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.