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Focusing on gaps in services for people with opioid addiction



For the Gazette
Monday, July 23, 2018

Early in her time working to prevent opioid deaths, Marisa Hebble had a front-row seat to tragedy. As coordinator for a new opioid task force, she worked in the former Franklin County Courthouse. From that vantage point, she watched people with opioid misuse disorder face criminal charges in one courtroom, grandparents seeking custody of children whose parents were addicted to opioids in another. She witnessed anguished family members desperate to help loved ones they feared might die.

She saw that pain and confusion, all consequences of the opioid epidemic, and wondered: How could conditions change to better help people entwined with both addiction and the law? Was there a way to reach people before the disease of addiction landed them in a jail cell?

“I was watching the real conveyor belt of the district court and how the courts were really scrambling to keep up with the science and the opioid crisis,” she said. “I hadn’t recognized how much the justice system deals with mental illness and addiction until that moment.”

Now an employee of the Massachusetts Trial Court, Hebble works with the Massachusetts Community Justice Project, which is taking aim at this problem. The project is an initiative of the Trial Court’s Task Force on Substance Abuse and Mental Health, launched by Chief Justice Paula M. Carey three years ago to review the trial court’s responses to people experiencing addiction and mental illness.

Using a process known as sequential intercept mapping, the community justice project has held 18 workshops across the state, with more planned. If “sequential intercept mapping” sounds like jargon, this is what it means: key players within the jurisdiction of a particular court gather for work sessions to reveal places within the system that individuals could be helped off that conveyor belt of addiction and incarceration. Could someone receive help when arrested to avoid a jail sentence and head toward recovery? Might appropriate services in jail or upon release prevent a return to jail? At each of these key “intercepts,” what additional support could prevent greater involvement with the criminal justice system?

For two days in early June, 50 people met in the Northampton Senior Center for one such workshop focused on Northampton District Court. Participants were already deeply familiar, from professional or personal experience, with the toll the opioid crisis is taking: probation officers, mental health professionals, lawyers, social workers, a judge, a minister, police officers, people in recovery and others involved in the opioid crisis.

Hebble and co-leader Benjamin H. Cluff, veterans’ services coordinator for the state Department of Public Health Bureau of Substance Abuse Services, led participants through a series of large group discussions and small group activities. Data underscored the urgency of the work:

Not since the AIDS epidemic has Massachusetts seen such a sharp increase in one cause-of-death category.

Nearly 1 in 10 people who have experienced a non-fatal opioid overdose die within two years.

Opioid death rates are 120 percent higher for people who have a history of incarceration.

In a nutshell, people suffering from mental health and substance use disorders disproportionately find themselves arrested and jailed for behaviors related to their illnesses. That is no big surprise, of course, nor is this: Because jail is not the best place for people with substance use disorders to get help, once released, many repeat the behaviors and land back in jail. Intercept mapping aims to stop that cycle.

Participants in the Northampton workshop discussed barriers to treatment and points at which individuals might accept help. They discussed gaps in services and got to know each other better — a step toward smoother working relationships that can fill in some of those gaps.

“We’re really trying to increase the collaboration,” Hebble said. “I’m talking about specific, effective collaboration because we can’t solve this problem with any one sector.”

Hampshire Sheriff Patrick Cahillane noted that when they arrived, participants selected seats in distinct groupings: jail employees, courthouse personnel, police, treatment providers. Such divisions get in the way of matching people with services, he said

“This is a piece of what we’ve got to talk about. Collaboration is survival for all of us if we’re going to make things right,” he said. “We all have a role to play in reducing the number of deaths and the level of addiction. Going to jail should not be the norm in any part of the Commonwealth to get the treatment they need, but in many cases it is.”

The mapping workshops are largely an assessment tool, Hebble said, with the real work coming when participants figure out how to bring the priorities into focus. After a workshop in Franklin County last year, participants worked on increasing parenting support, expanding treatment options, adding crisis services dedicated to children and youth and training “navigators” to be resource specialists for individuals needing help.

Northampton workshop participants brainstormed a long list of ideas to improve prospects for people facing addiction and mental health issues, and then narrowed that down to these priorities:

Develop low-threshold shelter and housing (places that do not require abstinence);

Create a navigator system;

Create specialized services for people with complex mental health issues or cognitive impairment;

Push for more specialty courts for people with substance misuse and mental health disorders;

Engage in street-level outreach and harm reduction to work with drug users.

To turn priorities into action, communities need what Hebble termed a champion, which in Hampshire County will be Hampshire HOPE, the county-wide, multi-sector coalition already at work on responding to the opioid crisis.

J. Cherry Sullivan, Hampshire HOPE coordinator said “by taking a deeper dive into what the issues are,” the workshop created a blueprint for the coalition’s work over the next few years.

In the nearly two months since the mapping workshop, Sullivan said, the group has held several meetings to revamp policies that aren’t helpful in getting services to the people most in need.

For example, shelter or housing policies that require people to be abstinent get in the way of reaching some drug users who need help.

“You can’t expect people to work on a substance use disorder if they’re not housed,” she said.

“We want to change systems, and that’s where the real work in public health is,” she said.

Laurie Loisel is director of community outreach and education for Northwestern District Attorney David E. Sullivan and part of the Hampshire HOPE opioid prevention coalition run out of the city of Northampton’s Health Department. Members of the coalition contribute to a monthly column in this space.