State introduces reforms to involuntary commitment policies

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

The State of Alaska says it plans to change its policies for handling involuntary commitments among people in severe mental distress. The new plan could keep residents experiencing acute psychological crises from lingering in jails and emergency rooms.

In October of last year, Superior Court judge William Morse found that the state’s policy of housing severely mentally ill people in correctional facilities when medical accommodations weren’t available was unacceptable. The state began the practice because when the Alaska Psychiatric Institute can’t accept new patients, they often had nowhere else to go. The judge gave the state 90 days to find an alternative plan.

On Wednesday in Juneau, Department of Health and Social Services Commissioner Adam Crum shared details of that plan with reporters.

“One of the main take aways is that Department of Health and Social Services cannot change the behavioral health system on its own,” he said.

The department released a report on proposed fixes to existing gaps in Alaska’s psychiatric system. Many of them include relatively modest adjustments to how correctional facilities, hospitals, and the state coordinate on Title 47 designations, the statute under Alaska law wherein a judge deems an individual to be either gravely disabled or a threat to themselves or others, ordering them to be involuntarily committed to an institution.

The new plan includes hiring a position to coordinate Title 47 placements and more preventative programming paid for through recent changes to expanded Medicaid coverage. According to Crum, many collaborating organizations are eager for policy reforms.

“All of our partners recognize this is not the ideal situation in Alaska, but this is how we can work together to improve it,” Crum said.

Several of the measures have been in place for awhile, but are now being formalized. However, Crum clarified, the policy changes are non-binding, and without additional resources some people in the midst of psychiatric crisis will inevitably wait in jails and ER’s before getting proper care.

“The goal of this plan is to mitigate that as much as possible while the rest of the system gets built up,” Crum said.

The report points to the diminishing number of treatment beds at API over the decades. When it opened in 1962, the report notes, it could accommodate 225 patients. The facility now has room for just 80, though that number is further reduced by persistent staffing shortages. Simultaneously, there’s been a rise nationally in the number of people seeking help for mental health and substance abuse-related crises, according to the document.