When someone is born as or becomes a Trust beneficiary, the individual and the family want the best care possible — the most helpful services close to home. Accessing behavioral health care can be difficult for Alaskans in small communities, for those who have inadequate or no health insurance, or whose access to information is limited. Not all communities, even larger ones, have a range of treatment programs and other needed supportive services. Without strong support and treatment services, people may not get the services they need, may become homeless, or become involved with the justice system.
Health Goal #1: Enhance quality of life through appropriate services for people with mental and cognitive disabilities and substance use disorders
Good physical and mental health is a common measure of an individual’s well being. One way to assess a population’s overall health is with a set of measures known as “Healthy Days.”13 Developed by the National Center for Disease Control, Healthy Days is one of the few population-based surveys of mental health status. It measures individuals’ self-evaluation of their physical and mental health within the past 30 days.
Figure 1 — Days of Poor Mental Health in Past Month by Age Group, 2009
Data from the Behavioral Risk Factor Surveillance Survey21 show the percent of Alaskan adults surveyed who self-report the number of days in the prior month that they experienced “poor mental health.”
In 2009, thirteen percent of survey respondents reported more than five days of poor mental health during the previous monthand six percent reported poor mental health for over half the time. Those aged 65 and above reported the best mental health
BRFSS does not collect data from individuals living in an institutional setting. Consequently, those who are experiencing bad mental health days and are living in an institutional setting, are not included in this data.
Figure HM-1 —Percent of Alaskans Reporting Frequent Mental Distress , 2001–2009
Data from the Behavioral Risk Factor Surveillance Survey21 show the percent of Alaskan adults who self-report the number of days in the prior month that they experienced “poor mental health".
Figure HM-1 indicates that each year from 2001 to 2009, 5 to 7 percent of Alaskan adults experienced frequent mental distress, ( poor mental health for 14 or more days during prior month). In 2009, the Alaska rate was 5.9 percent and the national rate was 10 percent.
BRFSS does not collect data from individuals living in an institutional setting.. Consequently, those who are experiencing bad mental health days and are living in an institutional setting, are not included in this data.
Figure HM-2 — Mean Number of Days in Past Month when Mental Health Was Not Good, Alaska and U.S.
The “mean” number of days of poor mental health was slightly lower in Alaska than it was in the U.S. for most years between 2001 and 2009.
Health Goal #2: Reduce the abusive use of alcohol and other drugs to protect Alaskans’ health, safety, and quality of life.
Alcoholism and chemical dependency have long been recognized as Alaska’s number one behavioral health problem. Alcoholism and other addictive diseases not only compromise individuals’ health but also create profound social problems. The social cost of alcohol abuse is seen in rates of related injuries, chronic disease, and deaths. National research shows that substance abuse has been implicated in 70 percent of all cases of child abuse and that 80 percent of the men and women behind bars are there because of drug or alcohol related crime.14
Figure 2 —Adults who Engage in Heavy Drinking, Alaska and U.S., 2004–2010
According to the 2010 Behavioral Risk Factor Surveillance System (BRFSS), Alaska ranks number 13 in the U.S. for heavy drinking, with 5.6% of Alaskans classified as heavy drinkers.
The CDC National Center for Chronic Disease Prevention & Health Promotion defines heavy drinking as more than 2 alcoholic drinks for men or more than 1 drink for women each day during the past 30 days. The Centers for Disease Control found that these are the levels at which mortality increases.
For Anchorage data about public inebriate pick-up, transport and sleep-off, see Anchorage Community Service Patrol 2009 Data Summary & Analysis. Community Service Patrol van staff take persons incapacitated by alcohol (in public places) into protective custody and transport them to the sleep-off facility (TS) located in the Anchorage Jail Complex. Clients are assessed using basic physiological parameters, and those falling outside safe standards for sleep-off are taken to hospitals for medical clearance or further care. From 2007 to 2009, Sleep-Off Intakes increased by 18%.
Figure 3 — Adults who Engage in Binge Drinking, Alaska and U.S., 2004–2010
The CDC National Center for Chronic Disease Prevention & Health Promotion defines binge drinking as 5 or more drinks (men) or 4 or more drinks (women) on one or more occasions in the past 30 days. According to the Behavioral Risk Factor Surveillance System, Alaska’s ranking for binge drinking in 2010 moved from number 11 in the U.S. to number 2.
