When we think about mental health care across our state, our first thoughts might go toward the few psychiatric institutes, crisis management teams and recovery centers operating in Alaska. However, the state’s leading provider of mental and behavioral health care services is actually the Department of Corrections (DOC).
About 60% of the prison population has a mental health issue, about 80% has a diagnosed substance use disorder, and about 55% of the prison population has a dual-diagnosis, meaning that they have both a mental health issue and a substance use disorder, according to Megan Edge, the Prison Project director for the American Civil Liberties Union of Alaska. According to the DOC, these numbers are increasing, and there has been a notable rise in both the number of people with mental illness that are being incarcerated and the severity of mental illness that they are experiencing.
The shortage of adequate mental health services, especially for at-risk populations, available throughout the state has created a system where the majority of the population really has no access to mental health care outside of carceral settings. The majority of people interacting with the prison system have never seen a mental or behavioral health professional, and if they have it is likely that it was during their last carceral experience.
Edge says that there-in lies the problem at hand. “It means we’re lacking in our community,” she said. “I think we need to rethink all of the money that we’re throwing at the DOC and spend the money in a better way.”
The Alaska Psychiatric Institute (API), for example, only has 80 beds available at any given time – for a state with a population of over 730,000 people, getting a spot is akin to winning the lottery. This lack of bed availability at the API means that people who are court-ordered to receive care at API oftentimes end up remaining incarcerated in jail waiting on a bed at API to open up. While in-limbo, they’re offered mediocre mental health resources in a carceral setting instead of getting the psychiatric treatment they need.
“We have designed a social structure in which prisons have become the catch all for all of our other social failures,” Edge said. “The thing is, prisons were never designed to be hospitals. They were not designed to be therapeutic.”
A document released by the State of Alaska bluntly states “mentally ill offenders are being placed under the [DOC’s] custody in worse shape than ever before.” The jails and prisons across the state struggle to provide maintenance and preventative care, and primarily scrabble together intervention services when a person is undergoing a crisis.
Edge hears from hundreds of incarcerated people every month as a prison reform advocate and attests to the complicated nature of the issues they face. The mental health units within the DOC are often full, if not overcapacity entirely. As a result, many incarcerated folks in need of mental or behavioral health care end up stuck in solitary confinement instead. Edge says she talks to people in prison with such severe mental illness that they aren’t able to explain why they’re in a solitary cell, or even in prison to begin with.
“You put the most sane person in the solitary confinement cell for two days, and they’re not going to be okay when they come out,” Edge says. “That’s never a therapeutic option.”
Since the correctional system was never designed to be a therapeutic treatment for people with complicated mental health issues, the DOC fundamentally lacks the desperately needed, qualified treatment providers. For the 226-person capacity of Lemon Creek Correctional Center in Juneau, there is only one full-time mental health clinician available to provide assessments, crisis intervention and treatment and release planning. It’s not hard to imagine that with a 226:1 person ratio, the capacity for care is stretched thin; increasing the odds that a person undergoing a crisis is simply put in solitary.
This complete lack of mental health resources is seen consistently throughout the state. In 2023, there were only 40 mental health clinicians available to treat the nearly 5,000 people behind bars in Alaska. Even for the best clinician, managing that many clients with care, thought and professionalism isn’t realistic.
“DOC’s default has been to say, ‘We don’t know what to do with you, we are going to put you in solitary confinement,’” said Edge. “We see people in solitary confinement because they’re transgender, and the DOC doesn’t know what to do. We see people in solitary confinement because they have dementia.”
The reality is that we are seeing people who have ongoing mental health issues spending significant amounts of time in solitary confinement because the DOC doesn’t know what to do with them. While solitary confinement is still legal on a state-by-state basis, many make the argument that it’s torture. These folks in the system serve their sentence and head straight from solitary back into the community, Edge said.
“What a shock that is – you’re not doing them any favors as far as helping their transition back to a normal life, but you’re also not doing the community any favors because that person is going to have even more issues than when they went in,” Edge said.
While improving access to treatment options within the prison system is necessary, the solution up to this point has been to allocate more money into the DOC’s budget.
“You could throw billions of dollars at a prison system, and at the end of the day it’s still a prison system: It is a concrete box, and it is staffed by people who are not experts in mental health and substance use treatment,” Edge said. “So you could throw money all day at it, but like, that’s not what needs to happen.”
Funding for effective mental health, behavioral health and substance abuse treatment programs in the community need be the priority moving forward. Funding that goes straight towards the DOC could instead be reallocated for things like safe, sober living options for offenders with mental illness that are ready for re-entry. Community accessible treatment programs could prevent the amount of people stuck in jail that were originally court-mandated to spend time at API for treatment. Housing programs could offer stability for the un-housed population and prevent likelihood of mental health episodes and relapses. Edge argues that money may be better spent if it is allocated to programs that bring preventative mental health treatment into communities instead of programs that treat the DOC as the therapeutic center it can never be.
“When we go through the budget process no one really bats an eye when DOC asks for more money,” Edge said. “Yet, in other areas of government, whether that be health care or education, those budgets are so critically examined. However, those services would be so much better serving our community if they were in our community, not in our jails and prisons. It would prevent a lot of bad things from happening.”
Rachel Levy is a Juneau-based photojournalist whose work culminates at the intersections of environmental justice, arts and culture, and sustainable tourism. A 2022 graduate of Harvard University's Environmental Policy program, she is also the director of the award-winning documentary "Hidden in Plain Sight" that exposes the labor exploitation and colonial framework burdening Tanzania's safari industry.
