Legislature(2001 - 2002)
04/10/2002 01:40 PM Senate JUD
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 302-DEFINITION OF MENTAL HEALTH PROFESSIONAL
MS. SHEILA PETERSON, staff to Senator Gary Wilken, said that she
would read the sponsor statement for Senator Wilken who was
needed to make a quorum in another committee.
SB 302 is a mental health professional definition bill.
It recognizes the growth of the clinical mental health
profession; it broadens the mental health professional
definition to include licensed clinical social workers,
licensed marital and family therapists, and a licensed
professional counselor. The current Title 47 definition
was written in 1981, prior to the passages of Alaska's
licensing requirements governing these master level
mental health clinicians.
SENATOR COWDERY asked if that was in 1981 or 1986.
MS. PETERSON explained there was a revised sponsor statement that
was provided March 21. Originally, Senator Wilken thought the
year was 1986 but upon further research found it was 1981. She
then continued reading the sponsor statement.
A more inclusive mental health professional definition
increases the capacity of Alaska's mental health system
to protect our youth and adults who are experiencing
acute psychiatric crises in our communities. Today, not
enough mental health professionals are authorized under
the current definition to respond to some critical
public safety situations, particularly in rural Alaska,
and yet there are hundreds of licensed professionals
who are qualified to aid these Alaskans but cannot, as
they do not fall within the current statutory
definition. SB 302 recognizes this problem and updates
the Title 47 definition. The expanded mental health
professional definition as stated in SB 302 increases
the number of trained professionals: who will be
allowed to provide mental health treatment for
prisoners; authorized to evaluate children and minors
in custody; to determine placement in residential
treatments; required to report incidences of harm to
vulnerable adults and allowed to conduct civil
commitment evaluations.
MS. PETERSON informed committee members that Ms. Anne Henry from
the Department of Health and Social Services was present to
answer questions if necessary.
[SENATOR WILKEN arrived.]
SENATOR THERRIAULT asked about the proposed committee substitute.
MS. PETERSON said the sponsor statement addressed the committee
substitute.
CHAIRMAN TAYLOR asked if the proposed committee substitute was
adopted.
MS. PETERSON said it was not.
SENATOR COWDERY moved to adopt Version J as the committee
substitute for SB 302.
CHAIRMAN TAYLOR announced that without objection, Version J was
adopted as the committee substitute.
SENATOR WILKEN noted that Anne Henry and others were available to
answer questions.
MS. ANNE HENRY, Division of Mental Health and Developmental
Disabilities, Department of Health and Social Services (DHSS),
told members that when the definition of mental health
professional was originally written, it included all of the
recognized professions at the time. She explained that an
evaluation for civil commitment determines whether a person is
suicidal, homicidal, or gravely disabled at that moment. When a
clinician decides in favor of civil commitment, the clinician
gets concurrence from the psychiatrist on duty at the time and
then calls a judge, who makes the final decision about commitment
to hospitalization where the person would be evaluated by a staff
psychiatrist. The law allows people who are employed by community
mental health centers around the state to do civil commitment
evaluations. They receive state funding for emergency services
for mental health crisis situations. Of about 900 licensed
professionals in Alaska now, only about 140 people work for those
agencies. Those are the people who this bill applies to. DHSS is
finding that agencies all over the state are having difficulty
hiring and retaining people of that level of professionalism. She
noted that since the law was originally written, the legislature
has recognized licensure clinical social workers, marriage and
family therapists, and professional counselors. Every one of
those professions has the statutory authority to diagnose, which
is what is done in an evaluation situation. She told members that
SB 302 is supported by DHSS, the Alaska Mental Health Authority,
the Association of Mental Health Consumers in Alaska and the
Alaska Community Mental Health Services Association.
SENATOR WILKEN referred to a chart in members' packets and said
it provides a visual explanation of what the bill will do.
CHAIRMAN TAYLOR took public testimony.
