CLARK COUNTY — Legislation aimed at reducing overdose and suicide deaths in Indiana has already garnered overwhelming support at the statehouse, and some Clark County leaders are getting a head start.
Indiana House Bill 1182, which would allow greater access to information related to deaths from overdose or suicide for purposes of seeking preventive measures, passed the Indiana House committee 98-0 Tuesday.
It is authored by Rep. Ed Clere, co-authored by Rep. Rita Fleming and sponsored in the Indiana Senate by Ron Grooms.
If passed, the legislation would support the formation of multi-disciplinary, county-level Suicide and Overdose Fatality Response teams, by opening doors to what kinds of records the groups — whose members agree to confidentiality of information — can access. It would also protect such information from being harvested by third parties for other purposes, such as in court proceedings or other unrelated matters.
A GRASSROOTS EFFORT
In Clark County, a team has already been formed in anticipation of the legislation. It includes Beth Keeney, senior vice president for Community Health and Primary Care Services at LifeSpring Health Systems, and Clark County Health Officer Eric Yazel, who initially approached Rep. Clere about drafting it. Clark County Prosecutor Jeremy Mull and Coroner Billy Scott are also part of the team.
"The purpose of the team is really to look at each of these types of fatalities in depth and identify patterns and trends to see if there are system or community-level improvements that can be made," Keeney said.
For example, Keeney said among the six other Indiana counties with similar programs in place, one found that in a considerable number of suicide deaths, there had been a divorce filed within the previous year.
"So they were able to implement screenings to family court along with referrals for people that needed further assistance," she said.
With overdose deaths, the team will look to see if there's correlation between the substance use disorder and things like not having access to medication or treatment, not having access to the opioid overdose reversal drug Narcan or having recently left jail.
"The point is we don't really know, because nobody's looking," Keeney said.
CLOSING THE GAPS
Clark County Health Department numbers show a fairly steady rate of deaths attributed to suicide over the past five years, fluctuating between 17 and 19 deaths per year between 2015 and 2019.
For overdose deaths, numbers have been less stable — 2014 and 2015 hovered just over 50 deaths per year before a spike in 2016 to 89. By 2019, that had dropped again to 47.
The spike has been attributed in large part to where Clark County was in the midst of the opioid and addiction crisis, and Yazel, the Clark County health officer, said the drop is likely due to measures taken by local government and community agencies in response to it.
He said this includes the syringe exchange program opened in early 2017, the addition of problem-solving courts to help those experiencing addiction, wider availability of intensive outpatient programs and medication assisted treatment and a lot of community education and outreach.
"What we offer somebody who needs help today versus five years ago, the difference is astronomical," he said.
But he said the fact that there were still 47 overdose deaths in 2019 shows something is missing.
"Overdose deaths have gone down but they've kind of plateaued," he said. "It's my suspicion that there's a whole subset of our population that we're missing in our efforts and I think this...review team will help us figure out how to reach that and hopefully [take] the next step to help."
He said combining the response team to include both overdose and suicide deaths was a natural fit; so often the issues of one overlaps the other.
"People who have substance use disorder have a higher rate of suicide, and people who [die by suicide] have a higher rate of using drugs," Yazel said. "You really have to [look at] both to be effective."
MAKING AN IMPACT
Clere, who drafted the legislation as part of a bill which modernizes the language surrounding HIV, said he was very open to supporting the teams, which he believes could help push the envelope in reducing stigma and creating a greater understanding of addiction and suicide.
"I think that's exactly what's needed here," he said. "Making additional progress is going to require this sort of approach. Clark County has been a leader in this, including harm reduction. I hope other counties, including Floyd County, can follow suit."
Although there is no funding attached specifically with this legislation, Clark County will be using a portion of state grant funds to further it — $10,000 to aid the coroner in data collection and $2,500 for implementation.
"It has the potential to make a tremendous impact at very little public expense," Clere said.
Records sought used by the teams could include health department and Department of Child Services files, law enforcement and school disciplinary records, coroner and autopsy reports, and others.
The legislation specifies that any records, documents or reports acquired or produced by a response team are "not subject to subpoena or [court] discovery," and not admissible as evidence in a case.
Ross Silverman, professor of Health Policy and Management at the Indiana University Richard M. Fairbanks School of public Health at IUPUI, agreed with the legislation's authors and supporters that this is a crucial piece in making the programs reach full potential.
"There are a lot of laws in place that prevent full information sharing within these groups across organizations," he said. These include things like HIPPA, and other privacy laws.
"You need to have the law in place that grants permission to these groups to have a fuller discussion about mental health, substance use [and] health care issues," he said. "To have all of these groups talking together requires the umbrella protections for the nature of those conversations, as well as permissions to share information within those groups."
Silverman was part of a research team who studied several pilot counties in Illinois who formed teams over about 18 months. Although a formal report of the study hasn't been released, what researchers found was that there were in fact people slipping through the cracks, and that often there was overlap in suicide deaths and people experiencing addiction.
"I think the challenge with ensuring appropriate, consistent service to these very vulnerable populations is people falling through any number of cracks between agencies," Silverman said. "I think this really helps tighten up the connections. It just gets everybody in a room talking together, keeping everybody updated on best practices."
For LifeSpring's Keeney, who has fought for the legislation in these early stages, including testifying at the statehouse, it's about improving the health of the community, and tapping into resources for preventable deaths.
"The point is, one [death] is too many," Keeney said. "It is not a peer review, it is not to place blame...it really is to say where could we have improved and then figure out how to do it."