Issue 2: Crisis Services
Goal: Ensure that crisis intervention services are readily accessible throughout the state.
An adequate continuum of care for mentally ill adults must contain widely distributed access to crisis respite services. Crisis respite services are a "first line" effort to prevent hospitalization and a service which, after brief hospitalization, can minimize the need for extended hospitalization. Without adequate crisis respite services available, people in crises will be sent to hospitals first. However, Alaska's public psychiatric hospital, Alaska Psychiatric Institute (API), has been decreasing its bed capacity for nearly a decade. Plans call for the future API to divert more acute patients to regional hospitals for evaluation and treatment and to crisis beds, when this is determined to be the most appropriate level of care. Unless we fund adequate crisis respite services, we will overuse more costly hospital care.
Although good community support services reduce remission crises, there will be times when acute care and crisis stabilization services are required. Local hospital resources throughout Alaska could provide psychiatric evaluation services. Frequently, even a short stay for evaluation can provide enough support that a person can avoid further hospitalization, especially if crisis respite services are available upon discharge. In addition, strides have been made to use alternative facilities for the detox/evaluation needs of those who are intoxicated and threatening to harm themselves, rather than hospital level care. As API re-directs its mission toward tertiary care, more regional psychiatric treatment capacity will be needed to address acute care needs. This care will be closer to clients' homes and families and may be less costly than centralized care. However, system changes will be necessary for this new configuration of services to succeed. Some of the costs for decentralized care may be paid for by decreased use of centralized hospital services, as proposed in the October, 1997 Alaska Psychiatric Institute Community Implementation Plan.
190. The Alaska Mental Health Board, Department of Health and Social Services, and the Alaska Mental Health Trust Authority will advocate for increases in the availability of crisis respite services throughout the state.
191. Explore the possibility of joint/shared crisis facilities in rural areas.
192. Implement the Alaska Psychiatric Institute Community Services Implementation Plan regarding an emergency services system for the Anchorage area, especially for increased crisis respite services, including care for those who have a history of aggressive behavior.
193. The Alaska Mental Health Board, Department of Health and Social Services, and the Alaska Mental Health Trust Authority will advocate for adequate funding to meet the psychiatric in-patient evaluation and treatment needs of involuntarily committed individuals, as well as those who seek care "in lieu" of involuntary commitment, that is, who meet the commitment standards.
Responsible party (actions 1-4): Alaska Mental Health Board, Department of Health and Social Services, Alaska Mental Health Trust Authority
194. The Alaska Mental Health Board and Division of Mental Health and Developmental Disabilities will review the current "indigency standard" and options, such as sliding fee scales, for user participation through sliding fee scales in paying for in-patient care.
Responsible party: Alaska Mental Health Board and Division of Mental Health and Developmental Disabilities
195. The Division of Mental Health and Developmental Disabilities' regulations will provide that all hospitals and other facilities that come in contact with individuals who are substance abusers and have mental disorders refer those individuals for substance abuse services, at a minimum, upon discharge.
196. Alaska Psychiatric Institute will provide outreach to hospitals providing psychiatric evaluation and designated treatment with 24 hour psychiatric consultation on request.
197. The Division of Mental Health and Developmental Disabilities will work with regional hospitals to ensure additional evaluation and designated treatment sites.
198. The Division of Mental Health and Developmental Disabilities will develop processes to assure consistent quality care among providers of psychiatric in-patient services.
Responsible party (actions 6-9): Division of Mental Health and Developmental Disabilities