The prevalence of binge drinking in Alaska is highest among males, those who are employed, and those who are divorced or separated. (Alaska BRFSS 2008 Annual Report)
Source: Behavioral Risk Factor Surveillance Survey (BRFSS) and Centers for Disease Control
Figure HA-2 — Rate of Alcohol-Induced Deaths, Alaska and U.S., 2001–2009
Definition: Alcohol-induced deaths include fatalities from causes such as degeneration of the nervous system due to alcohol, alcoholic liver disease, gastritis, myopathy, pancreatitis, poisoning, and more. It does not include accidents, homicides, and other causes indirectly related to alcohol use15
Between 2006 and 2008, Alaska’s rate of alcohol-induced deaths was approximately 3 times the U.S. rate. The alcohol-induced death rate is significantly higher for Alaska Natives than for non-Natives.
Figure HA-3: Illicit Drug Use, Alaska and U.S., Ages 12 and Older
According to SAMHSA’s National Survey on Drug Use and Health, illicit drug use among those ages 12 and older has been consistently higher in Alaska than in the U.S. as a whole. In 2009, Alaska ranked number 4 in the nation for illicit drug use.
Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used non-medically.
Risk and Protective Factors:
For information about risk and protective factors related to substance use in Alaska, see Influences on Substance Use in Alaska: Significant Risk and Protective Factors Influencing Adolescent Substance Use and Their Indicators (November, 2007)
Health Goal #3: Promote healthy births and encourage early childhood interventions to reduce the risk of disability
Fetal Alcohol Spectrum Disorders
- Fetal Alcohol Spectrum Disorder is a permanent birth defect syndrome caused by women drinking while pregnant
- FASDs are one of the most common causes of developmental disability and the only cause that is entirely preventable.
- FAS is a medical diagnosis defined by the presence of specific growth and nervous system abnormalities and other factors.
- Alaska has the highest rate of FAS in the nation among states that track this data. As many as 200 children are reported to the Alaska Birth Defects Registry each year with a suspected FASD.
- There is no known safe amount of alcohol to consume during pregnancy. Alcohol can cause damage to a developing fetus even before a woman knows she is pregnant.
- FASD is found among all races and all socio-economic groups – wherever women drink alcohol, FASD can exist.
- Alaska tracks the rate of FAS and FASD to identify risks associated with these conditions and improve prevention programs by targeting groups at risk.
- A state and federally funded Alaska Comprehensive Fetal Alcohol Syndrome Project has expanded the state’s diagnostic capability, developed a multimedia public education campaign, and improved training for service providers in Alaska to help them better understand and serve affected individuals and their families.
- Like all disabilities, improvements can be made in how a person adjusts to their disability.
- With a comprehensive diagnosis, parents and providers can identify which services will most help children with an FASD in school and social settings.
- With the right diagnosis, support and understanding, many individuals with FASD can live happy and full lives.
The exact number of people in the U.S. with FASD is not known. CDC studies have shown that 0.2 to 1.5 cases of fetal alcohol syndrome (FAS) occur for every 1,000 live births in certain areas of the United States. Other studies using different methods have estimated the rate of FAS at 0.5 to 2.0 cases per 1,000 live births. (Centers for Disease Control)
For more information, see Alaska DHSS Division of Behavioral Health “Information on FASD”.
Figure 4: Percentage of Mothers Reporting Having Any Alcoholic Drinks during Last 3 Months of Pregnancy
Between 2000 and 2008, approximately 4 to 6 percent of mothers in Alaska reported having alcoholic drinks during the last three months of pregnancy. In 2008, Alaska’s rate was among the lowest of the 29 states reporting this data, with only 6 states showing lower rates. [CDC Pregnancy Risk Monitoring System (PRAMS) CPONDER]
Figure HA-4: FASD Prevalence by Birth Year, Alaska Birth Defects Registry, 1998 - 2003
Figure HA-4 shows the unduplicated number of children reported to the Alaska Birth Defects Registry with ICD9 code 760.71 (fetus or newborn affected by maternal alcohol use), by their.6th birthday, and matched to an Alaska birth certificate. (The chart shows children reported by 8/2/10). Since 1998, the numbers have continually declined.
Children are often not identified and reported as FAS/D until around age six, when they are entering school; this is why 2003 is the most recent birth year reported. Challenges in the diagnosis of FAS and related conditions include the lack of specificity related to the ICD9 code and variations in the age at which the characteristics become evident.
Health Goal #4: Reduce the number of suicides in Alaska.
