State of Alaska Division of Legislative Audit

Behavioral Health Improving Service Findings Table

Finding NumberFinding
2.2.1The Department does not provide the full continuum of care required to deliver effective behavioral health services.
2.2.2Although the Department has successfully introduced new service capacities and more effective types of treatment in some parts of the care continuum, other parts of the continuum have witnessed a reduction in service capacity.
2.2.3Access to services increased significantly during the review period, but the growth in service utilization has occurred unequally across regions, and disproportionately in mental health over substance abuse services.
2.2.4The quality of overall service delivery has remained relatively static over the course of the review period.
2.3.2Although the Department has progressively shifted spending away from institutional care to finance more efficient treatment within the community, increased numbers of community providers offering more intensive services are needed to realize the full benefits of community treatment.
2.5.1The Department’s acute intensive services are neither effective nor efficient, due to a combination of administrative inefficiencies, inadequate sub-acute infrastructure, and lack of community partners.
2.5.2Gaps in the Department's residential services system limit its effectiveness, but efforts to improve service capacity for certain populations have significantly improved efficiency.
2.5.3The Department's limited capacity for intensive support services, especially for assertive community treatment and substance abuse intensive outpatient services, substantially limits the effectiveness and efficiency of care for high-need populations.
2.5.4The Department is limited in the resources available to provide living supports such as transportation and assisted living services effectively, but it has made improvements in using scarce resources efficiently.
2.5.5The Department is deficient in providing key community and recovery supports, such as housing, mentoring, and caregiver supports. Peer services have not been integrated into providers’ recovery supports to allow the most effective range of services.
2.5.6The Department's outpatient and medication services are broadly effective, but are increasingly overburdened and unable to keep pace with growing consumer demand.
2.5.7The Department has made progress in improving engagement services, including its assessment, evaluation, and service planning processes. However, more work needs to be done to deliver these services efficiently.
2.5.8The Department's prevention and wellness services have made significant progress in building strong community coalitions, but need to be integrated more effectively into core Division activities.
2.5.9Department efforts to foster care integration services of behavioral health and primary care have been mixed in their effectiveness and efficiency.
5.1.1National best practices require treatment of individuals at the least-intensive level of care appropriate to support community integration and social inclusion. Furthermore, widespread consensus exists on the array of mental health and substance use services required to ensure effective referral and placement into the most appropriate level of care.
5.1.2Best practices have emerged nationwide for referrals between community behavioral services and services delivered in the criminal justice system. These practices include jail diversion programs on the front end of the criminal justice system, and prisoner re-entry programs on the back end.
5.3.1Insufficient funding for community-based, prevention-focused behavioral health treatment has increased the need for costly psychiatric services.
5.4.1Low supply of psychiatrists nationally, along with a statewide shortage of other behavioral health professionals, impairs the Department’s efforts to ensure an effective service array of behavioral health services.
5.4.3The availability of affordable housing in Anchorage, Juneau and other population centers poses challenges for transitioning consumers into the community.
5.4.4Transitioning consumers from institutional care back into rural Alaska communities is complicated by limited village capacities to care for individuals with serious mental illness.
6.3.3Staffing for prevention and early intervention (PEI) services is commensurate with the administrative capacities required for direct service delivery.
7.2.3The Department’s proposed $1.6 million in budget reductions for BHTRGs are unlikely to impair behavioral health services substantially, because reductions are spread proportionately across services and providers, and are drawn primarily from lapsed funding amounts derived from the previous fiscal year.
7.2.4The Department’s proposed $347,300 in budget reductions to the Alaska Psychiatric Institute consist of the elimination of the hospital’s medical director position. Assuming that staffing levels are maintained for service staff and the functions of the medical director are able to be distributed effectively to remaining administrative staff, the review does not anticipate service delivery at API to be substantially impaired.
7.2.5The Department also proposed $20 million in budget reductions to be achieved through unspecified Medicaid cost containment measures. Although these reductions presented by the Department are not specific to behavioral health services, these proposed reductions would likely affect behavioral health services.
8.1.9The Department supports and facilitates effective use of IT for telebehavioral health services.
10.1.3The Department has formulated Medicaid regulations and grant and contract requirements to serve the needs of tribal communities, meet the challenges of rural-remote populations, and maximize opportunities for collaboration with tribal providers.
10.1.4The Department has already fully developed opportunities to incentivize tribal provider participation in Medicaid through enhanced reimbursement rates.
10.1.5The Department serves a disproportionate number of Alaska Natives with serious mental illness (SMI) due to under-developed service capacity for these individuals within the tribal system.
10.1.8Since 2010, the Department has collaborated directly with the VA Healthcare System through the Rural Veteran Health Access Program to expand telehealth capacity in Southeast Alaska and enroll non-tribal providers as VA vendors.