Federal report says Alaska children with mental health problems are over-institutionalized | Alaskan News

“For months and even years, they live separated from their families, friends, schools, and culture,” the report says. “Some children are being discharged without proper support from the community, leading to more admissions to these congregate facilities.”

The findings were announced last week on the federal justice department website.

Although the report is new, the problem is not. Similar research in 2009 found that children in Alaska are trapped in a cycle of institutionalization. The federal government is now threatening to take “appropriate action, including suing” if the state does not resolve the issue, the latest report read.

The Justice Department concludes that “Alaska’s system of care is highly institutionally dependent and that key community services and supports necessary to care for children with behavioral health disabilities in family homes, such as family home treatment, crisis services and therapeutic home treatment services are often not available.

The researchers conducted interviews, including with families of children receiving state-funded behavioral health services, toured facilities and reviewed thousands of documents.

They found that the situation is particularly dire for children in rural Alaska.

Alaska Native children and children diagnosed with a behavioral health disability and an intellectual or developmental disability are particularly vulnerable to out-of-home placements, the report says.

The trauma is compounded for Alaska Native children, who have historically been taken from their communities and sent to boarding schools, and who lose their sense of identity after spending long periods of time in institutions, according to the report.

Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said in a statement that the federal agency will work with the state of Alaska to “prevent the unnecessary institutionalization of children.”

In a statement, the Alaska Department of Health responded that improvements are being made to mental health services for children.

Alaska has been approved by the Centers for Medicare and Medicaid Services to test new approaches to expand access to behavioral health services, the statement said.

In addition, state legislators approved a bill last year that “provides a structure for Alaska to establish 23-hour crisis stabilization centers and crisis residential centers for stays up to 7 days, while improving the protection of patients’ rights,” the statement read.

The Justice Department’s Civil Rights Division opened the investigation in late 2020.

The researchers looked at mental health services provided between 2016 and 2021, with a focus on 2019 and 2020, and found that the state’s Medicaid system paid much more to institutionalize children than it did for community services.

“In 2020, through its Medicaid program, the state paid more than $56 million to treat children in psychiatric hospitals and an additional $14.5 million for acute psychiatric care for children in general hospitals,” the report says. “In comparison, Alaska Medicaid paid claims for all community-based behavioral health services for children in 2020, excluding services provided in residential settings, totaled less than $32 million.”

The Justice Department found that admissions to group centers have declined in recent years, with the covid-19 pandemic, but children stayed for longer periods in part due to a lack of mental health services in their communities of origin.

At least 150 children were laid off in the period from July 2018 to February 2021, according to the report.

One girl, an unnamed Bethel girl, had been placed in congregate settings almost continuously for more than four years beginning at age 12 when she displayed aggression toward her younger siblings.

“Our clinical expert found that she most likely could have been cared for in her own home, despite these symptoms, if she had received appropriate community services, such as intensive case management, theoretically available through the state Medicaid program.” says the report. reads “Instead, she stayed in North Star [the largest psychiatric hospital for children, based in Anchorage] for three weeks, only to return to the facility later that year for a five-week stay.

“After the second stay, instead of going home to her grandmother, she was transferred to Alpine Academy, North Star’s PRTF (psychiatric residential treatment center) for adolescent girls, where she stayed for 18 months. She returned to North Star Hospital in 2019 and again in 2020, culminating in another placement at Alpine Academy PRTF that was ongoing at the time of our review. Now that she’s approaching 18, she seems to be more used to life in an institution than at home.”

Another child, a boy from the Arctic Northwest, stabbed himself in the leg after learning he was being sent to an out-of-state treatment center, according to the report. He struggled in his home community, ended up in a juvenile justice center, and eventually entered the foster care system.

Another family told investigators that a son feels like an outsider to his family after years of living in institutions.

In another case, an 11-year-old boy was sent back to Texas for hospital treatment after “the boy’s previous discharge to his family was unsuccessful because he did not receive ‘necessary supports,’” the report says.

The justice department did not find any cases, between 2016 and 2020, in which a referral to an out-of-state treatment center was denied.

The report states that each month about 130 youth reside in foster care or inpatient psychiatric treatment due to a shortage of community-based mental health services and therapeutic foster home placements.