Dr. Aron Wolf was interviewed by William Schneider and Karen Brewster on December 7, 2010 at his private psychiatric office in Anchorage, Alaska. He came to Alaska in the late 1960s with the United States Air Force to provide mental health services to soldiers at remote bases, to dependents, and to veterans. He worked at the Langdon Clinic from 1970 to 1995, was medical director for Providence medical system until 2004, and then returned to private practice. In this interview, Dr. Wolf talks about the evolution of mental health services in Alaska, the role of community mental health centers, the field of forensic psychiatry, vocational rehabilitation programs, and the behavioral health aide program.
Digital Asset Information
Project: Alaska Mental Health Trust History
Date of Interview: Dec 7, 2010
Narrator(s): Dr. Aron Wolf
Interviewer(s): Bill Schneider, Karen Brewster
Transcriber: Carol McCue
After clicking play, click on a section to navigate the audio or video clip.
Section 1: How he became interested in psychiatry, his early influences, and his educational background.
Section 2: Coming to Alaska with the Air Force and providing mental health services to people stationed at remote sites around the state.
Section 3: Types of mental health problems seen in the military population and types of services provided.
Section 4: Psychiatric services available in Alaska to the non-military population in the late 1960s.
Section 5: Assessment of Morningside Hospital, lack of services in villages, and development of community based mental health centers.
Section 6: Delivery of mental health services in rural Alaska, particularly in the Bethel region, and teaching psychiatry in the Washington, Alaska, Montana and Idaho medical education program .
Section 7: Describes the field of legal or forensic psychiatry.
Section 8: Research into blackout and using it as a psychiatric defense in legal cases.
Section 9: Research methods used to study blackout and how it was used in legal defense and conviction.
Section 10: Development of Alaska’s first community mental health centers.
Section 11: Working in private practice in Anchorage, and his involvement with the American Psychiatric Association.
Section 12: Assessment of therapeutic courts, and role as medical investigator helping law firms with medical and psychiatric cases.
Section 13: Changes in the delivery of mental health services in Alaska, especially in rural Alaska and development of telemedicine as a way to see and treat patients.
Section 14: Development of consumer based entities for delivery of mental health services in Alaska, and their differences in approach to mental illness.
Section 15: Changes in mental health services with in-patient programs and dedicated psychiatric units at hospitals.
Section 16: Assessment of expanded services to beneficiaries, and of the Alaska Mental Health Trust Authority.
Click play, then use Sections or Transcript to navigate the interview.
After clicking play, click a section of the transcript to navigate the audio or video clip.
Section 1: BILL SCHNEIDER: Okay. Today is December 7th, 2010. I'm Bill Schneider, Karen Brewster's here, and we have the privilege today of doing an interview with Dr. Aron Wolf. And this is part of the Mental Health Trust series. And we're here in his office with his companion, Kayla, a lovely golden retriever. So thank you for taking the time to do this.
DR. ARON WOLF: You're welcome.
BILL SCHNEIDER: Let's start by a little bit of your career, where you grew up and some of the early influences, and then how did you get into psychiatry and medicine?
DR. ARON WOLF: I grew up in New Jersey, and my father was a physician, he was a surgeon. And he ‑‑ although he, for his entire life, said he never pushed me to be a doctor, I started making rounds with him when I was 7, and I was in the OR with him when I was 8 or 9, and at least once a week I made rounds with him, so that I was familiar with the hospital.
I am not very technically adept with my hands, so surgery was not going to be my forte; however, a friend of my father's, who was an intern when my father was a resident, was my wife's uncle, and he was the premier forensic psychiatrist in the United States and the vice‑president of the American Psychiatric Association.
And Uncle Henry, Dr. Davidson, actually influenced three of us who are psychiatrists, one ‑‑ one who is a retired professor at Columbia, a retired professor at Cornell, and myself. So we were all family, we all became psychiatrists, and we are ‑‑ we are all within three years of one another.
So Uncle Henry wrote the first book of forensic psychiatry that is still used. So ‑‑ so he was our major influence in terms of psychiatric practice.
BILL SCHNEIDER: Well, that's pretty good.
DR. ARON WOLF: Yes.
BILL SCHNEIDER: Where did you end up going to school?
DR. ARON WOLF: I wound up going to college in New Hampshire at Dartmouth, and was a ‑‑ was a premed and a psychology major, and then I followed my father's footsteps and went to the University of Maryland where I stayed for medical school.
In those days you had to take a separate internship, so I did, an internship in internal medicine, and then stayed for psychiatry for three years of psychiatry, being the chief resident the year before I left.
Section 2: BILL SCHNEIDER: Well, you certainly have a lot of qualifications on your resume.
DR. ARON WOLF: Yeah. Well, that's a lot of years.
BILL SCHNEIDER: Yeah.
DR. ARON WOLF: That's a lot of years. The ‑‑ I ‑‑ I am old enough that you had to go into the service, there was doctor draft, and so it was called the Barry Plan.
And you had ‑‑ you ‑‑ the first day of medical school, the first lecture was the military, and they got up and said you can either sign your deferment or there's a bus outside. Somebody looked out the back window and there was a bus outside. So all ‑‑ all of the guys signed, women were not in the military, we did have some women in the class even then, and so we all signed up.
And so 8 years later I had to go in the military.
