Questions swirl as staffing shortages land mental health patients in jail for psychiatric treatment

Published: Oct. 12, 2018 at 4:04 PM AKDT
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The Alaska Psychiatric Institute is the state-run entity charged with inpatient mental health services for individuals requiring hospitalization for a psychiatric crisis.

Since last Friday, however, at least four people ordered to be on psychiatric hold are not at API, and instead are being housed at the Anchorage jail, according to the Department of Corrections. So, why are potential patients being sent to correctional facilities?

API said Friday afternoon that moving people to DOC jails is not because the group is out of beds or at capacity. Instead, low staffing numbers and care requirements have apparently made it so that some patients must be treated at other locations.

"When we are at capacity, we have in the past informed hospitals and DOC that we're not able to take additional patients," said Duane Mayes, CEO for API. "It's no different than a hospital being at capacity."

API has eighty beds for patients, Mayes said, but as of right now, only 58 are available for us. Forty-nine of those are being used by patients currently undergoing treatment.

"Some (patients) require - due to doctor orders - one-on-one or two-on-one support, and so that sometimes impacts how many we serve," Mayes said.

More than $7 million has been allotted for dozens of new staffers so that API can utilize some 20 additional beds in its facilities, according to Mayes, but the implementation of those staff members will not be for another few months yet.

"When there's no other place for them to go - no bed at API, hospitals aren't an option - through Title 47 holds, the DOC is by default the place these individuals have to go," said Laura Brooks, Deputy Dir. of Health and Rehabilitation Services. "We bring them in and place them into protective custody."

About 65 percent of all individuals incarcerated by the DOC have mental illnesses, Brooks said, and the department remains the largest provider of mental health services already, with mental health clinicians, psychiatrists, and officers trained to deal with the mentally ill.

But does that make correctional facilities spaces in which those suffering from mental challenges can be treated?

Advocacy groups such as the Disability Law Center of Alaska maintain that the decision to treat patients in jails is not only concerning, but against the law.

"There are legal problems, and then there are the health concerns," said Joanna Cahoon, a Disability Law Center of Alaska attorney. "Infringing on someone's due process rights and violating the constitution by taking somebody who has not committed a crime and putting them in a punitive setting - which, the DOC is the epitome of a punitive setting - that's a problem.

"And if you're already in a psychiatric crisis, DOC is only going to be a kind of confining atmosphere, and is only going to make that crisis worse."

The DLC said in a written statement Friday that "criminally confining individuals with mental illness is an issue of concern touching Alaskan families across our state. Yet, this decision was made without prior notice to the public and without transparency.

"In addition, holding such patients in jails indefinitely on the basis of an ex parte pickup order, even though there is no evaluation facility to take them to, is contrary to Alaska Statute 47.30.705."

The group is calling for a release of information to the public regarding how the state plans to provide treatment for those with mental illness, particularly after recent developments at API, including the resignation of a former CEO in 2016.

In the meantime, the DOC is readying to accept more patients while trying to figure out how to manage non-criminal mental health cases, since the agency is required by law to do so.

"The DOC never gets to close our doors," Brooks said. "We have a number for each of our facilities that's considered max capacity, but even when we reach that, we still have to take them in."

Brooks added that the big misconception is that situations like this are an everyday occurrence.

"This is an unusual circumstance," she said. "And we are statutorily required to take these individuals in when there is no bed anywhere else."

As for the future, no one seems to know exactly how long the move of patients to DOC oversight will last.

"We can manage with the current resources," Brooks said of the current low numbers of non-criminal hold patients within the DOC system. However, she said, "depending on how long this goes, depending on how many individuals need hospitalization, it's hard to say how that's going to impact us if this runs long-term."