A Consumer Member's Report on Alaska Mental Health Board Issues
by Jim Gottstein
The views expressed here are the author's only
Big issues before the Mental Health Board from consumers' points of view in my opinion are (1) API Downsizing, also known as API 2000, (2) the Office of Consumer Affairs, (3) the Investigation of Emergency Services in Fairbanks, (4) Barriers to Employment for consumers, and (5) The Jails: An Integral Part of Alaska's Mental Health Program?
1. API Downsizing (API 2000). The plan is for the current Alaska Psychiatric Institute (API) building to be torn down and replaced with a mental hospital with a capacity of around 54 beds. The most likely scenario at this point is that the Charter North facility will be purchased and remodeled to reduce the number of beds there. Historically, the average number of patients in API has averaged well over 100, but a few years ago, it was reduced to 79 beds. How is this plan supposed to work? Well, the plan is that less restrictive "community services" will be substituted for hospital stays for those people that don't need to be hospitalized. It has been recognized for a long time that many of the people who have historically ended up at API could be treated in a "less restrictive setting" and at a lower cost if there were other places to send them and if there was a way to figure out who should really go where. The Alaska Mental Health Board has spent at least three years working very hard with the Division of Mental Health and advocacy groups at designing a system that accomplishes this and a plan to accomplish this is in place. The cornerstone of this plan is what is called a "Single Point of Entry" which will evaluate people and decide where to send them.
However, the entire plan is contingent upon the Single Point of Entry and the planned community services being adequately funded. As it has turned out, this funding has been tied to the downsizing of API through a very complicated and interrelated financing plan that requires the legislature to appropriate millions of dollars for the project. Because of the state financial crisis I am concerned that this won't happen and everything will fall apart. The Alaska Mental Health Board is working very hard to try and make sure that the community services and Single Point of Entry plan is implemented even if the new API funding is not forthcoming. In fact, during the January meeting various memebers of the Alaska Mental Health Board tried to get the State and The Alaska Mental Health Trust Authority (Trust Authority) to commit to the implementation of the community services part of the plan even if the API replacement funding did not fall into place. Unfortunately, the State and Trust Authority said that because of the complex and inter-related nature of the financing, that this would probably not be possible.
My concern is that the "community services" will not materialize as an alternative to API (I am the last person to recommend a stay at API) and even more consumers will end up on the street, in shelters, jail or dead. Query: Is jail a less restrictive alternative to API?
2. Office of Consumer Affairs. More than two years after the Alaska Mental Health Trust Authority granted the Division of Mental Health and Developmental Disabilities funds to establish an office of consumer affairs, on August 31, 1999, the Position was finallay advertised. The idea is to have an office inside the system to advocate for and effect change in the system to be more in line with what consumers want. The formal description is:
Under direct supervision of the Division Director, this position will provide expertise as a consumer consultant to the senior management team and the Director in all aspects of the following: planning; development; coordination; monitoring and evaluation of mental health programs and services for all populations statewide.
It is best, I would say essential, to have someone run the office who has lived with mental illness, the mental health system, and recovery for all kinds of reasons, but most importantly because experience in other states has proven that it is the only way to have an effective consumer affairs program. The deadline for applying is September 20, 1999, so I encourage any and all qualified consumers to apply. The job is restricted to Alaska residents.
3.Emergency Services in Fairbanks The Mental Health Board learned that there were 8 suicides of people supposedly in treatment in Fairbanks in less than six months. It was also reported that the Fairbanks Community Mental Health Center was not providing 24 hour emergency services as required under its state grant. There were reports that if it was after business hours, people in need of emergency mental health services were directed to the hospital emergency room by the Fairbanks Community Mental Health Center, but ended up in jails. It was also reported that the Fairbanks Community Mental Health Center was refusing crisis respite services to anyone except pre-existing clients. As a result of all of this, at its January, 1999 meeting, the Mental Health Board asked the Division of Mental Health to investigate what is going on in Fairbanks. The Division Report on Fairbanks Emergency Services details, in my mind, a classic story of bureaucracy at its worst, with the result being a very broken emergency service system in Fairbanks. The Fairbanks Community Mental Health Center's response was that "we did everything the grant says we have to." Frankly, I don't think so, because the Center had the obligation to provide 24 hour emergency services and it did not. The Division says that this year, the Fairbanks Community Mental Health Center's grant will be more tightly written and it will be held to the mark. We will see. We will see.