And I was already in the Air Force, I mean, that's what you signed up for, and I did not want to go to Vietnam at that point. And one way of not going to Vietnam was to go overseas. So I signed up for overseas; in fact, I even went down to Washington and to the Department of the Air Force, where ‑‑ where do you have slots? Oh, Wiesbaden and Barcelona and the Philippines and Tokyo and whatever, and three weeks later we got assigned to Alaska. So that's how I got to Alaska.
BILL SCHNEIDER: That's a good story.
DR. ARON WOLF: It is still overseas. It is still overseas. And we called the nearest Army base and said, what was living like at Elmendorf Air Force Base, and they said, well, we don't know, we think it's up near the DEW Line, so that's what we were expecting when we got here.
So I ‑‑ I ‑‑ so I came up and spent three years at Elmendorf.
KAREN BREWSTER: And what year did you come up?
DR. ARON WOLF: August 12th, 1967.
BILL SCHNEIDER: And so what did you find at Elmendorf?
DR. ARON WOLF: I found probably the biggest psychiatric department in the state at that point. There were five psychiatrists, one of whom was a child psychiatrist.
There were ‑‑ there was two social workers and two psychologists and scads of corpsmen, and it was an inpatient program and an outpatient program here in Anchorage, and it served the entire state. So it ‑‑ it was a huge program.
It was in the middle of the Vietnam War, we had air evacuation planes coming through every hour, and so we had ‑‑ we had all the bases in Alaska, we had the Army bases in Alaska to serve, we had the dependents to serve, there was no VA hospital so we served the veterans, and then we served the 18 remote sites around the state.
BILL SCHNEIDER: Are we talking DEW Line sites and White Alice?
DR. ARON WOLF: No. No, they were private. They were ‑‑ you they were the DEW Line sites, but White Alice was ‑‑ was private. Within six months of my getting here, because people left and whatever, I was made chief of all this. There were five new folks.
And ‑‑ and one of the things that the chief did is they became the human reliability monitor, which is an interesting thing. And so that person had to have a top secret cryptographic clearance, and that became me. They ‑‑ I heard they even asked my kindergarten teacher what ‑‑ what I was like for part of this clearance.
My kindergarten teacher is supposed to have said, what did he do now?
But that got me ‑‑ there were all these remote sites. The two around Anchorage were one up by Arctic Valley and one on Fire Island. And ‑‑ and then all of the state. Cape Romanzof, wherever, all over the state, all of Western Alaska that were listening to Russia.
And guys were sent there for 12 months, remote sites. The two hardest sites were the ones around Anchorage because they could see Anchorage. If ‑‑ if you were out on the tundra, you know, that's where you were for a year.
But people really had problems, and I started my travelling around the state within those six months.
I went to Eielson. I got here in August, I went ‑‑ made my first trip to Eielson in October of that year, and then I went out to the sites on ‑‑ on a regular basis. I got to all the sites. I got to Shemya, I got to Adak, I got to Kodiak on a regular basis, so I was doing travelling.
What was absolutely fascinating, and I think I mentioned this in our telephone conversation, was that I had met Joe Bloom, who was the first psychiatrist to the Native Service, Joe and I became friends, he was serving the villages, I was serving the sites, many of them were within a half a mile of one another, they ‑‑ they were two separate systems serving two sets of people and not communicating.
His ‑‑ he was serving the same villages, they weren't allowed to fraternize, my guys weren't allowed to fraternize, and so we were dupli ‑‑ even then we were duplicating services in the same area around Alaska.
Section 3: BILL SCHNEIDER: What were some of the key problems you were seeing at that time?
DR. ARON WOLF: Well, we were certainly seeing PTSD, coming back, if the guys got on the planes, and ‑‑ and then we also rode the air‑evac planes back to the Lower 48 and ‑‑ and they were hungry for any physician to help with these guys who were both mentally and physically wounded from Vietnam. So I did that a lot.
We served the bases in Greenland, so I got to go to Greenland, and ‑‑ and you landed in C‑130s on skis for those bases in order to serve them. And that ‑‑ that was pretty fascinating in those days, to ‑‑ to fly across Canada and then land in Greenland, and then do that remote site. But it was the isolation.
One of the issues that I was amused at recently in this whole controversy about Ask ‑‑ Don't Ask, Don't Tell is that one way of getting out of the military in those days was to say you were gay, and so there were several people in Anchorage who would aver that they had slept with the guys, and then they would be admitted to the psychiatric unit and ‑‑ and then they would be discharged.
So that was a way of ‑‑ of young men who simply didn't want to serve of getting out of the service.
We ‑‑ we never asked whether they actually had to do anything or whether they just had to pay these guys downtown to say so, but I mean, similar kinds of things, the stress, because there were rotations to Nam, and these young men didn't ‑‑ didn't want to go.
The wives felt very lonely, especially they didn't pay the non‑coms very much, there wasn't housing on base, housing in Anchorage was not what it is now, and so a lot of these young women from Arkansas or Texas, or whatever, were totally isolated up here, and so we had ‑‑ we had a lot of that going on.
BILL SCHNEIDER: And so you were treating the wives, too?
DR. ARON WOLF: We were treating the wives, too. Yeah. And the child psychiatrists were treating the families.
BILL SCHNEIDER: Yeah. Wow. What a reach.
