Legislature(2007 - 2008)BELTZ 211
03/27/2007 09:00 AM Senate STATE AFFAIRS
| Audio | Topic |
|---|---|
| Start | |
| SB16 | |
| SB100 | |
| SB101 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 16 | TELECONFERENCED | |
| + | SB 100 | TELECONFERENCED | |
| + | SB 101 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 100-SUBSTANCE ABUSE/MENTAL HEALTH PROGRAMS
CHAIR MCGUIRE announced the consideration of SB 100.
SENATOR JOHNNY ELLIS, Alaska State Legislature, sponsor of SB
100, said in 2005, 39,000 Alaskans abused or were dependent on
alcohol and other substances, and 79 percent of newly
incarcerated inmates were actively abusing or dependent on
alcohol or other substances in the year before incarceration.
Children in alcohol-abusive families are four times more likely
to be maltreated and ten times more likely to be neglected. He
noted the tragedy and state costs associated with that. In 2005,
37 Alaskans who needed treatment could not receive it due to a
lack of treatment availability. Alcohol and substance abuse
costs the state about $738 million per year, conservatively, in
lost productivity, accidents, health care, criminal justice, and
public assistance. Substance abuse and addiction is a tragic and
expensive problem, and the state should do better. He said the
bill is a long-overdue tune-up to the statutes with one
innovation. "Something new to try." Sections 1-7 are the free
parts of the bill that just bring the statutes up to date. The
important provision is supportive language to the Department of
Health and Social Services in its mission to provide evidence-
based and researched-based programming for Alaskans with
substance abuse.
9:09:50 AM
SENATOR ELLIS said he took a wait-and-see attitude regarding
changes made during the last administration, but now he is
supportive. Mental health and substance abuse was combined into
the same Office of Behavioral Health, finally giving recognition
that those issues should be combined. The artificial barrier has
been broken down. The bill sets out priority areas for any
grants, but it is not saying there has to be grants. It says any
substance abuse grant funding should go to priority areas,
especially for incarcerated individuals, youth, preventative
services, and targeted populations. Target populations are where
there is a crying need. Those are the targets for federal and
private grants, he said.
9:11:52 AM
SENATOR ELLIS said the bill also mandates priority treatment for
pregnant women in state-funded programs. The tragedy of fetal
alcohol syndrome (F.A.S.) is a plague on Alaska and is one
preventable birth defect. Putting pregnant women at the top of
the list makes all the sense in the world, he stated. This would
be the first time that is put in state statute. The bill also
includes a provision that receives strong support from faith-
based initiatives, and that is a non-discrimination clause for
effective faith-based programming. The science shows that
programs don't work for all people, so he supports a range of
programming from secular to faith-based. If faith-based programs
are effective they can't be disallowed.
9:13:56 AM
SENATOR ELLIS said 10 or 20 years ago he would not have
advocated involuntary commitment legislation for co-occurring
diagnoses, but because of the tragedy and Alaska's horrible,
embarrassing statistics, he is willing to try something that is
being tried in other states. The anecdotal evidence is quite
compelling, he said. Section 8 would set up 10 to 12 beds for
involuntary commitment cases in a secure setting in an existing
"detox" facility. Involuntary commitment is in the existing
statute for persons who present a threat to themselves or others
and are incapacitated by alcohol or drugs. "This is the co-
occurring mental health and substance abuse disorders." These
people are called high flyers. He spoke of the "million dollar
babies" few families can afford, and Medicaid largely pays to
have those children in the world. There are "million dollar
alcoholics" who cycle through law enforcement constantly. He
said he is not talking about the run-of-the-mill street
inebriate. It is the 40 or 50 people in Anchorage and other
communities that constantly cycle through the system until found
dead in the streets or until found guilty of murder. He called
the provision "treatment on command." Judges would use the
existing involuntary commitment statute for people who are
mentally ill, out-of-control substance abusers, and in danger to
themselves and others.