MS. SHARON BULLOCK, a licensed clinical social worker and
director of the Fairbanks Community Mental Health Center,
affirmed the Center has had difficulty hiring people straight out
of graduate school. The Center will have difficulty if SB 302 is
passed as is because the way it is written, only people with a
license or those with 24 months of experience after graduate
school can do the screenings. In Fairbanks, when someone files a
Title 47, the court gives it to the Center who sends someone out
to do the screening. The screener makes recommendations to the
court and the judge makes the final decision. The Center needs to
have enough employees who are eligible to help with the
screenings.
TAPE 02-15, SIDE B
MS. BULLOCK said she supports part of the bill that being that an
employee could be supervised by a licensed clinical worker. She
suggested shortening the 24-month requirement to 12 months.
CHAIRMAN TAYLOR informed Ms. Bullock that the committee
substitute before members provides for a 12-month period of work
experience in the field of mental illness post Masters degree.
MS. BULLOCK thanked Chairman Taylor for the update.
MR. WAYNE MCCOLLUM, a licensed clinical social worker and the
Community Support Program Director at the Fairbanks Community
Mental Health Center, stated support for the legislation and said
he shares the same concerns that Ms. Henry and Ms. Bullock
expressed. He said it is very difficult to recruit and retain
qualified individuals in the Interior and in rural communities.
SB 302 will allow the Center to recruit a wider pool of
individuals to perform an important service.
CHAIRMAN TAYLOR noted there was no one else who wished to testify
on SB 302 but the committee received a letter from Phillip Baker,
a licensed clinical psychologist from Anchorage, which he read
into the record:
My name is Phillip Baker, Licensed Clinical
Psychologist and Executive Director of the Alaska
Psychological Association. I am writing on behalf of
the Executive Staff of our association who voted
unanimously to oppose SB 302 and we urge you to oppose
this bill also.
We are aware of the need for qualified and trained
mental health professionals to work in remote
communities. We were informed that SB 302 was created
to help meet that need. The bill proposes to add
Licensed Marriage and Family Therapists, Licensed
Professional Counselors and an unlicensed mental health
worker under supervision. We feel this is the wrong
solution to the shortage of qualified mental health
workers in rural settings. Professional Counselors,
Marriage and Family Therapists and unlicensed
counselors have one or two academic courses in
assessment and evaluation, inadequate training for the
tasks required.
The unlicensed mental health worker under supervision
that is mentioned in this bill would be a great
liability to the State and to vulnerable mental health
consumers. There is no way to regulate the practices of
these particular mental health practitioners and no way
for consumers to seek recourse for inept, unethical and
poorly trained practices. Who would want their family
members, friend or loved one's mental health needs
determined by a poorly trained and unregulated provider
of these important and very personal services?
We urge you to return this bill to the Department of
Health and Social Services and inform them that SB 302
is an inadequate solution to their problem and it
increases the danger that vulnerable Alaskans will be
mistreated.
CHAIRMAN TAYLOR asked for a response to those comments.
SENATOR WILKEN said he believes Mr. Baker's concern about the
supervision of an unlicensed person has been taken care of in the
committee substitute.
MS. HENRY explained the current statute allows any Masters level
social worker with experience in the field to do civil commitment
evaluations. The committee substitute raises the qualifications
to a Masters level degree plus 12 months of experience and a six-
month internship. These professionals will be supervised by a
licensed professional, although that is not required by the
current statute. They must also be in the process of getting
licensed so their dedication to becoming licensed provides more
accountability. She noted that currently about eight PhD
psychologists work with emergency services throughout the state.
DHSS believes that most of those people work in a supervisory
capacity and do not actually do the evaluations themselves so the
work is being done by people who do not actually meet the
definition in SB 302.
CHAIRMAN TAYLOR pointed out that committee members received
several other letters.
SENATOR COWDERY said that he received letters from two
constituents who were concerned about the letter of intent that
accompanies HB 343.
MS. HENRY explained that letter of intent pertains to the
extension of the licensed professional counselor sunset date and
asks that the boards be combined and has nothing to do with SB
302.
