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August 16, 2019

Inmate Suicides, India and Kashmir, Health Care: RAND Weekly Recap

This week, we discuss Jeffrey Epstein's death and how to prevent inmate suicides; India and Kashmir; the surge of synthetic opioids; Iran's relationship with the Taliban; California's effort to reduce surprise medical bills; and how to improve mental health care for veterans.

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Inmates receive medical attention at the California Medical Facility in Vacaville, California, March 17, 2010

Photo by Robert Galbraith/Reuters

Reducing Suicide in Correctional Facilities

This past weekend, financier Jeffrey Epstein, a convicted sex offender and accused sex trafficker, died by a possible suicide in a New York City jail. Guards were required to check on Epstein every half-hour. But he was reportedly left alone for three hours before his body was discovered.

Somewhat lost in this story is a broader challenge: People who are incarcerated are at greater risk of taking their own lives. In fact, suicides account for more than 35 percent of jail deaths. According to a 2017 RAND study that examined the challenges in preventing all types of inmate deaths, correctional facilities need to increase adoption of best practices in suicide risk assessment and prevention.

Kashmiri women walk past an Indian security personnel during restrictions after the scrapping of the special constitutional status for Kashmir by the government, in Srinagar, August 11, 2019, photo by Danish Siddiqui/Reuters

Kashmiris walk past Indian security personnel in Srinagar, Jammu and Kashmir, August 11, 2019

Photo by Danish Siddiqui/Reuters

India Ends Autonomy for Kashmir

Last week, Prime Minister Narendra Modi revoked the part of the Indian constitution that gave the state of Jammu and Kashmir special autonomous status. What might happen next? According to RAND's Rafiq Dossani, Modi could use his new authority to invest in human development and clean governance in Kashmir. This would attract national and international goodwill. Based on Modi's recent re-election, the Indian people think he is the best bet for the future. Hopefully, that will also be true for Kashmiris, says Dossani.

Overdose rescue kits on a table during an Opioid Overdose Prevention Training class provided by Lourdes Hospital in Binghamton, New York, April 5, 2018

Overdose rescue kits on a table during an Opioid Overdose Prevention Training class provided by Lourdes Hospital in Binghamton, New York, April 5, 2018

Photo by Andrew Kelly/Reuters

Synthetic Opioids: A U.S. Public Health Emergency

Synthetic opioids, primarily fentanyl, were involved in two-thirds of all U.S. opioid-related deaths in 2018. A new RAND report examines the rise of these substances. While the problem is concentrated in the eastern half of the country for now, use of synthetic opioids may spread. Additionally, about half of cocaine overdose deaths also include synthetic opioids. This suggests that people who use cocaine are increasingly exposed to these drugs (although the reason for this is unclear).

Iran's Foreign Minister Mohammad Javad Zarif speaks during a news conference in Tehran, Iran, August 5, 2019, photo by Nazanin Tabatabaee/WANA/Reuters

Iran's Foreign Minister Mohammad Javad Zarif speaks during a news conference in Tehran, Iran, August 5, 2019

Photo by Nazanin Tabatabaee/WANA/Reuters

Iran-Taliban Relationship Could Affect U.S. Withdrawal from Afghanistan

In late 2018, it became clear that the United States was contemplating a withdrawal from Afghanistan. Shortly after, Iran acknowledged that it was meeting with the Taliban. How might this newly publicized relationship affect the future of U.S.–Taliban talks? RAND's Ariane Tabatabai explains: Iran has not yet complicated or derailed these negotiations, but it could. Also, the Taliban could leverage its ties to Tehran to make fewer concessions to Washington.

Pen on Medical insurance statement, photo by Snehitdesign/Getty Images

Photo by Snehitdesign/Getty Images

Reducing Surprise Medical Bills

Many patients receive large, unexpected medical bills—even when they are treated at hospitals within their insurance network. California recently aimed to address this by passing a law that limits the fees that out-of-network physicians can charge for care delivered in hospitals. According to a new RAND study, the law appears to be protecting patients from surprise bills. But there have also been some unintended consequences. Namely, bargaining leverage for payments is shifting in favor of insurance plans.

A licensed clinical social worker listens to her client during a therapy session at the Bay Pines Veterans Administration Healthcare Center in Bay Pines, Florida, October 29, 2015, photo by EJ Hersom/DoD News

A licensed clinical social worker listens to her client during a therapy session at a health care center in Bay Pines, Florida, October 29, 2015

Photo by EJ Hersom/DoD News

How to Improve Mental Health Care for Veterans

Roughly one in five U.S. veterans experiences mental health problems, such as PTSD, major depression, and anxiety. Risks for such conditions are especially high for veterans who deployed overseas. After conducting several studies on this issue, what have RAND researchers found? A new research brief outlines six broad recommendations to help ensure that those who serve receive the high-quality care that they need.

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