Too many Alaska children are unnecessarily institutionalized, says U.S. Department of Justice

The U.S. Department of Justice has released the findings of an investigation into the lack of adequate mental health services available to children in Alaska. The investigation found that youth in the state were forced to endure unnecessary and unduly long institutionalization in locked facilities because no alternatives exist.

Michelle Theriault Boots is an investigative reporter with Anchorage Daily News and wrote about the DOJ report.

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The following transcript has been lightly edited for clarity.

Lori Townsend: Department of Justice investigators traveled to Alaska twice. They toured facilities here and interviewed families, children and staff. What did they find?

Michelle Theriault Boots: The investigators, in their report, describe finding a lot of children and teenagers who are in facilities like North Star and other residential treatment facilities living away from their homes and families and communities who probably could and should be living at home. And that’s because the investigators found there aren’t enough supports in communities in Alaska to give them the help with mental health and psychiatric problems they need at home.

LT: Michelle, you’ve reported on trouble at Anchorage’s North Star psychiatric hospital and children being sent outside of the state. Give us some context here of when you started reporting on the lack of service for children, and what you found or how that relates to this particular investigation.

MTB: So for many, many years – decades really – Alaska has lacked kind of a middle layer of care for kids who are suffering from mental illness. So for a long time, kids whose behaviors or who are just acutely in mental crisis, have been sent to facilities outside of the state of Alaska for care. The only facility in Alaska that can treat kids 12 and under is North Star hospital at the hospital level, and there’s a very, very limited number of beds at the Alaska Psychiatric Institute. But beyond that, and in other parts of the state, there’s really very, very little. So the problem we’ve had for a really long time in Alaska is that if a kid is having a problem at all, they kind of automatically get sent to this high-level locked psychiatric hospital, which for a lot of kids is really not appropriate, and is really damaging because it takes them away from their home, their school, their family, their community, their tribe and puts them behind locked doors, sometimes for months and even years.

LT: Yes, there are clearly some egregious examples cited in the DOJ report – a girl from Bethel who at 12 was feeling sad and irritable, acting aggressively toward younger siblings, something that doesn’t sound tremendously unusual at that age. But she was sent to North Star and has been there for the majority of four years. The report says she’s more adjusted to institutionalized life than life at home, so such a terrible statement. This sounds like a multi-level failure. What were the recommended alternatives to this type of lockup?

MTB: A lot of the kids who end up in these institutions in Alaska and outside are in foster care. They’re in the custody of the state of Alaska. And it’s often the state Office of Children’s Services that places them in North Star or another institution. One alternative to that would be therapeutic foster homes, where people who are trained foster parents, who have special knowledge and training of helping kids with trauma, can take over and the kids can live in homes – that function like a home, not an institution – but also get a high level of therapeutic care. There’s also crisis intervention strategies that exist other places where, say, a kid is going into crisis, their parent is afraid of them or feels like they can’t be at home, well a crisis team would kind of swoop in and maybe they hold the kid for one day or two days or three days. But it’s not a long-term thing. It’s just enough time to stabilize the kid. But then the kid can go back home.

LT: The state acknowledged that it’s cheaper to treat children while keeping them with their families than to send them to far away psychiatric facilities. But how did they respond overall to the Department of Justice findings?

MTB: You know, it’s interesting, I asked for a response and got different responses from three different agencies. I got a response from the Department of Law, who would be kind of on the other end of any kind of legal action toward the state and they said, “We’re reviewing this; we want to work with the DOJ, we may not agree with all of the findings.” And I also got responses from the now-separate Department of Health and the Department of Family Services. And they both said, “We are willing to work on this, we are willing to work with the DOJ, and you know, here’s even some things that we are doing to move in this direction already.” And I think that there is an acknowledgment that – yes, like, nobody really wants kids to be locked up in institutions, right? We want this to work. It’s just how to implement it on a scale and with Alaska’s unique challenges, with many very small rural communities who are off the road system. How do you deliver the care that kids need, wherever they are?

LT: This report, Michelle, was just released. But have you talked with families about how these separations have affected them?

MTB: Yeah, I’ve talked to many families and many of the kids themselves, and it’s devastating. You know, there’s certainly kids out there who will say that they needed help in an institution, and that it overall was a good thing for them. But there are many who say that they felt locked away and forgotten, that they didn’t get the help they need. And for parents, it’s also really, really scary and hard to have your kid kind of go behind the doors and not necessarily have access to them, sometimes for a long period of time, and I think it’s often presented to parents as this is your only option. And we’re talking about kids that, you know, for the most part are adolescents or even younger. So kids as young as 5 and 6 are in institutions in Alaska and Outside.

LT: Michelle, the Justice Department gave the state recommendations that there are resources available to use expanded Medicaid funds, grants and income from the state and federal sources and also income from the Alaska Mental Health Trust to help kids before they get sent away. Is the state following or has the state followed this guidance?

MTB: In 2019, Alaska had a Medicaid waiver expansion, which basically paid for a new menu of services. And so that’s an exciting thing, and that was progress. But what this report says is that that really hasn’t reached its full potential yet. You know, really, a relatively small number of children in Alaska have gotten to use these services, sometimes only in the dozens. The DOJ kind of says, “Well, Alaska has had this opportunity, but really hasn’t fully implemented it yet.”

LT: Michelle, thanks so much for coming in and clarifying this really important issue for Alaskans through your reporting.

MTB: I appreciate you having me, Lori. Thank you.