Holding Alaskans forced into psychiatric treatment by a court order in jail cells because there's no room in hospitals is unconstitutional, a lawsuit against the state filed by a disability rights group charges.
The lawsuit, filed Friday by the Disability Law Center of Alaska in Anchorage Superior Court, asks the courts to immediately stop the practice.
People in the midst of psychotic episodes are spending days in cells in the Anchorage jail, where they are treated no differently than inmates — though they haven't been charged with any crime, a violation of due process rights, said David Fleurant, the executive director of the Disability Law Center.
"We want people to understand this is a real crisis," he said. "It's pretty bad when the only place you can put people in medical crisis is jail."
As of Monday, a judge had not yet heard the case.
The state Department of Law will explain its position in a filed response to the complaint, said spokeswoman Cori Mills.
"It has never been the state's plan or policy to divert people who need acute mental health care to correctional facilities," Mills wrote. "The policy is to find placement at another health facility."
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The Alaska Public Defender agency has also filed a writ of habeus corpus, asking the court to justify the jail detention of psychiatric patients, said agency head Quinlan Steiner.
The Department of Health and Social Services, which oversees API, declined to comment because of the pending litigation.
The state usually sends people who've been involuntarily committed by court order to psychiatric treatment to the Alaska Psychiatric Institute, or at times to hospital emergency departments.
But because the state-run Alaska Psychiatric Institute is understaffed and can't take more patients and hospital emergency rooms are full, the state has been sending some involuntary committed people to be detained in jail while waiting for evaluations since the beginning of October.
At least two people in the Anchorage area involuntarily committed to psychiatric treatment were being held in jails as of Monday: One at the Anchorage jail, and one at Hiland Mountain Correctional Center, said Megan Edge of the Alaska Department of Corrections.
No one seems to know exactly how many acute psychiatric patients are in the overflow population that the state is trying to find spaces for. Steiner and Fleurant both estimated 30-40 statewide. The number of patients detained at the jails ebb and flow with involuntary commitments and changes in bed availability at API.
"People will cycle in and out of this particular set of circumstances," Steiner said.
In Anchorage, men are being sent to an Anchorage jail housing unit known as "Mike Mod," named like other facility housing units "Bravo" and "Lima" for letters in the phonetic alphabet.
Mike Mod is where the Alaska Department of Corrections houses the most severely mentally ill inmates in the prison system. The unit is differentiated from other housing mods in the Anchorage jail by having specialized psychiatric nurses and therapists on duty.
But it is physically like any other unit in the jail, designed for punishment and containment: The same concrete-walled cells with thick steel doors, trays of prison food pushed through a slot, hard cots, suicide-proof gray blankets and shatterproof steel sinks and toilets.
On Oct. 12, two investigators with the Disability Law Center toured the Anchorage jail unit to see how the psychiatric patients were faring.
The investigators found inmates and detainees in Mike Mod "screaming, yelling, moaning" and banging on walls and doors, according to an affidavit filed as part of the suit.
The psychiatric patients on the mod were wearing the same yellow jumpsuits as the prisoners.
The investigators found one patient in his cell naked, with feces on the floor. Correctional officers "tried their best to protect his dignity" when they took him to the communal shower, the investigator wrote.
The patients are supposed to be kept away from the general population, so they're locked down in their cells almost all the time, said Fleurant.
For one hour per day, the psychiatric patients are allowed recreation time on the yard — a concrete pad encircled with walls and a mesh and barbed wire roof open to the air.
Personal belongings are limited, according to the affidavit.
"Comfort items on Mike Mod consist of a tear proof smock like blanket," the investigator wrote.
Conditions at API are much different, according to the affidavit: Patients have bedrooms with regular beds, dressers, desks and chairs.
At API, patients can have photographs, books and three sets of personal clothes, the investigator wrote. They can garden or use the gym during the day, and have opportunities for recreation 24 hours a day. They also have phone access and visitors.
In Mike Mod, the detainees communicated through the small slot in the cell door with the guards. One of the two patient detainees was required to have two correctional officers escort him every time he left his cell. Staff in Mike Mod seemed to not know that the psychiatric patient detainees had the right to a lawyer, the affidavit said.
"The setting now is identical to someone who is incarcerated," said Steiner of the Public Defender Agency. "Patients are not being treated any differently."
Joanna Cahoon, a staff attorney with the Disability Law Center, says she's concerned about what could happen if Mike Mod is full. Because the patients must be kept away from the general population, the next step could be putting a psychiatric detainee in isolation in a segregation unit, with even less contact with the outside world.
"It's hard to imagine a worse environment for a person experiencing a mental health crisis," she said.