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Behavioral health: a multi-layered matter.

Alaska's suicide rate is nearly double that of the nation's. Alcohol-related deaths are three times as high. The state's rate of adults who use illicit drugs is also significantly higher than the national rate. Clearly, Alaska faces some serious behavioral health issues.

Behavioral health is a general term encompassing the prevention and treatment of mental illness, substance abuse and addiction, as well as the promotion of emotional wellbeing.

Partners in Alaska's behavioral health industry are many, and include the Alaska Dept. of Health and Social Services, The Alaska Mental Health Trust Authority, University of Alaska, Alaska Native Tribal Health Consortium and numerous local and regional organizations. The overarching goal of all these entities combined is healthy Alaskans.

Diverse Approaches

Kate Burkhart, executive director of the Alaska Mental Health Board, emphasizes the multi-dimensional and multi-disciplinary nature of behavioral health. The basic needs of those with behavioral health challenges are often not being met--things like food, shelter and health care; economic security; personal security and dignity; access to justice; and community inclusion.

Burkhart says that at the root of most of these difficulties is stigma about the person's condition or situation. Attitudes and behaviors reflect a lack of understanding and acceptance of individuals experiencing mental health and substance use disorders. Sufferers are assigned blame, shame or disgrace, and are often discriminated against and excluded from part or all of community life. "Stigma not only results in isolation and discrimination against people experiencing behavioral health disorders," says Burkhart, "but also creates a barrier to accessing necessary services. Changing public attitudes and perceptions takes time and effort--and that is the first step to changing behaviors."

Several entities, including the Alaska Mental Health Board, the Advisory Board on Alcoholism and Drug Abuse, the Alaska Mental Health Trust Authority, Alaska Department of Health and Social Services, advocacy groups and community organizations, have banded together to create anti-stigma campaigns that include media advertising, radio spots and printed materials to address the fact that we all know someone with behavioral health issues and that finding solutions needs to be a collective effort.

Workforce turnover is one of the main challenges in the behavioral health system, according to Melissa Stone, director of the state's Division of Behavioral Health. Integrating substance abuse and mental health care into a single behavioral health system, and then integrating behavioral health into primary care is another important, ongoing issue. Efforts continue to grow community-based systems of care and reduce the need for residential care. Stone says that it's challenging to develop and maintain a system flexible enough to accommodate all of Alaska's different cultural groups.


Suicide risk factors include "depression or other mental illness; a suicide attempt in the past; having been exposed to the suicide of another per son; needing but not receiving mental health care; increasing use of drugs or alcohol, including binge drinking; and access to a firearm or other means in the home," according to the state health department. The national rate of suicide is 11.7 per 100,000 individuals. Alaska's overall rate is at 20.2, with the Alaska Native suicide rate at a whopping 40.4. Geographically, suicide rates are highest in western and northwestern Alaska and lowest in Southcentral and Southeast.

Chief Executive Officer Andrew Mayo, PhD, of North Star Behavioral Health, says that youth suicide is definitely an issue in Alaska. North Star provides behavioral health services for the state's youth ages four to 17. "Alaska's youth face many challenges and represent a diverse group of children and families," he says.

One of North Star's closest partners is the Jason Foundation, a national youth suicide prevention foundation. Last year, the foundation opened its first affiliate office in Alaska at the North Star facility in Anchorage. It provides a wealth of youth suicide prevention materials to individuals, organizations and communities at no cost. Mayo says that North Star and the Jason Foundation recently worked in tandem to support and advocate for an Alaska state bill that requires training for school personnel on youth suicide and awareness. He says the foundation also provided 425 sets of materials to the Alaska Department of Education and Early Development and that those have since been distributed to schools throughout the state.

The Alaska Statewide Suicide Prevention Council lists six strategies in its plan for the next several years: 1) Alaskans accept responsibility for preventing suicide; 2) Alaskans effectively and appropriately respond to people at risk of suicide; 3) Alaskans communicate, cooperate and coordinate suicide prevention efforts; 4) Alaskans have immediate access to the prevention, treatment and recovery services they need; 5) Alaskans support survivors in healing; and 6) quality data and research is available and used for planning, implementation and evaluation of suicide prevention efforts.

