State releases court-ordered plan to get waiting psychiatric patients out of jails, ERs

Alaska officials on Wednesday released a court-ordered plan explaining how the state intends to keep psychiatric patients from being warehoused in emergency rooms and jail cells while they await scarce treatment beds.

The Alaska Department of Health and Social Services’ 30-page plan includes immediate fixes, such as changing the way people on the Alaska Psychiatric Institute wait list are prioritized for admission.

It also includes longer-term goals for transforming the state’s dysfunctional mental health system — though without a promise the more sweeping changes will actually happen.

The plan stems from a lawsuit filed in Anchorage Superior Court in 2018 by the Disability Law Center and the Alaska Public Defender Agency over the practice of holding people forced into psychiatric treatment in jail cells and emergency rooms for days and sometimes weeks because of the persistent waiting list for beds at the Alaska Psychiatric Institute, which has been operating well under its capacity of 80 beds.

In October, Anchorage Superior Court Judge William Morse ruled that the practice caused “irreparable harm” and ordered the state to explain how it would put an end to the practice — quickly.

Morse gave DHSS a deadline of Dec. 5 to come up with a way to stop the lengthy hospital and jail cell wait times. The deadline was extended until Jan. 21.

On a call Wednesday, Health and Social Services Commissioner Adam Crum said the plan was to better coordinate about use of existing treatment beds available in Alaska, “while the rest of the system is being built up.”

Some were underwhelmed by the substance of the resulting 30-page report.

“This plan does kind of the basic minimum of what the order requires, and not a whole lot more,” said Joanna Cahoon, an attorney with the Disability Law Center of Alaska.

The state’s 90-day plan includes:

• Hiring a person to act as a statewide coordinator to ensure that people waiting to get into court-ordered psychiatric treatment make it to an appropriate placement as quickly as possible.

• Making it possible for mental health workers to visit hospitals to do required evaluations. Of all the concrete changes described in the plan, this has the potential to make the biggest difference because it became a major roadblock in the past, said Mark Regan, also an attorney with the Disability Law Center.

• Order the wait list for a spot at API by priority, rather than chronologically. The sickest patients could be moved from emergency rooms or jails more quickly.

Critics say the report doesn’t commit to the more sweeping changes to the mental health system that some in the field were hoping the state would announce.

The last few pages of the report are devoted to “Crisis Now,” an approach that would create a statewide call line system, non-hospital “crisis stabilization centers” and even teams of mental health professionals to directly respond to calls for help.

The approach, already being used in Phoenix, has the potential to reshape the way Alaska responds to mental health crises, Regan said.

“There is not as much interest in or commitment to the Crisis Now ideas as I had expected,” he said.

DHSS would “pave the way as much as possible” for a similar model in Alaska, but wouldn’t commit to running those facilities or programs themselves, Crum said.

The report also stops short of saying that the practice of housing psychiatric patients waiting for a bed at API in jail will end immediately.

“We do not want the situation to continue,” said Crum. “We’re going to mitigate it.”

But “nothing structurally has changed,” Cahoon said. “There’s still more demand for beds at API for evaluations and treatment than the system can supply.”

It’s not clear how Judge Morse will respond to the plan. A status hearing in the case is scheduled for next week.