argue that this created economic incentives to increase the frequency of psychiatric diagnosis (and related diagnoses, such as ADHD in children) that did not happen in the era of costly hospitalized psychiatry.

In most countries (except some countries that are either in extreme poverty or are hindered from importing psychiatric drugs by their customs regulations), more than 10% of the population are now on some form of psychiatric medicine. This increases to more than 15% in some countries such as the United Kingdom. A 2012 study by Kales, Pierce and Greenblatt argued that these medicines were being overprescribed.

Victimisation

Moves to community living and services have led to various concerns and fears, from both the individuals themselves and other members of the community. Over a quarter of individuals accessing community mental health services in a US inner-city area are victims of at least one violent crime per year, a proportion eleven times higher than the inner-city average. The elevated victim rate holds for every category of crime, including rape/sexual assault, other violent assaults, and personal and property theft. Victimisation rates are similar to those with developmental disabilities.

Worldwide

Asia

Hong Kong

In Hong Kong, a number of residential care services such as halfway houses, long-stay care homes, supported hostels are provided for the discharged patients. In addition, community support services such as rehabilitation day services and mental health care have been launched to facilitate the patients' re-integration into the community.

Japan

Unlike most developed countries, Japan has not followed a program of deinstitutionalisation. The number of hospital beds has risen steadily over the last few decades. Physical restraints are used far more often. In 2014, more than 10,000 people were restrained–the highest ever recorded, and more than double the number a decade earlier. In 2018, the Japanese Ministry of Health introduced revised guidelines that placed more restrictions against the use of restraints.

Africa

Uganda has one psychiatric hospital. There are only 40 psychiatrists in Uganda. The World Health Organisation estimates that 90% of mentally ill people here never get treatment.

Australia and Oceania

New Zealand

New Zealand established a reconciliation initiative in 2005 to address the ongoing compensation payouts to ex-patients of state-run mental institutions in the 1970s to 1990s. A number of grievances were heard, including: poor reasons for admissions; unsanitary and overcrowded conditions; lack of communication to patients and family members; physical violence and sexual misconduct and abuse; inadequate mechanisms for dealing with complaints; pressures and difficulties for staff, within an authoritarian hierarchy based on containment; fear and humiliation in the misuse of seclusion; over-use and abuse of ECT, psychiatric medications, and other treatments as punishments, including group therapy, with continued adverse effects; lack of support on discharge; interrupted lives and lost potential; and continued stigma, prejudice, and emotional distress and trauma.

There were some references to instances of helpful aspects or kindnesses despite the system. Participants were offered counselling to help them deal with their experiences, along with advice on their rights, including access to records and legal redress.

Europe

Italy

Italy was the first country to begin the deinstitutionalisation of mental health care and to develop a community-based psychiatric system. The Italian system served as a model of effective service and paved the way for deinstitutionalisation of mental patients. Since the late 1960s, the Italian physician Giorgio Antonucci questioned the basis itself of psychiatry. After working with Edelweiss Cotti in 1968 at the Centro di Relazioni Umane in Cividale del Friuli – an open ward created as an alternative to the psychiatric hospital – from 1973 to 1996 Antonucci worked on the dismantling of the psychiatric hospitals Osservanza and Luigi Lolli of Imola and the liberation – and restitution to life – of the people there secluded. In 1978, the Basaglia Law had started Italian psychiatric reform that resulted in the end of the Italian state mental hospital system in 1998.

The reform was focused on the gradual dismantlement of psychiatric hospitals, which required an effective community mental health service. The object of community care was to reverse the long-accepted practice of isolating the mentally ill in large institutions and to promote their integration in a socially stimulating environment, while avoiding subjecting them to excessive social pressures.

The work of Giorgio Antonucci, instead of changing the form of commitment from the mental hospital to other forms of coercion, questions the basis of psychiatry, affirming that mental hospitals are the essence of psychiatry and rejecting any possible reform of psychiatry, that must be completely eliminated.

United Kingdom

The water tower of Park Prewett Hospital in Basingstoke, Hampshire. The hospital was redeveloped into a housing estate after its closure in 1997.

In the United Kingdom, the trend towards deinstitutionalisation began in the 1950s. At the time, 0.4% of the population of England were housed in asylums. The government of Harold Macmillan sponsored the Mental Health Act 1959, which removed the distinction between psychiatric hospitals and other types of hospitals. Enoch Powell, the Minister of Health in the early 1960s, criticized psychiatric institutions in his 1961 "Water Tower" speech and called for most of the care to be transferred to general hospitals and the community. The campaigns of Barbara Robb and several scandals involving mistreatment at asylums (notably Ely Hospital) furthered the campaign. The Ely Hospital scandal led to an inquiry led by Brian Abel-Smith and a 1971 white paper that recommended further reform.

The policy of deinstitutionalisation came to be known as Care in the Community at the time it was taken up by the government of Margaret Thatcher. Large-scale closures of the old asylums began in the 1980s. By 2015, none remained.

North America

United States

President John F. Kennedy signs the Community Mental Health Act.

The United States has experienced two main waves of deinstitutionalisation. The first wave began in the 1950s and targeted people with mental illness. The second wave began roughly 15 years later and focused on individuals who had been diagnosed with a developmental disability. Loren Mosher argues that deinstitutionalisation fully began in the 1970s and was due to financial incentives like SSI and Social Security Disability, rather than after the earlier introduction of psychiatric drugs.

The most important factors that led to deinstitutionalisation were changing public attitudes to mental health and mental hospitals, the introduction of psychiatric drugs and individual states' desires to reduce costs from mental hospitals. The federal government offered financial incentives to the states to achieve this goal. Stroman pinpoints World War II as the point when attitudes began to change. In 1946, Life magazine published one of the first exposés of the shortcomings of mental illness treatment. Also in 1946, Congress passed the National Mental Health Act of 1946, which created the National Institute of Mental Health (NIMH). NIMH was pivotal in funding research for the developing mental health field.

