scholarly journals Linking Opioid-Overdose Data to Human Services and Criminal Justice Data: Opportunities for Intervention

2018 ◽  
Vol 133 (6) ◽  
pp. 658-666 ◽  
Author(s):  
Karen Hacker ◽  
Latika Davis Jones ◽  
LuAnn Brink ◽  
Abby Wilson ◽  
Marc Cherna ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Mental Health Services ◽  
Health Services ◽  
Substance Use Disorder ◽  
Human Services ◽  
Medical Examiner ◽  
Allegheny County ◽  
Overdose Death ◽  
Overdose Mortality

Objectives: In Allegheny County, Pennsylvania, the incidence of opioid-related overdose deaths increased from 17.4 per 100 000 population in 2008 to 23.9 per 100 000 population in 2014. Our objectives were to describe local demographic characteristics of this epidemic, identify public human services targets for intervention, determine temporal relationships between use of public human services and overdose mortality, and provide recommendations about potentially beneficial interventions. Methods: We used autopsy data from the Allegheny County Medical Examiner to link people who died of overdoses from 2008 through 2014 to their premortem incarcerations and use of mental health services and substance use disorder services. We calculated the frequency of use of public human services by decedents and the interval between the last use of these services and overdose death. Results: Of the 1399 decedents, 957 (68.4%) had a public human service encounter before overdose death. Of these 957 decedents, 531 (55.5%) had ever been incarcerated, 616 (64.4%) had ever used a mental health service, and 702 (73.4%) had ever used a substance use disorder service. Of 211 decedents incarcerated in the year before their overdose death, 54 (25.6%) overdosed within 30 days of their last release from jail. Of 510 decedents using mental health services in the year before death, 231 (45.3%) overdosed within 30 days of their last use of the services. Of 350 decedents using substance use disorder services in the year before their overdose death, 134 (38.3%) overdosed within 30 days of their last use of the services. Conclusions: Merging data on overdose mortality with data on use of public human services can be a useful strategy to identify trends in, and factors contributing to, the opioid epidemic; to target interventions; and to stimulate collaboration to address the epidemic.

Dual diagnosis in older drinkers during the COVID-19 pandemic

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rahul Rao ◽  
Christoph Mueller ◽  
Matthew Broadbent
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Alcohol Use ◽  
Mental Health Services ◽  
Health Services ◽  
Older People ◽  
Substance Use Disorder ◽  
Dual Diagnosis ◽  
Opioid Use ◽  
Content Type

Purpose There is a dearth of literature examining the impact of the COVID-19 pandemic on older people with dual diagnosis referred to mental health services. The purpose of this study was to compare dual diagnosis before and after lockdown in people aged between 55 and 74 with alcohol use. Design/methodology/approach Data were collected for people referred to mental health services using an anonymised database of de-identified records to identify people with both substance use disorder alone, or accompanied by co-existing mental disorders. Findings In total, 366 older people were assessed with the Alcohol Use Disorders Identification Test (AUDIT), 185 before and 181 after lockdown. People with dual diagnosis were more likely to be referred than those without, after compared to before lockdown (13 and 6%, respectively, p < 0.05). People with any substance use disorder with and without dual diagnosis showed an even greater likelihood of referral after, compared with before, lockdown (61 and 34%, respectively, p < 0.0001). Opioid use more than once a month was more likely to be reported after, compared with before, lockdown (66 and 36%, respectively, p < 0.005). Research limitations/implications The finding of a higher likelihood of opioid use after compared with before lockdown during the COVID-19 pandemic warrants further exploration. There is also further scope for further studies that involve older non-drinkers. Originality/value A greater likelihood of both dual diagnosis and substance use disorder alone after, compared with before lockdown has implications for both mental health and addiction service provision during a pandemic.

scholarly journals Participation in Accountable Care Organizations Among Hospitals Offering Substance Use Disorder and Mental Health Services

