Overdose deaths have increased dramatically in the United States and are often attributed to prescription opioids. This study presents a framework for “overdose typologies”, including non-medical prescription drug use, to more accurately describe drug use patterns.
This study examined linked prescription drug monitoring program (PDMP) and toxicology data (2016–2018) from accidental overdose deaths from a large metropolitan coroner’s office in the Midwest (Indianapolis, Indiana).
In total, 1,112 accidental overdose deaths occurred and over two-thirds (68.0%; n = 756) were coded as an illicit drug user with no prescription opioid present in the toxicology. The most infrequent categories were prescription opioid users 5.5% (n = 61).
Linked PDMP and toxicology reports are useful in identifying drug use patterns that contribute to mortality.
Justice reform strategies to reduce mass incarceration will not be successful without healthcare and social supports for persons with chronic health conditions. This intersection of health and justice holds the potential for smarter spending, better health outcomes, reduced incarceration, and fewer persons with mental illness and substance use disorders under correctional control.
The Center for Behavioral Health Justice (CBHJ) at the Wayne State University (WSU) School of Social Work, in collaboration with the WSU School of Medicine and supported by the Michigan Justice Fund, has released a toolkit of key strategies for Michigan’s jails to mitigate the spread of COVID-19 in their facilities. This toolkit documents barriers and successes in Wayne County, where the CBHJ and the School of Medicine worked with county and state leadership to develop strategies to around testing, contact tracing, information sharing, and discharge planning. While decarceration has been a widely used to mitigate COVID-19 in correctional facilities, the strategies articulated in this toolkit promote smart decarceration. Amidst national data showing that incarceration settings have prevalence and mortality rates five times the general population, accounting for 80 percent of the largest COVID-19 outbreaks (surpassing nursing homes and food processing plants), the Wayne County Jail was able to reduce their COVID-19 positive rate to 1% by the beginning of August.
EMS legal representation has determined that EMS post-overdose referrals are allowable without patient consent, after the Wayne State School of Social Work Center for Behavioral Health and Justice (CBHJ) recently explored the issue of cross-agency data sharing. The recent legal decision allows CBHJ programs in Kent and Monroe counties to drastically increase incoming referrals from EMS agencies, and this new EMS referral pathway could create a new paradigm for overdose response if efforts are replicated across the state.
The overrepresentation of individuals with mental illness in the criminal/legal system is well documented. While professional associations urge diversion towards treatment, little is known about the practices these institutions use to identify this population. One understudied space in the criminal/legal continuum is jails. This exploratory study compares two types of mental health identification at jail booking to assess jail‐ and community‐based service outcomes by identification type (N = 2956): (a) staff observation and (b) a standardized screening instrument. Individuals identified through staff observation were significantly more likely to receive jail‐ and community‐based services, even though current symptomology and substance misuse were both significantly higher for individuals identified only by the screening instrument. These findings point to the importance of jails in providing stabilizing services during incarceration, but further, show the impact that identification practices have on individuals as they transition to the community. Community context showed varied rates of jail staff observations of mental illness, showing greater risks for individuals in rural communities. Implications include a need for system‐level changes by instituting evidence‐based identification practices in jails, and improving professional collaboration practices between mental health and criminal/legal practitioners as individuals enter and exit jails.
The Wayne State University School of Social Work Center for Behavioral Health and Justice (CBHJ) collaborated with the Wayne County Jail to identify key mitigation strategies county jails can use to mitigate the spread of COVID-19 in their facilities. The toolkit provides guidance for implementation of testing, contact tracing, information sharing, and discharge planning, along with examples of practices put in place in the Wayne County Jail.
We described the change in drug overdoses during the COVID-19 pandemic in one urban emergency medical services (EMS) system. Data was collected from Marion County, Indiana (Indianapolis), including EMS calls for service (CFS) for suspected overdose, CFS in which naloxone was administered, and fatal overdose data from the County Coroner’s Office. With two sample t tests and ARIMA time series forecasting, we showed changes in the daily rates of calls (all EMS CFS, overdose CFS, and CFS in which naloxone was administered) before and after the stay-at-home order in Indianapolis. We further showed differences in the weekly rate of overdose deaths. Overdose CFS and EMS naloxone administration showed an increase with the social isolation of the Indiana stay-at-home order, but a continued increase after the stay-at-home order was terminated. Despite a mild 4% increase in all EMS CFS, overdose CFS increased 43% and CFS with naloxone administration increased 61% after the stay-at-home order. Deaths from drug overdoses increased by 47%. There was no change in distribution of age, race/ethnicity, or zip code of those who overdosed after the stay-at-home order was issued. We hope this data informs policy-makers preparing for future COVID-19 responses and other disaster responses.