SENATOR ELLIS commented that he voted no on similar legislation
that passed through the committee last year because he received
an overwhelming amount of letters from people who express concern
about how careful the state should be in the area of civil
commitments because to deny a person their freedom or civil
liberties for any period of time is an awesome power. He asked
Ms. Henry to walk him through the civil commitment process and to
describe the minimum credentials of a professional who would be
permitted to do an evaluation.
MS. HENRY asked that Stacie Kraly answer that question.
MS. STACIE KRALY, Assistant Attorney General, Department of Law,
informed members that she does the civil commitments for
Southeast Alaska. She said she would defer to Ms. Henry to
describe the clinical part of the civil commitment process. She
explained that the process works in Juneau in the following way.
An individual who is in crisis is, either through a family
member, a police officer or a concerned community member, usually
brought to a hospital for a medical evaluation. If it appears the
individual is decompensating and suffering from a mental illness,
a clinical person is called in. An emergency services worker from
the Juneau Alliance for the Mentally Ill goes to the hospital to
conduct an evaluation of the individual in consultation with a
physician and sometimes a psychiatrist. An evaluation can take up
to four hours to determine whether the individual meets the
statutory criteria for a commitment; that being whether the
individual is mentally ill and as a result is a threat to self or
others or is gravely disabled. If the individual meets the
statutory criteria, the clinician meets with a psychiatrist to
make sure the assessment is accurate. The clinician then calls
the judicial officer and makes a recommendation and explains the
reasons behind the recommendation, i.e., the individual is
suicidal or was brandishing a knife in McDonald's. The judge
then determines whether to commit that person for 72 hours. If
so, the judge issues an ex parte order and the individual is
transferred from the emergency room to the mental health ward at
the hospital. Over the next 72 hours, the individual is evaluated
every 24 hours by a clinician, psychiatrist, and social worker at
the hospital. Within those 72 hours they are either released if
they no longer meet the criteria, they may volunteer to stay
longer, or the Department of Law can file a petition for a 30 day
commitment whereupon the Department goes to court, presents
evidence and calls witnesses, and the judge determines whether
the individual should be committed for up to 30 days.
CHAIRMAN TAYLOR asked Ms. Kraly to address Senator Ellis's
question about the minimum qualifications allowed for a clinician
under SB 302.
MS. KRALY said that statewide, in rural communities, the minimum
level could be pretty low. Statutorily the lowest level would be
an unlicensed social worker who is not supervised. In Juneau, a
few PhDs do this work.
CHAIRMAN TAYLOR asked how that would change under SB 302.
MS. KRALY replied that it would remain the same in the sense that
there would be the added qualifications of intending to be
licensed, having 12 months of supervision and clinical
experience.
SENATOR ELLIS asked if passage of the bill will increase the
qualification requirements of the lowest level person.
MS. KRALY replied, "Most definitely."
SENATOR ELLIS said he appreciated the explanation about Juneau,
although he is concerned about villages like Chevak or Kaktovik.
MS. KRALY said the process is basically the same everywhere so
that if an individual was being committed in Hoonah or Craig, a
village public safety officer would call a judge and provide the
information and the judge would order that the individual be
transferred to an evaluation facility in either Ketchikan, Sitka
or Juneau where the process would start over. If there is a
mental health professional in a rural village, he or she would
initiate the proceedings.
SENATOR ELLIS said his concern is that SB 302 dramatically
expands the number of people who can participate in this process,
yet the qualifications will be higher, not lower.
MS. HENRY explained that SB 302 expands the disciplines that are
recognized as being licensed and, in terms of those people that
are not licensed, it requires them to have a certain level of
experience, including the Masters degree. Currently, any social
worker with a Masters degree, whether trained clinically or not,
can do a civil commitment. A good portion of people who did civil
commitments in the past did not have clinical education. She
repeated the bill will require a Masters degree, 12 months of
field experience, and working toward being licensed. The pool
will be expanded because it includes all of the different
licensed disciplines.
SENATOR ELLIS asked if the impact will be an improvement in the
quality of the work done or whether it will just increase the
number of people who can do civil commitments.
