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As with the U.S. prison system in general, the Alaska correctional
system is the largest provider of mental health care services in the state.
According to a 1997 one-day snapshot study done for the Alaska Department
of Corrections (DOC) by Care Systems North, approximately 37 percent of
the DOC population exhibit a mental disorder. Twenty-nine percent exhibit
mental illness, with 12 percent showing major psychiatric disorders. Eight
percent exhibit chronic alcoholism. In comparison to correctional systems
in other states, Alaska prison administrators are dealing with fewer mentally
ill inmates, but these percentages are higher than national prevalence
rates, according to the snapshot study. A 2003 DOC grant proposal states
that the mental health staff see over 2000 separate individuals each year.
As of June 2004, the Alaska Department of Corrections
had 40 clinical positions, some unfilled, dedicated to mental health care
services. Additional positions are occasionally filled under temporary
contract. The system operates two in-patient acute care units—a
men’s unit with approximately 24 beds at the Anchorage Correctional
Complex and a women’s unit with approximately 18 beds at Hiland
Mountain. These units provide 24-hour psychiatric care and are usually
running at 75 to 80 percent capacity. In addition, there is a sub-acute-care
unit at Spring Creek and supported-housing units at Palmer and Hiland
Mountain.
The consensus among professionals working with
the mentally ill inmate population is that in Alaska, as elsewhere, staffing
and resources are inadequate to meet the needs of this population. There
are not enough sub-acute-care units, and there is little counseling available.
Moreover, screening at intake can be inadequate for identifying the mentally
ill, leading to lags in providing treatment and medication. However, the
state system follows the guidelines established by the National Commission
on Correctional Health Care (including submitting to outside monitoring
of its institutions) and is considered to be one of the better systems.
All Alaska correctional officers receive some
training in working with the mentally ill, and those COs who are assigned
to the specialized care units get additional training. Training for probation
officers also includes a mental health component. Some probation officers
carry solely mental health caseloads and coordinate the supervision of
released inmates with DOC and community health clinicians.
The system does use inmate segregation—or
isolation—as a tool for managing the prison population, including
those who are mentally ill.
DOC retains the seriously ill in-state, sending
only stabilized inmates to the private contract facility in Arizona.
In an effort to address the problems presented
by mentally ill who fall under supervision of the correctional system, Alaska
has put in place several small programs. Among these are the Institutional
Discharge Program Plus (IDP Plus), which provides pre-release planning and
case-coordination after release for mentally ill felons, and the Jail Alternative
Services program (JAS), which works in conjunction with the Court Coordinated
Resource Project (mental health court) to essentially divert eligible misdemeanants
from serving time in jail. Both of these programs attempt to construct a
net of services from different agencies and departments to provide access
to treatment and medication, benefits such as Social Security and Medicaid,
and housing. Both programs have shown some success in reducing recidivism,
but their funding is not secure.
Another administrative problem for the correctional
system with regard to the mentally ill is that DOC facilities admit over
two thousand individuals each year under protective custody. These individuals
have not been arrested and charged but rather are being held temporarily
because they have become incapacitated by alcohol, drugs or mental illness
and their behavior has led to police taking them into custody for their
own safety.
Beyond the immediate problems for DOC in supervising
the mentally ill who come under its jurisdiction lies the inadequacy of
the statewide behavioral health system, which presents reentry problems
for those leaving DOC’s supervision. A major stumbling block for
many released prisoners is that access to federal benefits is often delayed—leading
to gaps in treatment and periods without medication during which behavior
can deteriorate quickly. In addition, adequate housing is in very short
supply. Released prisoners vary in their need for structure in their living
situations. There is an absence of sufficient low-cost housing along the
entire continuum from low-income apartments, to single room occupancy
units, to intensive assisted-living facilities. Many released prisoners
resort to living in homeless shelters. Another gap in the overall community
mental health care system is the absence of enough treatment programs
that can handle individuals with a dual diagnosis—mental illness
combined with a substance abuse problem. Without housing or medication
or programs, a released inmate’s behavior can deteriorate to the
point where another arrest for another offense occurs.
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