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Moving Forward: Comprehensive Integrated Mental Health Plan, 2006-2011

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, a developmental disability, experience chronic alcoholism or Alzheimer’s disease or a related dementia. 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.

Extent of the Problem

With Alaska data and national prevalence data, we can estimate that there are currently up to 85,664 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 (adults over age 65): 5,100⁵
Brain injured: 11,900⁶
Developmentally disabled: 12,185⁹
Alcohol dependent: 22,000 (ages 12 and above)¹¹

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 2006 National Survey of Drug Use and Health estimated that 52,000 Alaskans experienced serious psychological distress and 37,000 had at least one major depressive episode (annual averages based on 2005-2006 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. ² “Serious psychological distress” is defined as having a score of 13 or higher on the K6 scale. ³

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

Alzheimer’s Disease and Related Dementia. Alzheimer’s disease is now the sixth leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics. An estimated 5.2 million Americans of all ages are living with Alzheimer’s disease; 13 percent of persons age 65 and older has the disease.⁴

Using national prevalence rates, the Alaska Commission on Aging estimates that as of 2007, there were 5,100 Alaskans aged 65 and above with Alzheimer’s Disease and Related Dementia (this estimate does not include brain injury). DHSS Division of Alaska Pioneer Homes reports that, as of April, 2008, 54 percent of residents in the Homes had a dementia diagnosis.⁵

In 2007, 9.8 million family members, friends and neighbors provided 8.4 billion hours of unpaid care to a person with Alzheimer’s Disease or a related dementia nationwide. This contribution can be valued at $89 billion. In Alaska, the estimated number of caregivers was 14,400.⁴

Brain Injury. According to a 2003 study by the University of Alaska, an estimated 11,900 Alaskans were living with brain injury.⁶ Each year the Alaska Department of Health & Social Services reports about 800 traumatic brain injury (TBI) cases resulting in hospitalization or death. The rates of brain injury in rural Alaska are twice as high as the non-rural rates.⁷

According to the National Center for Injury Prevention and Control, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. CDC estimates that at least 5.3 million Americans currently have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI.⁸

Of the 1.4 million who sustain a TBI each year nationwide:

50,000 die;
235,000 are hospitalized; and
1.1 million are treated and released from an emergency department. ⁸

The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

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 12,185 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 150 births.¹⁰

Chronic Alcoholism:

Rates of heavy and binge drinking are consistently higher in Alaska than in the United States as a whole. In 2006, the estimated number of Alaskans abusing or depending on alcohol or other substances was:¹¹

Alcohol dependence (age 12 or older): 22,000
Alcohol dependence or abuse (age 12 or older): 41,000
Alcohol dependence or abuse (age 12 to 17): 4,000
Illicit drug dependence or abuse (age 12 or older): 52,000

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

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