Safer Alaska, Building Resilient Communities

Improving Access to Mental Health and Substance Abuse Treatment

medics work on patient at the airportRecognizing and addressing mental health and substance abuse problems will be a critical component of improving public safety in Alaska. An essential first step to improving access to treatment will be working to increase the number of beds at treatment facilities in Alaska. To that end, DHSS plans to reach out to hospitals to advocate for more designated evaluation and treatment beds. Longer-term, state agencies will evaluate options for how the Palmer Correctional Center might be used for a mental health or substance abuse evaluation and treatment facility, pursue an exemption from federal regulations that limit the number of beds a provider can operate for residential substance abuse disorder treatments, and look into the possibility of releasing some patients subject to around-the-clock monitoring.
 
54. Continue interagency coordination to allocate mental health and substance misuse treatment funding. IN PROGRESS:
Collaboration among DPS, DHSS, DOC, and LAW on mental health and substance misuse treatment funding and recidivism reduction efforts continues to occur.
55. Continue and expand crisis intervention team (CIT) training for law enforcement. IN PROGRESS: Next training is scheduled for Oct. 2018 in Mat-Su Valley. DOC is also working to implement CIT training for probation officers and other DOC staff.
56. Propose ongoing stakeholder meetings to discuss the civil commitment process and options for improving the state psychiatric emergency system. (DHSS, LAW) IN PROGRESS: DHSS is coordinating ongoing meetings with on-the-ground staff from DHSS, LAW, the court system, PDs, OPA, and will eventually include representatives from hospitals.
57. Explore expansion of designated evaluation and treatment beds to increase capacity and improve availability of acute care mental health treatment and evaluation beds at Alaska Psychiatric Institute (API) and other hospitals. (DHSS)

ONGOING:

  •  In Nov. 2017, DHSS approved the Certificates of Need for projects at Mat- Su and Alaska Regional Hospitals allowing those hospitals to explore expansion of treatment beds.
  • DHSS received $14 million in Disproportional Share Funding (DSH) to be distributed to hospitals over the next two years to assist with the overflow of psychiatric inpatients for API.
  • The Governor requested and the Legislature funded $3.1 million for API to address nursing salaries in order to operate at its 80-bed capacity.
  • [NEW] DHSS will seek funding to increase salaries of Psychiatric Nursing Assistants at API, and add positions.
58. [NEW] Expand training opportunities to increase law enforcement understanding of mental health commitment process. [NEW] IN PROGRESS: The first “Mental Health Commitment Training” for law enforcement was held in August 2018, covering the Title 47 civil commitment process. The training will be replicated in Anchorage, Fairbanks, and Juneau and possibly as webinar for rural locations.
59. Legislation to authorize court orders requiring DOC to hold people who are intoxicated when they are arrested until they are sober. COMPLETED: Addressed in SB 54, bail schedule changed.
60. Evaluate current use of Title 47 safety net for individuals incapacitated due to substance abuse until a better long-term solution is found. IN PROGRESS: 

 LAW evaluated the current use of Title 47 holds; DOC considering clarifying policy.

61. Evaluate ways to increase availability of treatment resources for outpatient services.

ONGOING:

  • DHSS submitted an 1115 Behavioral Health Medicaid Waiver application on Jan. 31, 2018. If the waiver is approved, DHSS expects that a new array of local adult outpatient and acute care behavioral health services for children and adults to become available in 2019;
  • $18 million for expanding substance use disorder services over 3 years was included in the Governor’s FY19 budget request. The Legislature funded $12 million of this request. Requests for Proposals (RFPs) were issued in August 2018 which should bring additional treatment services online in 2019 including for crisis stabilization.
  • [NEW] DHSS will seek an additional $9.1 million in FY20 to further expand treatment options.
  • DOC continues to assist offenders who are in their last 30 days before release to complete Medicaid applications for submission upon release.
62. Evaluate how to incentivize treatment on demand so it is available when needed. IN PROGRESS: Agencies are also engaging with stakeholders in ACJC to develop solutions.
63. [NEW] Evaluate “Angel Program” model for possible use by law enforcement agencies in Alaska.. [NEW] IN PROGRESS: Evaluating the “Angel Program” model which would allow people with addictions to request help at local law enforcement agencies and be immediately connected with treatment options, thereby facilitating and encouraging pre-arrest addiction treatment.
64. [NEW] Pursue federal grant funding to expand prevention, treatment, and recovery support services in Alaska.

[NEW] COMPLETED:

a.        $8 million awarded in September by U.S. Substance Abuse and Mental Health Service to enhance and expand new and existing treatment and recovery support services over the next two years.

b.       $2.4 million awarded in September by the Center for Disease Control and Prevention over the next year to implement Alaska based programs and trainings for professionals and community providers on the front lines of the opioid and drug crisis.
65. Evaluate the ability to establish a restorative justice facility, such as a mental health and substance misuse evaluation and treatment facility. IN PROGRESS: At the request of DHSS, the Legislature approved funding for a feasibility study to explore the value of establishing a forensic hospital in Alaska. Contractor selected by DHSS.
66. Pursue an exemption from the federal institute for mental disease (IMD) rule that limits how many beds a provider can operate for residential substance misuse disorder treatment. (DHSS) IN PROGRESS: DHSS included a request for a waiver from the IMD exclusion as part of the state’s 1115 Waiver application (submitted in Jan. 2018) which, if granted, could allow for substance misuse treatment to be paid for with Medicaid funding in facilities with more than a 16 bed capacity. Many providers anticipated to immediately add additional treatment beds upon approval.
67. Increase and improve services for children who need institutional care, including increasing beds at treatment facilities. (DHSS) IN PROGRESS: Services for children pursued through the 1115 Behavioral Health Medicaid Waiver application. If approved, implementation of new targeted children’s treatment services to begin in 2020.
68. Develop a standardized system for evaluating and treating non-restorable patients and explore  possibility  of releasing some patients subject to around- the-clock monitoring to reduce costs and open rooms for other patients at API. (DHSS) IN PROGRESS: DHSS is studying options with a focus on the forensic feasibility study to explore the value of a forensic hospital for Alaska, including providing treatment for persons found non-restorable. Contractor selected by DHSS to conduct the feasibility study.
   
   
69. Develop long-term strategy for Title 47 holds. IN PROGRESS: ACJC is discussing long-term options.
70. Evaluate possible legislative or administrative options to ensure timely competency hearings. (LAW) IN PROGRESS: Representatives from the court system, LAW, OPA, PDA, and DHSS have determined that Title 12 competency and restoration issues need to be dealt with separately from similarly complicated civil commitment process issues; the committee is currently addressing the involuntary commitment procedure of AS 47.30.
 

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