New England Sees 900% Increase in Organ Donations Tied to Opioid Epidemic


October 14, 2016; NPR, “Shots”

This year, some hospitals in Massachusetts, like Lahey Hospital and Medical Center in Burlington, have dramatically increased the number of organ transplants they perform. The sources of these lifesaving gifts are the victims of the opioid epidemic. Although the increase in available organs represents hope for some and brings a small degree of comfort to the families of those lost to deaths from drug abuse, the wait continues for many more on the transplant list as well as families of addicts seeking services.

On June 30, 2015, Colin LePage found his thirty-year-old son, Chris, unresponsive after an apparent drug overdose. Over the next 24 hours, medical personnel from one of Boston’s largest medical centers revived Chris’s heart but struggled to stabilize his blood pressure and temperature. After two rounds of tests displayed no sign of brain activity, LePage listened to his son’s beating heart one last time before Chris was wheeled away. Although Chris died that day, his liver continues to function in a new body, that of a 62-year-old pastor.

The liver represents just part of the dramatic increase in New England organ donations since 2010, according to the New England Organ Bank, the organization responsible for gathering the organs in the six New England states. The expansion is due to the growing number of organ donors who fell victims to the growing epidemic of opioid abuse. Since the beginning of the year, more than one in four organ transplants in the New England area originated from people suffering a drug overdose. Nationwide, organs from deceased drug users accounted for 12 percent of all donations this year. Traffic accidents used to be the fourth-largest source of organ donation, behind deaths from strokes, blunt injuries, and cardiovascular disease, but drug overdoses, now the fastest growing category of organ donor, eclipsed them in 2014.

Before the epidemic took hold, organs from drug users were considered too risky for transplant. Drug users have long been associated with HIV, hepatitis C and other diseases. Although contraction from transplants is rare, tests have sometimes failed to detect infectious diseases, leading to donors contracting the diseases. (For example, in 2007, one donor transmitted both HIV and hepatitis C to four organ recipients.)

But as the shortage of organs continues to grow, the number of opioid overdose victims rises, and testing procedures improve, more people are receiving these donated organs. “We know now that the mortality rate of being on the waiting list for several years is higher than that of getting an organ with an infection that is treatable,” said Dr. Robert Veatch, a professor emeritus of medical ethics at Georgetown University, who has authored numerous articles on organ transplants. At the same time, recipients with HIV can receive organs from donors with HIV without additional risk. Earlier this year, surgeons from Johns Hopkins University Medical Center performed the first transplant of this kind.

“It’s an unexpected silver lining to what is otherwise a pretty horrendous situation,” said Alexandra K. Glazier, chief executive of the New England Organ Bank.—Gayle Nelson

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Nonprofits Respond to Connection between PTSD and Intimate Partner Violence


April 27, 2016; NPR, “Shots”

Veterans who have experienced combat are over six times more likely to suffer from post-traumatic stress disorder (PTSD) and over four times more likely to abuse their spouse or partner compared with other men. Since the violence stems from a source that differs from other intimate partner violence situations, the warning signs and circumstances surrounding the abuse differ as well.

As the number of veterans returning home from multiple tours of war has grown, nonprofit organizations serving them have developed. But a gap persists when it comes to the development of programs geared to the needs of their partners and spouses who experience domestic violence.

Author Stacy Bannerman called a hotline serving military families after her husband, a former national guardsman who recently returned from his second tour of duty, abused her. Stacy’s husband experienced trauma during his tour in Iraq and developed PTSD. During their eleven-year marriage, Stacy’s husband had never before acted this way. What she also did not expect was the hotline operator’s reaction. The operator began to cry; as she explained, she had experienced so many similar phone calls.

Although many veterans suffering from PTSD are not violent, growing research suggests vets with PTSD are three times more likely to carry out intimate partner violence, according to Dr. Casey Taft, a head researcher with the Department of Veterans Affairs. They are also two to three times more likely to suffer from depression, substance abuse and unemployment. Eighty-one percent of vets suffering from depression and PTSD committed at least one violent act against their spouse or partner within the last year.

Violence committed by combat veterans often has its own distinguishing pattern that varies significantly from other intimate partner violence. Instead of the power-and-control cycle of other abusive relationships, veteran interpersonal violence tends to involve only one or two “extremely violent and frightening episodes that quickly precipitate treatment seeking.”

Families seeking treatment face multiple challenges. One of the most prominent is that the services the families depend on are focused on the individual needs of the veterans, not their families. Additionally, many nonprofits serving vets’ families often ignore intimate partner violence, and organizations serving intimate partner violence survivors do not have the expertise to serve veterans’ families.

