We are all shocked when tragedies such as the recent shooting in Florida appear to be linked to a mental illness. That is true even though people with mental illnesses are generally no more likely to be violent than the general population. It seems to many that these events should be preventable and when they occur someone or some system is often blamed. Sometimes errors are made and we need to understand how those happen and make sure that they don't reoccur. But far more often it is an overall lack of the system's ability or capacity to provide necessary supports that leads to tragic events.
Predicting violent behavior is difficult, if not impossible. A continuum of care that addresses behavioral health needs, including mental health and substance abuse, as well as housing and employment is necessary in order to be effective. Some of these services are available across Alaska, but they are simply inadequate to meet demand.
Alaska Psychiatric Institute, Alaska's only public psychiatric hospital, is often at capacity and patients can wait days in an emergency room before being admitted. Is the answer necessarily a bigger API? In Fairbanks and Juneau the local hospitals have Designated Evaluation and Treatment beds that allow people to be stabilized closer to home. Because of this, those regions send far fewer patients to API. In Anchorage none of the three hospitals have developed this capacity. In the Valley, the fastest-growing region of the state, Mat-Su Regional Hospital has yet to bring this capacity on line although it is currently being discussed.
API and other designated inpatient facilities are largely where people end up when access to adequate community-based services is lacking. The last default option is the Department of Corrections where 40 percent of the admissions have significant behavioral health issues. Ensuring that people have access to mental health and addiction treatment, stable housing and employment opportunities is critical and is clearly the most effective way to support people in their recovery.
None of this is news to any branch of our state government or local communities. The judiciary sees people experiencing mental health crises cycle through the courts and has developed (and wants to expand) the very successful therapeutic court programs where people are linked to community services including treatment, housing and employment to get them off of the criminal justice merry-go-round. The executive branch, through departments such as Health and Social Services (DHSS), Corrections, and Labor and Workforce Development, are focused on addressing these needs. Last year, the Legislature passed landmark legislation to reform the Medicaid system (Senate Bill 74) and the criminal justice system (Senate Bill 91), both of which will improve our ability to support recovery.
As part of the SB 74 Medicaid reform, DHSS has engaged a full range of stakeholders to develop a proposal to seek permission from the federal government to modify Medicaid so it can pay for positive outcomes rather than the volume of services provided. If successful, we will be able to better support access to treatment, maintain housing and find employment. This is not only programmatically sound but will actually save money. SB 91 calls for pretrial diversion for those that need treatment rather than incarceration to be productive, law-abiding citizens. Research tell us that if these individuals are incarcerated they will actually have worse outcomes at greater expense.
The most important thing to remember is people with mental illness can recover to lead normal, productive lives in our community. No one solution will fit everyone. Some people need to go to a hospital for intensive treatment but others just need better access to the right services in their community. Some find medications helpful in controlling and managing their illness, but not everyone. But everyone does need support to achieve and maintain recovery.
We need to recognize these differences in how we design and fund our continuum of care to meet the unique needs of our friends and families.
Greg Jones is interim chief executive officer of the Alaska Mental Health Trust. Jeff Jessee is the trust's legislative liaison. The Alaska Mental Health Trust is a perpetual trust founded to improve the lives of Alaskans with mental illness, development disabilities, substance abuse disorders, traumatic brain injuries, and Alzheimer's disease and related dementia. More at mhtrust.org.