President John F. Kennedy had a special interest in the issue of mental health because his sister, Rosemary, had incurred brain damage after being lobotomised at the age of 23. His administration sponsored the successful passage of the Community Mental Health Act, one of the most important laws that led to deinstitutionalization. The movement continued to gain momentum during the Civil Rights Movement. The 1965 amendments to Social Security shifted about 50% of the mental health care costs from states to the federal government, motivating state governments to promote deinstitutionalization. The 1970s saw the founding of several advocacy groups, including Liberation of Mental Patients, Project Release, Insane Liberation Front, and the National Alliance on Mental Illness (NAMI).

The lawsuits these activist groups filed led to some key court rulings in the 1970s that increased the rights of patients. In 1973, a federal district court ruled in Souder v. Brennan that whenever patients in mental health institutions performed activity that conferred an economic benefit to an institution, they had to be considered employees and paid the minimum wage required by the Fair Labor Standards Act of 1938. Following this ruling, institutional peonage was outlawed. In the 1975 ruling O'Connor v. Donaldson, the U.S. Supreme Court restricted the rights of states to incarcerate someone who was not violent. This was followed up with the 1978 ruling Addington v. Texas, further restricting states from confining anyone involuntarily for mental illness. In 1975, the United States Court of Appeals for the First Circuit ruled in favour of the Mental Patient's Liberation Front in Rogers v. Okin, establishing the right of a patient to refuse treatment. Later reforms included the Mental Health Parity Act, which required health insurers to give mental health patients equal coverage.

Other factors included scandals. A 1972 television broadcast exposed the abuse and neglect of 5,000 patients at the Willowbrook State School in Staten Island, New York. The Rosenhan's experiment in 1973 caused several psychiatric hospitals to fail to notice fake patients who showed no symptoms once they were institutionalized. The pitfalls of institutionalization were dramatized in an award-winning 1975 film, One Flew Over the Cuckoo's Nest.

In 1955, for every 100,000 US citizens there were 340 psychiatric hospital beds. In 2005 that number had diminished to 17 per 100,000.

South America

In several South American countries,, such as in Argentina, the total number of beds in asylum-type institutions has decreased, replaced by psychiatric inpatient units in general hospitals and other local settings.

In Brazil, there are 6003 psychiatrists, 18,763 psychologists, 1985 social workers, 3119 nurses and 3589 occupational therapists working for the Unified Health System (SUS). At primary care level, there are 104,789 doctors, 184, 437 nurses and nurse technicians and 210,887 health agents. The number of psychiatrists is roughly 5 per 100,000 inhabitants in the Southeast region, and the Northeast region has less than 1 psychiatrist per 100,000 inhabitants. The number of psychiatric nurses is insufficient in all geographical areas, and psychologists outnumber other mental health professionals in all regions of the country. The rate of beds in psychiatric hospitals in the country is 27.17 beds per 100,000 inhabitants. The rate of patients in psychiatric hospitals is 119 per 100,000 inhabitants. The average length of stay in mental hospitals is 65.29 days.

 

Skid Row, Los Angeles

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Skid_Row,_Los_Angeles

Coordinates: 34°02′39″N 118°14′38″W

Skid Row, Los Angeles
Neighborhoods of Los Angeles
San Julian Street south of 5th Street
Location within Downtown Los Angeles
Coordinates: 34.044232°N 118.243886°W
Country	United States
State	California
County	County of Los Angeles
City	Los Angeles
Government
• City Council	Jose Huizar
• State Assembly	John Pérez (D)
• State Senate	Gilbert Cedillo (D)
• U.S. House	Jimmy Gomez (D)
Area
• Total	0.431 sq mi (1.12 km2)
Population  (2019)
• Total	4,757
ZIP Code	90013
Area code(s)	213

Skid Row is a neighborhood in Downtown Los Angeles. The area is also known as Central City East.

As of a 2019 count, the population of the district was 4,757. Skid Row contains one of the largest stable populations (about 4,200–8,000) of homeless people in the United States and has been known for its condensed homeless population since the 1930s. Its long history of police raids, targeted city initiatives, and homelessness advocacy make it one of the most notable districts in Los Angeles.

Covering fifty city blocks (2.71 sq mi) immediately east of downtown Los Angeles, Skid Row is bordered by Third Street to the north, Seventh Street to the south, Alameda Street to the east, and Main Street to the west.

Etymology

The term "skid row" or "skid road," referring to an area of a city where people live who are "on the skids," derives from a logging term. Loggers would transport their logs to a nearby river by sliding them down roads made from greased skids. Loggers who had accompanied the load to the bottom of the road would wait there for transportation back up the hill to the logging camp. By extension, the term began to be used for places where people with no money and nothing to do gathered, becoming the generic term in English-speaking North America for a depressed street in a city.

Demographics

Corner of San Pedro Street and East Fifth Street

In 2019 the total population was 4,757. Between 2018 and 2019 there was an 11% increase in total number of persons residing in the area. In the neighborhood, the population was spread out, with 7.78% under the age of 18, 1.38% from 18 to 24, 60.94% from 25 to 54, 19.49% from 55-61, and 10.41% who were 62 years of age or older. Veterans make up 9.90%.

The 2019 racial makeup of the neighborhood was 12.66% White, 58.21% Black/African American, 2.06% American Indian/Alaska Native, 0.63% Asian, 24.53% Hispanic or Latino, 0.79% Native Hawaiian / Other Pacific Islander, and 1.11% from other races.

The per capita income for the neighborhood in 2000 was $14,210. About 41.8% of the population were below the poverty line. In 2008, the median household income for Skid Row and the surrounding areas was $15,003.

History

The corner of 5th and San Pedro in 1875

 

Skidrow Serenade

The population is probably more motley than that in a similar district of any other American city. Jews, Greeks, and Italians in the doorways of pawnshops and secondhand clothing stores vie with one another to lure the unwary passer-by inside. A fat German runs a beer parlor and just across the street a dapper Frenchman ladles up 5-cent bowls of split pea soup. A large, blond woman named Sunshine, born in Egypt, manages one of the cleaner rooming houses. A few Chinese practically monopolize the hand laundry business, and Japanese the cheapest cafes and flophouses. Americans Indians barter for forbidden whiskey. Chattering Mexicans loiter on the steps leading up to a second-floor hotel. Dapper Negroes, better dressed than any other vagabonds, wander by in riotous groups.