DR. ARON WOLF: Yeah. No. It was a huge reach. It was a huge reach.
Section 4: BILL SCHNEIDER: And for the people that are listening, explain what was going on with the rest of the population in terms of psychiatric services.
DR. ARON WOLF: At that point, there were ‑‑ you know, this is ‑‑ this was '67, '68, and '69, so we were less than 10 years out from Statehood, and the state had started three state clinics at that point.
And there was an Anchorage clinic, a Juneau clinic, and a Fairbanks clinic, each one with one psychologist, one psychiatrist, and one social worker.
Mrs. ‑‑ Mrs. Doctor O'Malley of O'Malley Road and whatever, in Anchorage, was ‑‑ was the doctor in ‑‑ for the state clinic in Anchorage.
So it was that. There were several people in private practice. API was newly functioning, and Dr. Carl Koutsky had been brought up to run API and Carl did a great job in ‑‑ in those days. Even though ‑‑ and I don't know whether in your years here you had ever been through the old API?
BILL SCHNEIDER: No. I know his daughter, but I ‑‑
DR. ARON WOLF: Oh, okay. Well, the old API was built on a 1950s model, 1940s and '50s model, and so the third floor of the old API had an operating room to do lobotomies, and ‑‑ and that was never used, but API was outdated the day it opened.
But Carl did a great job of doing what he could with ‑‑ with a building that was ‑‑ was really outdated. I don't know where they got the plans from, but you know, it was to do ECT and it was to do lobotomies, and the kind of stuff they did pre World War II.
KAREN BREWSTER: What's ECT?
DR. ARON WOLF: Electric shock treatment.
BILL SCHNEIDER: And so there were private clinics at that time? Was ‑‑
DR. ARON WOLF: No, there were individual private psychiatrists. There were three. Dr. Langdon, who I later joined; Dr. Bill Rader, whose daughter is now practicing here at Langdon Clinic, and now Providence; and Dr. Barbara Uri (phonetic), who was a child psychiatrist. They were the three. That was it.
BILL SCHNEIDER: What about the rest of the state?
DR. ARON WOLF: The rest of the state didn't have ‑‑ they had the two ‑‑ and I don't even remember who they were. They ‑‑ there were two state psychiatrists, one in Juneau, and one in Fairbanks. That was it.
Section 5: BILL SCHNEIDER: One of the things we've been trying to come to grips with, before we get into the development of services in Alaska, one of the things we've been trying to come to grips with is the level of treatment in Oregon when people were sent out to Morningside. What was your assessment of that when you first came up here?
DR. ARON WOLF: Well, API had already opened.
And I didn't know that much about Morningside until I was here a little bit. And then I guess I'm biased because I joined Dr. Langdon, who had been the medical director there, and then was sent here to help develop API, and then opened his own clinic.
And J. Ray was just the most marvelous leprechaun and wonderful doc. And his view was that, given the years, that Morningside was as good a hospital as ‑‑ as any state hospital anywhere in the country. And ‑‑ and in some ways better because it was smaller.
I was talking about Uncle Henry, Dr. Davidson, and he ran a hospital in New Jersey that had 3500 people at any one time, so these were huge hospitals. Morningside was better because it was really almost on the model of the private clinics, like Institute of Living in New Haven.
So ‑‑ so once they got there, you know, you had to spend ‑‑ you know, if you had your breakdown in Nome, you stayed in the Nome jail for six months; but once you got to Morningside, it was okay. But lots of these people then stayed because there was no going back. I mean, the villages didn't want the folks. So ‑‑ so there was a problem in, if you will, discharge planning.
BILL SCHNEIDER: Yeah. And no level of services, really, in those remote villages.
DR. ARON WOLF: No. Oh, no, there was no level of services, very little services other than ‑‑ than Anchorage, really. Now, we were a much smaller state.
BILL SCHNEIDER: One of the things that's emerged is the growth of community groups where parents or families with members who had disabilities would form organizations.
DR. ARON WOLF: Yeah. Well ‑‑ well, Juneau ‑‑ Juneau was great that way, and especially with the developmentally disabled community, Juneau was the forerunner of that.
Prior to the Federal Community Mental Health Centers Act, there were two mental health centers here in the state that formed with community groups. They are both still functioning. One is Gateway in Ketchikan, and the other one's Kodiak.
And so they were two functioning mental health centers, 1965, I believe, they both opened. And Dr. Langdon became the consultant to the Kodiak one, so he would fly down there to that one. A number of us did that for many years afterward.
Section 6: BILL SCHNEIDER: We've been amazed at the stories coming out of Bethel, the efforts out there to provide services.
DR. ARON WOLF: Yes, but that was after ‑‑ that was after YK was formed. I mean, that ‑‑ and I ‑‑ I worked for YK, I consulted for YK for five years. Anyway, but that was much later. Bethel was much later. And it was an outgrowth of YK.
BILL SCHNEIDER: I was thinking of John Malone's efforts out there to ‑‑
DR. ARON WOLF: But John did that at about the same time. Well, and John ‑‑ about the same time that the state did a mental health clinic through YK. So ‑‑ so there was John and Vicky doing their group home, and it was wonderful, and then ‑‑ and then the YK clinic that served all 40 villages, and in my years of going out there, I had the privilege and honor of going to all 40 YK villages. Yeah. Yeah. So ‑‑ so there's that.
