ALASKA 

Alaska has been involved in a comprehensive planning effort for people with disabilities since the mid-1990s, stemming from a lawsuit that was settled in 1995. That settlement resulted in a mandate by the state Legislature for the development of a comprehensive plan and creation of four advocacy and planning boards for different groups of people with disabilities (mental illness, developmental disabilities, Alzheimer's disease and related disorders, and chronic alcoholism). Funded by the Alaskan Mental Health Trust Authority, each board develops a plan for community-based care for the disability group it represents.

The first Comprehensive Integrated Mental Health Plan, an umbrella plan created from the four separate plans, was released in 1996. After the fourth iteration of the plan was issued in December 2001, the state decided that the comprehensive plan would be updated every five years instead of annually.

State officials believe that the structure of four advocacy and planning boards enables them to involve a greater number of consumers and providers in the planning and development process than would be possible with only one planning board. The boards provide specificity on the needs of each disability group in their individual reports. In addition, officials see the Comprehensive Integrated Mental Health Plan as a tool that helps to educate policymakers and as a functional document for the Mental Health Trust Authority to use when pressing for budget dollars.

State officials believe Alaska has been making many positive moves forward on community-based care. They point out that the state ranks very high compared to other states in the allocation of its Medicaid long-term care dollars to community-based care (more than 54 percent in FY 2001, with 46 percent for institutional care).

During the past three years, community care options have increased by 70 percent while nursing home care has increased by only 2 percent. This progress, they note, has been made possible by the growth in the number of assisted living facility beds (from 240 beds in 1995 to 1,400 beds in 2001) and by the development of specialized housing for people with mental illness or developmental disabilities. The downsizing of the Alaska Psychiatric Institute continues, with the facility to be entirely replaced through the development of community-based alternatives by 2005.

State officials emphasize, however, that they need to obtain better data to measure the effectiveness of their efforts. They also point out that the ramifications of state fiscal constraints have yet to filter through programs and services. They question how they would measure the effects of cuts in alcohol treatment programs, for example, when the result might be that people simply fail to show up for those services. Another concern continues to be the large number of Alaskan children and youth who must leave the state to find appropriate mental health care in residential facilities. However, the state was unsuccessful in obtaining a grant from the U.S. Substance Abuse and Mental Health Services Administration or funding from the Alaska Mental Health Trust Authority. Still, the state has moved forward on an assessment of the services that children in out-of-state care would need to bring them back to Alaska and on identification of barriers to developing a more comprehensive system.