2018 ◽  
Vol 69 (11) ◽  
pp. 1131-1134 ◽  
Author(s):  
Michal J. McDowell ◽  
Alisa B. Busch ◽  
Aditi P. Sen ◽  
Elizabeth A. Stuart ◽  
Lauren Riedel ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Mental Health Services ◽  
Health Services ◽  
Substance Use Disorder ◽  
Accountable Care Organizations ◽  
Accountable Care

scholarly journals Protocol for a quasi-experimental, 950 county study examining implementation outcomes and mechanisms of Stepping Up, a national policy effort to improve mental health and substance use services for justice-involved individuals

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jennifer E. Johnson ◽  
Jill Viglione ◽  
Niloofar Ramezani ◽  
Alison E. Cuellar ◽  
Maji Hailemariam ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Health ◽  
Justice System ◽  
Mental Health Problems ◽  
Implementation Outcomes ◽  
Quasi Experimental ◽  
Matched Comparison

Abstract Background The criminal justice system is the largest provider of mental health services in the USA. Many jurisdictions are interested in reducing the use of the justice system for mental health problems. The national Stepping Up Initiative helps agencies within counties work together more effectively to reduce the number of individuals with mental illness in jails and to improve access to mental health services in the community. This study will compare Stepping Up counties to matched comparison counties over time to (1) examine the effectiveness of Stepping Up and (2) test hypothesized implementation mechanisms to inform multi-agency implementation efforts more broadly. Methods The study will survey 950 counties at baseline, 18 months, and 36 months in a quasi-experimental design comparing implementation mechanisms and outcomes between 475 Stepping Up counties and 475 matched comparison counties. Surveys will be sent to up to four respondents per county including administrators of jail, probation, community mental health services, and community substance use treatment services (3800 total respondents). We will examine whether Stepping Up counties show faster improvements in implementation outcomes (number of justice-involved clients receiving behavioral health services, number of behavioral health evidence-based practices and policies [EBPPs] available to justice-involved individuals, and resources for behavioral health EBPP for justice-involved individuals) than do matched comparison counties. We will also evaluate whether engagement of hypothesized mechanisms explains differences in implementation outcomes. Implementation target mechanisms include (1) use of and capacity for performance monitoring, (2) use and functioning of interagency teams, (3) common goals and mission across agencies, and (4) system integration (i.e., building an integrated system of care rather than adding one program or training). Finally, we will characterize implementation processes and critical incidents using survey responses and qualitative interviews. Discussion There are few rigorous, prospective studies examining implementation mechanisms and their relationship with behavioral health implementation outcomes in justice and associated community behavioral health settings. There is also limited understanding of implementation mechanisms that occur across systems with multiple goals. This study will describe implementation outcomes of Stepping Up and will elucidate target mechanisms that are effective in multi-goal, multi-agency systems.

scholarly journals Examining Access to Psychiatric Care in Michigan’s Upper Peninsula

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Jenna Bernson ◽  
Peter Hedderich ◽  
Andrea L. Wendling
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Substance Use ◽  
High Risk ◽  
Mental Health Services ◽  
Health Services ◽  
Health Resources ◽  
Care Physician ◽  
Upper Peninsula ◽  
Health Service Provision

Introduction: There is a shortage of mental health services in rural America, and little research is focused on rural underserved communities. Our aim was to identify and map clinical mental health services located in the Upper Peninsula of Michigan (UP) and explore primary care physician (PCP) mental health service provision and barriers to access experienced by this population. Methods: We mapped clinically active psychiatrists and inpatient psychiatric units in the UP, and identified high-risk regions based on &gt;30 mile distance to ambulatory services or low inpatient bed to population ratio. We surveyed PCPs in identified high-risk areas regarding provision of mental health services, comfort with providing services, and perceived barriers to care. Results: Half of UP counties had no psychiatrists, and only two counties had inpatient psychiatric beds. PCPs are attempting to fill gaps in care, and report comfort with treating depression and anxiety, but less comfort with treating with bipolar disorder and substance use. Nearly all PCPs report barriers to accessing mental health resources; 70% report no psychiatrists to whom they can readily refer. Conclusion: Michigan’s UP has a shortage of mental health resources. Proposed strategies to confront this shortage include additional training of PCPs for substance use and bipolar disorder, bolstering the mental health workforce, and improving access to consultative services.

scholarly journals Prevalence and Correlates of Suicidal Ideation and Deliberate Self-harm in Canadian Adolescents During the Coronavirus Disease 2019 Pandemic