The other ‑‑ the other thing that developed almost on another train ‑‑ well, Joe Bloom and the people that followed him developed an entire system for ‑‑ through Public Health, so there was that system that was developing. And they brought up a number of people along with them, the one who is still here is Vern Stilner in ‑‑ in Juneau, but Vern spent 10 years or 12 years in Bethel.
He came from Harvard, two nights in Anchorage with Joe and I, and then went to provide services in ‑‑ in Bethel.
KAREN BREWSTER: And he was a psychiatrist?
DR. ARON WOLF: He is a psychiatrist. Head of Bartlett ‑‑ he's a head of the psychiatry department at Bartlett and been around all this time.
No, he actually went ‑‑ went back to be a professor at University of Kentucky because Bob ‑‑ I don't know whether anybody's mentioned Bob Krause, but Bob was up here, and he became the first director of the WAMI program down here, and we all taught WAMI both in Fair ‑‑ and Joe and I taught WAMI in Fairbanks, I did for 12 years before it moved down here.
I taught the freshman psychiatry class in Fairbanks. I went up every spring, every Thursday in the spring for ‑‑ for 12 years to Fairbanks. So ‑‑ so there was that development.
So ‑‑ so you had Public Health, and there are a number of people who are still here who were brought up by the Public Health program, Wandell Winn, Royal Keel (phonetic) are all practicing psychiatrists all these years later for that. So you had that program.
Section 7: And then the other thing that J. Ray got us all involved in is the legal issues. He ‑‑ J. Ray Langdon started doing legal psychiatry in Alaska probably from the moment he got here, and interested both Joe Bloom and I in legal psychiatry.
And I was already one of the founding members of the American Academy of Psychiatry and the Law of which, along the line, Joe became president at some point, but we have con ‑‑ I have continued to do forensic psychiatry all these years.
So I've also traveled rurally helping ‑‑ helping the lawyers on both sides of cases, and developing case law in forensic psychiatry, helping Corrections develop ‑‑ I was asked and did run the sex offender program for the State of Alaska for 10 years.
BILL SCHNEIDER: Give us some general history on that. That's the first time I've heard that term, legal psychiatry.
DR. ARON WOLF: There is a whole branch and a subspecialty of psychiatry called forensic psychiatry. These days you've got to take a fellowship in it. There were 12 of us. I don't know where that certificate is.
There were 12 of us to take ‑‑ who got grandfathered, and we took the first boards, Joe was number 2 being B, and I was number 12 being W, but there are now probably a thousand psychiatrists in the United States who are board certified in forensic psychiatry.
KAREN BREWSTER: And what exactly is forensic psychiatry? What do you do?
DR. ARON WOLF: The interface of psychiatry and the law, if you will. It ‑‑ on the criminal side, you make ‑‑ can help make the determination whether somebody's competent to stand trial, whether somebody's responsible for what they did, and there are laws on that, and help develop the laws.
On the civil side, it ‑‑ it really is a person's mental health relative to either what they are suing for or what they are being sued about. So the whole mental health aspect of ‑‑ of the law, both civil and criminal, are ‑‑ you're involved in ‑‑ in doing that.
BILL SCHNEIDER: So what would be a case in that?
DR. ARON WOLF: Well, I ‑‑ I was just in Fairbanks and was asked by the District Attorney to evaluate and be involved in the case of the gentleman who killed the mental health worker in Fairbanks, and whether he's competent or not competent.
And he's ‑‑ if he were not competent to stand trial, he would be released because there's no holding somebody, and yet here's somebody who most likely killed somebody. So then ‑‑ then the trial ‑‑ and this hasn't happened yet, but the trial needs to happen, and then under Alaska law, is he responsible for what he did. That's a really totally separate question.
Section 8: Another thing I've been working on, and I was a little surprised at how long I've been working on it, but I pulled my original articles on it, is a number of people, especially in rural Alaska, have done their crimes and not remembered anything. It is ‑‑ after drinking. It is the usual in rural Alaska, unfortunately.
There is an entire body of literature in blackout in Natives and ‑‑ and northern peoples. And we were fortunate enough with the help of the Public Defender to do some of the original research, and published on it of a number of people who had committed their crimes in blackout, and didn't remember it, and these were violent crimes.
And we were able to get them drunk again on the same stuff that they drank, and we hooked them up to brainwaves because your brainwaves change during blackout.
And so I've been working with the lawyers and mental health people for now 30 years because I pulled the 1980 article out on what this means legally, what this means for people.
We ‑‑ we actually ran a blackout offender group in the sex offender group because there were a lot of people who were at Hiland who were sex offenders who had no idea that they had done this. So ‑‑ so that ‑‑ that whole piece on the forensic side that ‑‑ has taken up a lot of my interest.
An interesting total aside of changing the law is there is a Supreme Court case, I was asked to testify actually on a blackout case in Juneau, and suddenly the District Attorney said to me, do you belong to any nonprofits? And I ‑‑ I thought to myself, this is going nowhere.
And I had modeled as a male model the Saturday before for the Anchorage Arts Council, and after drinking one more glass of champagne than I should have, I was talked into modeling a set of briefs that said some things that were appropriate for that kind of thing and got a laugh.
