Issue 15: Substitute Judgement Decision Making

Goal: All individuals with a mental illness who are determined by the court to be incapacitated will have a competent and effective substitute decision maker.


Currently there are not enough alternative decision makers available to make competent and effective decisions for individuals in need of such support. The Office of Public Advocacy's Public Guardian Program has six public guardians who provide guardianship services to 540 incapacitated Alaskans. The average caseload of 90 individuals exceeds those of other states by two to three times. Caseloads of this size impact the ability of the public guardians to provide individualized, quality, or timely services.

Private guardianship is available only to individuals who can pay for such services. Public and private guardianship, and alternative representative payee programs, which provide only financial assistance, lack oversight, regulations or licensing.

Families that attempt to provide alternative decision making for their family member may lack support or information to most effectively carry out their duties. Existing protections for wards may inadvertently pose barriers to guardians in ensuring necessary mental health care. Specifically, Alaska Statutes apparently do not permit guardians to arrange for voluntary psychiatric hospitalization for a mental health consumer. Waiting for an incapacitated mentally ill person to decompensate so thoroughly that involuntary commitment is possible may jeopardize the life and ultimate functional capability of that person.


264. Promote excellence in public and private guardianship programs and representative payee programs through effective monitoring, regulations, and program evaluation and funding that include consumer satisfaction measures and consumer/family review.

265. Review the current programs that provide guardianship, conservatorship, and representative payee programs to determine strengths and areas for improvement.

266. Advocate for necessary changes in statutes, regulations, and programs to insure access to assistance is available to all individuals who require service.

267. Develop training and assistance programs for consumers and families regarding substitute decision making.
Responsible party (actions 1-4): Office of Public Advocacy, Alaska Mental Health Trust Authority, Department of Health and Social Services