Though substance abuse, family violence and mental illness can all be intertwined with suicide, the state's Department of Health and Social Services 2011 annual report notes that the department chose youth alcohol abuse and adult heavy and binge drinking as the most critical substance use challenges for funding purposes. Community action teams were also organized "to implement community-driven postvention (taking care of the survivors/the bereaved after a suicide loss) resources and outreach."

Substance Abuse

Last year, more than 6,500 Alaskans were treated for substance abuse. More than 40 percent were seen for an alcohol-only dependency, while another 30 percent for alcohol with a secondary drug. Nine percent were seen for abuse of marijuana. This information comes from the national Substance Abuse and Mental Health Services Administration. Alaskans 26 to 30 years old were the largest age group treated; about 60 percent of all age groups were males. In the mid-1990s, more than half of all fatal car crashes in Alaska involved alcohol. That percentage has come down since then, but alcohol-related fatalities on the state's highways still hover above 30 percent.

According to the Alaska State Troopers 2011 Annual Drug Report, about one-third of the cases Troopers initiated involved drugs and/or alcohol. The numbers of individuals charged and/or arrested in Alaska in 2011 related to drugs and alcohol were: alcohol, 392; cocaine, 108; heroin, 118; marijuana, 1,211; and meth, 194. Though crime prevention is not typically listed as a specific goal in behavioral health provider circles, it is certainly an important possible outcome of substance abuse treatment. Of all violent crime cases, nearly 60 percent involved drugs and/or alcohol.

Burkhart, who is also in charge of the state's Advisory Board on Alcoholism & Drug Abuse, says the need is high for increased research on behavioral health issues as they affect Arctic populations. She says she hears "from communities all over Alaska a pressing need for resources to support programs that promote positive youth development." This includes support systems for youth who experience mental health and substance use disorders, especially Fetal Alcohol Spectrum Disorders, and those transitioning from residential or foster care to independence. Burkhart says the state is continually working on these and other gaps in the system.

Mental Health

Mental health conditions are many: depression, anxiety, bipolar disorders, eating disorders, schizophrenia and more. According to state records, the number of days in the past month that adults experience poor mental health is somewhat lower than the national average. About one-quarter of Alaska's teens have experienced depression in the past year.

Treatment services range from inpatient hospitals such as Alaska Psychiatric Institute in the population hub of Anchorage to rural health clinics in remote or roadless communities.

"Each community has a unique behavioral health system, with its own strengths and weaknesses," says Burkhart. "Some communities, like Anchorage, have many agencies providing mental health and substance use disorder treatment, while other communities rely on itinerant counselors who visit once or twice a month. Some communities have robust community wellness coalitions and prevention programs, while other communities struggle to incorporate basic prevention activities."

The average length of stay at Alaska Psychiatric Institute in January of this year was 10 days. The facility had 132 admissions, of which almost all were involuntary.

The Alaska Mental Health Trust Authority is a state corporation whose mission is "to act as a catalyst for change and improvement in the systems that serve Trust beneficiaries." Beneficiaries include people with mental illness, developmental disabilities, chronic alcoholism and other substance-related disorders, Alzheimer's disease and related dementia and those with traumatic brain injury. The Trust focuses on a few key programs; one is called "Bring the Kids Home" and is intended to reform Alaska's mental health care for children and adolescents so they are diagnosed earlier and are treated as close to home as possible.

There Is Hope

Treatment works, people get better, lives improve. This and other similar mantras are common among behavioral health specialists. Anyone struggling with depression, alcohol dependence, drug use, thoughts of suicide or other behavioral health problems can call 888-464-8920 to find a treatment provider in or close to their community. CareLine, the statewide crisis line, is answered 24 hours a day by trained Alaskans. Call 877-266-4357 anytime for caring and confidential help. Peer support and education is available from Alaska's National Alliance on Mental Illness affiliates by calling 800-478-4462. Peer support resources can also be found through the Alaska Peer Support Consortium, 907-258-2772.

Susan Sommer is a freelance writer and editor living in Eagle River.
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Title Annotation:HEALTH & MEDICINE
Comment:Behavioral health: a multi-layered matter.(HEALTH & MEDICINE)
Author:Sommer, Susan
Publication:Alaska Business Monthly
Geographic Code:1U9AK
Date:Oct 1, 2012
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