The Aug. 5 ADN editorial, “The danger of ignoring Alaska’s mental health needs,” highlighted the lack of treatment options for Alaskans with severe mental health issues.
That issue is real, and it deserves attention.
It is not unique to the state of Alaska – just over a month ago, U.S. Surgeon General Vivek Murthy called youth mental health “the defining public health challenge of our time” during a roundtable here in Anchorage. And according to the Association of American Medical Colleges, more than 150 million people live in federally designated mental health professional shortage areas.
But the editorial board’s article painted a one-sided picture of Alaska’s mental health treatment system and unfairly places blame on the Alaska Psychiatric Institute (API) for broader, and more complex, community issues than can be solved by a single hospital. The editorial board did not contact the Department Family and Community Services for information about how well API is caring for patients today compared to 2018.
API today is not the same hospital it was in 2018; it has made tremendous progress in recent years. For example:
Bed capacity and utilization: The complex realities of mental healthcare are a spectrum of facilities and services. Bed capacity in April 2018 was at 20, today it is at 77. This year, API increased its available capacity to 80 beds. Hospitals should not and must not always be at capacity, particularly in mental health settings. Flexibility is essential to manage the unpredictable nature of mental health crises and ensure that each patient receives personalized care.
Centers for Medicare and Medicaid Services (CMS) oversight: Since 2021, API has maintained no CMS citations, reflecting its high standards of care and adherence to federal regulations.
Specialty unit success: In 2021, API reopened the Chilkat adolescent unit of 10 beds. API has been successful in decreasing patient-on-staff assaults by as much as 80% through the opening of another specialty unit. Both are testaments to the institute’s innovative approaches to care. Ongoing coaching and continuous training have also been implemented. Such targeted solutions are at the forefront of modern psychiatric care.
New programs: This year, API is developing two new criminal forensic restoration programs. In collaboration with Department of Corrections, a jail-based restoration will be established for the most violent individuals in custody. An outpatient restoration program will be established for those with misdemeanors without a violent history whom the court has released on bail.
Governing body: A significant change for API was the development of a governing body in 2019. The governing body incorporates stakeholders both internal and external to the state system to provide a mechanism of accountability for the hospital. The governing body meetings are publicly noticed and open to public attendance, which allows for a very high level of transparency. API provides the governing body operational data and quality metrics to support the hospital in continuously improving patient care and the work environment, as well as patient and staff safety.
Stable leadership: The pandemic caused unprecedented turnover and economic turmoil in health care. Nevertheless, API has maintained steady state-employed leadership over the past three years, allowing it to steer a clear course, create a unified vision, and enhance staff morale. This continuity is vital in healthcare institutions, where consistent policies and a shared sense of direction lead to better patient outcomes.
Five-year strategic plan: In 2023, API embarked on a comprehensive five-year strategic plan with stakeholders, and the plan addresses the specific challenges mentioned in the editorial, such as therapeutic programming, the need for bed expansion, telehealth and staff turnover. The results are already evident — staff retention has increased from 59% in 2018 to 72% in 2022, indicating a positive work environment and a stable setting for patients.
It’s essential to recognize that API, while a crucial part of the mental health system, cannot solve all the state’s problems. The Alaska Court System, Alaska Mental Health Trust, Legislature, local governments, law enforcement, social services, mental health providers and other community stakeholders are all needed to create a more comprehensive solution.
We never want to go back to the days when institutionalization was the only option for Alaskans with behavioral health challenges.
I am proud of the positive strides that API has made in the past three years. Gov. Mike Dunleavy’s vision with Executive Order 121 to restructure the Department of Health and Social Services allows the Department of Family and Community Services to prioritize API and our other sections. However, a lasting solution requires a nuanced understanding of the state’s unique challenges, collaboration across both the public and private sectors, and a recognition of the successes that can build a more effective and compassionate mental health system for Alaska.
Kim Kovol is the commissioner of the State of Alaska Department of Family and Community Services, which oversees the Alaska Psychiatric Institute.
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