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publication of the Justice Center |
Alaska Justice Statistical Analysis Center |
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According to data from a prison
census conducted by the Bureau of Justice Statistics, in 2000
one in every eight state prisoners was receiving some mental
health therapy or counseling services. Nearly 10 percent—105,000
individuals—received psychotropic medications, including
antidepressants, stimulants, sedatives, tranquilizers or other
anti-psychotic drugs. Alaska reported 9 per cent of inmates receiving
such medications. Nationally, about 10 percent of those identified
as mentally ill, approximately 19,000 inmates, were receiving
24-hour care in a special housing or psychiatric unit. (This
was 1.6% of all inmates nationally.) At the time of the census,
Alaska had 93 inmates receiving 24-hour care—2.9 percent
of all prisoners in state facilities.
Nationwide, nearly 70 percent of
all facilities housing state prisoners offer mental health services
to inmates. Forty-seven states, including Alaska, reported mental
health/psychiatric confinement as a special function with the
correctional department. In general, state prisons screen inmates
for mental health disorders prior to placement in a facility.
An earlier BJS study, conducted
in 1998, found that mentally ill inmates (who were self-identified
in this study) were more likely to be incarcerated for a violent
crime: 53 percent of those mentally ill, compared to 46 percent
of all other prisoners, had committed a violent offense. These
inmates also tended to have longer prior criminal histories.
Among the mentally ill, 52 percent reported three or more prior
sentences, compared to 42 percent of other state inmates.
The mentally ill inmates also reported
high rates of homelessness and unemployment. Among these prisoners,
20 percent reported a period of homelessness in the year before
their arrest; 39 percent had been unemployed.
The mentally ill inmates also exhibited
higher rates of alcohol dependence than other inmates. Approximately
one-third were assessed as alcohol dependent.
The Alaska Department of Corrections
is, in effect, the largest provider of in-patient psychiatric
services in the state. In the 2000 study Alaska reported 93 inmates
receiving 24-hour care; 286 receiving some type of therapy or
counseling and 238 receiving psychotropic medicines.
In this state, as elsewhere, the
high rate of incarceration of mentally ill persons can be at
least partially ascribed to the deinstitutionalization which
has occurred over the last few decades. Beginning in the 1960s,
advocates for the mentally ill sought to reduce the number of
persons in mental hospitals, maintaining that many patients who
at that time lived on a long-term basis in such institutions
could lead fuller lives outside these facilities if they had
access to appropriate medical care and other assistance in the
community. Now, while such patients are no longer confined to
mental institutions, adequate funding for the necessary network
of community care has never materialized, with the result that
the mentally ill often lack access to adequate housing, appropriate
activities and the medication necessary to maintain stable behavior.
Many live on the street or in shelters, under conditions that
can lead to deterioration in behavior and involvement with the
justice system.
In Alaska over the last two decades,
deinstitutionalization has resulted in a gradual reduction in
the availability of long-term, in-patient care at the Alaska
Psychiatric Institute, the state’s only long-term psychiatric
facility. Moreover, Alaska communities, particularly in the rural
areas, have little provision for emergency psychiatric care.
The absence of alternatives can lead to the police being needed
to assist with mentally ill individuals who have become unstable
and disruptive.
There are other aspects to the
problem of mental illness which are particular to Alaska. The
state has a high rate of occupational head injuries with no major
rehabilitative facility. In addition, Alaska has a high rate
of fetal alcohol syndrome. Individuals with these afflictions
who are not properly supervised and engaged in structured activity
can become disruptive and violent—leading to involvement
with the police, courts and Department of Corrections.
The Department of Corrections conducts
physical and mental health screenings of all individuals at intake,
resulting in approximately 2000 referrals made annually to the
department’s mental health staff. Treatment is available
at all institutions, with psychiatric hospital units at Cook
Inlet Pretrial for male inmates requiring this level of care
and at Hiland Mountain for female inmates. (There are no DOC
beds at API, but an adult secure/forensic unit has beds for court-ordered
evaluations, short-term competency restoration and longer stays
under certain conditions.) DOC also utilizes telemedicine and
telepsychiatry to extend the reach of treatment staff capabilities.
In addition to providing required
medical care, DOC conducts programs for all mentally ill felons
within its institutions. For inmates in the general population,
programs focus on training in anger management, correcting thinking
errors, problem-solving and developing a moral framework. Inmates
within the treatment units at Hiland Mountain and Cook Inlet
have a full daily schedule of intensive therapy and counseling.
The department also attempts to
provide a bridge of treatment programs for mentally ill inmates
being released. It has contracted with community social service
agencies to assist such inmates for a period after release from
prison. The agencies guide individuals in finding housing, in
structuring their days through jobs or other activities, and
in obtaining access to various benefits, including funding for
necessary medications,
The information in the preceding article is based on information from the Alaska Department of Corrections and BJS reports “Mental Health Treatment in State Prisons, 2000” (NCJ 188215) and “Mental Health and Treatment of Inmates and Probationers” (NCJ 174463).