2021 ◽  
pp. 070674372110366
Author(s):  
Brianna J. Turner ◽  
Christina L. Robillard ◽  
Megan E. Ames ◽  
Stephanie G. Craig
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Suicidal Ideation ◽  
Mental Health Services ◽  
Health Services ◽  
Online Survey ◽  
Warning Signs ◽  
Deliberate Self Harm ◽  
Health Concerns ◽  
Self Harm

Objective In light of recent evidence that the coronavirus disease 2019 (COVID-19) pandemic has resulted in marked increases in depression, anxiety, substance use, and other mental health concerns among Canadian adolescents, we investigated the rates of self-harm thoughts and behaviours in this population. Specifically, this study explored: (1) the demographic and geographic distributions of suicidal ideation (SI) and deliberate self-harm (DSH), and (2) the associations of mental health and substance use with SI and DSH. Method A total of 809 Canadian adolescents, aged 12–18 years, completed an online survey between June 17, 2020 and July 31, 2020. Results 44% of adolescents reported experiencing SI since the pandemic began, while 32% reported engaging in DSH. SI and DSH were more common among youth who: identified as transgender, non-binary or gender fluid; who did not reside with both parents; and who reported psychiatric concerns or frequent cannabis use. Conclusion Canadian adolescents appear to be experiencing higher rates of self-harm thoughts and behaviours relative to before the COVID-19 pandemic. It is important for adults who are likely to interact with distressed youth to be aware of potential warning signs that a youth is struggling with self-harm, and to refer youth to specialty mental health services where appropriate.

scholarly journals Protocol for the Implementation Mechanisms of Stepping Up (I.M. Stepping Up) Study, a Longitudinal Natural Experiment Examining Implementation Mechanisms to Improve Mental Health and Substance Use Services for Justice-involved Individuals in 950 Stepping Up and Comparison Counties Across the U.S.

2021 ◽  
Author(s):  
Jennifer E. Johnson ◽  
Jill Viglione ◽  
Niloofar Ramezani ◽  
Alison Cuellar ◽  
Maji Hailemariam ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Health ◽  
Justice System ◽  
Natural Experiment ◽  
Implementation Outcomes ◽  
Matched Comparison ◽  
The U.S

Abstract Background. The criminal justice system is the largest provider of mental health services in the U.S. Many jurisdictions are interested in reducing the use of the justice system for mental health problems. The national Stepping Up Initiative works with counties to reduce the number of individuals with mental illness in jails and to improve access to mental health services in the community. The Implementation Mechanisms of Stepping Up (I.M. Stepping Up) Study leverages a large natural experiment created by comparing Stepping Up counties to matched comparison counties over time to examine implementation mechanisms and outcomes. Methods. The study will survey 475 Stepping Up counties and 475 matched comparison counties at three waves: baseline, 18 months, and 36 months. Surveys will be sent to up to four respondents per county including administrators of jail, probation, community mental health services, and community substance use treatment services (3,800 total respondents). Implementation target mechanisms include: (1) use of and capacity for performance monitoring; (2) use and functioning of interagency teams; (3) common goals and mission across agencies; and (4) system integration (i.e., building an integrated system of care rather than adding one program or training). We will examine whether Stepping Up counties show a faster rate of improvement in hypothesized target mechanisms between Wave 1 and subsequent assessments (i.e., Waves 2 and 3) than do comparison counties (primary). We will also examine whether Stepping Up counties show a faster increases in implementation outcomes (number of justice-involved clients receiving behavioral health services, number of behavioral health evidence-based practices and policies [EBPPs] available to justice-involved individuals, and resources for behavioral health EBPP for justice-involved individuals). We will evaluate whether engagement of hypothesized mechanisms explains differences in implementation outcomes. Finally, we will characterize implementation processes and critical incidents using survey responses and qualitative interviews. Discussion. There are few rigorous, prospective studies examining implementation mechanisms and their relationship with behavioral health implementation outcomes in justice and associated community behavioral health settings. There is also limited understanding of implementation mechanisms that occur across systems with multiple goals. This study will elucidate target mechanisms in multi-goal, multi-agency systems.

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