As part of the mental health division of one of the largest safety-net health care systems in the Midwest, we come face to face with the opioid crisis and the lives it claims every day. One important lesson we have learned in treating people with substance use disorders is that we can’t just rely on an excellent clinical team — we also need lawyers to help address critical social issues that arise for our patients during recovery.
Marcia (not her real name) is in recovery at Eskenazi Health Midtown Community Mental Health in Indianapolis. She got her first job in several years with help from a job coach and her care team. This was a huge step for Marcia, but it was almost derailed by a miscommunication between her car insurance company and the state’s Bureau of Motor Vehicles. The state suspended Marcia’s driver’s license after a car accident, saying she had failed to provide proof of insurance. But she had done that. If Marcia couldn’t drive to work, she would lose her job, jeopardizing her recovery. If she drove without a license, she risked her safety and her freedom.
We referred Marcia to our medical-legal partnership program. Within two weeks, her license was reinstated and she was able to keep the job that was so vital to her recovery.
Marcia’s story highlights the reality that many people need more than excellent clinical care for successful recovery. The Substance Abuse and Mental Health Services Administration says that recovery is best supported when people live in stable housing, have purpose (such as working or parenting or going to school), and are part of a supportive community. Many people with opioid-related substance use disorders are estranged from family and other natural supporters, and are often living in poverty. They need more specialized services, including legal help, to achieve and sustain recovery. That is certainly true of many of the patients we see.
Four years ago, Midtown formed a partnership with Indiana Legal Services. Attorneys work in the clinic to provide civil legal aid to patients in situations similar to Marcia’s. They work with the clinical team to break down structural barriers that get in the way of attaining support services. Many of these systemic and policy barriers are based on false stereotypes about treatment and stigma around substance use disorders.
Lawyers in our clinic help people stay in their homes when they have been threatened with eviction. They expunge criminal records that make it difficult to find employment. They also help people in recovery maintain or regain custody of their children. Lawyers are uniquely capable of navigating these complex systems, and we need their expertise on our recovery team.
Essential clinical services, such as providing medication to address cravings for opioids, instituting behavioral health counseling, and recommending support groups, are the keystones for successful recovery. Integrating legal aid with them ensures more complete and coordinated care.
Many individuals with a substance use disorder have had some involvement with the criminal justice system, and may distrust lawyers and the legal system. That trust can be rebuilt with a referral to legal help through a health care provider. Because many people don’t realize that a problem they face may have a legal solution, they don’t seek out legal help on their own. Having attorneys available for consultation in a health care setting is an effective way to reach many individuals who would not access help otherwise.
The Midtown partnership isn’t unique. The National Center for Medical-Legal Partnership estimates that there are currently 373 such partnerships at health care organizations across the country, addressing a variety of medical conditions and populations. Initial studies show positive linkages between legal services and health care utilization and patient well-being. A recent study conducted at Veterans Affairs medical centers, for example, demonstrated stronger housing and mental health outcomes for vulnerable veterans who received help from a medical-legal partnership.
Responding to the opioid crisis and preventing more lives from being lost requires an all-hands-on-deck approach. We see medical-legal partnerships as a key step in the way forward. Over the next year, we plan to significantly expand our medical-legal partnership program by working with Indiana Emergency Management Services to quickly provide legal help as part of wraparound services to individuals soon after an overdose. We encourage other health care organizations to integrate civil legal aid as part of their holistic recovery strategies.
Gregory Singleton, M.D., is the chief medical officer at Eskenazi Health Midtown Community Mental Health and assistant professor of clinical psychiatry at Indiana University School of Medicine. Jay Chaudhary, J.D., is the managing attorney and director of medical-legal partnerships at Indiana Legal Services, and adjunct faculty at Indiana University Richard M. Fairbanks School of Public Health.