Two recent evaluation studies conducted by the Wayne State University School of Social Work Center for Behavioral Health and Justice (CBHJ) show that graduates of the Michigan Re-entry Project (MIREP) experience improvements in drug cravings, mental health wellness, PTSD rates, and other positive outcomes.
On Thursday, September 17, the Center for Behavioral Health and Justice hosted a team Lunch & Learn featuring the Honorable Derek Meinecke, chief judge of the 44th District Court in Royal Oak, Michigan.
The Wayne State University School of Social Work Center for Behavioral Health and Justice (CBHJ) facilitated the sixth annual Jail Diversion Pilot Summit on August 20, 2020. The summit, an annual event hosted by State Diversion Administrator Steven Mays and the Michigan Mental Health Diversion Council (MMHDC), has evolved over the years. Traditionally held in Romney Building in Lansing, the event has brought together criminal/legal and behavioral health stakeholders from the ten funded Jail Diversion pilot counties from across the state to network and share information on their jail diversion efforts and best practices. Under the leadership of School of Social Work Dean Sheryl Kubiak, the CBHJ has served as the data and evaluation team for the pilot program since 2015. In 2019, the annual summit expanded to include stakeholders from Stepping Up counties that engaged in technical assistance provided by the CBHJ under a separate grant from the Diversion Council. This year, due to COVID-19, the summit moved to an online platform.
Given the increased use of for-profit providers in carceral settings, understanding how these organizations differ from nonprofit providers is imperative to ensure individuals in jails with SMI have the opportunity to engage in high-quality mental health services. The lack of empirical evidence surrounding for-profit providers may force policymakers and practitioners to make decisions about mental health service provision without information about what they are purchasing. In addition, most of the work on the issue of for-profit and nonprofit service providers attributes most differences between the two types of provider modalities,13, 15,16,17, 20, 47 which fails to take into consideration the structural and procedural concerns.24 This is important, as the policy recommendations that focus on a theorized profit motive of for-profit organizations will be significantly different than recommendations focusing on how, structurally, for-profit and nonprofit organizations differ within the jail and community, and how these structural differences affect treatment outcomes for individuals with SMI. This research represents a first step in building a literature on how effective for-profit providers are in providing services in carceral settings, and how well they work and collaborate with jail staff and administrators.
This study presents an adaptation of the Crisis Intervention Team Model (CIT) to a jail setting. Pre-post surveys and interviews assessed changes in corrections officers’ (CO) knowledge of and attitudes toward mental health. Cell Removal Team (CRT) services assessed the impact of CIT on the use of this specialized unit. Results indicate positive changes in CO attitudes, increased de-escalation skills, and an abrupt decrease in the level of CRT usage, with results sustained in the 8-month follow-up period.
Jails seeking to begin individuals on methadone treatment for opioid use disorder (OUD) during the COVID-19 pandemic now have one less barrier to overcome. Under the crisis exceptions in place during the pandemic, the Substance Abuse and Mental Health Services Administration (SAMHSA) will allow Opioid Treatment Program (OTP) providers across the country to observe in-person physicals conducted by certain* jail medical staff over telehealth for methadone inductions.
Studies suggest that up to 44% of individuals in the criminal/legal system have a severe mental illness (SMI), and although diversion programs have been established, a significant portion still end up incarcerated. The Sequential Intercept Model is a framework designed to reduce the overrepresentation of individuals with SMI in the criminal/legal system by identifying points of interception to prevent individuals from entering or moving further into the system. Although studies assess programs in each intercept, none has evaluated how individuals process through all intercepts. Using data from eight counties (N = 1,160), this exploratory study assesses criminal/legal involvement across each intercept between individuals identified with (n = 880) or without (n = 280) SMI. Findings indicate longer stays in jail, low rates of treatment engagement and enrollment in specialty courts, and poorer diversion outcomes for individuals with SMI. Recommendations for research, policies, and practices are proposed to advance Smart Decarceration efforts.