Huston Irvine, Los Angeles Times (March 26, 1939)

1880s through 1960s

At the end of the 19th century, a number of residential hotels opened in the area as it became home to a transient population of seasonal laborers. By the 1930s, Skid Row was home to as many as 10,000 homeless people, alcoholics, and others on the margins of society. It supported saloons, residential hotels, and social services, which drew people from the populations they served to congregate in the area.

In June 1947, Los Angeles Police Department (LAPD) chief Clemence B. Horrall ordered what he called a "blockade raid" of the whole Skid Row area. Over 350 people were arrested. Assistant Chief Joseph Reed, who claimed that "at least 50 percent of all the crime in Los Angeles originates in the Skid Row area," stated that there had been no "strong arm robberies" on Skid Row as late as one week after the raid. Long time residents, however, were skeptical that the changes would last.

In 1956, the city of Los Angeles was in the midst of a program to "rehabilitate" Skid Row through the clearance of decaying buildings. The program was presented to property owners in the area as an economy measure. Gilbert Morris, then superintendent of building, said that at that point the provision of free social services to the approximately one square mile of Skid Row cost the city over $5 million per year as opposed to the city average of $110,000 per square mile annually. The city used administrative hearings to compel the destruction of nuisance properties at the expense of the owner. By July 1960, the clearance program was said to be 87% complete in the Skid Row area. With increased building codes during the '60s, owners of residential hotels found demolition to be more cost-effective than adhering to repairs. The total number of these buildings is estimated to have dropped from 15,000 to 7,500 over the following decade. Many residents of the area found themselves homeless with the loss of half of the affordable housing provided by hotels.

1970s through present

Skid Row was established by city officials in 1976 as an unofficial "containment zone", where shelters and services for homeless people would be tolerated.

During the 1970s, two Catholic Workers — Catherine Morris, a former nun, and her husband, Jeff Dietrich — founded the "Hippie Kitchen" in the back of a van. Over forty years later, in March 2019, aged 84 and 72, they remained active in their work feeding Skid Row residents.

Throughout the 1960s and 1970s, many veterans of the Vietnam War found themselves drawn to Skid Row, due to the services and missions already in place there, and feeling outcast from other areas. Like those after World War II, many of them ended up on the streets. It was around this time that the demographics of Skid Row shifted from predominantly white and elderly to those here today.

1987 crackdowns

In February 1987, LAPD chief Daryl Gates, backed by then-Mayor Tom Bradley, announced plans for another crackdown on the homeless on Skid Row. Police and firefighters conducted a number of sweeps through the area but the plan was abandoned due to opposition by advocates for the homeless.

When Gates announced in May that the crackdown would resume, Los Angeles City Attorney (and future mayor) James K. Hahn responded that he would not prosecute people arrested in the planned sweeps. Hahn stated that he was "not going to prosecute individuals for not having a place to stay. I simply will not prosecute people for being poor, underprivileged and unable to find a place to sleep until I'm convinced that a viable alternative to sleeping on the streets exists." Gates, still backed by Bradley, responded: "As the elected city attorney of Los Angeles, Mr. Hahn has a responsibility to file prosecutable cases which are presented to him by the Los Angeles Police Department."

A few days later, then-Councilman Zev Yaroslavsky introduced a proposal that the city stop enforcing its anti-camping laws on Skid Row until adequate housing could be found for all its residents. The council rejected Yaroslavsky's proposal, but after hearing testimony from Assistant Police Chief David Dotson describing the LAPD's intended crackdown methodology, the council passed a motion asking Gates not to enforce the anti-camping laws until adequate housing could be found for the area's residents.

Patient dumping

In September 2005, hospitals and law enforcement agencies were discovered to be "dumping" homeless people on Skid Row. Then-Mayor Antonio Villaraigosa ordered an investigation and William Bratton, LAPD chief at the time, claimed that the department was not targeting homeless people specifically, but only people who violated city ordinances. The Los Angeles City Attorney investigated more than 50 of about 150 reported cases of dumping. By early 2007, the city attorney had filed charges against only one hospital, Kaiser Permanente. Because there were no laws specifically covering the hospital's actions, it was charged, in an untested strategy, with false imprisonment. In response to the lack of legal recourse available to fight patient dumping, California state senator Gil Cedillo sponsored legislation against it in February 2007.

Since Mike Feuer took office as City Attorney in 2013, he has settled eight additional cases of patient dumping with various hospitals around Los Angeles. These cases have been a part of a larger attempt to solve the issue, in addition to working with some hospitals on long term solutions. The total settlements from all eight have been over 4 million dollars.

2000 to present

In 2002, newly appointed LAPD Chief William Bratton announced a plan to clean up Skid Row by, among other things, aggressively enforcing an old anti-camping ordinance. Robert Lee Purrie, for instance, was cited twice for violating the ordinance in December 2002 and January 2003 and his possessions: "blankets, clothes, cooking utensils, a hygiene kit," and so on, were confiscated by the police.

The Midnight Mission on Skid Row

In April 2006, United States Court of Appeals for the Ninth Circuit ruled in favor of the American Civil Liberties Union (ACLU) in its suit against the city of Los Angeles, filed on behalf of Purrie and five other homeless people, finding that the city was in violation of the 8th and 14th Amendments to the U.S. Constitution and sections of the California Constitution guaranteeing due process and equal protection and prohibiting cruel and unusual punishment. The court stated that "the LAPD cannot arrest people for sitting, lying, or sleeping on public sidewalks in Skid Row." The court said that the anti-camping ordinance is "one of the most restrictive municipal laws regulating public spaces in the United States."

