A lone Anchorage prison guard sits at the receiving end of Alaska's failed mental health system, trying to keep 28 acutely disturbed men from harming themselves or others.
The Mike Module, as the unit is called at Anchorage Correctional Complex, is staffed by a single corrections officer and a single nurse except when clinicians visit. I sat down with two retired officers to find out what that job is like.
"It can be miserable," said Bobby Houser, who worked in the unit for a dozen years before retiring recently. "You've got to grow eyes in the back of your head with some of them, because some of them will just pop, like flipping a switch."
Besides the sudden flares of aggression, officers deal with inmates who rave wildly or bang their heads, or who exhibit bizarre behavior with their waste.
"You get a lot of that thrown on you," Houser said
Some suicidal inmates have to be watched every minute, even when they shower, while the officer remains responsible for all the others. Calling for help disrupts the entire complex.
The Alaska Department of Corrections cares for far more mental patients than the state hospital, Alaska Psychiatric Institute. On a typical day, two-thirds of the inmates in Alaska prisons have a mental health diagnosis, said Laura Brooks, health care administrator for the department.
Most receive treatment in the general population, but Alaska's prisons also have 288 beds for acute and sub-acute mental health care. API has only 50 acute care beds and 30 for long-term patients.
Houser and his former co-worker, Gerald Tamura, met some of Alaska's most notorious criminals in Mike Mod, including Charles Meach, whose 1982 murders spurred the criminalization of mental illness in Alaska.
But unlike scary criminals, many of the mentally ill inmates were just pathetic. A caring society would help rather than punish them.
"They end up in jail quite often over petty stuff, like trespassing," Houser said. "They have no place to go, so they trespass to get warm."
Brooks said it takes a special kind of officer to deal with these inmates, one who is able to accept that their negative behavior may not be intentional. Houser and Tamura both said they succeeded in Mike Module by connecting with inmates and showing them respect.
Corrections doesn't have money for talk therapy. It stabilizes patients with drugs and sometimes they can participate in groups. But officers listen to the prisoners. Houser said building rapport and figuring out the motivations of irrational inmates allowed him to keep control of the unit.
Tamura, who worked in the module much of the time for 17 years, said it took a while to pick up the skills. He addressed prisoners as mister and sir.
"I use a lot of humor," said Tamura, who was known for carrying a stuffed owl. "You treat the inmate the way you wish to be treated if you were in their place."
Over the years, he learned about mental health from doctors who came to work with inmates. Stabilizing severely mentally ill patients can require experimenting with drugs and dosage. Once stable, patients can move to units with lower levels of supervision, Brooks said.
"Once they make the proper adjustments, you see inmates becoming normal. But this takes time," Tamura said. "That's something you can't do without long-term care. Three days in API, you can't do it."
He said meds worked for Meach, who lived in Mike Mod for a few months before he died in 2004. Meach behaved like a gentleman and they talked about Civil War history.
In 1982, Meach killed four teenagers in Russian Jack Springs Park while on a pass from API, where he had been held after being found mentally ill in a previous murder. The devastating event led the Alaska Legislature to pass one of the toughest laws in the U.S., making the insanity defense almost impossible here.
Instead, Alaska has a verdict called "guilty but mentally ill." Convicts serve a full sentence as if they were mentally competent, but get treatment from the Department of Corrections.
"That was the beginning of the real problems in the state's mental health system," Dr. David Sperbeck told me last year. "It continues to be responsible for a huge number of mentally ill people going into the Department of Corrections."
A killer like Meach needs to be in prison permanently. But that doesn't mean mental illness is a crime.
Punishing people for being ill is inhumane, ineffective and expensive. Alaska spends $8.3 million on mental health care for prisoners in addition to the $50,000-per-year cost of holding each of them.
Last year, the Legislature passed a sweeping change of criminal laws to provide treatment to minor offenders rather than jailing them. Substance abuse and mental health care would more often take the place of incarceration.
Evidence shows that punishing people for petty crimes doesn't help, but addressing the causes of the behavior might. The law hasn't been in effect long enough to see if it works.
Now, facing claims of a spike in theft, the Legislature is considering rolling back the law, increasing sentences again. But light sentences might not be the cause of the problem. Crimes could be going up because of cuts in police and prosecutor budgets and the opioid epidemic.
Let's not make another knee-jerk decision to put people in jail because we're frustrated. We can be safer and save money by being humane.
Houser knows mentally ill prisoners better than most of us do. He learned it didn't make sense to be a strict rule-enforcer in Mike Mod.
"A lot of them don't know what they're doing because of their mental issues," he said. "You can't come down hard on them like you would with somebody who has his full senses and actually knows the difference between right and wrong."
Legislators and prosecutors could learn something from that attitude.
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