Congress passed Public Law 830, July 28, 1956, granting the Territory of Alaska authority over its mental health laws and provided $6.5 million in funds to create “an integrated mental health program.”; $5.35 million was used to build the first Alaska Psychiatric Institute.
Ever since 1956, Alaska has taken two steps forward and one step back when providing psychiatric patient care. The top mistakes: the downsizing of the Alaska Psychiatric Institute, and not providing people a smooth transition from a psychiatric emergency room to community care. But there are also other mistakes.
In 2019, the Department of Health and Social Services revised how people experiencing a mental health crisis would be treated in emergency rooms by adopting a “crisis now” model. The multimillion-dollar program is expected to continue and will be funded in part by a 1115 Waiver from Medicaid.
From territory days to now, there have been multiple plans on how the state would care for acute care psychiatric patients. Almost every DHSS plan had a common flaw: Psychiatric patients and their guardians were not involved in the planning.
In DHSS’ own words, they want to “design and implement a behavioral health crisis response system equivalent to the physical health system.”
In my opinion, treating mind and body is different. To be successful, a psychiatric emergency room has to be specially designed, from the height of the ceilings to the colors to oversized space and safety issues. Along with specialized training for attendants and patient advocates.
The document, “A 10-year History of the Alaska Psychiatric Institute, 1962-72,” was written by API staff and in the nine pages there is useful information that for the most part has been forgotten by DHSS, i.e.—“The traditional hospital routine perpetuates the return to hospitalization” and making patients part of the treatment process is important to recovery. It is my personal experience the hard-learned lessons in the 1960s concerning successful patient release are not a priority in psychiatric emergency rooms or the hospitals today.
Providing trauma-sensitive services is one of the keys to effective treatment in psychiatric emergency rooms. The state of Maine in 1995 was the first state in the nation to begin systematically addressing the interpersonal violence that impacts the majority of people served through their Department of Behavioral and Developmental Services. In 1997, a 75-page book was printed, “In their own Words,” containing stories of what traumatized psychiatric patients locked in institutions.
The unnecessary trauma that psychiatric patients often face during treatment or transportation could be greatly limited if the state required hospitals and transportation policies to be updated to increase the possibility of patient recovery. Protecting patients from unnecessary trauma is something Alaska has not put into policy or practice.
In 2010, the CEO of API stated that patients should wait until they leave API before receiving treatment for institutional trauma. Which contradicts most experts who believe that traumatic events should be addressed as soon as possible to reduce the effects.
Too often psychiatric institutions and psychiatric emergency rooms overuse restraints, isolation rooms, takedowns and removal of patient rights to alter behavior and there is very little recognition of the role that sexual or physical abuse in the patient’s past contributes to institutional trauma.
There are approximately 10,000 people each year who enter an acute care psychiatric facility or unit in Alaska. Currently, state agencies, including the Legislature, lack even the basic information necessary when providing psychiatric services: The number of patients injured during treatment or transportation, the number and type of complaints, etc.
For hospitals to successfully release people who have been in crisis, and for the Legislature to craft reasonable laws, the voice of the psychiatric patients must be included. From my point of view, a fair statewide grievance and appeal process, recognition and treatment of institutional trauma, fair rights, updating of hospital patient policies and independent assistance when filing a grievance are at the top of the list.
Currently, issues that psychiatric patients consider important are not included in the “crisis now” model supported by the Department of Health and Social Services and others.
Faith J. Myers is the author of the book, “Going Crazy in Alaska: A History of Alaska’s Treatment of Psychiatric Patients,” and has volunteered as a mental health advocate for over 10 years.