The ACLU sought a compromise in which the LAPD would be barred from arresting homeless people or confiscating their possessions on Skid Row between the hours of 9:00 p.m. and 6:30 a.m. The compromise plan, which was accepted by the city of Los Angeles, permits sleeping on the sidewalk except "within 10 feet of any business or residential entrance" and only between these hours.

Downtown development business interests and the Central City East Association (CCEA) came out against the compromise. On September 20, 2006, the Los Angeles City Council voted to reject the compromise. On October 3, 2006, police arrested Skid Row's transients for sleeping on the streets for the first time in months. On October 10, 2006, under pressure from the ACLU, the city tacitly agreed to the compromise by declining to appeal the court's decision.

In 2012, the Skid Row Running Club was founded by Los Angeles Superior Court Judge Craig Mitchell, as an effort to improve the livelihood of those in the area. A documentary, entitled “Skid Row Marathon” was made about the group, which includes homeless, police officers, and convicted felons.

The city came to an agreement in May 2019 that removed the limit on the number of possessions kept on the street in the neighborhood. The agreement allows the city to still seize any items that threaten public safety and health, as well as large “bulky items.” This includes most pieces of furniture or appliances. Items that do not fall into those categories will be stored for 90 days. If an item is deemed important enough, such as medication, it must be able to be claimed within 24 hours.

Crime

Within the LAPD Central Area, which includes Skid Row and other areas in Downtown Los Angeles, crimes in Skid Row constituted 58.96%. In 2005, auto thefts, aggravated assaults, and robberies made up 59% of crimes in Skid Row.

Within the first two years of the 2006 implementation of the Safer Cities Initiative in Skid Row, 18,000 arrests were made and 24,000 citations were given for non-violent offenses such as jaywalking, littering, and sitting on the sidewalk. This is 69 times the rate of policing in the rest of Los Angeles.

Between July and October 2019, the crime breakdown of 997 reported crimes within 0.5 miles of Skid Row’s center was 21.97% vehicle break-in/theft, 27.08% larceny, 24.67% assault, 1.04% sex crime, 13.14% robbery, 6.12% burglary, 4.61% motor vehicle theft, 0.6% arson and 0.4% homicide.

Safer Cities Initiative

The Safer Cities Initiative was a 68-week policy implemented in 2006 by the Los Angeles Police Department to reduce crime activity within Skid Row. The policy, led by former police chief William Bratton, assigned approximately 50 police officers to the Skid Row area to enforce stricter policing of offenses in accordance with the broken windows theory of policing. Through policing these offenses (including non-violent offenses such as jaywalking or littering), the LAPD sought to establish a heightened appearance of public order as a punitive deterrent for criminals. One study by the LAPD claimed that four years post-implementation, crime rates had reduced by approximately 46%, while deaths dropped approximately 34%.

While the Los Angeles Police Department has stood by the policy's effectiveness and its impact on the local community, one study suggested that while crime rates have reduced, higher incarceration rates were a contributing factor to the area's increasing homeless population. These claims have been echoed by local activists, who argue that the initiative's frequent use of arrest warrants and tickets prevented individuals in-need from acquiring long-term housing.

Culture

Skid Row is home to many artists. Due to its location bordering districts such as the Historic Core and the Arts District, Skid Row often hosts events that cross neighborhood borders. A performance group called the Los Angeles Poverty Department provides artistic resources to Skid Row, primarily in the form of theater classes and performances. Los Angeles Times journalist Margaret Gray claimed that audience members “somehow felt like part of a family” when the performers were on stage and noted “while many charitable organizations focus on warehousing and policing homeless populations, LAPD attempts to remind them of their unique humanity, to empower them to take collective responsibility for their neighborhood and one another’s health and safety”. Since 2009 the organization also puts on the Festival for All Skid Row Artists.

The "Skid Row City Limits Mural" was created solely by volunteers to express the community’s feelings about the history and modern state of the neighborhood. The "Dear Neighbor Mural" is another Skid Row art piece, aimed at making housing a right for all citizens. In addition, Skid Row Karaoke is a long time tradition of residents, which is weekly and open to all.

Government and infrastructure

The Los Angeles Fire Department (LAFD) serves the neighborhood with Station No. 3 in the Business District, one in the West and Station No. 9 in Skid Row. Station No. 9 operates one engine, one truck, two ALS rescue ambulances, and one BLS rescue ambulance. It currently is the busiest firehouse in Los Angeles. Fire engines and ambulances serving the neighborhood have historically had "Skid Row" emblazoned on their sides. On June 1, 2006, the Los Angeles Times reported that fire officials planned to change the legend on the vehicles to read "Central City East". Many residents supported the change, but it was opposed by firefighters and some residents who take pride in the sense that they live in a tough area.

The Los Angeles County Department of Health Services operates the Central Health Center in Downtown Los Angeles, serving Skid Row.

Services for homeless people in Los Angeles are centralized in Skid Row. Examples include the Volunteers of America, the Union Rescue Mission, The Jonah Project, Downtown Mental Health (a branch of the Department of Mental Health), LAMP, Downtown Women's Center, The Weingart Foundation, Los Angeles Mission, Fred Jordan Mission, The Society of St. Vincent de Paul's Cardinal Manning Center, and Midnight Mission. In 2007, Union Rescue Mission opened Hope Gardens, a facility outside of Skid Row which is exclusively for women and children.

