Judge approves settlement between DHSS and local advocacy group, limiting holds on mental health patients

The order was signed on Thursday following years of legal action
Published: Sep. 4, 2020 at 12:00 AM AKDT|Updated: Sep. 4, 2020 at 4:59 PM AKDT
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ANCHORAGE, Alaska (KTUU) - After a series of lawsuits spanning several years, and following a dispute prompted by the treatment of people in mental health crises, a settlement has been reached between the State of Alaska Department of Health and Social Services and the Disability Law Center.

The settlement was signed and approved by Judge William Morse on Thursday, and focused on how mental health patients — in particular, those under Title 47 holds, or involuntary commitments — were being held before receiving treatment from a health care professional. The Disability Law Center’s initial lawsuit, back in 2018, specifically targeted the elimination of the practice of holding mental health patients in emergency rooms and correctional facilities as they awaited services through the Alaska Psychiatric Institute, a state-run facility.

“In the fall of 2018, the civil commitment system was approaching a crisis,” according to the settlement. Back then, API had a capacity of about 80 patients, and 72-hour evaluations were being done at that facility, as well as three others across the state.

“API had, however, come under significant regulatory scrutiny due to high rates of patient seclusion and restraint, high rates of patient and staff injury, and it was in serious jeopardy of being forced to close,” court documents state. “In response, API implemented a capacity policy... respondents experienced longer wait times for admission to API for evaluation, and some respondents who had been picked up in the community were brought to correctional facilities because they could not be admitted directly to API for evaluation, and no hospital would admit them.”

Among other complaints, the DLC and petitioners represented by the Public Defender Agency maintained that the lack of timely evaluations, and holding people in jails as they await evaluations, is unconstitutional.

Included in the agreement are several provisions, such as DHSS committing to training peace officers to not bring people to jail when jail is not deemed appropriate; mental health professionals being sent to patients wherever they are, as is possible; the state providing monthly reports through the middle of 2021 showing where people were held and for how long; and the implementation of a system called “Crisis Now,” which, in general, seeks to make short-term stabilization centers more readily available for evaluations.

“A lot of what our settlement looks at is the future,” said DLC Legal Director Mark Regan. “The future is going to be a less intrusive, less institutional system called ’Crisis Now.’

“We do think we now have both an agreement that will be helpful for people, and a commitment from the state to ’Crisis Now,’” he added, “which wouldn’t have been in the picture until this past winter.”

Also detailed in the court documents is a requirement that DHSS reinstate its online data dashboard so that the public and law enforcement can once again track API’s daily capacity and the number of people on the facility’s waitlist. The department will also hire someone for a specific position to focus on discharge planning, and will “contract with, or employ, or use provider agreements for” Mental Health Professionals to perform statutorily required Title 47 evaluations, both of which line up with a plan previously made public by DHSS: A report released by the department in January of 2020 detailed a course of action and a timeline to alter psychiatric hold practices in the state of Alaska. That package proposed a 90-day plan for moving toward improved practices, including several of the above.

DHSS had not provided any statement on the settlement as of publication and said that no one was available to comment late Thursday evening.

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