Issue 8: The Lack of Title 47 Evaluation Services in Most Rural Communities
Goal: Develop statewide Title 47 evaluation services in hospitals throughout Alaska.
In most cases, rural communities are inadequately equipped to respond to client situations requiring evaluation for involuntary commitment under Title 47. The law requires that the evaluation take place within a hospital setting. Presently there are very few rural hospitals that are actually providing Title 47 evaluation services. Many clients are therefore detained in jails, alongside criminal detainees, until they can be transferred to an urban hospital or Alaska Psychiatric Institute for evaluation.
The net result is that the primary respondents to acute, mental health crises in rural areas are usually law enforcement officers with little or no mental health support. Rural hospitals, clinics and community mental health aides are currently unable to provide necessary screening and evaluation services or safe, alternative detention while awaiting transfer of the client to an available evaluation facility.
Encouraging rural hospitals to function as Title 47 evaluation facilities will allow rural consumers to remain closer to their communities and families while reducing the burden on urban facilities to accept additional patients. Recently, Bethel has begun to provide Title 47 evaluation services on a routine basis within its local hospital. The impediments to developing psychiatric evaluation services in other rural hospitals should be more fully explored and resolved.
It is also important to note that the effectiveness of rural hospital psychiatric evaluation services is in part dependent on the availability of crisis respite services in local communities. Crisis respite may be needed prior to hospital-based evaluation and as a discharge option for transition to less restrictive community care. It is therefore important that there be concurrent planning for rural crisis respite and Title 47 evaluation services.
169. Review psychiatric admission data for Alaska Psychiatric Institute and other hospitals to determine those rural communities with the greatest need for local/regional evaluation services.
170. Conduct meetings with representatives of rural hospitals to better understand the impediments to providing Title 47 evaluation services.
Responsible party (actions 1-2): Alaska Mental Health Board, Division of Mental Health and Developmental Disabilities
171. Explore the possibility of limiting liability for hospitals agreeing to work with Title 47 patients.
Responsible Entities: Division of Mental Health and Developmental Disabilities, Department of Law
172. Publicize and enhance the availability of Alaska Psychiatric Institute's 24-hour psychiatric back-up consultation to local hospitals.
173. Explore the possible use of telemedicine for consultation and/or screening and evaluation in relationship to Title 47 services.
174. Continue and enhance technical assistance efforts to rural hospitals that are providing Title 47 evaluations or are considering adding this service.
Responsible party (actions 4-6): Division of Mental Health and Developmental Disabilities/Alaska Psychiatric Institute
175. Provide funding for any renovations necessary to accommodate Title 47 evaluations within rural hospitals.
176. Implement pertinent recommendations from the Alaska Mental Health Board's regional planning process for inpatient psychiatric services. (Under this process, local hospitals and community mental health centers within pre-defined regions received planning grants to assess the need for regional inpatient psychiatric services.)
Responsible party (actions 7-8): Alaska Mental Health Board, Division of Mental Health and Developmental Disabilities, Alaska Mental Health Trust Authority