The rate of death by suicide in Alaska has consistently remained among the highest rates in the nation and almost twice the national average
Figure 5 — Suicide Rate by Year, Alaska and U.S., 2001 – 2009 (Age Adjusted Rate per 100,000)
Alaska’s suicide rate has consistently remained among the highest rates in the nation and almost twice the national average. Between 2001 and 2009, the age-adjusted rate for suicides in Alaska increased 22 percent, from 16.5 to 20.2 deaths per 100,000.
The rate among Alaska Natives in 2008 was almost double the rate for Caucasians. Intentional self-harm or suicide remained the sixth leading cause of death in Alaska. Between 1999 and 2008, on average 36.1 years of life were lost prematurely for each suicide death. Firearms was the leading manner of suicide death.
Figure 6 — Alaska Suicide Rates (and Numbers) by Region, 2000-2009 (Map)
Figure 6 shows Alaska’s age-adjusted suicide rates per region for the years 2000 through 2009. The regions with the lowest rates of suicide were Kodiak and Southeast, while the highest rates were in Northwest Arctic, Nome census area, and Bethel/Wade Hampton.
Figure HS-1 — Alaska Teen Suicides, 2000-2009
The number and rate of deaths by suicide among Alaskans aged 15 to 19 decreased between 2008 and 2009. Between 1994 and 2007, the rate of teen suicide (ages 15 to 19) in Alaska averaged almost 5 times the U.S. rate for this age group. (CDC Wonder)
The Alaska Suicide Follow-back Study contains information from interviews with the families of some of Alaska’s suicide victims from 2003 to 2006. According to the interviews, more than half (54%) of the decedents had a disability or illness that made it difficult for them to take care of normal daily activities. Almost two-thirds (62%) of decedents were reported to have had current prescriptions for mental health medications at the time of their death but many were not taking the medications as prescribed.20
Among the suicide cases that had a follow-back interview, a binge drinking rate of 43 percent was reported, which is 2.5 times higher than the Alaska rate and three times higher than the national estimated rate according to the 2005 BRFSS. The interviews indicated that 54 percent of the decedents had smoked marijuana within the past year. The reported rate for alcohol and drug use by Alaska Natives was exactly the same as for non-Natives. Although Alaska Natives comprise only 16 percent of the population, they accounted for 39 percent of the suicides.20
Suicidal ideation/attempts from Youth Risk Behavior Survey (YRBS22)
- Percentage of students who seriously considered attempting suicide during the past 12 months:
- 2003 YRBS: 16.7 %
- 2007 YRBS: 16.5%
- 2009 YRBS 13.9%
- Percentage of students who actually attempted suicide one or more times during the past 12 months:
- 2003 YRBS: 8.1%
- 2007 YRBS: 10.7 %
- 2009 YRBS 8.5%
Figure HS-2 — Non-fatal Suicide Attempts by Sex, 2001-2009
Figure HS-2 shows the rate of non-fatal suicide attempts in Alaska that required hospitalization for at least 24 hours. In Alaska, almost twice as many females attempt suicide as males (non-fatal). The rate of attempts by Alaskan females age 15 to 24 has been significantly higher than in any other population group.
In both Alaska and the U.S. the rate of nonfatal suicide attempts is noticeably higher for females than for males, but in Alaska the difference between the rates for males and females is even more striking. In 2009 the U.S. rate for nonfatal attempts by females was 34 percent higher than for males, but in Alaska the rate for females was 75 percent higher than for males. (CDC WISQARS Nonfatal Injury Reports – attempts requiring hospitalization for at least 24 hours)
Figure HS-3 - Non-Fatal Suicide Attempts Requiring Hospitalization, Alaska and U.S.
by Year, 2001-2009
Alaska’s rate of non-fatal suicide attempts requiring hospitalization for at least 24 hours continues to be significantly higher than the U.S. rate. In 2009, Alaska’s age-adjusted rate was 92 per 100,000 population, while the U.S. rate was 51.
. (DHSS DPH Alaska Trauma Registry)
Suicide Protective Factors
Measures that enhance resilience or protective factors are as essential as risk reduction in preventing suicide. Positive resistance to suicide is not permanent, so programs that support and maintain protection against suicide need to be ongoing.
