Judge orders state to end practice of holding psychiatric patients in jails, ERs

Alaska’s practice of detaining people held on civil psychiatric holds in jails due to the Alaska Psychiatric Institute’s inability to treat them causes “irreparable harm” and must end, an Anchorage judge has ruled.

For the last year, dozens of severely mentally ill Alaskans forced into state custody have been essentially warehoused in windowless prison cells, sleeping on concrete slabs, shackled and isolated in solitary confinement, said the 61-page ruling issued Monday by Anchorage Superior Court Judge William Morse.

“Civil detainees are being subject to extraordinary conditions that amount to punishment,” he wrote.

Morse issued the ruling in a lawsuit filed a year ago by the Disability Law Center of Alaska and the Public Defender Agency seeking to stop the sometimes lengthy jail and emergency room detentions of people in the throes of a mental health crisis.

The ruling orders the Alaska Department of Health and Social Services to come up with a plan by Dec. 5 to stop the practice, with a few very narrow exceptions. The state has another 90 days to make sure the plan is enacted.

The order will put additional pressure on Alaska Psychiatric Institute, a trouble-plagued institution embroiled in continuing regulatory crisis, lawsuits and staffing and management turmoil.

It is not clear how the state will comply.

As of Tuesday, there was an estimated 18-day wait for an adult civil commitment bed at API, according to the state’s psychiatric bed availability online tracker.

Clinton Bennett, a spokesman for the Department of Health and Social Services, referred questions about the ruling to the Department of Law on Tuesday. Cori Mills, a spokeswoman for the Department of Law, said attorneys are still digesting the ruling.

“We don’t have any further comment at this time,” Mills said.

The issue of involuntarily committed psychiatric patients being held in jails due to lack of space at API came to light last October. At the time, API couldn’t find enough staff to open enough beds to accommodate the daily tide of people from all over the state sent there to be treated for severe mental health problems.

So people ordered by a judge into state custody because they were a danger to themselves or others were dropped off at the Anchorage jail, taken to Hiland Mountain Correctional Center or sometimes to hospital emergency rooms because there was no room at API.

Some stayed a long time. Over the past eight months, 68 people were detained for 10 days or more before being admitted to API or released, the Disability Law Center said.

And some were extremely ill. One person held as a civil detainee at the jail after the criminal charge against him was dismissed was described as “catatonic, lying in his cell with vomit in his hair and on the floor. Patient defecated on himself this morning. (Patient) needs evaluation and stabilization,” according to the ruling.

The Disability Law Center of Alaska and the Alaska Public Defender Agency filed legal actions challenging the practice, and asking the court to immediately intervene.

As the case has played out in court, the state has struggled to get API working again.

In early February the state turned over management of the floundering hospital to Wellpath, a private corporation, which promised to get more patient beds up and running — in theory opening up more room for civilly committed patients to be seen at API in a timely manner.

But in April, the state canceled the controversial no-bid, long-term contract it had awarded to Wellpath. The union representing many API workers sued to block privatization efforts. And this month state canceled and reissued a bid for a contractor to study whether API should be privatized at all.

As of now, Wellpath is acting as a consultant at the hospital but isn’t allowed to make most hiring and firing decisions or directly manage most staff, according to company vice-president Jeremy Barr.

“The effort has been delayed as DHSS’s plan to have Wellpath employ API staff is subject to collective bargaining agreements API may have failed to honor,” Morse wrote. “Thus the transition to Wellpath has been delayed."

Meanwhile, API can currently only take about 47 patients due to continued problems hiring and retaining nursing staff, Barr said. That’s up from a low of 27 this spring.

The problem of how to house a backlog of civil commitment patients seems to be worsening, not getting better. In September, 18 people on psychiatric holds were held in Department of Corrections custody — the highest number in the last eight months, according to data included in the ruling.

Morse’s ruling says the state’s plan to stop psychiatric patients from being sent to jail can’t simply be to increase the number of beds open at API, said Joanna Cahoon, an attorney for the Disability Law Center.

“The court does not discern any improvement,” Cahoon said.

Cahoon said that while the issue has fallen out of the public spotlight, the order makes it clear that it isn’t resolved.

“This problem is ongoing,” she said.

The ruling also sheds light on the conditions detainees have been spending days and sometimes week waiting for treatment in.

During almost a year of hearings in the case, Morse took an unusual judicial field trip, visiting the Anchorage jail’s mental health housing unit himself. Morse found that “civil detainees at API are held in dramatically different conditions than civil detainees at DOC facilities.”

The ruling describes windowless cells outfitted with concrete slabs for sleeping. Psychiatric detainees are in solitary confinement for 23 hours a day and can’t go to group therapy or educational classes with other inmates.

“The conditions under which the State holds (people on mental health holds) at correctional facilities are harsher than the conditions experienced by an inmate who is mentally ill but detained on criminal charges,” the ruling said.

By contrast, API offers wide, bright hallways with high ceilings and windows, an atrium with a coffee stand and rooms with regular bedding, windows facing the outside, a gym, cafeteria and other amenities. Detainees can wear their own clothes. Patients aren’t regularly strip searched, the ruling says.

The Disability Law Center says the state will have to do three things to comply with the plan:

• Eliminate the practice of taking people to DOC when other facilities can’t admit them.

• Provide evaluations, potentially in emergency rooms, to see if a person no longer meets the legal criteria to be held, or could go to another facility for anyone stuck awaiting a room at API.

• Make sure people in jail whose charges are dismissed but meet criteria for civil commitment move to a psychiatric facility within 24 hours.

The ruling is a step in the right direction, Cahoon said. But while fixing the system for emergency care is important, the state needs to tackle a much broader transformation of its mental health system to keep people out of crisis to begin with, she said.

“In the long term what really needs to happen is we need what everyone is always talking about, which is community based treatment,” she said. “We need that lower-level community supports so fewer people come in with an emergency.”