OPINION: How can Alaska improve psychiatric patient outcomes?

On Sept. 27, I was one of the presenters at the “Improving Lives” conference at the Dena’ina Center in Anchorage. In 20 minutes, I tried to answer this question: “How can the state improve psychiatric patient outcomes?”

The conference is sponsored by the Alaska Mental Health Trust Authority. Sixty organizations or individuals applied to be presenters. I believe I was the only person offering suggestions who has spent more than seven months locked in a psychiatric facility as a patient. Because of that experience, I have a unique point of view of what the state must do to improve psychiatric patient outcomes.

Almost every state has created a statewide standardized grievance and appeal process for individuals the state considers having a disability. Alaska has not. Psychiatric patients may receive a level of state protection after being injured or after they are mistreated in a psychiatric facility. But the Alaska Legislature has passed very few laws to prevent psychiatric patients from being mistreated, injured, or traumatized.

My first piece of advice: Any state that does not critically examine its past mistakes in mental health care is not giving itself the best opportunity to improve psychiatric patient outcomes.

On June 6, 1900, Congress passed a law that allowed the U.S. Department of the Interior Office of the Territories to contract for the care of Alaska’s psychiatric patients. Between 1900 and 1904, Alaskans who the government determined needed care were sent to the Oregon Insane Asylum, later called the Oregon State Hospital, and Alaska forgot about them.

In 1904, the U.S. Department of the Interior awarded Morningside Hospital in Portland, Oregon, a federal contract to provide care for Alaskans with a disability for $1 per day. With one dollar, the hospital was expected to provide medical care, clothes, therapy, food and a bed. Around 1959, the state of Alaska took over the contract.

From 1900 to 1968, many Alaska Natives and others were shipped from Alaska to psychiatric facilities in Oregon and forgotten. In total, approximately 3,500 Alaskans made the journey. Of the people who died during treatment, very few were returned to Alaska for burial by their families; most were buried in Oregon.

In 1959, when Alaska became a state, the cost of caring for Alaska’s disabled did not remain a dollar per day per patient. But the cost remained low because the private hospitals providing care, even the ones financially supported by the state, did not expect or receive many concerns or questions from the state of Alaska about patient rights, quality of care or patient outcomes. Today, the Alaska Legislature is still not setting a sufficient standard of psychiatric patient care and protection.

The state-run Alaska Psychiatric Institute opened its doors in 1962 with 225 beds. Psychiatric patients were still being sent to Oregon at that time. By 2021, the number of patients annually at API was 862, with only about 50 beds. Management at API was encouraged by state agencies to downsize and go in a new direction. Instead of improving a patient’s rights and choices and preparing an individual to go back to society and community care, patients were released, often back to the streets, with insufficient preparation and support.

As of now, more than 90% of the acute care psychiatric patients in Alaska that spend at least one night in a facility for a forced evaluation or treatment do so outside of state-run API. By any measurement, they are not well protected by the state. Outside of API, the standard of psychiatric patient care receives even less scrutiny by the state.

Just like 60 years ago, private/nonprofit psychiatric facilities, even the ones financially supported by the state, are allowed to keep secret the number and type of patient complaints, injuries, traumatic events and whether patients are treated respectfully, because the state does not require independent patient exit polls.

The title of my presentation at the “Improving Lives” conference was: “Improving acute care psychiatric patient outcomes by improving psychiatric patient rights.” I pointed out that the Alaska Legislature has to go in a new direction. Instead of just creating new programs for psychiatric patients, psychiatric patient rights must be brought up to or exceed best practice in all programs as the best way to improve psychiatric patient outcomes.

Faith J. Myers is a psychiatric patient rights activist and author of the soon to be released e-book, “Mental Health Care in Alaska 2022: a report card by a former psychiatric patient.” She lives in Anchorage.

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