OPINION: Paper reveals shocking mistreatment of Alaskans with mental illness

Editor’s note: In its original form, this commentary stated that the public comment deadline for the state’s report on psychiatric patient rights was the end of September. The state has extended the comment period to Oct. 6; comments can be filed online.

House Bill 172 became law in July 2022. It resulted from a successful lawsuit against the state for illegally confining Alaskans with mental illness in jails and emergency rooms. While abjectly failing to treat current patients, Alaska Psychiatric Institute also wasn’t admitting new patients who’d been forcibly committed. HB172 provided for short-term crisis stabilization centers.

The law also required relevant state agencies and the Mental Health Trust to submit a report to the Legislature within one year. The report must assess and make recommendations for improving patient outcomes, patient rights and the grievance process, and also address institutional trauma and patient injuries.

As input for the report, in May of this year, a group of distinguished authors published a startling document titled “White Paper on Improving Patient Outcomes, Addressing Treatment Caused Trauma & Injuries, Enhancing Patient Rights, and Grievance Procedures for the Report Required by HB172.” The authors’ decades of expertise include: “lived experience,” mental health law, services, and academics, as well as internal medicine and psychiatry. Their analysis is well documented, with citations to evidence and authority.

The paper is difficult to read. Not because it’s complicated. Rather, it is woefully simple. Alaskans with mental illness are being subjected to inhumane “treatment” without due process under the guise of protecting them.

These individuals are being psychiatrically incarcerated and drugged against their will by court order in non-emergency situations. Staff physically overpower them, strap them to a gurney and forcibly inject them with a psychotropic drug if they resist.

Our state Supreme Court acknowledges such drugs have grotesque, disabling side effects. But the worst side effect, says the court, is the intended altering of the mind — equivalent to lobotomy.

The United Nations has repeatedly stated such forcible intervention against psychiatrically disabled people can amount to torture. It isn’t “treatment.” It’s behavior control.

While the above is haunting, evidence in the white paper that it causes worse patient outcomes than feasible, humane treatment is enraging. Studies by the National Institute of Mental Health and the World Health Organization, combined with patient outcomes in non-coercive programs in Sweden, Switzerland, Finland and the U.S., show that maintaining people on psychotropic drugs versus treating them without such drugs reduces their recovery rate from a possible 80% to 5%, and reduces average lifespans by approximately 20 years.

The white paper discusses numerous proven, community-based treatment alternatives with better outcomes. These alternatives share voluntariness and informed choice, relationships as the first line of treatment, respect for the individual and their life experience, emphasizing community inclusion. They are cheaper in the long run, and their better outcomes mean less homelessness, involvement with the criminal system, revolving-door commitments and subsidization, as well as more employment, self-sufficiency and contribution.

Why is Alaska still engaging in draconian behavior? Let’s examine the accomplices.

The Legislature is uninformed regarding the science. It is also susceptible to overlooking the problems of those without power and, when it does act, to pick short-term solutions with the biggest lobbies.

Next, the state psychiatrists. Beginning in the 1950s, big pharmaceutical companies with their profit motives and power enticed psychiatry to join them in the lie of “magic pills” and “miracle cures.” For another example of this, look no further than our opioid crisis. The difference is our psychotropic drug crisis is hidden in closed court proceedings and locked institutions.

That science hasn’t caught on with our state psychiatrists, I attribute first to what our state Supreme Court noted is an inherent conflict of interest in psychiatrists tasked with treating individual patients while also maintaining order and managing institutions. Sedation isn’t treatment, but it makes more patients easier to manage with less staff.

A second reason for state psychiatrists to ignore the science of psychotropic drugs is an inferiority complex. The “magic pills” of the 1950s elevated psychiatry to the biological world of medical diagnosis and response by “real doctors.” Relationship, trust-building, talk therapy, guidance and support sound like a “soft” social science — one that may not even need psychiatrists with their prescription pads.

Psychiatrists needn’t worry. There are patients who want drugs. That psychiatrists also forcibly inject patients who don’t want to feel lobotomized and suffer other disabling side effects, and endure a reduced chance of positive outcomes, has been rightly condemned by the United Nations.

Then there are the overworked court-appointed counsel representing individuals the state is trying to forcibly “treat.” They have inadequate time and resources to prepare an effective opposition for their client. They may also struggle with zealously representing that interest when the Legislature has eliminated successful, less intrusive mental health services by defunding them.

Finally, the courts have abdicated to the Legislature their separate power to uphold the guarantees of liberty, privacy and due process for persons with mental illness — saying they can’t force the Legislature to fund less intrusive, humane treatment. In contrast, the same courts consistently demand the state fund humane conditions for incarcerated criminals — or free them.

Not only does this happen in secrecy, there is no accountability during or after the fact. There is no publicly available information about the number of Alaskans forcibly committed and drugged, their grievances, their injuries or traumas, their treatment outcomes or their revolving-door admissions and deterioration.

It’s all there in the white paper. It will be interesting to see how the state responds to this information in its mandated report. The draft report was supposed to be posted publicly in August. September was for public comment. It was posted on Sept. 15, and the public comment period ends Oct. 6. I can hardly wait to read it. I urge you to. It’s time for some accountability.

Val Van Brocklin is a former state and federal prosecutor in Alaska who now trains and writes on criminal justice topics nationwide. She lives in Anchorage.

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