OPINION: Alaska’s psychiatric care system is far from perfect. But we’re working to improve it.

I write this opinion piece with some unease. Very recently, commentator Val Van Brocklin wrote a scathing attack on Alaska’s psychiatric involuntary commitment procedures, describing both a lack of funding and humanity throughout the system. My discomfort lies in the fact that defending our current practice seems unnatural. I would rather live in a world where psychiatric patients in Alaska (or anywhere, really) are not forcibly injected with psychotropic medication. Sadly, I don’t live in that world.

However, because Van Brocklin’s commentary was so full of errors — errors with which I have some familiarity as a legislator working intensely on reform of the involuntary commitment process — I feel obligated to offer this rebuttal.

In 2006, the Alaska Supreme Court ruled that its trial courts will be the final arbiters of whether involuntary injections of psychotropic drugs may occur in the absence of an emergency. This was a great legal victory for civil libertarians, mental health patients and all Alaskans broadly. The decision (Myers v. Alaska Psychiatric Institute) actually begins with the presumption that involuntary provision of medication is not allowed. In the absence of an emergency, psychiatric patients who do not consent to involuntary injections will presumptively not receive them. However, if an emotionally detached trial court judge finds that (1) the medication is in the best interests of the patient and (2) there are no less intrusive alternative treatments available, the patient may very well receive injections. Put differently, forced injections, however medieval they may sound, are the law of the land throughout the United States, including Alaska — subject to significant protocols, caveats and requirements.

Therefore, Van Brocklin’s fundamental and most critical error was her conclusion that the “courts have abdicated to the Legislature their separate power to uphold guarantees of liberty, privacy and due process for persons with mental illness.” As I’ve noted, in the 2006 Myers decision, the opposite thing occurred. To be clear, Myers largely won her case. Again, due process and civil liberties were the victors, too. But not in Van Brocklin’s telling. Her commentary suggested patients have no rights and are not heard by the hospital and/or the courts. This is flatly wrong as to the question of forced injections.

Second, a reader of the Van Brocklin piece shouldn’t be blamed for concluding that Alaska’s allegedly macabre practices aren’t being considered for significant reform and improvement. Again, the opposite is true. Van Brocklin alluded to a lawsuit between the Alaska Disability Law Center and the State. The lawsuit was fully settled in September 2020, with an agreement for increased (albeit modest) state funding of mental health appropriations. Much more significantly, however, the parties’ agreement requires that the state Department of Health and Social Services “advocate for statutory changes in 2021-2022 that would permit involuntary holds and 72-hour evaluations at less restrictive community-based settings.” This was a reference to a treatment protocol model commonly called Crisis Now.

Additionally, the settlement agreement also required DHSS to “continue its efforts to help establish the services described in the Mental Health Trust’s Crisis Now report through cooperation and coordination with the Mental Health Trust and by making funding available for the full array of services described in the Crisis Now report (crisis hotlines, Mobile Crisis Teams, 23-hour stabilization centers, etc.).” This was not idle chatter — these goals were met through passage of Senate Bill 120 (Sen. Cathy Giessel) and House Bill 172 (Gov. Mike Dunleavy’s bill), creating the Crisis Now program, the latter supported 52-5 by the Alaska Legislature in 2022. Rather than defunding mental health programs, Crisis Now was stood up with an $8 million state grant to Providence Alaska. Ground-breaking of a renovated facility for Crisis Now occurred just last month, with major health policy leaders in attendance.

Third, Van Brocklin focused on mental health patients. This is appropriate and understandable. However, more recently, legislative efforts have focused on protection of victims of crimes committed by incompetent persons who cannot, in some instances, be held to account in a criminal court because of their mental incapacity. Noteworthy, mentally ill persons have not been shown to present any more public safety threat — and perhaps less — than persons not mentally ill. Still, the randomness of the assault on Angela Harris at Loussac Library was cause enough for Sen. Matt Claman (through Senate Bill 53) and myself (through House Bill 80) to file legislation to tighten up competency and commitment statutes to ensure that every conceivable effort is made to protect the public from individuals whose criminal history and erratic behavior suggested a severe mental illness needing attention, treatment, or even isolation in extreme circumstances. In this effort, Van Brocklin may be comforted to know that I have emphasized that — in the first instance — the government should look at the very best programs for treatment, rehabilitation and public safety, with much less regard for cost. In other words, let’s consider what is achievable and entertain affordability only after outlining our highest goals.

Institutional comparisons to Finnish, Swedish and Swiss mental health systems as regards psychotropics are also unfair. Ours is a far more complex and strained social economy. One need only consider the vastly greater economic disparity between Americans, costly military expenditures here and ubiquitous firearms in this country, as just a few material differences that impact available resources and possible approaches.

Finally, Van Brocklin attacks public defenders (with some compassion), the court system, the state government, the Legislature and psychiatrists (and their putative allies, the pharmaceutical industry). The fact is that each stakeholder has been integrally involved in reform efforts that began in earnest, as noted, with Crisis Now, House Bill 172. Reforms will continue, and enhancement of the system will be never-ending, as is necessary with any health care structure. No one, least of all me, believes our model is perfect. But I do think it’s improving.

Rep. Andy Josephson represents House District 13 (South Anchorage, Taku and Campbell) in the Alaska Legislature.

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