Transportation

The community is served primarily by 10 Los Angeles County Metropolitan Transportation Authority bus lines:

Local lines

• Line 16/316 – Downtown Los Angeles to Century City (via Fifth and Sixth streets)
• Line 18 – Koreatown to Montebello (via Fifth and Sixth streets)
• Line 20 – Downtown Los Angeles to Westwood (via Seventh Street)
• Line 51/351 – Compton to Wilshire/Vermont Station (via Seventh and San Pedro streets)
• Line 52 – Harbor Gateway Transit Center to Wilshire/Vermont Station (via Seventh Street, San Pedro Street, and Avalon Boulevard)
• Line 53 – California State University, Dominguez Hills to Downtown Los Angeles (via Fifth and Sixth streets)
• Line 60 – Artesia Station to Downtown Los Angeles (via Seventh Street)
• Line 62 – Hawaiian Gardens to Downtown Los Angeles (via Fifth and Sixth streets)

Rapid lines

• Metro Rapid Line 720 – Commerce to Santa Monica (via Fifth and Sixth streets)
• Metro Rapid Line 760 – Artesia Station to Downtown Los Angeles (via Seventh Street)

Landmarks

The Skid Row City Limits Mural

• Star Apartments, a residential housing complex opened in October 2012, built specifically for the needs of the homeless.
• Indian Alley is the unofficial name given to a stretch of alley, in reference to the significance the area held for indigent American Indians from the 1970s to the 1990s. Indian Alley comprises a block of Werdin Place, running south from Winston Street to East 5th Street. It is bounded to the west by Main Street and to the east by Los Angeles Street.
  
• The Skid Row City Limits Mural is an 18-by-50-foot mural displayed on San Julian Street, created in 2014. It features a map demarcating Skid Row's officially recognized boundaries alongside an official-looking sign, replete with city seal, reading "Skid Row City Limit, Population: Too Many." This is the initial installation of a mural project that is planned to eventually cover the whole wall on the San Julian block north of 6th Street. Installed in compliance with the city's mural ordinance, the project was organized by Skid Row activist General Jeff Page with local street art crew Winston Death Squad, and carried out with the labor of Skid Row citizens. Los Angeles City Councilman Jose Huizar's office has hailed the mural, saying, "It's community pride on the one hand, it's cleverly done and it creates conversation and debate, which often great public art does."

In popular culture

In Skid Row, tents line entire city blocks

Lost Angels: Skid Row is My Home, a feature length documentary produced by Agi Orsi, tells the story of eight homeless people, including an Olympic athlete and Harvard graduate, who navigate a world of poverty, drug abuse, and mental illness to build a sense of community. The film examines how the City of Los Angeles criminalizes homelessness by prohibiting Skid Row residents from standing and sitting for a prolonged period of time in a public place.

The site has appeared as a location in several movies, including The Sting, and television shows such as Starsky & Hutch, Baretta, and Quincy, M.E.. The 1960 comedy horror film The Little Shop of Horrors is set in Skid Row; however, the location of the 1982 musical (and its 1986 film adaptation) was moved to New York City (although the song Skid Row (Downtown) exists in both).

Skid Row was also used as a location for filming the music videos for the Michael Jackson songs "Beat It" and The Way You Make Me Feel.

Rock band U2 performed "Where The Streets Have No Name" upon a rooftop for the song's music video; the performance referenced The Beatles' final concert, as shown in the film Let It Be.

Notable residents

• Johnnie Ray – singer, songwriter, and pianist.
• Danny Harris – Olympic hurdler and silver medalist.
• George Takei and family – Japanese-American actor, director, author, and activist.
• Nathaniel Ayers – Juilliard trained multi-instrumentalist found to have been schizophrenic and homeless, subject of the 2009 movie The Soloist.
• Lil Peep - rapper, singer and songwriter.

Crime prevention through environmental design

From Wikipedia, the free encyclopedia

Crime prevention through environmental design (CPTED) is an agenda for manipulating the built environment to create safer neighborhoods.

It originated in America around 1960, when urban renewal strategies were felt to be destroying the social framework needed for self-policing. Architect Oscar Newman created the concept of ‘defensible space’, developed further by criminologist C. Ray Jeffery who coined the term CPTED. Growing interest in environmental criminology led to detailed study of specific topics such as natural surveillance, access control and territoriality. The "broken window" principle that neglected zones invite crime reinforced the need for good property maintenance to assert visible ownership of space. Appropriate environmental design can also increase the perceived likelihood of detection and apprehension, known to be the biggest single deterrent to crime. And there has been new interest in the interior design of prisons as an environment that significantly affects decisions to offend.

Wide-ranging recommendations to architects include the planting of trees and shrubs, the elimination of escape routes, the correct use of lighting, and the encouragement of pedestrian and bicycle traffic in streets. Tests show that the application of CPTED measures overwhelmingly reduces criminal activity.

History

CPTED was originally coined and formulated by criminologist C. Ray Jeffery. A more limited approach, termed defensible space, was developed concurrently by architect Oscar Newman. Both men built on the previous work of Elizabeth Wood, Jane Jacobs and Schlomo Angel. Jeffery's book, "Crime Prevention Through Environmental Design" came out in 1971, but his work was ignored throughout the 1970s. Newman's book, "Defensible Space: – Crime Prevention through Urban Design" came out in 1972. His principles were widely adopted but with mixed success. The defensible space approach was subsequently revised with additional built environment approaches supported by CPTED. Newman represented this as CPTED and credited Jeffery as the originator of the CPTED term. Newman's CPTED-improved defensible space approach enjoyed broader success and resulted in a reexamination of Jeffery's work. Jeffery continued to expand the multi-disciplinary aspects of the approach, advances which he published, with the last one published in 1990. The Jeffery CPTED model is more comprehensive than the Newman CPTED model, which limits itself to the built environment. Later models of CPTED were developed based on the Newman Model, with criminologist Tim Crowe's being the most popular.

As of 2004, CPTED is popularly understood to refer strictly to the Newman/Crowe type models, with the Jeffery model treated more as multi-disciplinary approach to crime prevention which incorporates biology and psychology, a situation accepted even by Jeffery himself. (Robinson, 1996). A revision of CPTED, initiated in 1997, termed 2nd Generation CPTED, adapts CPTED to offender individuality, further indication that Jeffery's work is not popularly considered to be already a part of CPTED. in 2012 Woodbridge introduced and developed CPTED in prison and showed how design flaws allowed criminals to keep offending.

1960s

In the 1960s Elizabeth Wood developed guidelines for addressing security issues while working with the Chicago Housing Authority, placing emphasis on design features that would support natural surveillability. Her guidelines were never implemented but stimulated some of the original thinking that led to CPTED.