One organization with a program created by vets for vets is the Domestic Abuse Project’s (DAP) Change Step program. Change Step integrated the military culture and language into the proven mainstream curriculum. It addresses the specific issues combat vets experience, including multiple deployments and PTSD.

Spouses and partners seeking to leave abusive vets also face barriers. Often, they are caregivers; the family receives income from the VA for their services, and once they leave, this income stream disappears. Additionally, many vets would be unfavorably discharged and lose their benefits if the abuse were reported.

Stacy has a long history of supporting other military families. She is the author of When the War Came Home: The Inside Story of Reservists and the Families They Leave Behind(2006). Her newest book, Homefront 911, describes how war destroys military families. She fought for the Military Family Leave Act of 2009 and received the Patriotic Employer Award and the Above & Beyond Award from the Employer Support of the Guard & Reserve.

Bannerman is currently fighting for introduction of the Kristy Huddleston Act in Congress. The Act is named after Stacy’s friend and fellow military wife. Kristy was a nurse and worked for the VA before she was murdered by her husband, a U.S. Marine combat vet who served three tours of duty in 2012. The proposed legislation, if a sponsor can be found to introduce it and it is subsequently passed by Congress, would provide financial support to military wives and their children when a service-member is found guilty of domestic abuse.—Gayle Nelson

The Promise of Partnerships between Mental and Physical Health Services


February 23, 2016; CNN (Kaiser Health News)

Serious mental illness (SMI), including schizophrenia, bipolar disorder, and major depression, affects more than 9.5 million adults, almost four percent of adults living in the United States. A 2006 report from the National Association of State Mental Health Programs revealed adults suffering from SMI die an average of twenty-five years earlier than those without these conditions, and that the rate is rising. Grants funded through the federal Substance Abuse and Mental Health Services Administration (SAMHSA) indicate locating physicians and other physical medical partners in mental health clinics improves physical health in this needy population.

Although Tracy Young has to take two buses to San Fernando Mental Health Center, she never misses an appointment. The fifty-year-old describes these appointments as key to controlling her depression and schizophrenia.

Unfortunately, like many people suffering from mental illness, Young did not always receive regular medical care. The lack of essential care leads to a higher percentage of people with severe mental illness dying prematurely, often from treatable chronic diseases such as hypertension, diabetes, and obesity. It also leads to an increase in the cost of care and gaps in the care received.

Frequently, the barriers low income individuals suffering from mental illness face are due to transportation and lack of integrated care between the mental and physical health care systems. Increasing cooperation and communication between providers is a goal of the Affordable Care Act.

In the past, leaders focused on adding mental health services to physical health offices. Recent grants are focused on offering physical health services in mental health clinics, as is the case at San Fernando Mental Health Center. Joint clinics are in development in many states, including California, New York, Washington, and Florida. Many are funded by grants administered under the Primary and Behavioral Health Care Integration (PBHCI) program of SAMHSA. Since 2009, the department has awarded $150 million in grants for this purpose.

Clinics funded under the program received up to $500,000 annually to integrate physical and mental services. In 2014, The RAND Corporation evaluated fifty-six of these programs around the country. Their study revealed patients receiving primary care at their mental health clinic increased their control of their diabetes and hypertension. Results were not as positive for patients who smoked or suffered from obesity.

The clinics also reported early enrollment success measured by over half of patients using integrated services in the first year they were offered. But care specialists found it difficult to target those most likely to benefit from integrated care.

Although many of these clinics successfully developed models of co-locating behavioral and primary care services, they struggled to develop a joint culture and long-term funding.

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Wisconsin’s High Rate of Incarceration Taken Up by Grassroots Groups


Although the state of Wisconsin has a population similar to Minnesota, its prison population is roughly double. This translates into one in thirty-nine people, or 88,920, who are under the supervision of the state’s Department of Corrections. These responsibilities lead to a department budget of $1,290,784,000, which is expected to grow to $2.5 billion by 2019. These expenses contribute to a state budget deficit of two billion dollars. The state’s activities are increasingly under a microscope, as its governor prepares for a run for president.

Wisconsin’s Governor Scott Walker is expected to announce his presidential campaign next month. In preparation, he and other presidential contenders spoke at a forum hosted by Florida governor Rick Scott. In his speech, Walker discussed the country’s staggering prison population and highlighted his record handling nonviolent criminals. Specifically, he stated, “In our state, we have relatively few [people incarcerated for committing nonviolent offenses] compared to the federal government.” Then, Walker added, “The challenges in terms of people being incarcerated for relatively low offenses is not a significant issue in the state of Wisconsin.”

