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


Living with Dignity

Living with dignity can be defined as being valued and appreciated by others for the choices and contributions one makes and being able to take advantage of the opportunities available to all Alaskans. The Comprehensive Plan focuses on three issues related to life with dignity: community participation, housing, and education and training.

To be part of a neighborhood, live in acceptable housing and attend the public school are marks of community membership. Alaskans experiencing mental illness, substance use disorders, developmental disabilities, and age-related dementia need to engage with family, friends, and neighbors and participate in their communities. Social contributions can include volunteer or paid work, subsistence activities, active membership in spiritual and other community organizations, and successful school attendance. People with cognitive or developmental disabilities may need support and assistance to connect with and become contributing members of their communities. Prejudice may limit social acceptance in school, religious organizations and volunteer activities. In some communities, unavailability of transportation services can limit participation in community life.

While many Alaskans struggle to find decent, affordable housing, people with cognitive or developmental disabilities and their families often find it especially difficult to obtain appropriate housing because they are more often poor and because they face discrimination. Poverty makes a person particularly vulnerable to homelessness: an individual may be less than a paycheck away from losing shelter. Many of Alaska’s homeless are people with mental, developmental or cognitive disabilities or addictive diseases. Once people are homeless, finding and keeping a treatment schedule becomes even more difficult.

Gaining new skills and experiences in supported environments can prepare adolescents and adults with cognitive or developmental disabilities for jobs and participation in community life. All children are entitled to a public school education where they learn the social, academic and practical skills needed to become adults who are as independent as possible. Children can progress further when developmental delays are identified and addressed early. Schools can also help in identifying students with emotional disturbances and referring them to behavioral health care providers. Schools can educate all children about addictive disorders and healthy lifestyles.

Dignity Goal #1: Make it possible for Trust beneficiaries to be productively engaged in meaningful activities throughout their communities.

The Client Status Review (CSR) tracks the quality of life of consumers of the Alaska behavioral health treatment system. When clients enter the system they are asked a series of questions about their “life domains” such as thoughts of self-harm, feelings of connectedness, productivity, etc. For comparison, they are asked the same questions at different intervals during treatment, and at discharge.

Figure 9: Positive Outcomes in Life Domains – All ages, SFY 2009 & 2010 (Percentage of Behavioral Health Consumers Improving or Maintaining Quality of Life)

The Client Status Review (CSR) tracks the quality of life of consumers of the Alaska behavioral health treatment system. When clients enter the system they are asked a series of questions about their “life domains” such as thoughts of self-harm, feelings of connectedness, productivity, etc. For comparison, they are asked the same questions at different intervals during treatment, and at discharge. Figure 9 shows that at discharge, most consumers reported that their conditions were the same or better than they had been when they entered the system.

In fiscal years 2009 and 2010, at least 75% of individuals who received Behavioral Health community-based services and completed a follow-up Client Status Review reported "functioning well" for the following four life domains: Financial/Basic Needs, Housing Situation, Physical Health, and Thoughts of Self Harm. Less than 75% of individuals reported functioning well for two life domains: Meaningful Activities/Employment and Mental/Emotional Health.

The DHSS Division of Behavioral Health target is for 75% of individuals who receive Behavioral Health community-based services to report functioning well for each of of the six life domains (Financial/Basic Needs,Housing, Activities/Employed, Mental/Emotional Health,Physical Health, &Thoughts of Self Harm)

Youth Connectedness at Levels of Family, School, and Community - Youth Risk Behavior Survey 22

Connectedness is a key protective factor correlated with a decrease in youth risk behaviors (use of tobacco, alcohol and other drugs, suicide ideation, violence and early sexual activity).29 The term "connectedness," in this context, refers to the feeling of support and connection youth feel from their school and their community.

Youth who help others or who are engaged in community service activities are less likely to be involved in anti-social behaviors, to be suspended from school or to become pregnant.30 Service activities also provide an opportunity for youth to form close relationships with caring adults.

