In the Business of Keeping People Alive: Notes from a Public Health Judge
Hon. Patrick Shannon, MPH ’92
Chief Judge, Saginaw Chippewa Tribal Court
April 14, 2020, Alumni, Health Management and Policy, MPH, Adolescent Health, Chronic Disease, Epidemic, Health Disparities, Mental Health, Michigan, Opioids, Pain Management, Pharmaceuticals
Monday mornings at the Saginaw Chippewa Indian Tribal Court in Mount Pleasant, Michigan, are usually very busy. This is when Chief Judge Patrick Shannon holds adult substance misuse hearings. In lay terms, this is “drug” or “treatment court.”
“We have seen every kind of substance here since I have been a tribal judge, but nowadays it’s mostly all hydrocodone, oxycodone, morphine, and especially fentanyl,” says Shannon, who studied Health Management and Policy at the School of Public Health.
Instead of handing out jail sentences, Shannon can choose to sentence offenders to addiction and medical treatment.
On Mondays, Shannon sees firsthand the spectrum of problems that arise from the current national opioid epidemic. The stories go well beyond what laws were violated into areas of abuse, neglect, family, and mental health. Instead of handing out jail sentences, Shannon can choose to sentence offenders to addiction and medical treatment.
Hospital Beds versus Jail Beds
“I think historically in court systems, the idea was to put people in jail and not deal with the problem," says Shannon. "With treatment court, it’s hospital beds versus jail beds. We’ve reduced jail time 50 percent in the last year. We have an addiction specialist on staff and a nurse on our team to help us review cases. It's incredible to have their input in sentencing.”
Shannon's courtroom is just one window into the epidemic across the state of Michigan. In 2017, Michigan had 2,033 overdose deaths involving opioids, a 93 percent increase from those reported in 2014 and a significantly higher percentage than the national rate.
The judge credits his education at the University of Michigan School of Public Health with giving him the tools needed to help transform the tribe’s approach to what has become a very complicated epidemic.
Shannon has a bachelor's degree from Central Michigan University (CMU) in business, a law degree from the University of Detroit, and a doctorate in education from CMU. But the judge credits his education at the University of Michigan School of Public Health with giving him the tools needed to help transform the tribe’s approach to what has become a very complicated epidemic.
“We really have put on the public health approach,” says Shannon. “How do you prevent it, how do you intervene, where do you intervene, and then, how do you treat it?”
Since the drug court started in 2013, not only have tribal incarceration rates been halved, but the Tribal Court has also partnered with the local county sheriff to help insure that Medical Assisted Treatment (MAT) is more available to incarcerated individuals struggling with substance use disorders, resulting in reduced overdose deaths.
“My Attitude Has Really Changed”
Shannon grew up in Belding, Michigan, a small town near Grand Rapids. After completing his undergraduate studies and meeting his wife-to-be on Mackinac Island while working there one summer, he received his law degree and began practicing in the Upper Peninsula. In 1980, he began working with the native tribal community on the landmark fishing case US v. Michigan, which resulted in the official recognition of tribes’ inherent ability to regulate themselves and have their own courts. After that, he was elected county prosecutor of Michigan’s Chippewa County for five terms while also working as a prosecutor for different tribal courts.
“We recognized a few years ago we're in the business of keeping people alive now. I wouldn't have thought that 30 years ago because I was a young prosecutor and pretty aggressive. My attitude has really changed.”
“I saw people die. I had them in the courtroom and then I'd release them from jail and they'd be dead in three days.”
When asked how his views on best approaches to the opioid epidemic have changed over time, his answer is simple: “I saw people die. I had them in the courtroom and then I'd release them from jail and they'd be dead in three days. It was because they would get clean while they're in jail and then come out and use at the same level—whatever they were using—and they'd die. I just never want that to happen again, so I really had to learn more about this.”
Even though it can be very frustrating, Shannon looks forward to Monday mornings. A real “people person,” he enjoys building relationships with the tribe members he sees and strives to treat each individual with respect. When he talks about the court’s success stories, Shannon’s smile says volumes.
“We stopped calling our folks defendants and refer to them now as clients. Sometimes they fall along the wayside. But what I've discovered is that some of them learn a great deal, have applied what they learned, and are successfully overcoming many of the issues they've had.”
Sharing the Message
So far, the Saginaw Chippewa Indian Tribe has sponsored two Tribal, State, and Federal Opioid Summits. At those events, Shannon and other staff members share what they have learned over the past six years, with workshops designed to help advance this model of a more client-centered, multidisciplinary approach to dealing with the current opioid crisis. Most importantly, Shannon sees these summits as a way to bring Michigan’s many stakeholders together.
“I'll be real frank. We haven't done a good job in this state. There are 83 different counties and each county is trying to do something—but in 83 different ways. There are a lot of good things happening in Michigan, but we all need to be at the table. We want to get everyone involved.”
“Our advice to other professionals working in similar treatment courts,” says Shannon, “is to consider the basic principles of public health as you work toward promoting a more collaborative, client-centered, and productive approach for justice.”
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