Grading the States 2006: Alaska - Narrative
Alaska is unique. Land mass, climate, and even distance from the "lower 48" continental United States are relevant in evaluating its public mental healthcare system. Its Native Alaskan population poses a special cultural challenge.
With the second-highest suicide rate in the nation, Alaska is focusing on the interplay between mental illness and substance abuse. In 2004 the Division of Behavioral Health (DBH) assumed responsibility for Medicaid planning, mental health, and substance abuse services - a foundation for an integrated system. The state also received a federal grant to increase capacity for integrated treatment, giving it priority as an evidence-based practice (EBP). Finally, it has policies in place to ensure that people with mental illnesses are not discharged from treatment because of substance abuse.
In that area, Alaska may someday become a national leader, except that today, evidence-based practices are virtually nowhere to be found. Assertive Community Treatment (ACT), illness self-management, supported housing, and integrated dual diagnosis treatment scored among the lowest of any state. There is nowhere to go but up.
Health promotion and studying causes of death are not DBH priorities, but should be, as part of its movement to align policy and funding for integrated treatment - and to learn from other changes.
The bright spot is the Alaska Psychiatric Institute in Anchorage, which used to be a shabby facility with high doctor turnover and a bad reputation. Advocates now describe API as "bright, warm, welcoming, with access to the outdoors," and adequately staffed. This transformation of a facility both physically and in personnel development is a stellar accomplishment. The state is proud to report they are working hard to reduce their currently "very limited" use of restraints and seclusion. The turnaround of the facility is worth close study.
Alaska is fortunate to have a Mental Health Trust Authority established by the state from a pre-statehood federal grant. Its role as an innovation generator may be unique and not easily replicated, but conceptually, might provide a model for other states also to consider.
Still, the need for more gears moving in the community-based service system is profound. Psychiatric emergency room services, ACT, and respite are only part of the list of services in short supply. Hospital access is a concern, especially in the outlying regions. The state understands the concept of supported housing, but there is a dire shortage, which directly impedes recovery.
Looking at numbers in the state correctional system, it is easy to see the result of gaps - more like chasms - in the mental healthcare system. The state acknowledges that "the Department of Corrections is the largest provider of institutional mental health services in the state." At any time, more than a third of inmates in state custody are estimated to suffer from mental disabilities. The state has only one mental health court and one jail diversion program, both in Anchorage.
The Anchorage court was one of the very first mental health courts in the country, and Judge Stephanie Rhoades plays a national role as an advocate both for this model, for increased illness self management programs and more community services.
Alaska has a significant commitment to consumer and family involvement; the majority of members of the state planning board are consumers and family members.
Telemedicine and workforce development are urgent needs, and the state system is working on both. The state scored well on NAMI's "Consumer and Family Test Drive" for access to information - which is a significant accomplishment and essential for such a geographically challenging state.
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