Well, they were not appropriate in court. And he said didn't ‑‑ didn't they say such and such. And the guy was convicted because I was thought to be not very professional.
And the Supreme Court case that came out of that now says you can only ask a professional witness about their professional qualifications. So we got a really ‑‑ and then went back to trial for that case, and he was acquitted. But ‑‑ so that there were ‑‑ there have been all of these interesting kinds of legal things setting precedent, setting law, all ‑‑ all of those kinds of things over the years.
Section 9: BILL SCHNEIDER: Just a clarification of that. So in these cases, you would insist that the person drink until they reached a certain level of inebriation?
DR. ARON WOLF: Yeah. We measured their blood‑alcohol every half hour.
BILL SCHNEIDER: Okay. So they would reach it ‑‑
DR. ARON WOLF: They would reach ‑‑ they would reach it, their brainwaves would change, that was our hypothesis, and it was true.
They reached a certain level, 150 milligrams percent or more, which is what the literature said. They reached it. They ‑‑ their whole demeanor changed, their brainwaves changed. And we kept measuring it, and then we at some point would stop because we didn't want them to, you know, get problems.
We would keep them in the hospital until the next morning, and that ‑‑ and we would then ask them what happened, and their memories stopped at the point their brainwaves changed.
BILL SCHNEIDER: And were these ‑‑ did they do it voluntarily, or ‑‑
DR. ARON WOLF: They ‑‑ well, certainly, they did it voluntarily, and they did it part ‑‑ as a part of their defense. This was all paid for by the Public Defender.
And where we've gotten to by and large over the years is that these individuals, when they are in that state, it's, for want of a better word, akin to sleepwalking, and so they can't ‑‑ they can't plan. They can't ‑‑ so it goes from, for instance, first degree murder, which has intent, to either second degree murder or ‑‑ or manslaughter.
So it isn't a question of getting the person off, it's a question, if you will, of incarcerating the person for the crime they committed.
BILL SCHNEIDER: How do you treat that?
DR. ARON WOLF: Well, lots of these folks, you know, the fact that they spent 10 or 15 years in jail and are in alcohol treatment programs, most of them don't commit these crimes.
You know, it ‑‑ it's unfortunately horribly rampant still in rural Alaska.
And what's been found is that Native peoples, whether here or in the Lower 48, or the Sami people or the northern people in ‑‑ in Scandinavia all are able to drink much higher amounts of alcohol and sustain blood‑alcohol levels that most Caucasians cannot, and they have blackouts early.
So very different. It isn't a question of good or bad, it's just very different.
And so the literature is American Indian and northern peoples for all of this. And there's a huge ‑‑ there's a huge literature. I just amassed the thing because the Federal Public Defender is doing habeas corpus about this, and one of the Federal Public Defenders, somebody's been in jail where they didn't bring it up at trial, and he's been in jail 22 years,
and so the Federal Public Defender has just asked me whether I would copy a piece of the file so she could put it in his habeas case.
BILL SCHNEIDER: Right. Well, let's ‑‑ let's back up.
DR. ARON WOLF: So I've gotten off track. I'm sorry.
BILL SCHNEIDER: No, that's ‑‑
DR. ARON WOLF: I like talking about this.
BILL SCHNEIDER: That's very interesting, and pretty important.
Section 10: KAREN BREWSTER: I wanted to ask about the Federal Community Mental Health Centers Act ‑‑
DR. ARON WOLF: Yes.
KAREN BREWSTER: ‑‑ that you mentioned. If you could tell us more about that and what that meant here in Alaska.
DR. ARON WOLF: Yeah. The Federal Community Mental Health Centers Act was part of Johnson's Great Society.
And this was part of ‑‑ of the whole deinstitutionalization of the mentally ill. And so the feds divided up the entire country into catchment areas. And Alaska was allotted 22 catchment areas.
And so we ‑‑ we had no mechanism to ‑‑ to create these. What ‑‑ what do you do with them and how do they get funded, and yet there was some federal funding for this.
So Governor Hammond appointed the first Mental Health Board, and I had the privilege of serving on that, and being chairman of it the third year I was on.
Chairman ‑‑ the first chairman, either the first or second chairman is Representative Max Gruenberg, so he was involved in it right from the beginning.
And what that first Mental Health Board did was get applications from mental health centers, fledgling.
And they weren't even centers, they were fledgling groups of community people who wanted to run a nonprofit or community‑based mental health center.
And so the first two we got were the two that were functioning, which were Kodiak and Ketchikan.
The third we got was what's now Anchorage Community Mental Health Services, and then I believe we got one ‑‑ one from Fairbanks and one from Sitka. Those were the very first. Followed ‑‑ followed by YK.
Section 11: BILL SCHNEIDER: Well, let's go back. So you were in the military, you got out of the military, you worked for Langdon at that point?
DR. ARON WOLF: At the point I got out, and Joe ‑‑ and Joe got out of the Public Health Service, Dr. Langdon was looking for partners, and ‑‑ or people. And he very graciously said let's do a clinic. I mean, it was his practice. He had eight psychologists and a social worker working for him at the point.
And so rather than working for him, we became equal partners right from the start. And so we ‑‑ we started what then became Langdon Clinic. It had been his practice.
