Amid a shortage of hospital beds, psychiatric patients put in jails

Alaska Psychiatric Institute (Photo courtesy of the Alaska Department of Health and Human Services)

A small number of Alaskans experiencing psychiatric crises are being diverted from healthcare facilities to custody within the Department of Corrections. Critics worry the emergency measure is not only unlawful, but putting patients in jeopardy.

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Since last Friday, October 5th, the Alaska Psychiatric Institute has had to reduce the number of available beds due to staffing and safety concerns. With fewer beds available, individuals involuntarily committed under the state’s Title 47 law are being brought to private hospitals, but also to state-run correctional facilities for holding. So far, four patients in need of acute mental care have been put placed inside jail or prison buildings.

Duane Mayes is the CEO of API, and said right now the facility has several high-need patients who require multiple staffers to be on hand out of safety concerns. That, according to Mayes, has reduced the number of available beds from 58 to 49.

“When we realize we cannot take more (patients), we inform those entities such as the hospital, DOC, that we’re not able to do that, because of the capacity issue,” Mayes said.

Only a few weeks into his new role as the head of API, Mayes said he had been informed by staff that shifting patients over to correctional facilities amid psychiatric emergencies is not unprecedented, and has happened in the past.

But that might not be accurate.

Laura Brooks, who works with DOC’s Division of Health and Rehabilitation, said the Department is not accustomed to absorbing mental health patients who have no criminal charges against them.

“This is a new process for us,” Brooks said.

In the Anchorage area, those committed involuntarily under Title 47 because of substance abuse issues severe enough to pose a threat to themselves or others are being sent to the Anchorage Correctional Complex or Hiland Mountain Correctional Center.

“We have mental health units for the criminal population and so we are going to house them on those units, in separate cells, but we will house them on those units,” Brooks said. “We will not be putting these individuals in our general population areas.”

Of the four Title 47 patients put into DOC custody during the last week, one has since been released.

Retired mental health court judge Stephanie Rhoades thinks this practice is a misapplication of involuntary commitment laws and puts patients in jeopardy. In an email, Rhoades wrote that laws governing Title 47 allow individuals to be held in jails only as a last resort. She pointed to a section in the code that reads, “A person taken into custody for emergency evaluation may not be placed in a jail or other correctional facility except for protective custody purposes and only while awaiting transportation to a treatment facility.”

According to Rhoades, that provision was meant to be applied in rural areas when inclement weather or a delay in a plane arriving necessitated keeping people in small community jails. Use of correctional facilities as an overflow option for API was never the intention, and Rhoades believes it is a violation of patients’ rights.

David Flourant with the Disability Law Center agrees, and thinks housing psychiatric patients in correctional facilities could hinder recovery.

“There’s a significant difference between being placed in jail and being placed in a psychiatric facility that provides treatment and care for someone that has a mental illness,” Flourant said. He cited a case where individuals placed in jail instead of a therapeutic environment demonstrated “aggravated symptoms as a result of that placement.”

Flourant feels the state has not been adequately transparent about why it decided to put patients in correctional facilities rather than in nearby hospitals.

The Alaska Psychiatric Institute says each day it is evaluating whether it can open more bed space for new patients. In the meantime, DOC says correctional centers around the state are preparing to potentially house patients needing urgent mental healthcare.