Results from 2009 Youth Risk Behavior Survey22 of Alaska high school students:

  • 17 percent  agree or strongly agree that they feel alone in their life.
  • 59 percent agree or strongly agree that they have teachers who really care about them and give them a lot of encouragement.
  • 54 percent agree or strongly agree that in their community they feel they matter to people.
  • 52 percent spend one or more hours helping or volunteering at school or in the community during an average week.
  • 83 percent said they would feel comfortable seeking help from one or more adults besides their parents if they had an important question affecting their life.

Dignity Goal #2: Enable Trust beneficiaries to live in appropriate, accessible and affordable housing in communities of their choice.

Alaska Housing Finance Corporation Winter Survey Reports show that the number of homeless Alaskans increased 65 percent between 2006 and 2010. In 2010, approximately 11 percent of the homeless individuals had severe mental illness, 16 percent experienced chronic substance abuse, six percent were victims of domestic violence, and two percent were unaccompanied youth (under 18 years). Of the total homeless individuals, 57 percent were in families with children.. 31

According to the Alaska Housing Trust, homeless children are more likely to experience conditions of anxiety, withdrawal, depression, hunger, asthma, ear infections, stomach problems and speech problems than their peers.32 Homelessness results from a complex set of circumstances that require people to choose between food, shelter, and other basic needs. Contributing factors include:

  • Inadequate income. A 2001 study found 57% of Alaska households could not afford a median-priced home and 46% could not afford the average rent.33 In Anchorage, a person needs to earn $19.83 per hour to afford a modest two-bedroom apartment at the average fair market rent of $1031.34 (For more information about rent-wage disparities in Alaska, please see Table E-1.)
  • Inadequate supply of affordable housing. The private housing market alone cannot supply enough affordable housing because of high land prices and other costs. The waiting list in Alaska for publicly financed housing is over 3,000 households.35
  • Catastrophic events and destabilizing forces. A sudden economic downturn caused by illness, injury, divorce or job loss may push people into homelessness. Mental illness and addiction disorders are also destabilizing forces that can cause homelessness.
  • Insufficient supportive services. In Alaska, homeless prevention services, case management services, after-hours mental health counseling and other housing retention services are not widely available. Once special needs clients have been placed in housing, there is a great need for “house calls” by occupational therapists or other providers to help the client retain the housing.37

Figure 10 —Estimated Rate of Homelessness in Alaska by Year, 2001 - 2010

Figure 10 is an estimate based on the Alaska Housing Finance Corporation Winter Survey Reports. According to the Alaska Housing Finance Corporation, the following factors may have contributed to the recent increase in homelessness: (1) rising rent and utility costs, (2) stagnant wages & benefits; and (3) lack of available rental assistance.35

The AHFC survey is completed annually on a predetermined day by providers of services for homeless people and community volunteers. Although the survey has many limitations, including low survey return rates, it does provide some idea of the number of homeless Alaskans and their characteristics.36

Section 8 Public Housing

Approximately 4,275 Alaska residents currently are using Section 8 public housing vouchers In addition, as of July 1, 2010, there were 5,850 households still waiting for Section 8 vouchers. Public housing vouchers are allocated from the U.S. Department of Housing and Urban Development to the Alaska Housing and Finance Corporation’s Public Housing Division. Based on the average per unit cost to assist a household in Alaska, the amount of funds received by HUD can actually support approximately 4,077 households. To absorb this deficit, AHFC issued very few vouchers in State Fiscal Year 2010.35

Homeless Bed Inventory

According to the Alaska Housing and Finance Corporation, the 2010 Homeless Bed Inventory showed 1,081 year-round emergency shelter beds and 730 transitional housing beds for a total of 1,811 temporary beds in Alaska..36

Supportive Housing

There are approximately 506 supportive housing units statewide. These units, designed for those who are homeless with special needs, enable people to live as independently as practicable.In supportive housing, residents have their own housing units and lease agreements..36

Assisted Living

Throughout Alaska there are 3,408 assisted living beds in 612 licensed facilities..(Assisted Living Home List rev. 2/2011)37 Assisted living is a more structured and regulated form of special needs housing. Often the landlord and service provider are the same and housing tenancy is tied to using the services provided. Many of these required services are related to activities of daily living. In Alaska, virtually all of the special needs housing for persons with developmental disabilities are licensed assisted living homes.

