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More Alaska psychiatric patients may be held in jail cells due to hospital staffing shortage

Alaska Dispatch News - 10/13/2018

Oct. 13--Workplace safety fears and staffing shortages at the state-run psychiatric hospital has the Alaska prison system bracing to house more and more psychiatric patients in jails.

In a two-week period from the end of September to early October, reports of patients injuring staff at the Alaska Psychiatric Institute doubled, said Cynthia Montgomery, the acting director of nursing. At that point, Montgomery said, the hospital decided it could not safely take on more patients without additional staff.

This is not the first time API has been at capacity and could not take more patients, said Duane Mayes, the director of API. He said he expects to hire close to 50 new psychiatric nurse assistants in the next three to six months, which will allow the hospital to open all 80 of its beds.

At the moment, amid the employee shortage and safety concerns, API is now using only about 50 of its beds.

If there isn't room for a patient at API, the next step is placement at another treatment facility, like a local emergency room. And Anchorage's hospital emergency rooms have been overflowing this year with psychiatric patients, in part because of API staffing shortages.

Without hospital beds available, some potential API patients are expected to find themselves held in a jail mental health ward, even if they are not accused of a crime.

Staff with the Disability Law Center of Alaska visited Anchorage Correctional Center Friday morning and confirmed that two psychiatric patients were currently being held at the jail that should have been evaluated at API, said Dave Fleurant, the executive director of the center. Megan Edge, a spokeswoman for the state Department of Corrections, said two psychiatric patients were being held at the Anchorage jail, a third is at Hiland Mountain Correctional Center and a fourth had been released to a group home. She said the patients had been coming since Oct. 5.

One of the patients had been waiting at the jail for almost a week, Fleurant said. He criticized the state for a lack of transparency.

"This has happened in the past, but never at this level, and never for an indefinite period of time," Fleurant said.

That law allows the person to be held at a local hospital or correctional facility until the patient can be brought to a treatment facility, Brooks wrote in the memo, a copy of which was obtained by the Anchorage Daily News. Once a patient arrives at a treatment facility such as API, he or she must be evaluated within 72 hours, under state law.

But there is no time limit for those who are waiting to begin the evaluation process, according to Brooks' memo.

"With bed space at API extremely limited, and local hospitals resistant to taking (Title 47 holds), we can expect many of these individuals who are awaiting API commitment to end up in our facilities," Brooks wrote to colleagues. "I do not know how many (Title 47) detainees we will see or how long they may remain with us."

The memo said the number of beds at API had dropped to 36, though Brooks later said in a later phone interview the number was incorrect and should be 49.

The memo prompted alarm among public defenders and advocates for the mentally ill in Alaska. While it isn't unheard of psychiatric patients to be placed in jail cells when hospitals are full, that has been regarded as the option of last resort, said Quinlan Steiner, the head of the state public defender agency.

"What appears to be happening is that this is just going to be standard procedure," Steiner said.

Mike Abbott, the chief executive of the Alaska Mental Health Trust Authority, said Friday his agency was aware of the challenges in the system, and knew many people were working hard to make sure appropriate care was available for people with serious mental illnesses.

"But putting people in jail -- because there's not a better therapeutic option -- is generally not acceptable," Abbott said.

Patients who are committed to API may be experiencing a range of conditions that cause them to pose a danger to themselves or others, from an acute crisis such as a suicide attempt to the psychotic effects of drugs to the chronically mentally ill.

In her memo, Brooks, the corrections official, described the possible rise in commitments as a fresh challenge facing the prison system.

"This is new to all of us so please be patient as we work through a new process," she wrote to fellow corrections officials.

Her memo outlined a series of procedures for jails and prisons to follow, including an immediate referral to a mental health clinician and a warning for staff not to use restraints unless a detainee was actively harming themselves and all other de-escalation attempts had failed.

In a phone interview Thursday, Brooks said psychiatric patients who come to the Department of Corrections would be placed in specialized psychiatric care wards in the downtown Anchorage jail, Hiland Mountain Correctional Center or Goose Creek Correctional Center in Knik. The patients will not be placed with the general jail population, she said.

She said the patients would be prioritized by the acuteness of their illness.

As of Thursday, Brooks said she didn't have any data on the number of patients actually being housed at DOC. She said she was trying to be proactive, but noted that her facilities are not meant to treat psychiatric patients.

"The bottom line is, these are jail cells, these are not hospital rooms," Brooks said.

The shortfalls in staffing at API, which officials characterized as short-term, is the latest crisis for an institution that has been struggling for years with management and safety. A September report by attorney Bill Evans corroborated concerns about an unsafe working environment at API, and shortly after, then-director Ron Hale and two top health department officials resigned.

Hayes, who was appointed API director after Hale's resignation, said the Evans report heightened his level of concern about patient and staff safety. He said he was working "aggressively" to fill the new nursing jobs in the next few months. Some patients need two nurses and full-time monitoring.

He said the state has boosted nurse salaries and is also offering a $10,000 signing bonus.

Montgomery, the acting director of nursing at API, said the recent spike in staff injuries was the main factor in the decision to turn away patients. She said there were 22 staff injuries by patients in a two-week period from the end of September to early October, compared to 11 injuries over the same period in August and July.

Laura Russell, a behavioral health policy adviser with the state Division of Behavioral Health, said API is constantly assessing the number of people it can safely care for.

"We are at the capacity that our resources can handle at this time," Russell said.

But so are local emergency rooms. An Anchorage Fire Department website that shows hospital status listed the emergency rooms at all three major hospitals as "closed" to psychiatric patients. That means the hospitals have alerted police and paramedics that it is no longer safe to continue delivering patients to the emergency rooms, and officials should seek other treatment facilities first.

Steiner, the public defender, said the short-term question is whether hospitals can somehow accommodate these patients so they don't have to go to jail. In the long term, other advocates said the solution is not a bigger hospital but better supports and care for people with mental illness to avoid crises in the first place.

Fleurant, the executive director of the Disability Law Center, said in a Friday statement that detaining civilly committed individuals in jails was unconstitutional. He said the prospect of a lawsuit was being researched.

"This is how we buy ourselves, as a state, some time," said David Fleurant, an attorney with the Disability Law Center who was monitoring the situation. "We lock up our patients. And I can't believe there isn't another alternative out there."

Faith Myers, a longtime advocate for the mentally ill in Alaska, said Thursday she had not heard of psychiatric patients being placed in jail because there wasn't room elsewhere. She said that concerns about patient safety have taken a backseat to concerns about staff safety in recent years.


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