Opinions

Are we really back to cages, stalls and pens?

"I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, stalls, pens!"

These were the words of Dorothea Dix to the Massachusetts Legislature in 1843, during her campaign for reform in the care of patients with mental illness. Her advocacy led to the establishment and expansion of psychiatric hospitals for their care. Alaska's reform began with the creation of the Alaska Psychiatric Institute (API) as part of the statehood effort.

Last week, we were hurled back to the mid-1800s. Several people in mental health crisis were brought before a judge, involuntarily committed to our state's psychiatric hospital for evaluation and treatment, and instead booked into our jails. Ironically, it was National Mental Illness Awareness Week.

The state of Alaska, having turned a blind eye to staffing shortages and the need for staff training to deal with patients who by legal definition are a danger to themselves or others, has now fully abdicated its statutory duty to provide psychiatric evaluation and treatment for those involuntarily committed to the state hospital by a court.

The result? Psychiatrically vulnerable Alaskans are now being placed into the modern version of the cages, stalls and pens that Dorothea Dix railed against in the 1800s.

[Here's what drove the former head of API to quit. Eighteen months later, the problems aren't fixed.]

Jail conditions are overwhelming for those unaccustomed to them. For people with active symptoms of acute mental illness the conditions are terrifying. The noise, lights and other stimuli can be excruciating and serve only to increase symptoms of illness. Suicide risk is higher in jails; victimization is as well. Isolation is likely and traumatization is nearly certain.

ADVERTISEMENT

Our state has systematically underfunded API for years. The pension and other benefits that once lured staff to API despite low salaries have been eliminated or severely curtailed. Without competitive wages, the state cannot recruit and retain enough qualified staff. Our "hospital of last resort" cannot provide sufficient training and support to prepare staff to effectively care for its patients – patients who are, by definition, so severely disabled they present a danger to themselves or others.

It is predictable that some patients committed to API will exhibit violence. Staff must have tools to deal with these expected behaviors. Without these tools and with inadequate numbers, API staff face an increased risk of harm by patients who lash out from fear, delusion and other illness.

The tragic flip side is that patients placed in the hospital for treatment to alleviate risk of harm to themselves or others have increasingly been arrested in the hospital and then jailed for the very behavior that required treatment. We have criminalized patients for the predictable and ineffectively treated symptoms of their illness. All of this was a recipe for the near-total breakdown of the state's only psychiatric hospital.

[API is an unsafe workplace, investigators say. This caregiver suffered the consequences.]

To solve problems stemming from years of mismanagement, our government is now punishing its most disabled mentally ill citizens by applying a twisted interpretation of laws intended to protect them. Our laws allow a person suffering mental illness to be held in a jail or other correctional facility "for protective custody purposes and only while awaiting transportation to a treatment facility." This was deliberately limited only to circumstances in which a person is so gravely disabled that they are "likely to cause serious harm to self or others of such immediate nature that considerations of safety do not allow the initiation of" normal court procedures for hospital commitment.

This law was intended to be used only when a person, because of their illness, is so dangerous to self or others that safety requires they be held in a secure place until hospitalized and a petition for commitment can be presented to a court. It provides a stop-gap measure to protect the person and community. It was intended to address, primarily, the realities of rural Alaska, where our mentally ill citizens do not have immediate access to hospitalization to protect them in dire situations. The classic application is in village settings where the need for air travel and challenging weather delays transportation of the person to an urban hospital. In very rural locales, there truly are no alternatives to the local jail — typically a locked plywood room — when people pose an immediate risk of harm to themselves or others. Anchorage, by contrast, has the most robust service system this state has to offer. This is not the place that this law was contemplated for use at all, let alone after an involuntary commitment order has been issued.

[API director, other top state health officials resign in wake of critical report]

This law was never intended to allow Alaskans to be punished for the persistent failures of those charged with their care. Our government's recent transfer of already hospitalized patients to jails for indeterminate periods is completely unjustified. Involuntary commitment had already occurred in each of these cases. None of the patients were awaiting transportation to a treatment facility – the treatment facility simply closed its doors to them.

Imagine making the gut-wrenching decision to seek hospitalization of your child or spouse because they are in crisis and at immediate risk. Now imagine seeing them jailed instead of hospitalized. You would be outraged. You should be outraged.

Alaskans cannot allow the jailing of people with mental illness who need treatment. There is no other ailment for which we would ever tolerate punishing the person suffering from it by criminalizing them for it. We should not tolerate it now. The executive branch must (and can) find an immediate alternative for those who have been incarcerated. The Legislature must appropriately fund API to conduct its statutory duties.

Mental health advocates have been rendered nearly speechless over this abuse. Those who have been incarcerated solely because they have a brain disorder that requires treatment are unable to speak for themselves. They are in jail, and their truth is hidden by a confidential system intended to protect them. We cannot remain silent and passively allow Alaska to return to the abuses of the 1800s.

Stephanie Rhoades is a retired District Court Judge who lives downtown. She started one of the first Mental Health Courts in the United States in 1992 in Anchorage. She serves on the Board of Anchorage Community Mental Health Services and is the lead food coordinator for Project Homeless Connect.

The views expressed here are the writer's and are not necessarily endorsed by the Anchorage Daily News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)adn.com. Send submissions shorter than 200 words to letters@adn.com or click here to submit via any web browser. Read our full guidelines for letters and commentaries here.

ADVERTISEMENT