Number of individuals discharged to homeless situations from Alaskan institutions:

Alaska Psychiatric Institute (API):

When Alaska Psychiatric Institute patients return to their home community, staff works to identify appropriate living arrangements whenever possible. Those who are homeless at discharge are typically referred to shelters in the community.

            Living Situation at Discharge from API: January to December 201032

Homeless

11 of 1281

0.86%

Shelter

37 of 1281

2.89%

.

Alaska Department of Corrections:

When individuals are released from prison or jail, the ability to access safe and secure housing within the community is crucial to their successful reentry. Studies have shown that the first month after release is a vulnerable period during which the risk of becoming homeless and/or returning to criminal justice involvement is high. Yet, in most communities to which individuals return after incarceration, accessible and affordable housing is in exceedingly short supply. The additional challenges unique to people with criminal histories make it even more difficult for them to obtain stable housing. (Alaska Prisoner Reentry Task Force Five-Year Prisoner Reentry Strategic Plan, 2011 - 2016, p. 65. For more information and strategies, see Five-Year Prisoner Reentry Strategic Plan, 2011 - 2016, Chapter Seven: Housing Newly Released Prisoners , pp. 64-71.).

For more information on affordable, appropriate housing:  Alaska Mental Health Trust Authority Affordable Housing Focus Area Fact Sheet

Dignity Goal #3: Assist Trust beneficiaries to receive the guidance and support needed to reach their educational goals.

The federal Individuals with Individuals with Disabilities Education Act (IDEA)38 is the primary law that entitles children with disabilities to a free and appropriate education. IDEA requires states to provide special education and related services to students who meet eligibility requirements. To be eligible, a student must meet criteria established in the law and the condition must adversely affect his or her educational performance. Children with disabilities must be taught in the least restrictive environment and among non-disabled children to the maximum extent appropriate.

IDEA requires schools to provide necessary accommodations, as identified in each student’s required Individual Education Plan, for special education students to participate in the high school exit examination. This accommodation includes development of an alternate assessment for students with significant disabilities. It is critical for children to participate in school and complete a high school course of study as part of their preparation for a life as independent as possible.

Figure 11 — High School Graduation Rates for Students Receiving Special Education compared with Students not Receiving Special Education

The 2009 graduation rate for Alaska high school students receiving special education services was 43 percent, and the rate for those not receiving special education was 71 percent.This data includes only students graduating with a regular diploma and not a GED.

Alaska loses a significant number of students over their four years of high school. Reasons for discontinuing school include pursuing a GED, entering the military, becoming employed, facing family problems, illness, pregnancy, or alcohol/drug dependency, failing, truancy, being expelled due to behavior, transferring to non-district sponsored home schooling, or leaving for unknown reasons without a formal request for transfer of records. Part of the recent decline in overall graduation rates may be tied to better record keeping and reporting in the districts.

The data used to generate the graduation rate is the same for all students, whether or not they are on an Individual Education Plan. The actual yearly graduation rate is computed by determining the total number of graduates divided by the sum of the continuing 12th grade students plus the total of yearly “drop-outs” for each of the four preceding years (i.e., a cohort model).

For information about students who received special education services and are now employed or enrolled in post-secondary education, please see the Alaska Scorecard: Key Issues Impacting Alaska Mental Health Trust Beneficiaries

Figure DL-1 - Grade 10 Students Passing Qualifying Exams – Students Receiving Special Education Services and Students not Receiving Special Education Services, Spring 2010

The High School Graduation Qualifying Examination (HSGQE) measures minimum competencies of essential skills in reading, writing, and mathematics. Passing all three sections of the HSGQE is part of the requirements to receive a diploma in the State of Alaska. Students must take the HSGQE for the first time in the spring of the 10th grade.

Figure DL-1 provides information about Alaska students in10th Grade statewide who participated in the High School Graduation Qualifying Exam. In 2010, the percentage of students receiving -------------special education services and scoring above proficiency in reading, writing, and math was 48% to 64% lower than the percent of students not receiving special education and scoring above proficiency.

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