MS. HENRY said she believes both will increase. She noted that
she recently spoke with the director of the mental health center
in Galena who said Galena has had no VPSO for six months, there
are two troopers who could participate but they cover an area the
size of Oregon, and she is not qualified to participate. The
troopers have told her that unless someone has a knife, gun or
rope in their hands, they will not get involved because they have
more urgent priorities. Ms. Henry said if no one in the community
is qualified, individuals end up in jail or being sent home with
family members who don't know what to do. She noted that the
Alaska Psychiatric Institute has reported that it gets an
inappropriate number of people come in to be committed so they
are sent back, a traumatic and expensive experience. She said she
believes SB 302 will provide greater access to those people who
really need services in a time of crisis and with Alaska's high
suicide rate, the need is critical.
SENATOR THERRIAULT said he received a lot of feedback on last
year's civil commitment bill but most of the people who wrote
were under the mistaken assumption that individuals would be able
to commit themselves. He asked what level of scrutiny the judges
use to make these determinations.
MS. KRALY said under the ex parte order it is similar to a
probable cause situation. For a 30-day commitment or anything
further, the standard is clear and convincing evidence on the
part of the state in the form of expert testimony by a
psychiatrist.
SENATOR THERRIAULT commented the scrutiny is fairly loose for the
initial 72 hours but anything after that is more rigorous.
MS. KRALY said that if, at any time during the 72-hour evaluation
period, the individual no longer meets the statutory criteria,
the individual must be released. She noted that very few
individuals are sent to a 30-day commitment hearing; most people
are released or go voluntarily.
SENATOR COWDERY asked Ms. Kraly if her recommendations have ever
been denied by the court.
MS. KRALY said yes, occasionally. She said the judges she works
with in the First Judicial District are very aware of the liberty
interests at stake and take these cases very seriously. They do
not grant 30-day commitments with any joy.
SENATOR COWDERY asked Ms. Kraly if she has denied the
recommendation of another.
MS. KRALY said that is an interesting question because many of
these petitions are based upon medical expertise and she
certainly would defer to a psychiatrist who believes that a
petition should go forward. However, there have been instances in
which she has questioned whether or not the petition is
appropriate, so she has questioned some of the petitions she has
seen but generally she defers to the experts.
MS. HENRY added that the standard in the mental health profession
is to do whatever is the least restrictive, given the particular
situation. She said she is aware of situations where clinicians
have had to come up with alternatives to keep the individual safe
because the individual does not quite fit the statutory criteria.
CHAIRMAN TAYLOR maintained that because of the arduousness of the
task, it is probably easier to charge a person with a criminal
act so it is important to get the best people involved. He added
that Joe Juneau was successful in establishing the mine in
Juneau. His family was concerned about his activities and wanted
to take over his mine. In the Territorial Days, if 10 friends and
neighbors signed a petition, you went before a judge and the
judge would decide whether you should be committed. Mr. Juneau
was committed to a mental institution and his family took over
the business. Several years later, Mr. Juneau returned to Juneau
with a certificate declaring that he was safe. Chairman Taylor
found it ironic that no one else in the town could be declared to
be safe. Chairman Taylor noted we have come a long way and
thanked the sponsor and DHSS staff for their efforts.
SENATOR ELLIS said he appreciates the work done on the bill also.
He noted that the people who contacted him last year did not seem
to be misguided about who had the power to do a civil commitment.
Their main point seemed to be that the people who do the initial
evaluations have a lot of influence in the process. He said he
believes SB 302 is moving in a good direction and that he will
have to trust professional judgment about the balances this bill
strikes. He asked participants to keep in mind that the goal is
to increase the quality of mental health professionals. He noted
that the lack of funding in rural areas and difficulty in
providing decent coverage across the state should not be used as
an excuse to change the laws. He said that does not appear to be
the reason for SB 302 but it is of concern.
CHAIRMAN TAYLOR said with no further testimony or comments, he
would entertain a motion.
SENATOR COWDERY moved to pass SB 302 from committee with
individual recommendations. There being no objection, the motion
carried.
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