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By FAITH MYERS
Inadequate rights for individuals diagnosed with a mental illness or co-occurring disorders adds to the homeless population. It was never enough to just downsize or open the doors of massive psychiatric facilities and let patients walk out. The Alaska government in the 1960’s should have provided fair rights and care for the disabled that stayed behind in psychiatric institutions and the disabled that ended up on the streets after leaving institutions because of downsizing. Inadequate rights hurt the disabled, but it is not a fatal flaw—it can be fixed.
In the 1960’s patient advocates had a profound effect on cities big and small, especially the size of the homeless population; “the disabled must be provided the least restrictive environment.” The decree was a game changer. From 1955 to 1994 there was a reduction in civil commitments to psychiatric hospitals of 92%. There was a catch. There was no place for many of the released disabled to go other than the streets. And the courts were reluctant to force states to provide community care.
Decades earlier stories were being printed concerning the mistreatment of psychiatric patients. Hats off to investigative reporter, Nellie Bly, who in 1887 arranged to be civilly committed in the notorious “Women’s Lunatic Asylum on Blackwell’s Island.” After 10 days of documenting mistreatment of patients, she was released and wrote the book, “Ten Days in a Madhouse.”
In the 1950’s, locked psychiatric facilities were often large imposing structures that were best described as work farms where the disabled could be locked away from the general public and according to proponents, given useful work. Overbrook Asylum in Cedar Grove, New Jersey held 3,500 patients. The hospital was so large it had its own train stop. The psychiatric hospital favored by the Alaska Department of Health and Social Services was Morningside Hospital in Oregon. In a 60-year period, from territorial days to the late 1960s, 3,500 Alaskans would be committed to Morningside.
The combination of changes in civil commitment laws and new families of psychotropic medication, Thorazine, and related Stellazine, Melaril and Haldol, forced many locked psychiatric hospitals to close their doors. A half a million people with a disability were left to find new accommodations, and cities and states were left to decide if they would pay the added cost of community mental health treatment and care centers. Many states did not.
What is the status of Alaska’s acute care psychiatric facilities and units to provide adequate care? Probably not as bad as what Nellie Bly found in the 1800’s; probably closer to a 2003 South Carolina study, “Trauma within the psychiatric setting; a preliminary empirical report.” The study determined that up to 47% of patients in a psychiatric institution experience trauma that could cause or exacerbate Post Traumatic Stress Disorder. In Alaska, hospital employee union rules, poor hospital policies, poor design of psychiatric units and lack of state laws to protect the disabled in the grievance process all hinder patient recovery and expose patients to unnecessary mistreatment.
For over 50 years the Alaska Psychiatric Institute set the standard of care statewide. In 2005, patient advocates filed a complaint that patients at API could not file a formal grievance. In 2011, Disability Law Center cited API that psychiatric patients could not file a grievance in a fair way. In 2016, Medicaid and Medicare cited API for not letting psychiatric patients file a grievance in a fair way and the type of patient grievances at psychiatric facilities and units statewide include physical abuse, sexual abuse, medication errors, etc.
Technically, the disabled have a legal right to file a grievance with a hospital or provider. As a patient advocate and a former patient, I can tell you that the grievance rights laws in Alaska are not designed to help a disabled individual. Where Alaska is failing: The general public and Legislature don’t know the number and type of complaints filed by the disabled during forced treatment or transportation. There is no uniform grievance procedure with a suitable due process for the disabled. And the disabled are not provided appropriate assistance to file a grievance.
The rights for the disabled in Alaska are stationary. They are not going to improve to best practice until the Legislature revises the grievance laws to protect all the disabled, even the disabled that have found their way to the streets, the homeless.
Faith Myers spent over five months locked in Alaska Psychiatric Institute. The last stay was in 2003. She prevailed in the Alaska Supreme Court case “Myers v API” with the help of attorney James Gottstein.