As of Monday, Feb. 9, officials had counted 18 suspected cold-weather deaths among New Yorkers found outside during the city’s longest stretch of below-freezing temperatures since 1958. According to news reports, some of the dead had been given placements in city shelters but had declined to go, saying they feared getting robbed or attacked. Others had strangers looking out for them but refused help. While three of the deaths are believed to be overdose-related, they raise the same question: How can we help neighbors who are outside in the cold or otherwise in need of assistance?
For answers, we watched the Feb. 10 City Council hearing on the city’s response to the snowstorm and freezing temperatures, reached out to the Mayor’s Office of Community Mental Health (OCMH) and reviewed guidance from Coalition for the Homeless, one of the oldest organizations serving unhoused people. We also spoke with a longtime safe streets activist who regularly does outreach in parks and along commercial avenues in Queens.
First, understand why some people resist assistance
For many New Yorkers holed up at home during freezing temperatures, it may be tough to understand how anyone would stay outdoors if they had options. But people experiencing a mental health or overdose crisis or who are scared to go to a city shelter may not see any of their choices as viable.
At the Council hearing, Molly Wasow Park, who recently resigned as commissioner of the city Department of Social Services, outlined common reasons people decline shelter during extreme cold:
• mental health conditions including psychosis, disorganized thinking, severe trauma and substance use disorders
• distrust of the government or strangers
• concerns about privacy and safety in shelters
• fear of being separated from their pets, which are generally not allowed in city shelters
Jim Burke, co-founder of the 34th Avenue Open Streets Coalition and a volunteer who does outreach in and around Travers Park in Jackson Heights, echoed that distrust is common. Many people living outside have already identified spots they consider safer or more familiar than shelters, he said, even if those places offer little protection from the cold.
A volunteer’s guide on how to help someone in freezing weather
Burke offered guidance based on his outreach near 34th Avenue and in helping run community resource programs such as coat and food distributions. While his experience reflects that specific area and may not apply to every neighborhood, it offers practical insight into what has and hasn’t worked in helping neighbors, sometimes in extreme weather conditions. His responses below have been lightly edited.
Epicenter NYC: What’s the first thing to know about helping someone sleeping outside in the cold?
Jim Burke: Once you become a trusted [volunteer or community] member, they know your name, and they’re much more willing to accept help. Really, the people who should engage them are the people who are already on the street for other reasons, because they already have a trust factor built in.
Epicenter NYC: Ok, but what about before or while those people arrive? Is there anything you can do if you’re not yet someone they know and trust?
JB: Yes, if you have a specific thing to offer them. So when we have hot soup, when we have a meal, when we have a warm jacket, just stopping by and saying, “We’re giving out hot soup or warm jackets. Are you interested?” Engaging in that way, we found that it’s been very positive.
Epicenter NYC: What if a neighbor is not connected to that kind of resource, but they’re worried that someone’s out and it’s below freezing?
JB: I would suggest you say, “Look, are you okay? Do you want me to call for any help or any assistance you need?” That would be the furthest I would take that.
Epicenter NYC: And if they decline but you’re worried, because it’s below freezing and they don’t seem protected?
JB: You can certainly call [the DHS outreach team if they’re at risk or 911 if it’s a medical emergency]. I know that, from my experience on 82nd Street, that often they would refuse to go, they would refuse medical treatment. But it’s always an option. You really want to be engaging with them first.
Epicenter NYC: If they decline, are there certain signs you would look for to see if it’s warranted to call 911?
JB: If I see the lips look the wrong color, or the hands look the wrong color, then yes, I would definitely immediately call 911. You can see if someone is suffering from hypothermia or freezing or frostbite.
Epicenter NYC: At that point, if the person is conscious, I imagine you would let them know that you’re calling 911 and why?
JB: Exactly. You can say, “This will just take 10 minutes. You can even warm up. You don’t even have to go with [the EMT], but they’ll bring you into the van and check your vitals, and you can always refuse at any point not to go.” Remind them they can refuse but to at least get checked up.
Epicenter NYC: At least one of the people who died during this recent cold snap was someone who had been discharged from the hospital. If you come across someone who was discharged from the hospital and you think they are at risk, what do you do?
JB: We’ve encountered people on 89th Street and Northern Boulevard, when we’re doing some distributions there, that still have the bracelets from Elmhurst Hospital. Sometimes we call because maybe they signed themselves out against medical advice but still had the bracelets on. So we felt very comfortable calling the hospital and saying, “They still have the bracelet on. They don’t look good.” Maybe they have to send an ambulance.
Epicenter NYC: What were the signs that they needed help?
JB: They were not conscious or not speaking properly.
Epicenter NYC: When you encounter someone who appears to be sleeping outside and they don’t respond, other than speak loudly, what should you do?
JB: I would lightly touch them, but I counsel — I’ve done it myself, I have physically shaken people, but I do not advise other people to do that, because they could act out against you. Your own safety comes first.
Epicenter NYC: Are there certain words that you found can help build trust?
