When Alaska residents go through a severe mental health crisis, many rural clinics lack the resources to ensure their safety. Often when patients are at risk of harming themselves or others, it is up to local law enforcement to provide a secure space that can be monitored.
Health providers and law enforcement in Haines question whether a rural jail is appropriate for holding such patients until they can receive treatment.
Haines Borough Police Chief Heath Scott opens the door to a white-walled room with a concrete floor.
“All of our cells are the same, but if you’re a mental health consumer, you’re sitting in here,” Scott says.
There are two cots on either side and a metal toilet at one end. The cell is bathed in a pale light filtered through a barred window.
This is where people in Haines are held after they have been involuntarily committed under the state’s title 47 law. The law allows guardians, spouses, relatives and certified physicians to commit an alcoholic or drug abuser for 30 days if they are likely to harm on someone else.
“Their liberties are suspended for a short period of time. You don’t have the ability to leave this environment. We have to have a clinician review your current status to see are you well enough to leave our facility,” Scott says.
Stephanie Pattison is the director of the Southeast Alaska Regional Health Consortium (SEARHC) clinic in Haines. She says there are a few ways that someone may end up committed through title 47.
“A person in a mental health crisis either comes into the clinic or goes over to Lynn Canal Counseling. They are just not able to make rational decisions. They may be threatening to hurt somebody or hurt themselves,” Pattison says.
After a thorough medical examination, a clinician will determine whether the individual should be held and monitored.
The Haines rural jail is used to temporarily house the individual until the crisis passes or transportation to a larger hospital arrives. The nearest hospital is a plane flight away from Haines, which limits transport options.
“They can’t go commercial and they can’t go medevac,” Pattison says. “A security company that is trained to care for and transport clients or patients—arrangements have to be made for them to come on a charter to collect that individual.”
It takes at least a day or two before patients can be transferred to an adequate health care facility.
Chief Scott says the rural jail is the only available space to hold them while they wait for treatment.
“When we don’t have a hospital bed, so to speak, and a security guard at a hospital, our best solution is putting them in a detention center and watching them here,” Scott says.
The clinic in Haines is not staffed 24 hours a day and lacks a secure room for monitoring.
Medical staff checks up on patients held in the jail on a regular basis to monitor their health. Sometimes their condition improves to the point that they can be released before being sent for treatment elsewhere.
However, Pattison thinks that a jail is a stressful environment for patients.
“If I was in there, I would truly wonder what I had done wrong,” Pattison says. “Unfortunately, it’s not that they’ve done anything wrong, it’s just that they’re ill and it’s the place we can keep them safe. In a perfect world, it would be wonderful to have a facility that would not be the jail. But I’m not sure what that is.”
About 10 patients are held in the Haines rural jail each year due to title 47 committals. Chief Scott says while it isn’t a tremendous number of incidents, he feels uncomfortable detaining people who are unwell.
“They’re not criminals. They’re sick,” Scott says.
Recently, the Haines Borough has been trying to collaborate with SEARHC to build a better safe room for patients. The SEARHC clinic in Haines will undergo a remodel in the near future. Borough manager Debra Schnabel has suggested adding a safe room to the renovation plans.
Pattison says she has worked at hospitals with safe rooms in the past. These spaces, while safer, are not very different from a jail cell.
“It’s a padded room. There is nothing that can be removed by a person in it, with literally a mattress on the floor. Most floors are just linoleum with a drain tile in,” Pattison says.
Pattison is unsure whether it will be possible to add such a room to the clinic in Haines. However, she is willing to work with stakeholders to find a solution.