Jane Jacobs' book, The Death and Life of Great American Cities (1961) argued that urban diversity and vitality were being destroyed by urban planners and their urban renewal strategies. She was challenging the basic tenets of urban planning of the time: that neighborhoods should be isolated from each other; that an empty street is safer than a crowded one; and that the car represents progress over the pedestrian. An editor for Architectural Forum magazine (1952–1964), she had no formal training in urban planning, but her work emerged as a founding text for a new way of seeing cities. She felt that the way cities were being designed and built meant that the general public would be unable to develop the social framework needed for effective self-policing. She pointed out that the new forms of urban design broke down many of the traditional controls on criminal behavior, for example, the ability of residents to watch the street and the presence of people using the street both night and day. She suggested that the lack of "natural guardianship" in the environment promoted crime. Jacobs developed the concept that crime flourishes when people do not meaningfully interact with their neighbors. In Death and Life, Jacobs listed the three attributes needed to make a city street safe: a clear demarcation of private and public space; diversity of use; and a high level of pedestrian use of the sidewalks.

Schlomo Angel was an early pioneer of CPTED and studied under noted planner Christopher Alexander. Angel's Ph.D. thesis, Discouraging Crime Through City Planning, (1968) was a study of street crime in Oakland, CA. In it he states "The physical environment can exert a direct influence on crime settings by delineating territories, reducing or increasing accessibility by the creation or elimination of boundaries and circulation networks, and by facilitating surveillance by the citizenry and the police." He asserted that crime was inversely related to the level of activity on the street, and that the commercial strip environment was particularly vulnerable to crime because it thinned out activity, making it easier for individuals to commit street crime. Angel developed and published CPTED concepts in 1970 in work supported and widely distributed by the United States Department of Justice (Luedtke, 1970).

1970s

The phrase crime prevention through environmental design (CPTED) was first used by C. Ray Jeffery, a criminologist from Florida State University. The phrase began to gain acceptance after the publication of his 1971 book of the same name.

Jeffery's work was based on the precepts of experimental psychology represented in modern learning theory. (Jeffery and Zahm, 1993:329) Jeffery's CPTED concept arose out of his experiences with a rehabilitative project in Washington, D.C. that attempted to control the school environment of juveniles in the area. Rooted deeply in the psychological learning theory of B.F. Skinner, Jeffery's CPTED approach emphasized the role of the physical environment in the development of pleasurable and painful experiences for the offender that would have the capacity to alter behavioral outcomes. His original CPTED model was a stimulus-response (S-R) model positing that the organism learned from punishments and reinforcements in the environment. Jeffery "emphasized material rewards . . . and the use of the physical environment to control behavior" (Jeffery and Zahm, 1993:330). The major idea here was that by removing the reinforcements for crime, it would not occur. (Robinson, 1996)

An often overlooked contribution of Jeffery in his 1971 book is outlining four critical factors in crime prevention that have stood the test of time. These are the degrees to which one can manipulate the opportunity for a crime to occur, the motivation for the crime to occur, the risk to the offender if the crime occurs, and the history of the offender who might consider committing the crime. The first three of these are within the control of the potential victim while the last is not.

For reasons that have received little attention, Jeffery's work was ignored throughout the 1970s. Jeffery's own explanation is that, at a time when the world wanted prescriptive design solutions, his work presented a comprehensive theory and used it to identify a wide range of crime prevention functions that should drive design and management standards.

Concurrent with Jeffery's largely theoretical work was Oscar Newman and George Rand's empirical study of the crime-environment connection conducted in the early 1970s. As an architect, Newman placed emphasis on the specific design features, an emphasis missing in Jeffery's work. Newman's "Defensible Space – Crime Prevention through Urban Design (1972) includes extensive discussion of crime related to the physical form of housing based on crime data analysis from New York City public housing. "Defensible Space" changed the nature of the crime prevention and environmental design field and within two years of its publication substantial federal funding was made available to demonstrate and study defensible space concepts.

As established by Newman, defensible space must contain two components. First, defensible space should allow people to see and be seen continuously. Ultimately, this diminishes residents' fear because they know that a potential offender can easily be observed, identified, and consequently, apprehended. Second, people must be willing to intervene or report crime when it occurs. By increasing the sense of security in settings where people live and work, it encourages people to take control of the areas and assume a role of ownership. When people feel safe in their neighborhood they are more likely to interact with one another and intervene when crime occurs. These remain central to most implementations of CPTED as of 2004.

In 1977, Jeffery's second edition of Crime Prevention Through Environmental Design expanded his theoretical approach to embrace a more complex model of behavior in which variable physical environments, offender behavior as individuals and behavior of individual members of the general public have reciprocal influences on one another. This laid the foundation for Jeffery to develop a behavioral model aimed at predicting the effects of modifying both the external environment and the internal environment of individual offenders.

1980s

By the 1980s, the defensible space prescriptions of the 1970s were determined to have mixed effectiveness. They worked best in residential settings, especially in settings where the residents were relatively free to respond to cues to increase social interaction. Defensible space design tools were observed to be marginally effective in institutional and commercial settings. As a result, Newman and others moved to improve defensible space, adding CPTED based features. They also deemphasised less effective aspects of defensible space. Contributions to the advance of CPTED in the 1980s included:

• The "broken windows" theory, put forth by James Q. Wilson and George L. Kelling in 1982, explored the impact that visible deterioration and neglect in neighborhoods have on behavior. Property maintenance was added as a CPTED strategy on par with surveillance, access control and territoriality. The Broken Windows theory may go hand in hand with CPTED. Crime is attracted to the areas that are not taken care of or abandoned. CPTED adds a pride of ownership feeling to the community. With no more "broken windows" in certain neighborhoods, crime will continue to decline and eventually fall out completely.
• Canadian academicians Patricia and Paul Brantingham published Environmental Criminology in 1981. According to the authors, a crime takes place when all of the essential elements are present. These elements consist of: a law, an offender, a target, and a place. They characterize these as "the four dimensions of crime", with environmental criminology studying the last of the four dimensions.
• British criminologists Ronald V. Clarke and Patricia Mayhew developed their "situational crime prevention" approach: reducing opportunity to offend by improving design and management of the environment.
• Criminologist Timothy Crowe developed his CPTED training programs.