JB: I identify myself, like, “Hey, I work outside. I’m right over here on the avenue, or I’m right here on 82nd,” to let them know that I’m also working outside, I’m also here, I know that it’s freezing. And asking if they need services.
Epicenter NYC: If neighbors are concerned about someone freezing outside in the cold and they’re not responding, is it better to call 911 or the homeless services outreach number [212-NEW-YORK or 212-639-9675]?
JB: If they’re exhibiting signs of medical danger (for instance, if their color’s wrong) or they’re not responding, call 911. However, if they’re lucid, but you still think they need help, then I would call homeless services, because then someone could talk to them.
Epicenter NYC: Some of the deaths from this cold snap are believed to be overdose related. Are there any signs folks should look for in terms of someone possibly overdosing outside?
JB: We see a lot of alcohol issues in the neighborhood. That’s very dangerous, and I’ve called [911] for that. I’ve seen people look really, really terrible, and then I’ve seen them walk two weeks later with their family, and they’re back home. Some people just have a bad moment and fall off the wagon.
Epicenter NYC: Since you mentioned concrete items you leave people with, does it make sense to leave any information, like for some warming centers or other resources?
JB: People generally don’t take anything. So no, we usually just give the information and leave them because most resources are close by. So for example, when offering the soup, “It’s ready.” Or “Come right over here, get your coat,” or “If you walk over to Corona Avenue today, they’re giving out hot lunches.”
Epicenter NYC: Got it. So it’s better to be more concrete and say, “it’s right around the corner” than, say, giving an information pamphlet. What about donating subway fare in case they later decide to go to a warming center or shelter intake?
JB: In our limited experience around Travers Park (around 89th and 90th Street Park and Dunningham Triangle), we have really found that most of those people are already kind of close to home. Some of them might even have a place to sleep, or at least a favored warmer area. It may not be a great place, but maybe a vestibule or other place they go. So they’re not taking the subway anywhere. They feel comfortable where they are. That may sound tough to believe, but they already have their mattress, they already have their blankets. These are the corners that they sleep on, and they’re already used to doing that.
Epicenter NYC: Is there anything people shouldn’t do, even if they’re well-intentioned, when trying to help out a neighbor who’s outside?
JB: You should really respect people’s space. So if they don’t want help, you can’t force it on them. You can offer it to them, and, obviously, if they’re in distress, you can call 911. But otherwise, we ought to have bodily autonomy, and can’t force anybody to do anything.
Epicenter NYC: Is there anything else you wish people would just understand about helping people outside in the winter?
JB: Just that whenever we’ve offered a jacket or soup, people have been super grateful. And then we see them a week later, and they smile and say hello, and it’s a nice relationship to develop.
The official guidance on what to do if you encounter someone at risk
Staff with the Mayor’s Office of Community Mental Health also recommended the following steps:
- If someone is sleeping or otherwise seems unconscious, they may not hear you. Speak up so they can hear you. If they still don’t respond, lightly touch their leg to wake them up.
- Once you get a response, introduce yourself and say why you’re speaking to them. For example, you can say you’re trying to help them get to a warmer place.
- Offer information about available resources: You never know what others don’t know. You can explain that the city’s warming centers have food, blankets and other items to keep people warm (socks, hats) along with hygiene items and access to a phone or computer.
- If the person wants to be taken to a warming center, call 311 (or, as mentioned above, donate subway fare). The same goes for helping someone who wants to apply for shelter or housing.
- If a neighbor is unwilling or unable to talk and may be at harm from extreme cold or other danger, ask for a homeless outreach team via 311. You can also call 212-NEW-YORK (212-639-9675) to request help for a homeless person.
The city also directed Epicenter NYC to this guidance from the Coalition for the Homeless:
- Ask if the person is OK, has someplace to go and needs help.
- Hand out the Coalition’s crisis card (email info@cfthomeless.org to request some), which lists available resources.
- Donate subway fare in case they want to pursue any of these resources.
When to call 311
Unless you’re trained to do outreach or understand the lived experiences of people who are homeless or have a mental health or substance misuse disorder, there’s only so much you can do by yourself.
Outreach workers at the Department of Homeless Services — the same team you can request via 311 — are generally the people to call when you’re concerned about an unhoused person being at risk. They also conduct on-the-ground assessments of whether someone shows signs of a mental health crisis and whether they understand what danger they’re in.
During the recent Council hearing, former commissioner Park cited examples such as noticing whether a person is dry, layered and protected from the cold and asking questions such as “How are you doing?” and “What’s your plan if you get colder?” to determine the person’s risk and capacity to make decisions.
In rare cases, she said, if someone is judged to be a danger to themselves and unable to understand the risk, clinicians may initiate an involuntary transport, as a last resort and based on clinical judgment only.
Park also mentioned the fear of vulnerable New Yorkers abandoning their pets if they seek shelter. So when offering information about the city’s warming buses and other centers, you might also mention that the city has expanded a pilot program during Code Blue periods that allows people to bring one cat or dog under 45 pounds to select drop-in shelters in the Bronx, Manhattan and Queens.
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More guidance on how to help unhoused neighbors in other situations is available from the Coalition for the Homeless.