We hired a number of more social workers, we hired a child psychiatrist, so we became the largest private provider very quickly.
And we built our own building up the street on ‑‑ on the corner of Dale and 42nd Street.
BILL SCHNEIDER: Then did you stay with that for a while, or ‑‑
DR. ARON WOLF: I stayed with that ‑‑ well, I ran it ‑‑ Dr. Langdon died in '81, and then I ran it from '81 to '95, when I left to become the first medical director of Providence Health System in Alaska.
So I almost ‑‑ got out of psychiatry for almost 10 years, '95 to '05. And got back into medicine being medical director for the entire Providence system here in the ‑‑ in the state. They never had one of those before, and so that was fun, too.
KAREN BREWSTER: So Langdon you started in '79?
DR. ARON WOLF: Langdon we started in '70. And the three of us ran it. Joe left in '77, J. Ray died in '81. Left me.
BILL SCHNEIDER: But then you got back into psychiatry.
DR. ARON WOLF: I got back into psychiatry in '04. I never quite left, I kept a couple of patients that I saw at Langdon during those years.
I mean, I would ‑‑ I would work all day there and then come back, see two, three, four hours of patients in the early evening.
The other thing that I did is psychiatry wasn't very organized. As I said, there was the three of ‑‑ three older generation folks, and then there were a number of us younger generation.
The American Psychiatric sort of saw us as the tail end of things. And every ‑‑ every state had a branch of American Psychiatric except Hawaii, Alaska, Oregon, and Washington were all one branch. And ‑‑ oh, and British Columbia.
And British Columbia wanted to break away and ‑‑ because we were rotating who was president of our little branch ‑‑ our little whatever we had then.
I had met somebody from British Columbia and he said, come to the meeting with me in Washington, and we got passed that every state should have their own branch.
So we became the Alaska District Branch, the five or six of us. And so we ‑‑ we had that.
And I stayed with the APA during the years that Joe went with the American Academy of Psychiatry and Law, and wound up running that. I stayed with the American Psychiatric and actually wound up being the vice‑president of the assembly of the APA, and also the national membership chairman.
Section 12: BILL SCHNEIDER: But I want to maybe return to these courts a bit. We just finished an interview, was it last week, with Jeff Jessee.
DR. ARON WOLF: Yeah.
BILL SCHNEIDER: And he was talking about the ‑‑ the courts that are held, set up particularly for people with mental illness, cases that come in where ‑‑
DR. ARON WOLF: The API cases?
KAREN BREWSTER: Therapeutic courts is what they are.
DR. ARON WOLF: Oh, therapeutic courts.
BILL SCHNEIDER: Uh‑hum. Was ‑‑ was your involvement in ‑‑ in that at all, that aspect of it?
DR. ARON WOLF: No. No. I certainly think it's a great idea, but that ‑‑ that was the Trust and ‑‑ and the Court system. And they had gone to several national meetings where there were similar kinds of things through the ‑‑ through the court system, so ‑‑ so no, the ‑‑ no.
And I've actually done more civil stuff over the last 10, 12 years than I've done criminal. I mean, even though I have to do the Fairbanks thing and I'm still doing some of the blackout stuff, my major involvement is on the civil side.
BILL SCHNEIDER: Meaning that you ‑‑ explain a little bit more about that aspect of it.
DR. ARON WOLF: For instance, a case where with ‑‑ with an employer and somebody was injured and then they have PTSD after their injuries, and what part does that play, and how ‑‑ how compens ‑‑ well, you know, what percentage is he ‑‑ he or she disabled, and how compensable is that, and there are all sorts of rules about all those kinds of things.
I ‑‑ the other thing is a number of ‑‑ no, several law firms have used me as their medical investigator. So I review all of their medical data, medical and psychiatric, and then I help them find experts, medical and psychiatric, through ‑‑ from throughout the country.
BILL SCHNEIDER: But they would be having a particular case where they are trying to get ‑‑
DR. ARON WOLF: They would have a ‑‑ they would have a particular case, their lawyers don't understand all the nuances of the medical data, they ask me to review them, write sort of a precis about it, and then help the lawyers. And I'm never noted in that one. I'm under the confidentiality of their law firm.
But then I go, they need a neurosurgeon or they need a psychiatrist or they need a X or Y, I've now, through my APA stuff and through my Providence stuff, know a wide variety of folks, and call Dr. X who is a neurosurgeon or an orthopedist, or whatever, would you review this material and see whether you can help these folks.
Section 13: BILL SCHNEIDER: Back to the big picture, what ‑‑ what have you seen in terms of the changes in evolution of services to people over the years?
DR. ARON WOLF: Both good and bad. There's probably less duplication of systems.
The ‑‑ as ‑‑ as the Native system morphed into the nonprofits such as YK or whatever, they all became part of the community mental health system. So for good or bad, it became one system. Really difficult getting folks to serve out in the rural communities.
The other thing, a number of ‑‑ a number of us have done, Greg McCarthy, who I helped hire who was trained by Joe Bloom in Oregon, is now doing full‑time consultation. He worked at Langdon, he doesn't work in town at all anymore. He works for Barrow, he works for Sitka, or he works for ‑‑ he ‑‑ he only goes out. A number of us did that part‑time in and out.