1990s

Criminology: An Interdisciplinary Approach (1990), was Jeffery's final contribution to CPTED. The Jeffery CPTED model evolved to one which assumes that

The environment never influences behavior directly, but only through the brain. Any model of crime prevention must include both the brain and the physical environment. ... Because the approach contained in Jeffery's CPTED model is today based on many fields, including scientific knowledge of modern brain sciences, a focus on only external environmental crime prevention is inadequate as it ignores another entire dimension of CPTED – i.e., the internal environment. (Robinson, 1996)

Crime Prevention Through Environmental Design (1991) by criminologist Tim Crowe provided a solid base for CPTED to move forward into the rest of the 1990s.

From 1994 through 2002, Sparta Consulting Corporation led by Severin Sorensen, CPP managed the US Government's largest CPTED technical assistance and training program titled Crime Prevention Through Environmental Design (CPTED) in Public Housing Technical Assistance and Training Program, funded by the US Department of Housing and Urban Development. During this period Sorensen worked with Ronald V. Clarke and the Sparta team to develop a new CPTED Curriculum that used Situational Crime Prevention as an underlying theoretical basis for CPTED measures. A curriculum was developed and trained to stakeholders in public and assisted housing, and follow-up CPTED assessments were conducted at various sites. The Sparta-led CPTED projects showed statistical reductions in self reported FBI UCR Part I crimes between 17% to 76% depending on the basket of CPTED measures employed in specific high crime, low income settings in the United States.

In 1996, Oscar Newman published an update to his earlier CPTED works, titled, Creating Defensible Space, Institute for Community Design Analysis, Office of Planning and Development Research (PDR), US Department of Housing and Urban Development (HUD).

In 1997, an article by Greg Saville and Gerry Cleveland, 2nd Generation CPTED, exhorted CPTED practitioners to consider the original social ecology origins of CPTED, including social and psychological issues beyond the built environment.

2000s

By 2004, elements of the CPTED approach had gained wide international acceptance due to law enforcement efforts to embrace it. The CPTED term "environment" is commonly used to refer to the external environment of the place. Jeffery's intention that CPTED also embrace the internal environment of the offender seems to have been lost, even on those promoting the expansion of CPTED to include social ecology and psychology under the banner of 2nd Generation CPTED. In 2012 Woodbridge introduced and developed the concept of CPTED within a prison environment, a place where crime still continues after conviction. Jeffery's understanding of the criminal mind from his study in rehabilitative facilities over forty years ago was now being used to reduce crime in those same type of facilities. Woodbridge showed how prison design allowed offending to continue and introduced changes to reduce crime.

CPTED techniques are increasingly benefiting from integration with design technologies. For instance, models of proposed buildings developed in Building Information Modelling may be imported into video game engines to assess their resilience to different forms of crime.

Strategies for the built environment

CPTED strategies rely upon the ability to influence offender decisions that precede criminal acts. Research into criminal behavior shows that the decision to offend or not to offend is more influenced by cues to the perceived risk of being caught than by cues to reward or ease of entry. Certainty of being caught is the main deterrence for criminals not the severity of the punishment so by raising the certainty of being captured, criminal actions will decrease. Consistent with this research, CPTED based strategies emphasise enhancing the perceived risk of detection and apprehension.

Consistent with the widespread implementation of defensible space guidelines in the 1970s, most implementations of CPTED by 2004 were based solely upon the theory that the proper design and effective use of the built environment can reduce crime, reduce the fear of crime, and improve the quality of life. Built environment implementations of CPTED seek to dissuade offenders from committing crimes by manipulating the built environment in which those crimes proceed from or occur. The six main concepts according to Moffat are territoriality, surveillance, access control, image/maintenance, activity support and target hardening. Applying all of these strategies is key when trying to prevent crime in any neighborhood crime ridden or not.

Natural surveillance and access control strategies limit the opportunity for crime. Territorial reinforcement promotes social control through a variety of measures. Image/maintenance and activity support provide the community with reassurance and the ability to inhibit crime by citizen activities. Target hardening strategies round up all of these techniques to resolve crime into one final step.

Natural surveillance

This curved street with balconies allows for additional opportunities for residents to spot suspicious activity, while also making it difficult for criminals to plan escape routes.

Natural surveillance increases the perceived risk of attempting deviant actions by improving visibility of potential offenders to the general public. Natural surveillance occurs by designing the placement of physical features, activities and people in such a way as to maximize visibility of the space and its users, fostering positive social interaction among legitimate users of private and public space. Potential offenders feel increased scrutiny, and thus inherently perceive an increase in risk. This perceived increase in risk extends to the perceived lack of viable and covert escape routes.

• Design streets to increase pedestrian and bicycle traffic
• Place windows overlooking sidewalks and parking lots.
• Leave window shades open.
• Use passing vehicular traffic as a surveillance asset.
• Create landscape designs that provide surveillance, especially in proximity to designated points of entry and opportunistic points of entry.
• Use the shortest, least sight-limiting fence appropriate for the situation.
• Use transparent weather vestibules at building entrances.
• When creating lighting design, avoid poorly placed lights that create blind-spots for potential observers and miss critical areas. Ensure potential problem areas are well lit: pathways, stairs, entrances/exits, parking areas, ATMs, phone kiosks, mailboxes, bus stops, children's play areas, recreation areas, pools, laundry rooms, storage areas, dumpster and recycling areas, etc.
• Avoid too-bright security lighting that creates blinding glare and/or deep shadows, hindering the view for potential observers. Eyes adapt to night lighting and have trouble adjusting to severe lighting disparities. Using lower intensity lights often requires more fixtures.
• Use shielded or cut-off luminaires to control glare.
• Place lighting along pathways and other pedestrian-use areas at proper heights for lighting the faces of the people in the space (and to identify the faces of potential attackers).
• Utilizing curved streets with multiple view points to multiple houses' entrances, as well as making the escape route difficult to follow.

