My Turn: Alaska can improve care for psychiatric patients

Posted: Sunday, November 28, 2010

Psychiatric patients is one of the most vulnerable populations in society, especially those court-ordered for treatment, civil commitment, forced evaluation or in a locked facility or unit.

Up to 10,000 Alaskans a year are brought into a psychiatric hospital or unit for forced evaluations, civil commitment, court-ordered treatment, etc.

Alaska is a young state and in our opinion as longtime patient advocates, Alaska has not developed new laws and regulations to protect psychiatric patients in relatively new psychiatric units and locked facilities and must do so.

Of the 10 states we have looked at, including Alaska, the Department of Health and Social Services or their equivalent had to be forced before making any significant improvement in psychiatric patient rights and care. In some states the governor stepped in to help. And this is what we would like to see happen in Alaska.

However it is done, Alaska must improve psychiatric patient rights and care. The following is our wish list:

• A state Ombudsman's report critical of DHSS for not keeping statistics of the number and type of complaints filed by psychiatric patients.

The Department of Corrections keeps statistics at 12 locations. DHSS should be required to keep statistics of all psychiatric patient complaints by facility and unit.

• Alaska may be the only state that has not written specific laws that protect all psychiatric patients in the grievance process. Alaska must revise the grievance procedure statutes, especially for those patients civilly committed or forced to be evaluated in a locked facility or unit.

• DHSS is required to investigate psychiatric patient complaints. According to a state Ombudsman's Report, DHSS has not investigated a psychiatric patient's complaint in five years. Alaska may be the only state that does not have a specific state office that investigates psychiatric patient complaints in a legitimate way.

• State psychiatric hospital or psychiatric units that do civil commitments and/or forced evaluations have for 10 years had staff periodically attend conferences on patient trauma. The one thing psychiatric hospitals or units in Alaska are not doing and should be doing is to be required to recognize in a patient's record incidences of institutional trauma (such as physically restraining a patient, placing a patient in isolation, strapping a patient to a gurney or other device as a means of restraint, using force to medicate a patient, physical takedowns, etc.) and provide treatment. It needs to happen in this state soon.

• In many states (not Alaska) it is a law that DHSS, or its equivalent, must protect psychiatric patients and protect their rights (those granted by statute or regulation). It could be done by an administrative order but it must be done somehow in Alaska.

Historically, it is shown advancement in psychiatric patient rights translated to improved quality of patient care, more opportunity for patient recovery and less trauma for patients.

What is it like to be in an acute care psychiatric hospital or unit? Karen J. Cusack and others, to an extent answered that question in a 2003 report, "Forty-seven percent of subjects (patients) reported experiencing a DSM-IV defined traumatic event while in the hospital" (which may cause or exacerbate Post Traumatic Stress Disorder).

Alaska hospitals are not routinely required to recognize, document and treat institutional trauma. Continuing in the same report, "Subjects (patients) consistently reported experiencing fear, helplessness or horror in response to traumatic events." The feeling of helplessness is amplified in Alaska when psychiatric patients often cannot file a grievance in a fair way. And until the state is willing to revise its psychiatric patient grievance procedure statute, patients will continue to feel helpless.

Alaska has a long way to go to be compared with some of the more progressive states when it comes to enumerating psychiatric patient rights and protecting those rights.

It is going to take good citizens calling their legislative representatives to bring about necessary improvements for psychiatric patients.

• Myers and Collins are mental health advocates in Anchorage.

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