One of the big advancements right now is the grant to do telemedicine. And so that's done out of API and it's done to all the rural mental health centers, or there's a separate system of telemedicine through ANMC , so they also have a ‑‑ a studio over there. But there's a studio at API, and Dr. Wandell Winn sees folks there.
And ‑‑ and that's a huge advancement and a huge financial saving because the ‑‑ the health aide in Kwethluk or whatever can be sitting with, you know, somebody in Kwethluk and Wandel can be here, and they both have the chart, and ‑‑ and it really ‑‑ that's ‑‑ that's a huge advance that way.
BILL SCHNEIDER: So it might be that the person is having some sort of a psychiatric condition, and the health aide recognizes it needs the treatment, and they would hook up ‑‑
DR. ARON WOLF: Yeah.
BILL SCHNEIDER: ‑‑ telegraphically.
DR. ARON WOLF: They would hook up telegraphically and ‑‑ and it's now ethical to prescribe that way, and so you can prescribe. You know. And so you have your session on ‑‑ you know, via television and ‑‑ and voice activation.
KAREN BREWSTER: And does that provide a ‑‑
BILL SCHNEIDER: How does it work?
KAREN BREWSTER: Yeah. How does it work in terms of patients not being ‑‑ versus being in person?
DR. ARON WOLF: Probably 70 percent, but ‑‑ but if you have it every month so you get to know your doctor, rather than ‑‑ when I went to YK, as I said, I was privileged to get to all 40 villages, but you'd get to any one village every two years.
And, you know, otherwise maybe they could get to Bethel but maybe in a snowstorm they couldn't.
So this is much more reliable; much, much more reliable. And so you get to know your doctor every month, you have ‑‑ you come in and you have your session, and how's your medicine doing, and, you know, what's happening with this, and are you having any side effects. It works. It works.
BILL SCHNEIDER: And they are able to maintain privacy in some degree?
DR. ARON WOLF: Yeah. One of the ‑‑ one of the things of using that thing is it's encrypted. You can't ‑‑ I mean, I would love to sit here and use Skype, but it's not encrypted. And so you ‑‑ you can't use those kind of networks to ‑‑ to see patients.
BILL SCHNEIDER: When you say "encrypted," you mean no one could break in?
DR. ARON WOLF: Nobody can break in.
KAREN BREWSTER: It's private.
DR. ARON WOLF: It's private.
BILL SCHNEIDER: Are those ‑‑ those videos kept? Do you keep them as a record?
DR. ARON WOLF: I don't know whether they do. I don't know. Ron Adler at API can ‑‑ can probably answer that. I ‑‑ I don't know whether they record them.
Section 14: BILL SCHNEIDER: What other changes have you seen? That's a big one.
DR. ARON WOLF: That ‑‑ that's a huge one. The other one, and I know you've talked to Jim Gottstein about a number of things, but the entire movement ‑‑ and this really was the Trust, is the Trust ‑‑ for consumer‑based move ‑‑ movements.
And so there are a number of very functional consumer‑based entities that are providing really good services.
KAREN BREWSTER: What's a consumer‑based entity example?
DR. ARON WOLF: The Web in Anchorage. Choices and Soteria in Anchorage, which Jim started, and which I ‑‑ he had me write the original business plan for, but the Polaris House in Juneau. Polaris House and The Web are drop‑in centers.
All of these programs, being they are consumer run, must have a board, they are all nonprofits, must have a board that's at least 51 percent consumers, either folks who are receiving mental health services or who have received mental health services or families of people who have received significant mental health services.
And then a number of the providers are also folks who either are or were consumers, and they all have an emphasis on recovery. So this is an entire recovery‑based focus. This is a ‑‑ a real change, fostered by the Trust, funded by the Trust, at least as startups.
So, for instance, Soteria, which is a program that's a residential program that is based on one National Institute of Health did for 15 years in the San Francisco area, has been up and ‑‑ well, we ‑‑ we wrote the business plan five years ago, the Trust funded it three years ago, it opened 18 months ago. The Trust funded all of that.
They funded the first year of operation, and then we're now ‑‑ last year, the state funded it out of their budget.
So that is hopefully the progression of this ‑‑ what the Trust wants to do, and I think it's wonderful, is get a number of these very creative programs in a number of spheres started, funded, and then on their own. You know, either funded by Medicaid or funded by state general fund monies.
KAREN BREWSTER: How is their emphasis on recovery different than other mental health service providers's focuses?
DR. ARON WOLF: I think for the very seriously mentally ill, unfortunately, many of the more traditional mental health centers, the emphasis is not on recovery, the emphasis is on containment.
And so, you know, you need to come and take your medicine and this is ‑‑ and you need to get on Social Security and this is the best you're ever going to be.
And the recovery programs really say, look, if this can happen early, if we can get ahold of you early, the data prior to the major psychotropics were that a certain percentage of people recovered.
They had one, perhaps, very difficult psychotic break, but a substantial number of people recovered.
And so there's less emphasis on medication in these programs, and more emphasis on what used to be known as milieu therapy, and so they do that.
And, you know, the ‑‑ Soteria is only 18 months old, but it's having some success with the young people who are just starting into this who don't see themselves as disabled. You know.
Can you ‑‑ can you catch them before ‑‑ before they be ‑‑ you know, they label themselves disabled. You know, there are ‑‑ just like with any illness, there's some folks who are ‑‑ you're not going to be able to keep from being disabled.