Natural surveillance measures can be complemented by mechanical and organizational measures. For example, closed-circuit television (CCTV) cameras can be added in areas where window surveillance is unavailable.

Natural access control

A picket fence reduces access, while allowing bystanders to see suspicious activity.

Natural access control limits the opportunity for crime by taking steps to clearly differentiate between public space and private space. By selectively placing entrances and exits, fencing, lighting and landscape to limit access or control flow, natural access control occurs.

• Use a single, clearly identifiable, point of entry
• Use structures to divert persons to reception areas
• Incorporate maze entrances in public restrooms. This avoids the isolation that is produced by an anteroom or double door entry system
• Use low, thorny bushes beneath ground level windows. Use rambling or climbing thorny plants next to fences to discourage intrusion.
• Eliminate design features that provide access to roofs or upper levels
• In the front yard, use waist-level, picket-type fencing along residential property lines to control access, encourage surveillance.
• Use a locking gate between front and backyards.
• Use shoulder-level, open-type fencing along lateral residential property lines between side yards and extending to between back yards. They should be sufficiently unencumbered with landscaping to promote social interaction between neighbors.
• Use substantial, high, closed fencing (for example, masonry) between a backyard and a public alley instead of a wall which blocks the view from all angles.

Natural access control is used to complement mechanical and operational access control measures, such as target hardening.

Natural territorial reinforcement

A dilapidated chain link fence signals that the building it is protecting is not very secured, while a well maintained bush indicates risk due to evidence of recent activity.

Territorial reinforcement promotes social control through increased definition of space and improved proprietary concern. An environment designed to clearly delineate private space does two things. First, it creates a sense of ownership. Owners have a vested interest and are more likely to challenge intruders or report them to the police. Second, the sense of owned space creates an environment where "strangers" or "intruders" stand out and are more easily identified. By using buildings, fences, pavement, signs, lighting and landscape to express ownership and define public, semi-public and private space, natural territorial reinforcement occurs. Additionally, these objectives can be achieved by assignment of space to designated users in previously unassigned locations.

• Maintained premises and landscaping such that it communicates an alert and active presence occupying the space.
• Provide trees in residential areas. Research results indicate that, contrary to traditional views within the law enforcement community, outdoor residential spaces with more trees are seen as significantly more attractive, more safe, and more likely to be used than similar spaces without trees.
• Restrict private activities to defined private areas.
• Display security system signage at access points.
• Avoid chain link fencing and razor-wire fence topping, as it communicates the absence of a physical presence and a reduced risk of being detected.
• Placing amenities such as seating or refreshments in common areas in a commercial or institutional setting helps to attract larger numbers of desired users.
• Scheduling activities in common areas increases proper use, attracts more people and increases the perception that these areas are controlled.
• Motion sensor lights at all entry points into the residence.

Territorial reinforcement measures make the normal user feel safe and make the potential offender aware of a substantial risk of apprehension or scrutiny. When people take pride in what they own and go to the proper measures to protect their belongings, crime is deterred from those areas because now it makes it more of a challenge. Criminals don't want their job to be hard, because if it was hard, then they wouldn't do it. The more difficult it is to commit a crime in certain areas, the less crime will occur.

Other CPTED elements

Maintenance and activity support aspects of CPTED were touched upon in the preceding, but are often treated separately because they are not physical design elements within the built environment.

Maintenance

Maintenance is an expression of ownership of property. Deterioration indicates less control by the intended users of a site and indicate a greater tolerance of disorder. The Broken Windows Theory is a valuable tool in understanding the importance of maintenance in deterring crime. Broken Windows theory proponents support a zero tolerance approach to property maintenance, observing that the presence of a broken window will entice vandals to break more windows in the vicinity. The sooner broken windows are fixed, the less likely it is that such vandalism will occur in the future. Vandalism falls into the broken windows category as well. The faster the graffiti is painted over, the less likely one is to repeat because no one saw what has been done. Having a positive image in the community shows a sense of pride and self-worth that no one can take away from the owner of the property.

Activity support

Activity support increases the use of a built environment for safe activities with the intent of increasing the risk of detection of criminal and undesirable activities. Natural surveillance by the intended users is casual and there is no specific plan for people to watch out for criminal activity. By placing signs such as caution children playing and signs for certain activities in the area, the citizens of that area will be more involved in what is happening around them. They will be more tuned in to who is and who isn't supposed to be there and what looks suspicious on a day-to-day life.

Effectiveness and criticism

CPTED strategies are most successful when they inconvenience the end user the least and when the CPTED design process relies upon the combined efforts of environmental designers, land managers, community activists, and law enforcement professionals. The strategies listed above can't be fulfilled without the community's help and it requires the whole community in the location to make the environment a safer place to live. A meta-analysis of multiple-component CPTED initiatives in the United States has found that they have decreased robberies between 30 and 84% (Casteel and Peek-Asa, 2000).

In terms of effectiveness, a more accurate title for the strategy would be crime deterrence through environmental design. Research demonstrates that offenders might not always be prevented from committing some crimes by using CPTED. CPTED relies upon changes to the physical environment that will cause an offender to make certain behavioral decisions, and some of those decisions will include desisting from crime. Those changes are crafted so as to encourage behavior, and thus they deter rather than conclusively "prevent" behavior.

Beyond the attraction of being cost effective in lowering the incidence of crime, CPTED typically reduces the overall costs of preventing crime. Retrofitting an existing environment to meet CPTED can sometimes be costly, but when incorporated in the original design phase of facility planning, cost of designing to CPTED principles are often lower than with traditional approaches. Operational costs are often lower also, as CPTED lighting designs can significantly lower energy use. Adding to the attraction of CPTED is that it lowers liability. At times the entire street style must be changed and buildings have to be up to code with more windows and changing their view and access points to other areas around the building like the parking lot or store front.