Alaska foster youth are admitted to acute psychiatric facilities an average of 90 times per year, according to the state. Lawmakers want to make sure they don’t have unnecessarily long stays.
The Alaska House of Representatives passed House Bill 36 unanimously on Wednesday. The bill would require foster youth hospitalized in psychiatric facilities to have a court hearing within seven days, a reduction from the current requirement of 30 days.
As the state is the legal guardian for foster youth, requiring the time for a court hearing to be within a week aims to prevent youth from unnecessarily long stays in psychiatric facilities – after reports of foster youth having to stay for weeks and even years.
“This is closing such a dark chapter,” said Rep. Andrew Gray, D-Anchorage, who sponsored the bill, in an interview after the vote. “And there’s just so many kids that we don’t even know about that were held there for too long, with no one coming to get them.”
Gray said the Legislature is required to take action after an Alaska Supreme Court ruling last year, “that we must do this, that not having any guidance in our statutes for what should happen to foster kids admitted to acute psychiatric facilities was enabling these tragic stories to happen,” Gray said. “Where foster kids, through no fault of their own, were ending up in facilities for long periods of time with no intervention. So it was incumbent upon the Legislature to act.”
The House voted 39 to 0 passing the bill, with Rep. Sarah Vance, R-Homer, absent.
The issue was the focus of a 2024 Alaska Supreme Court ruling in the case of Kwinhagak v. State. The case related to a 14-year-old girl in foster care, who was first hospitalized in Sitka and then placed in a private Anchorage youth psychiatric hospital, North Star Behavioral Health. She went 46 days before the court held a hearing on her hospitalization.
Her Tribe, the Native Village of Kwinhagak filed a lawsuit against the state, and the Alaska Supreme Court agreed that the 46 days “was far too long to satisfy due process,” according to the ruling.
The bill would require interested parties to be notified within 24 hours of a child being admitted to acute psychiatric facilities. The state Office of Children’s Services must notify the court, the child’s parents, and any other parties involved in their foster care case, or “child-in-need-of-aid” case.
Under the bill, the court would require a court-appointed attorney for the child, and a hearing before a judge within a week — with two-way video for the child to access the hearing. At the hearing, the judge would review the need for hospitalization and consider options for placement in a less restrictive environment. It would also require a follow-up every 30 days after the initial hearing.
Time in acute psychiatric care is for emergencies, for someone in a mental health crisis to stabilize, and should be very short, Gray added.
“If a child needs ongoing psychiatric care, in-patient for months, then they need to be in a residential psychiatric facility,” Gray said. “This is a very, very rare occurrence in which a child would be in this type of facility for longer than a month. But if it happens, then yes, at the 30-day mark, it has to be reevaluated.”
The conditions and practices of the Alaska foster care system, including psychiatric hospitalization, have been the focus of high-profile investigative journalism, a class action lawsuit, federal investigation of North Star Behavioral Health System, and a civil rights investigation by the Department of Justice, in recent years.
“This is huge for us, as a state,” said Amanda Metivier in an interview after the vote. She is the co-founder of the advocacy nonprofit Facing Foster Care in Alaska, a social worker, foster parent, and former foster youth herself. She said former foster youth, some with their own experiences of being hospitalized for long stays, were watching Wednesday and cheered the House vote.
“So a win for them, too,” she said. “To be able to give back to those youth that come next, who don’t have to have those same experiences of being in an acute psych hospital.”
Metivier said the state has a history of overreliance on hospitals and out-of-state facilities for care of foster youth, and work has been done to improve community-based, behavioral health care. But there is also a significant lack of foster home options.
“Today there are youth who are sleeping in hotels for lack of foster homes, with security guards, or who are sleeping in offices for lack of foster homes,” she said. “And so if a young person lands in an acute psych hospital, I think for the caseworker, there’s probably this initial sense of relief, right, in that they’re safe right now, but are easily forgotten.”
Metivier said that OCS caseworkers, courts, tribes, family attorneys, parents and guardians can all be involved already in a foster case, and acting in the interest of the child, and so the seven-day timeline should be appropriate.
“It shouldn’t be burdensome for the state, because it offers an opportunity to create this sense of urgency for everyone to start thinking about what happens next,” she said. It can reduce days of hospitalization, which has the effect of “compounding trauma, to be in a facility, you know, for a young person, where they don’t need to be. And it’s more cost effective for the state too,” she said.
She said the state’s estimate of foster youth being hospitalized 90 times each year is high, and a reason to have protocols in place to assess youth for ongoing care, or a supportive foster placement.
Metivier emphasized that reducing time in psychiatric hospitals can also limit further psychological harms.
“They’re witnessing physical and chemical restraints, or maybe experiencing those themselves, or put in isolation,” she said. “So there is a lot they see and experience around them that can be to the detriment of their own mental health too, definitely.”
The bill now moves to the Alaska Senate. While the court system notified the Legislature that more frequent hearings would not incur any additional costs, OCS submitted a fiscal note estimating that the cost for the department would be $18,700 annually.
Gray, who is also a parent and adopted a former foster youth, became emotional talking about the legacy of children left in psychiatric facilities with no intervention.
“They were the state’s responsibility. They were the Legislature’s responsibility,” he said. “So the fact that we didn’t act on this sooner kills me inside, and there’s no way we can ever make it up to those kids who suffered profound harm. It’s our fault. I’m grateful that nothing like that will happen again, if this bill makes it through both bodies and gets signed by the governor.”