Sadly, according to many nonprofit organizations across the state, his record, unlike that of other presidential candidates including Ran Paul and former Texas Governor Rick Perry, does not completely match his declarations. Wisconsin’s prison population has more than tripled since the 1990s and its efforts are not cheap. In fact, theDepartment of Corrections budget of $2.315 billion is larger than the university system’s budget of $2.247 billion.

In addition, the state’s incarceration rate for minorities is much larger than all other states. According to one of the state’s largest newspapers, 12.8 percent, or one out of eight African American men between the ages of 18–64 are incarcerated. This rate is nearly double of the nation as a whole, as well as significantly higher than Oklahoma, which incarcerates the second-highest percentage, 9.7 percent. In the county with the largest population, Milwaukee County, over half of African American men in their thirties have served time in state prison.

One of the main reasons is the state’s truth-in-sentencing law introduced by then-legislator Walker. It took effect in December 31, 1999, and is one of the toughest in the nation. It requires all offenders regardless of their crime to serve every day of their sentence. Many other states have truth-in-sentencing laws, but they only apply toviolent crimes.

Another factor is the large number of people re-incarcerated after violating their parole. In 2013, the state sent 8,000 people to prison, and more than half were incarcerated because they broke a rule of their probation. Overall, the state spends more than $100 million a year housing people who violated their parole requirements. According to Mark Rice, who chairs a revocation workgroup for the criminal justicereform organization WISDOM, these offenses include using a computer or cellphone without authorization, entering a bar, borrowing money, or crossing county lines.

WISDOM is a grassroots organization of mostly religious congregations of many denominations advocating on social justice issues. About 160 congregations practicing nineteen different religious traditions participate in the group’s activities. One of their campaigns is 11×15, which fights for reducing the state’s prison population by half to 11,000 by the end of 2015 through the funding of alternatives to incarceration.

Governor Walker has focused resources on alternatives to incarceration that include day reporting centers and mental health and drug courts. These efforts have decreased the number of people incarcerated. Data from the Department of Corrections calculated the state’s recidivism rate of 14.3 percent in 2011—almost half the rate in 2009 of 30.1 percent.

Sadly, even if Wisconsin were able to achieve WISDOM’s goal of 11,000 by 2015, the state would still have a higher incarceration rate than the State of Minnesota.

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Princeton Joins New Jed & Clinton Health Matters Campus Program


In the face of a lawsuit and growing demand for mental health services in college campuses across the country, Princeton University joined over 55 other colleges and universities in becoming members of the Jed & Clinton Health Matters Campus Program.

The dynamic growth in the need for services on college campuses was documented in the 2013 National Survey of College Counseling Centers. The survey reached out to 203 college centers serving 1.8 million students. In these schools, the average percentage of students accessing services was 11.37 percent in four-year institutions and 12.9 percent in two-year institutions. The average ratio of counselors to clients at these schools was 1 to 1,604 students. The survey also found that smaller schools (those with fewer than 15,000 students) had considerably lower ratios than larger schools.

The number of students accessing services at counseling centers is overshadowed by the number experiencing mental illness or substance abuse. According to a 2010 survey by the American College Health Association, in the twelve months preceding the survey, 45.6 percent of students reported feeling that “things were hopeless” and 30.7 reported feeling “so depressed that it was difficult to function.” Additionally, according to a 2007 study by the National Center on Addition and Substance Abuse, half of college students participated in binge drinking, abused prescription drugs, and/or abused illegal drugs.

The Jed Foundation describes the Clinton Health Matters Campus Program as a “groundbreaking self-assessment and feedback program that helps colleges create more comprehensive solutions to support their students.” Current members of the program include schools in the Big Ten, Midwest liberal arts colleges, community colleges, and religious institutions. After a school joins the program, it takes a confidential self-assessment survey assessing current mental and substance abuse services and opportunities for enhancement. The survey leads to participation in four years of technical assistance activities to expand and enhance these services. The program was created this past June and is a partnership between the Jed Foundation and the Clinton Foundation’s Clinton Health Matters Initiative.

Princeton University’s mental health program has been under intense scrutiny recently after two students reported being pressured to drop out of school due to their medical conditions. One filed a federal lawsuit this past March alleging his confidentiality was violated when his medical records were turned over to campus security following his suicide attempt.

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