BILL SCHNEIDER: That's amazing.
Section 15: BILL SCHNEIDER: What other programs? What other things have you seen that are advancements, in your mind?
DR. ARON WOLF: I do ‑‑ I do think ‑‑ well, one of the things that we've had is the ‑‑ Providence has done a very good ‑‑ well, Providence, in opening its mental health unit 20 years ago now, was a big advancement.
Their average, like the state, is between five and seven days. They moved to a hospitalist mode in which there are just docs at the hospital who focus on the inpatient side of things, who ‑‑ who are adept at running an inpatient program to really focus on the needs of the patient while they are in.
So it isn't that we're running over there and we're doing this and whatever. Dr. Telford and his people do ‑‑ do a really good job of ‑‑ of that.
So ‑‑ so I think the fact that we have that, and then the fact that Bartlett, Fairbanks, and the SEARHC program in Sitka all have designated psychiatric units, so you don't have to come to Anchorage.
That's all very positive. And it would ‑‑ it would be wonderful if it was elsewhere. Well, but it is, sort of.
When they built the new Kodiak hospital, there are a couple of rooms, and the Kodiak Mental Health Center is also run by the hospital, and so their psychiatrist functions inpatient and outpatient, there's a psychiatrist in Kodiak that's been there 15 years, or a little bit longer.
The other major change, and I'm not sure it's happened in reality as much as it had happened on paper, is about six or seven years ago, the state made the mental health programs and the substance programs combined. They were funding ‑‑ the state was funding two separate lines of programs, the mental health programs and substance dependence programs.
And they had two separate boards, advisory boards, and two totally separate sets of providers. And the state said there shall be one of these in ‑‑ in each venue, in each of the 22 catchment areas, there will only be one of you, and you will provide both sets of services.
Well, the cultures of those two kinds of things certainly are different, but they ‑‑ they have grown together, and so because most of the folks with mental health problems have substance problems, they ‑‑ they self‑medicate, and ‑‑ and lots ‑‑ lots of the substance dependence folks secondarily to their substance, you know, get depressed or have mental health issues.
BILL SCHNEIDER: Yeah.
DR. ARON WOLF: So ‑‑ so the fact that that is ‑‑ they are working toward that is really, really important, and a really good change.
BILL SCHNEIDER: One of the ‑‑
DR. ARON WOLF: And I think that was ‑‑ that was ‑‑ the state did it, but that was another thing that was sort of arm‑twisted by the Trust.
Section 16: BILL SCHNEIDER: I know that there's been an expansion of the beneficiaries.
DR. ARON WOLF: Yes.
BILL SCHNEIDER: And one of the areas that they, I think, got included was Alzheimer's.
DR. ARON WOLF: Yes.
BILL SCHNEIDER: And so that seemed to me to be an example of expansion of services.
DR. ARON WOLF: It ‑‑ that's an expansion of services, for the moment, more in name.
There are ‑‑ there are ‑‑ there are not enough services for those with Alzheimer's, especially younger folks. You know, there are, unfortunately, folks who start their mental degradation in their forties rather than in their eighties.
And ‑‑ and so that ‑‑ that is one where it's really great that there's a focus, but there needs to be ‑‑ as we go forward, there needs to be more action on that front.
BILL SCHNEIDER: That probably is true of all of the services you see.
DR. ARON WOLF: Well, but mental health is ‑‑ is the big one. If you go to a Trust meeting and during ‑‑ during the years that I was pushing on Choices and Soteria, Dr. Doolittle is chair of this, who I think is a great guy, you know, kept saying, you know, I was a ‑‑ I was a Trust groupie, but ‑‑ but as I listened to that, I would say that 90 percent of the discussion, even at the Trust meetings, is on traditional mental health kinds of services.
So even ‑‑ even though the Trust does all of this other stuff, you know, maybe 90 percent is ‑‑ is on mental health, 7 percent is on substance, and then the other stuff you don't hear, yeah, there's a report by Aging and there's a report by this. As they move forward, they ‑‑ they ‑‑ they need to spread out because their mission really is that.
BILL SCHNEIDER: I guess that brings us to that general question of how would you assess the ‑‑ the Trust, and what it's been able to do or not do?
DR. ARON WOLF: I think the Trust ‑‑ the Trust is a wonderful thing. I mean, I ‑‑ it was ‑‑ it was given a ‑‑ a mandate that no one ‑‑ no one could tackle immediately. I think Jeff and the staff have done an amazing job with the money and staff that they've had.
They've had to narrow it, you know, because the staff can only do just so much.
So, for instance, in just the couple of years, they've been focusing on housing. Well, housing is incredibly important and will benefit all the ‑‑ all the classes of their beneficiaries.
But then what didn't get looked at, you know, because you're focusing on housing, you know, and doing that, but I think you need to look at what the Trust does over a 20‑year period or a 25‑year period. It's there, it ‑‑ it's creative, and it's nipping away at ‑‑ at all of the stuff. We'll get ‑‑ and it has the freedom to do it much more than the state department.
I mean, the state department is responsible, the commissioner who's responsible to the Governor and his or her whims at that given time. The Trust has a little bit of that, but it's somewhat ‑‑ well, it's significantly freer of ‑‑ of the political end of this.