Protective factors include:
- Effective and appropriate clinical care for mental, physical, and substance abuse disorders
- Easy access to a variety of clinical interventions and support for help seeking
- Restricted access to highly lethal methods of suicide
- Family and community support
- Support from ongoing medical and mental health care relationships
- Learned skills in problem solving, conflict resolution, and nonviolent handling of disputes
- Cultural and religious beliefs that discourage suicide and support self-preservation instincts 42
Health Goal #5: Access: ensure high quality treatment, recovery and support services are provided as close to one's home community as possible.
The Department and The Trust aim to provide sustainable, comprehensive behavioral health services that are based in local communities so that residents can be served as close to their home as possible. Some of the current initiatives that address this goal are the Bring the Kids Home Initiative, the Community-based Suicide Prevention and Rural Human Services project, the Comprehensive Fetal Alcohol Syndrome Project, and Workforce Development.
Estimated Number of Alaska Mental Health Trust Beneficiaries Served by DHSS Divisions (Figure HC-1)
The Department of Health and Social Services serves many Trust beneficiaries in its various programs throughout the state. An estimate of the number of Trust beneficiaries served by each division within the Department is shown in Figure HC-1. Since people served remain anonymous, and the same person may have been served by more than one program or division during the same year, there is not a way to avoid duplication in the numbers in all divisions.
Public perceptions of care
The public behavioral health system is responsible for providing safe and effective care. The system has changed with consumers’ increasing involvement in choosing the types of treatment and other services they receive. Today, many agencies include consumers on their boards of directors. Consumers participate in quality assurance reviews for mental health, developmental disabilities, and early intervention/infant learning programs. Consumer satisfaction surveys are included in most provider reviews conducted by the Department of Health and Social Services.
Public perceptions of care as indicated through number of complaints to the Long-Term Care Ombudsman (Figure HC-2).
In 1978, the federal Older Americans Act began requiring every state to have a Long Term Care Ombudsman Program to identify, investigate and resolve complaints and advocate for seniors. The ombudsman investigates complaints about nursing homes, assisted living homes, and senior housing units as well as concerns about individuals’ care and circumstances. Consumers, family members, administrators, and facility staff can make complaints regarding the health, safety, welfare, or rights of a long-term care resident. The Alaska ombudsman’s office is administratively managed by and resides in the office of the Alaska Mental Health Trust Authority. The majority of funding for the office comes from grants through the federal Administration on Aging.
Figure HC-2 shows the number of complaints from consumers that the Alaska’s Office of the Long-Term Care Ombudsman opened for investigation. According to the LTCO, the majority of complaints have related to problems in assisted living facilities. The top three complaints in 2011 have been problems with medication administration and management, injuries/falls/improper handling, and shortage of staff.
The number of complaints received and the number of cases opened for investigation have both increased. Currently it is not known if the increases in complaints reflect increased problems, increased public awareness of options for reporting, increased number of long term care facilities, or larger numbers of seniors in long term care, (Long Term Care Ombudsman’s Office, email 6/8/11).
Alaska has one of the fastest-growing senior populations of all the states, with the number of seniors expected to more than double by 2030. While Alaska seniors have a higher mean and median income than U.S. seniors as a whole, higher living costs may consume much of that additional income. Incomes of senior households located in rural areas and those headed by Alaska Natives have substantially lower incomes. The poorest group is seniors age 85 and over, which is also the fastest-growing sub-group of the senior population. By 2030, the number of Alaskans in this age group is expected to triple. 23
Consumers Satisfied with Public Mental Health and Substance Abuse Services (Figures HC-3a and HC-3b).
Figures HC-3a, b and c show the results of a cooperative effort between the DHSS Division of Behavioral health and providers to ask consumers to evaluate services. Questions were asked about satisfaction with services, quality, participation in treatment outcomes, access to services, social connectedness, improved functioning, and cultural sensitivity. According to interviews in fiscal year 2011, satisfaction ranged from 59 to 84 percent. Youth and parents or caregivers of youth were most satisfied with “social connectedness” and “cultural sensitivity,” while adults were most satisfied with“quality and appropriateness.”
Public perceptions of care as indicated through agencies with family members or consumers on governing/advisory boards
A majority of the behavioral health and developmental disability agencies now include consumers on their governing boards. All 84 agencies providing behavioral health services met the review standard of having consumers or family members in sufficient numbers on the agency governing body or board to ensure their meaningful participation. Consumers of publicly funded behavioral health and developmental disabilities services demand increased involvement in their treatment and care. Consumers or family members of consumers also sit on each of the four statewide advocacy boards and commission.
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