‘A very long time coming’: API launches new programs for mentally ill defendants

Officials at Alaska Psychiatric Institute, the state’s sole psychiatric hospital, say they plan to double the facility’s capacity to treat felony-level criminal defendants deemed incompetent to stand trial.

A separate program will offer treatment for people facing less serious misdemeanors — a change from the current practice of largely dismissing such charges.

The new programs help address a major backlog within the state’s criminal justice system when it comes to providing what’s known as “competency restoration” for people with mental health issues, officials at the facility say. People charged with crimes in Alaska must be able to understand court processes or meaningfully assist in their defense in order to stand trial; otherwise, the charges against them must be dropped.

API is the only facility in Alaska for defendants with severe mental illnesses to receive competency restoration to meet that threshold, decided by a judge.

The facility has come under fire in recent years because a lack of beds left people spending months behind bars waiting for admittance, leaving their criminal charges in limbo. The hospital has only 10 so-called competency restoration beds, and for years, waitlists for the program have been months or years long, a situation that court and hospital officials have agreed is unacceptable.

At a recent open house, forensic psychologist Dr. Christine Collins and other top API officials announced a new program that will allow more felony defendants to receive competency restoration treatment while in custody. A jail-based program will open 10 new beds for people accused of felony-level crimes and another 10 spots will open in an outpatient clinic for those facing misdemeanor charges, they said.

Before the new programs, there were only the 10 competency restoration beds at API to serve the entire state — the smallest per capita number in the entire country, said Dr. Kristy Becker, chief of clinical services.

Defendants facing misdemeanor charges will now have the opportunity to go through an outpatient restoration program that aims to connect them with the state’s mental health court, where they will have access to additional resources and services, Becker said.

Rather than punishment for misdemeanor offenses, the new outpatient program aims to offer community oversight, legal restoration, and access to additional support, she said.

“It sort of serves as a bridge to get them out of a custodial setting into a community setting with a greater degree of oversight than they would have otherwise if their charges were just dismissed, which is what’s essentially happening now for these misdemeanor cases,” Becker said.

Dismissed charges come at a cost

Competency restoration is more like training than treatment. Such programs use various techniques including therapy or medication to stabilize a patient, then teach them the basics of the trial process enough that their cases can proceed.

The practice has raised questions nationally about the money spent simply making sure defendants can get through the trial process when some say they shouldn’t be in the criminal justice system in the first place.

Researchers say people with serious mental illnesses are usually not violent and are more likely to be the victims of crime than commit crimes themselves. Still, the programs can keep potentially violent offenders from having charges dropped, putting them back in the community.

Two random violent attacks in Anchorage involving people who had been found incompetent to stand trial highlighted challenges within Alaska’s competency restoration system.

A man found incompetent to stand trial last year after attacking two women in separate incidents was released from jail and then stabbed another woman at the Loussac Library. During 2018, a man found incompetent to face charges stemming from a string of violent, unprovoked assaults was released from custody after his charges were dismissed, and he then fatally stabbed an employee at the Alaska Zoo.

Misdemeanor charges involving incompetency have generally been dismissed because the lengthy waitlist for services often means the accused person spends longer in jail waiting to get into the program than they’d spend in custody if they were sentenced for the crime, which judges have ruled violates the defendant’s rights.

Right now, few defendants found incompetent to stand trial ever make it to API for restoration services. But even those who do get admitted to the facility aren’t assured success: More than half can’t be restored to the competency threshold. That means their charges are dismissed or they are held under a civil commitment.

Statewide, an average of 216 defendants a year were found incompetent to stand trial over the past three years, according to API data. Of that number, just under 20% received competency restoration services.

In Anchorage, nearly two-thirds of the just over 200 cases a year involving defendants who received competency evaluations resulted in a finding they were unable to stand trial, according to average fiscal year data over three years provided by the Alaska Court System. An average of 53, or roughly a quarter, were referred for restoration, according to the state’s data.

Of that number, only 12 Anchorage defendants on average actually made it to API for the restoration program each year. Some cases were still on the waitlist, and in a few the defendant was found competent prior to API admission, but the data showed an average of 32 of those cases were dismissed either by the court or by prosecutors.

In total, 37 Anchorage defendants made it to the restoration during the last three fiscal years. Of that number, 14 were competent after the program, but 21 still did not meet the required threshold and their charges were dismissed, the data showed. A few cases involved defendants still in the program.

[Statewide data tells mixed story about crime in Alaska]

Tackling a long wait

Backlogs and lengthy waitlists are a problem nationwide, because the need for competency restoration services has grown significantly in the last few decades.

In Alaska, a 2019 study identified the outpatient and jail-based competency restoration programs as a potential solution. The programs being rolled out now have been “a very long time coming,” Collins said.

There are 50 people on API’s competency restoration waitlist now, said Melissa Luce, a paralegal for the facility. Each person will spend about five months in jail waiting to get a bed and start the program, she said.

If someone is unable to be restored to competency after going through the program, criminal charges against them legally have to be dismissed. There also may be some defendants not suited for restoration, such as those suffering from a severe intellectual disability, who will have their charges dismissed, Becker said.

The 10 additional beds made available for competency restoration through the new program will be located inside the Anchorage Correctional Complex, Becker said. They will house felony-level defendants who don’t require hospitalization — people who can take their medications, go to group therapy and follow directions in a jail, she said.

The outpatient program is located in a small office on Gambell Street and staffed by Collins and two psychiatric nursing assistants. It will offer competency restoration treatment to people facing only misdemeanor charges for nonviolent offenses and out on bail, Collins said.

Ideally, it will restore competency to people whose charges would otherwise be dismissed so they can enter the mental health court and be connected to services there, Becker said. Mental health court is a voluntary program that serves defendants with mental health disorders or disabilities to offer treatment plans and monitor progress in hopes of managing underlying factors that may cause a person to commit crimes.

The new programs — named “Journey to Resilience” — were funded in part by $850,000 from Alaska Mental Health Trust Authority spread across three fiscal years to establish and oversee the program, as well as $800,000 from the Alaska Legislature, to be added to the base budget of API each year, according to Brian Studstill, communications director for the Alaska Department of Family and Community Services.

API plans to track data about patient outcomes and analyze the effect of the new programs on the waitlist and backlog, Becker said.

The programs officially began several weeks ago, but officials plan to begin intake sessions with the first few clients in coming weeks and begin group therapy sessions by early next month, Collins said. The program will take on just a few patients at first, but the plan is to expand to serving 10 people in each program within the next three to six months, Becker said.

She is hopeful the new programs will shorten Alaska’s waitlist, but it’s not yet clear how significant any changes may be.