4. Barriers to Employment. A work group representing the Governors Council on Disibilities and Special Education, the Alaska Mental Health Board, the Division of Vocational Rehabilitation, and others have been studying barriers to employment of consumers and ways to reduce and hopefully eliminate them. In September of 1998, its report, entitled Review of Alaska-specific Work Disincentives for Individuals with Significant Disabilities was issued. In July of 1999, the Survey of Employment Barriers for Persons with Severe Disabilities was published. In addition to discrimination by employers, the mental health system itself creates major impediments for consumer employment. For example, in most cases, consumers essentially lose all welfare benefits when they become employed. This makes it way too risky for many consumers to try employment. A pilot program called Juneau Works is going on at REACH in Juneau and will develop training and technical assistance for other providers. All of this was funded by a three year grant from the Alaska Mental Health Trust Authority ending June 30, 2000. Most importantly, the Congress is poised to pass the Work Incentives Improvement Act of 1999, which has many provisions to lessen the barriers to employment, the most important ones being, elimination or reduction of many of the risks of attempting to work, and what is called the "Ticket to Work" program. More specifically, states are allowed to extend Medicaid to cover people who go to work, and prohibits loss of disabled status based just on going to work. In the latter case, it means that if you get a job and it doesn't work out, you can go back to getting your benefits without a hassle (supposedly).
5. The Jails: An Integral Part of Alaska's Mental Health Program? Unfortunately, for many consumers, rather than receive mental health services, they are thrown into jail. It seems to me that almost every long-time consumer with whom I come into contact has been put in jail at least once rather than receive appropriate mental health services. This is borne out by the statistics that show around 25% of the people in Alaska's jails at any given time are consumers. And in "reading between the lines" of the State Department of Corrections (Jails) presentation during the January 1999 Alaska Mental Health Board meeting, it seems that virtually none of these consumers are receiving any mental health services at all while in jail. Only those prisoners who are so disruptive and uncontrollable in the normal (very controlled) jail setting seem to be getting any services. This leaves out the vast majority of non-violent consumers who inappropriately end up in jail because of the system's failure to provide appropriate services. I have grave concerns that this will be made worse when API is downsized and the community services that are supposed to handle the people that API would have handled in the past do not materialize. The result will be more people inappropriately (and expensively) housed in the jails, more street consumers, more consumers in the homeless shelters, and more dead consumers. On the plus side, the Alaska Mental Health Board is involved in a task force regarding supported housing for mentally ill persons being released from the jails and has supported increased services in the jails. Also, at the Mental Health Board's recent Program Evaluation and Review Committee (PERC) the situation in the jails was a prominent topic of discussion and I believe there was consensus on having this issue be an important part of the Board's look at the overall effectiveness of the state's mental health program.
Another really important issue is what is known as "Parity." This is a movement to require health insurance policies to include mental health services on a basis that is reasonably comparable to physical health coverage.
The Alaska Mental Health Board will be meeting in Juneau from March 25 through March 27, 1999. See, the Agenda.
Jim Gottstein is a recovered mental health consumer who was appointed to the Alaska Mental Health Board in December of 1998. Jim has written an article on recovery, entitled "The Mental Health System: Recovery Should be the Goal," which describes the philosophy and orientation he brings to his service on the Alaska Mental Health Board. Jim also worked as one of the lead plaintiffs' attorneys in the Mental Health Trust Litigation, which created the The Alaska Mental Health Trust Authority.
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partially updated 9/1/1999