Department of Justice investigation finds Alaska unnecessarily institutionalizes children, violating federal law

A major U.S. Department of Justice investigation has concluded that children in Alaska with mental health issues are “forced to endure unnecessary and unduly long” institutionalization in locked psychiatric hospitals and residential treatment facilities because no alternatives exist.

The state of Alaska is violating the Americans with Disabilities Act by failing to provide services that would allow kids to stay in their homes and communities, the U.S. Department of Justice’s Civil Rights Division found in a report released Friday.

Alaska kids are regularly sent for six months or more to hospitals like North Star hospital in Anchorage or facilities as far away as Missouri and Texas for lack of other options in their home communities, the department concluded.

“Each year, hundreds of children, including Alaska Native children in significant number, are isolated in institutional settings often far from their communities,” said Kristen Clarke of the Justice Department’s Civil Rights Division. “Most of these children could remain in family homes if provided appropriate community-based services.”

[‘I watched it rapidly turn into absolute chaos’: Inside the deepening dysfunction at North Star psychiatric hospital]

The state of Alaska is reviewing the report and “will be working closely with the Departments of Health and Family and Community Services to respond appropriately,” said Patty Sullivan, a spokeswoman for the Department of Law.

“While we may not agree with many of the assertions about Alaska being in violation of the ADA, we share the goals expressed in this report to ensure that children in Alaska receive appropriate behavioral health services in the most integrated setting,” she said.

The Justice Department’s Civil Rights Division began investigating Alaska’s behavioral health system in 2021. The department didn’t reveal exactly why it picked Alaska to examine, but the state’s Disability Law Center had lodged complaints before, said Leslie Jaehning, an attorney with the center.

Similar federal civil rights investigations in states like West Virginia have led to reforms aimed at improving mental health offerings for children.

Investigators traveled to Alaska twice, toured hospitals and other facilities and conducted interviews with children, families and professionals in the mental health field in addition to reviewing documents and medical files.

What they found amounts to a harshly critical indictment of Alaska’s paltry, stagnant mental health system for children.

‘Devastating’

Nothing about Alaska’s failure is novel, the investigators found: The system has functioned poorly for so long that multiple generations have experienced the same thing — parents who were institutionalized now have children who are too.

Being institutionalized “can be devastating for children — and uniquely so for Alaska Native children, compounding the trauma of past generations when Alaska Native youth were routinely taken from their communities and sent to boarding schools,” the report says.

Children living at Outside residential treatment facilities and North Star told the investigators about wanting to go home so they could spend time with grandparents, help build a cabin and play outside.

A girl from Bethel had first gone to North Star at 12, when she was “feeling sad and irritable, and exhibiting some aggression toward her younger siblings.”

An expert found that she could just as well have stayed home with her family and gotten treatment like intensive case management.

Instead, she’d been almost continuously institutionalized at North Star for four years.

“She appears to be more accustomed to life in an institution than at home,” the report said.

The situation remains particularly dire in rural Alaska, according to the report. At worst, kids in a psychiatric crisis end up staying in emergency rooms and even jail cells.

“In some cases, law enforcement responds to children in crisis by taking them to a general hospital or a jail,” the report said. “Children have stayed for days in local jails waiting for a flight to a hospital.”

Another teenage girl had been living in a psychiatric institution in Utah for eight months but could “very likely return” to her home, a village near Bethel, if the services she needed were available somewhere nearby. But there were no services for her, so she remained locked up in Utah.

She told the investigators she missed “being free.”

Missed opportunity

The Justice Department recommends that the state of Alaska use expanded Medicaid funding, federal and state grants and money from the Alaska Mental Health Trust to expand proven techniques for helping kids in crisis before they get sent away from home.

The state’s previous efforts to do just that have fallen short, the report found.

In 2019, Alaska applied for a Medicaid Section 1115 waiver, which was supposed to help the state offer an array of new services that went beyond institutions.

The state planned to boost funding for tested efforts to keep kids in their homes, including crisis response teams, therapeutic foster homes and intense case management.

But, two years later, the promise of the waiver hasn’t materialized, the investigators found. Alaska “has not meaningfully improved access to community-based services for children at serious risk of institutionalization in Alaska.”

In 2021, just five kids received mobile outreach and crisis services through Alaska Medicaid. The same year, just 35 kids received another service provided by the Medicaid expansion called home-based family treatment.

The Alaska Department of Health is making improvements, said spokesman Clinton Bennett, pointing to legislation passed in 2021 to allow short-term crisis stabilization centers.

“In addition, the Division of Behavioral Health received approval from the Centers for Medicaid and Medicare Services (CMS) to implement an 1115 waiver to expand access to behavioral health services and recently published a proposed rate increase currently out for public comment,” he wrote. “These are major milestones, and we remain committed to working with our stakeholders and constituents on additional improvements to the system.”

The Department of Family and Community Services, which oversees child welfare and the juvenile justice agencies, “is committed to ensuring that children with complex behavioral health needs receive the services in an appropriate placement setting,” said spokesman Brian Studstill. Staff in the commissioner’s office is working to improve the care of children in state custody, he said.

Alaska, the investigators found, needs to expand what’s already available to families using its “substantial” Medicaid funds supplemented with federal and state grant money and income from the Alaska Mental Health Trust Authority. The state acknowledges that it would be cheaper — “treating children in psychiatric hospitals ... costs more than serving them in their home communities.”

The Justice Department said it hopes to work with Alaska to “reach a consensual resolution.” If that doesn’t happen, the U.S. government could sue the state to force changes.

Read the report: