Immediate Aid for Long-Term Mental Health
The Alaska Mental Health Trust invests in care for Alaska’s most vulnerable
In the wake of celebrating its 25th anniversary in 2019, the Alaska Mental Health Trust Authority has stepped in to provide $1.5 million in grants to organizations responding to the COVID-19 pandemic in the Last Frontier.
“We are concerned about the near- and long-term impacts of the pandemic on mental healthcare,” Alaska Mental Health Trust CEO Mike Abbott explains. “Providers that are doing the day-to-day work with our beneficiaries are in many cases struggling because they’re losing revenue, operational requirements are different and typically more expensive, and they are adapting to telemedicine where they might not have used that technology much before.”
The COVID-19 grants for Alaska providers serving Trust beneficiaries were allocated based on three broad areas: assistance for emergent beneficiary needs, identified health and safety issues, and operational assistance.
“The Trust will prioritize requests for needs and services necessary to support the life, health, and safety of Trust beneficiaries and for entities that have not already received a COVID-19 response grant from the Trust,” the Trust’s website stated in May.
“We understand the urgency of this, and we have the capability of acting pretty nimbly,” Abbott says. “We can make decisions quickly when we need to.”
The turnaround time for the COVID-19 grants, which have been in the range of $2,000 to $25,000, are being issued within about a week of receiving an application. Typically, the Trust’s rolling grant application process takes about a month to be processed.
“Depending on the amount of the grant and the complexity, it would take somewhere between three and six weeks to get an answer back from us,” Abbott says. “That’s assuming the applicants have all of their information available.”
The grants and public policy work done by the Trust are designed to support its beneficiaries: Alaskans with mental illness, developmental disabilities, chronic alcohol or drug addiction, Alzheimer’s disease and related dementia, or traumatic brain injuries.
“There’s no sort of list, there’s no membership card to the Trust, there’s no census or database that lists names,” Abbot says. “Most of our funding goes to programs that support people by class and not necessarily individual beneficiaries. Our programmatic work is designed to improve the systems that support our beneficiaries. Typically our funding is provided to state government, local governments, nonprofits, tribes, and other providers that are doing work that improves the lives of Alaskans with those challenges.”
Abbott estimates that, based on population density estimates, somewhere between one in seven and one in ten Alaskans qualify as a Trust beneficiary, which means the Trust serves between 70,000 and 100,000 Alaskans.
The Trust, the only organization of its kind in the nation, was created in 1956 when Congress transferred the responsibility of providing mental health services to the Territory of Alaska. To fund this responsibility, which was inherited by the state, 1 million acres of land were transferred to Alaska, creating the Alaska Mental Health Trust.
In 1994, a decade after a class action lawsuit ruled that the state breached its fiduciary responsibility to manage Trust land, the Alaska Mental Health Trust Authority was established. A board of seven trustees, appointed by the governor and confirmed by the legislature, was put in place to manage the Trust, which received 1 million acres of land reconstituted and a $200 million cash payment from the state to be invested with Alaska Permanent Fund Corporation.
“The Trust gains revenue for annual expenditures from two primary sources. The first of them are repeatable, ongoing revenues associated with land management activity,” Abbott says. “Our other primary revenue stream is the larger of them and that is the earnings off of our investments. The Trust has approximately $600 million worth of assets that are invested by, primarily, the Alaska Permanent Fund Corporation on behalf of the Trust.”
About $50 million of those funds are managed by the Department of Revenue, Abbott notes, adding that the land management activity generates millions of dollars annually through leasing and permitting.
Since 1994, the Trust has approved more than $355 million to fund more than 3,200 beneficiary-serving projects and more than 8,600 mini-grants to beneficiaries throughout Alaska, according to the Trust’s 2019 Annual Report. On average, the Trust grants more than $20 million a year across the state for community-based projects and statewide initiatives.
A Catalyst for Care
Abbott makes it clear that the funds provided by the Trust are not designed to subsidize gaps in the state budget but rather provide catalytic funding for projects and initiatives that stand to have a positive impact on Trust beneficiaries.
One primary example of how Trust catalytic dollars drive change in the state is evident in Medicaid reform, Abbott says.
The Affordable Care Act, signed into law by then-President Barack Obama in 2010, included section 1115, which created an opportunity for states to find ways to use Medicaid differently than the federal government would typically allow if the state could demonstrate that such uses were ultimately less expensive than the standard federal Medicaid program.
“One of the areas that we have encouraged, and the [Alaska Department of Health and Social Services] has embraced, is in testing or building a five-year pilot whereby behavioral health services would be allowed to be funded by Medicaid with the expectation that will reduce overall Medicaid expenses: that if you treat substance abuse and mental health issues using lower-cost systems, you will reduce total cost because people won’t use the emergency room or more expensive hospital environments,” Abbott explains.
“The Trust has invested several million dollars in that 1115 demonstration project. We are committed to testing that. We want that lowest level of care to be expanded for Medicaid eligible patients so that folks are getting their care in their communities, in their homes, while they’re living at home, while they’re working, rather than seeing their conditions go untreated and then becoming more acute and ultimately requiring more intensive care that is ultimately more expensive.”
Abbott notes that while the Trust isn’t opposed to helping the state save money to provide services, its objective is to provide better care to its beneficiaries.
Rasmuson Foundation President and CEO Diane Kaplan points out that though the Trust wields a significant amount of money, it pales in comparison to the state budget.
“But, if you can leverage that, then you can make $20 million look like $200 million. So they learned quickly, and I think it has to do a lot with the genius of Jeff Jesse [Trust CEO from 1995 to 2017], that was the way to go,” Kaplan says, noting that the foundation partners with the organization for various projects. “They really became experts at that—and still are under Mike Abbott’s leadership.”
In some ways, the Trust has become a touchstone for the Rasmuson Foundation, Kaplan explains.
“If we’re going to fund a project that’s about behavioral health—that’s assisted living, that’s mental health, that’s around addiction—it would be very odd for us not to check in with them,” Kaplan says. “If a proposal came before my board of directors and they didn’t see the Mental Health Trust as one of the funders, they would question whether it was a good project.”
Rasmuson Foundation has built a strong partnership with the Trust to tackle issues of drug abuse and recovery through the Recover Alaska program, Kaplan says. In 2019, the Trust awarded a $100,000 grant to the program for “programmatic support for work to reduce the harm caused by alcohol to Trust beneficiaries.”
The two also co-funded the Pay for Success Program operated by United Way of Anchorage. The program is designed to provide housing for challenging-to-house people in the homeless population through a series of interventions and high touch counseling, Kaplan says. The Trust is currently considering additional funding for this initiative.
“Pay for Success means that if [United Way of Anchorage] meets the established goals, the City will pay them to continue with the program. The incentive for the City is savings in the form of needing fewer police patrols and [other expenses associated with the target population],” Kaplan says. “So far, it’s been a success.”
Homelessness is among the many issues the Trust combats in its holistic approach of supporting its beneficiaries.
“Housing is critical in that people can come to a clinic and receive a treatment service, but if they leave that appointment and go back into homelessness or live in a vulnerable situation, that treatment will likely be insufficient,” says JAMHI Health and Wellness CEO Dave Branding.
JAMHI, which provides behavioral health clinical and rehabilitation services on a sliding scale in Juneau, received $100,000 from the Trust for “organizational support for the Juneau Reentry Coalition Coordinator” and $99,882 in “support for the Forget-Me-Not Manor Housing First project” in 2019.
The Forget-Me-Not Manor in Juneau comprises thirty-two efficiency apartments for people with chronic alcoholism, Branding explains.
“Most of the residents in that facility, prior to living there, have been homeless for an average of nine years,” Branding says. “Each person has a lease and a housing voucher that helps them pay for rent.”
The housing does not require people living there to be sober or to be in the process of recovering from alcoholism.
“Some people who live there may never recover from their alcoholism but might be experiencing other physical healthcare problems associated with chronic alcohol use or can be intoxicated much of the time,” Branding says. “But they’re doing it in a place that is safe and they’re not dying on the street.”
Branding points out that those with chronic alcoholism and substance use disorder often have a challenging time qualifying for Medicaid, which is the primary funding source of behavioral health services in Alaska.
“People who have Medicaid coverage are able to receive public behavioral health services in Alaska,” Branding says. “But that requires an assessment that can take several hours. If someone is highly intoxicated nearly all the time, they might have an attention span or an ability to engage in that assessment for about five minutes.
“Those people never become eligible for services. So organizations like ours don’t have a funding source to serve them. From the community’s perspective, those are the people that we should be serving. There are people that are troublesome out on the streets. They’re incredibly vulnerable. And it looks like we’re not doing our job.”
However, because the Trust funds a clinician to work with and develop a therapeutic relationship with this population, as well as engage with them during the necessary assessment—even if it’s five minutes at a time—JAMHI is able to eventually receive state funds through Medicare to provide the services they need.
“So the Trust funding, in this example, allows access to services for the most vulnerable, addicted people in our community,” Branding says.
The Trust works to protect the value of timber resources so its timber program can provide a long-term source of revenue from its land base. The recent Icy Cape timber harvest near Yakutat, pictured here, has generated more than $3.7 million in revenue for the Trust.
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Building Sound Policy
In addition to the vast amount of work conducted by the Trust as a grantor, the organization is also instrumental in policy development in the Last Frontier. In partnership with the Alaska Department of Health and Social Services, the Trust helped write Strengthening the System: Alaska’s Comprehensive Integrated Mental Health Program Plan 2020-24, which was finalized in July 2019.
According to the Office of the Commissioner, the plan “identifies priorities for the next five years to inform planning and funding decisions to meet the needs of Alaska Mental Health Trust beneficiaries. The intent is to strengthen the system of care to allow a comprehensive approach that quickly meets their needs.”
The plan is only one example of the policy and advocacy work that the Trust does, Abbott says. Both Kaplan and Branding make it clear that the Trust’s voice and expertise in behavioral health issues that impact Alaska are vital to the state’s ability to improve its systems and heal people.
“We pledge to continue to identify and implement innovative solutions to the challenges our beneficiaries face, to solicit and apply beneficiary perspectives to our efforts, and to increase the corpus of the Trust as well as our spendable income,” Abbott and Board Chair Mary Jane Michaels wrote in the 2019 Annual Report. “Our trustees and staff will keep working to fulfill the mission of the Trust. We look forward to another twenty-five years of partnering with the state and our fellow Alaskans to improve the lives and circumstances of Trust beneficiaries.”