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I. Introduction

Plan Vision

The vision of the Comprehensive Integrated Mental Health Plan is optimal quality of life for all Alaskans, especially those experiencing mental and emotional illness, cognitive and developmental disabilities, alcoholism and substance use disorders, and Alzheimer’s disease or similar dementia.

Authority for Plan

Alaska Statute 47.30.660 requires the Department of Health and Social Services, in conjunction with the Alaska Mental Health Trust Authority, to develop and revise a plan for a comprehensive integrated mental health program for Alaska. Under the statute, the preparation of this plan is to be coordinated with federal, state, regional, local, and private entities involved in mental health services.

Purpose of Plan

The purpose of this Comprehensive Integrated Mental Health Plan (Comp MH Plan) is to guide resource allocation decisions in the development of services, workforce, and facilities to meet the needs of Trust beneficiaries. The overall goal is a service system that quickly meets the needs of each individual, where highly qualified staff from state, federal, tribal and private agencies have the resources necessary to work together to provide seamless care for the best outcome possible for each person. Another goal is to reduce the incidence of Trust beneficiaries’ disabling conditions through prevention and early intervention, to the extent possible.

Moving Forward: Comprehensive Integrated Mental Health Plan is coordinated with plans developed by the Alaska Mental Health Board, the Governor’s Council on Disabilities and Special Education, the Governor’s Advisory Board on Alcoholism and Drug Abuse and the Alaska Commission on Aging, collectively called the beneficiary planning and advocacy boards, and by the Department of Corrections’1999 plan. This plan is also linked with such DHSS plans as Healthy Alaskans 2010 and other planning initiatives.

Target Population of Plan

Moving Forward: Comprehensive Integrated Mental Health Plan has a vision of optimal quality of life for Alaskans, especially those Alaskans who receive services under the Comprehensive Integrated Mental Health Program (AS 47.30). By law, these service recipients (also called Trust beneficiaries) are Alaskans who have a mental illness or a developmental disability, experience chronic alcoholism or Alzheimer’s disease or a related dementia, or could be diagnosed with a comparable disorder due to either a general medical condition such as brain injury or a substance-induced disorder (AS 47.30.056 and 20 AAC 40.510). Efforts include prevention, to the extent possible, of these disabling conditions. Those who may need services in the future are included in this plan since prevention is the surest way to limit human suffering and is usually the least costly strategy.

Prevalence of Trust Beneficiary Populations

With Alaska data and national prevalence data, we can estimate that there are currently up to 86,421 Trust beneficiaries in Alaska, as follows. There are unavoidable duplications in this estimate (e.g. some individuals are in more than one beneficiary group, so they are counted more than once).

• Serious mental illness (adults): 21,754¹
• Serious Emotional Disturbance (youth): 12,725¹
• Alzheimer’s Disease and Related Disorders (ages 55+): 7,581⁵
• Brain injured: 11,900⁶
• Developmentally disabled: 12,461⁹
• Alcohol dependent (ages 12 to 17): 1,000¹¹
• Alcohol dependent (ages 18+): 19,000¹¹

Mental Illness:

A recent report on behavioral health prevalence estimates in Alaska estimates that in the year 2006, 4.6 percent (21,754) of Alaskan adults in households had a Serious Mental Illness and 7.2 percent (12,725) of Alaska youth had Serious Emotional Disturbance. The adult estimates include only those with a diagnosable DSM IV disorder that has persisted over one year and is associated with significant impairment.¹

The 2007 National Surveys on Drug Use and Health estimates that 53,000 Alaskan adults (age 18 and older)  experienced serious psychological distress and 36,000 had at least one major depressive episode (annual averages based on 2006-2007 NSDUHs). The NSDUH survey did not include an assessment of how the disorder affected a person’s ability to function in everyday life. “Major Depressive Episode” is defined as a period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms for depression as described in the DSM IV. “Serious psychological distress” is defined as having a score of 13 or higher on the K6 scale.²

Alzheimer’s Disease and Related Dementia (including Brain Injury):

Alzheimer’s Disease and Related Dementia.

Alzheimer’s disease is now the seventh leading cause of death in the United States, and the fifth leading cause of death for Americans age 55 and older. An estimated 5.3 million Americans of all ages are living with Alzheimer’s disease; one in eight people age 65 and older has the disease. Almost half of those age 85 and older are affected.³

The Alaska Commission on Aging estimates that as of 2009, there were roughly 7,581 Alaskans with Alzheimer’s Disease and Related Dementia (6,008 Alaskans aged 65 and above and 1,573 aged 55 to 64).4  This estimate does not include those with brain injury.  As of October, 2010, 53 percent of residents in the Alaska Pioneer Homes had a dementia diagnosis.⁴

An estimated 10.9 million Americans provide unpaid care for people with Alzheimer’s or other dementia. In 2009, they provided 12.5 billion hours of unpaid care, a contribution to the nation valued at $144 billion. In Alaska, an estimated 16,313 caregivers provided over 18.5 million hours of unpaid care, valued at nearly $213 million.³

The number of Americans with Alzheimer’s disease is increasing each year due to the aging of the population. Because of pipeline-era (1970s and 80s) in-migration of young and middle-aged workers, Alaska now has the fastest-growing population age 65 and older in the United States. The number of older Alaskans with Alzheimer’s Disease is projected to nearly triple by 2030.6

Traumatic Brain Injury. An estimated 11,900 Alaskans are living with disability due to a Traumatic Brain Injury.7 The highest rates of TBI are among Alaska Natives, residents of rural Alaska, youth ages 15-19 in motor vehicle crashes, and elders who fall. Each year the Alaska Department of Health & Social Services reports about 800 traumatic brain injury (TBI) cases resulting in hospitalization or death.8 The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

According to the Alaska Brain Injury Network, the available TBI data does not include service-related injuries, but it is estimated that 20 to 30% of service members returning to Alaska from Iraq and Afghanistan will need TBI services.

 

Developmental Disabilities:

According to national prevalence data, 1.8 percent of the national population has a developmental disability. At this rate, it is estimated that 12,461 Alaskans have developmental disabilities.⁹

According to the U.S. Department of Education and other agencies, autism is the fastest-growing developmental disability. It is the most common of the Pervasive Developmental Disorders, affecting an estimated one in 110 births.¹⁰

 

Chronic Alcoholism:

Rates of heavy and binge drinking are consistently higher in Alaska than in the United States as a whole. According to the 2008 National Surveys on Drug Use and Health (NSDUH), the estimated number of Alaskans abusing or depending on alcohol or other substances was:¹¹

• Alcohol dependence (age 18 or older): 19,000
• Alcohol dependence (ages 12-17): 1,000
• Alcohol dependence or abuse (age 18 or older): 38,000
• Alcohol dependence or abuse (age 12 to 17): 3,000

Dependence or abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).¹¹

According to the 2009 Youth Risk Behavior Survey, 22 percent of Alaska’s high school students engaged in binge drinking. The high prevalence of alcohol use among Alaska teens is a significant concern, because research shows that young people who begin drinking before the age of 15 are four times more likely to develop dependence.¹²

The 2008 National Surveys on Drug Use and Health also found the following about use of illicit drugs:

• Illicit drug dependence (age 12 or older): 11,000
• Illicit drug dependence or abuse (age 12 or older): 16,000

“Illicit Drugs” include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically

. ¹¹