9:17:31 AM
SENATOR ELLIS said the statute is under-utilized because of a
shortage of facilities. A 2006 study recommended that
interventions toward the high flyers could be very cost
effective. He noted that similar facilities in Washington have
resulted in a decrease in medical and psychiatric costs. "The
longitudinal studies are not there yet…I don't want to oversell
this, but the anecdotal information is quite promising." After
20 years of trying other approaches, "I'm ready to take this
step," he concluded.
SENATOR STEVENS said he has always heard that programs only work
when a person participates willingly. He wants to be convinced
that involuntary commitment will turn someone's life around.
9:19:55 AM
KATE HERRING, Staff to Senator Ellis, said new studies show that
treatment is most effective when people are ready, but it looks
like involuntary is better than none at all.
SENATOR ELLIS said he attended a conference on substance abuse
and budgeting with experts from around the country. The Alaska
Department of Corrections agrees with those experts in that it
is a myth that people need to hit rock bottom before treatment
will work. It varies from person to person. He questioned the
idea that people shouldn't try until they lose their jobs,
family, and everything, but when they are found dead in a snow
bank, it's too late. "Your understanding that people have to
lose everything and be at rock bottom and be ready to accept
treatment in a willing, rational way for it to work is something
that experts in the field have sort of tried to disabuse me of
that notion-it's more complicated than that and the people
involved are more diverse than that." There are a lot of
preconceived notions, he said.
SENATOR STEVENS said it is an enormous problem and it may be
time to try something different.
9:23:44 AM
SENATOR BUNDE asked if staff from state-run programs will
testify. He said this is a huge problem for Alaska, and when he
was chairing the Health, Education, and Social Services
Committee the issue came up at times. The information then, on
state-funded programs, was not good. Recidivism was incredibly
high, he said, but when people chose to join AA or other groups
the success was much higher. "If there's been a change in that
data, I hope there's someone who can share that with us."
SENATOR FRENCH said there is a narrow, identifiable group of
individuals that cause enormous problems. They cycle through
shelters, treatment providers, and jails and they cost the state
tens of thousands of dollars. The bill is the right approach,
and he noted it is not just substance abuse alone but is
combined with mental health problems. Sometimes just a small
amount of medication turns them around. A person can get sober
and then work with a professional to find the correct
medication. It is absolutely crucial, he opined. He said he has
seen some disturbing reports of poor health assessments for the
individuals so they can never "get to a place in their lives
were they can even make a sober assessment of their own lives."
He applauds the coercive nature of the bill to get mental health
issues dealt with before they can take the next step of
attacking the substance abuse issue.
9:27:16 AM
CHAIR MCGUIRE said the bill is not changing statute, but
involuntary commitment has not been used due to lack of beds.
JEFF JESSEE, CEO, Alaska Mental Health Trust Authority, said he
is pleased with the legislation and the Trust worked closely
with Senator Ellis on developing it. The establishment of
priorities--there is never enough resources for everyone-focuses
on people in greatest need and people that put the greatest
strain on the system. Fetal alcohol problems are the most
preventable and most costly disabilities in the system, he said.
There are subtle consequences of that disability that cause
behavioral problems and are difficult to manage. The Trust is
looking at evidence-based practices and programs. "It won't do
us a lot of good to just throw money at these problems and
would-be solutions if we don't know that…they are effective."
9:31:02 AM
MR. JESSE said the involuntary commitment approach will hold
people more accountable to their behavior. It is one thing to
say that a person has an illness and buy into the medical model
of addiction, but it is more important to have someone take
responsibility for the illness and be able to work on treatment
and manage the illness. The statement that involuntary
commitment isn't effective is countered by data, he believes.
Regarding the Fairbanks detox replacement project that the Trust
is working on, if all you do is sober people up for a few days,
they will come back again and again. The state can't afford
that. "We have to intervene, involuntarily if necessary, and get
these people into a treatment program." There is evidence that
involuntary treatment is effective, but part of the bill is that
this program will be rigorously evaluated. He will present the
evidence on the pilot project, he assured the committee.
9:33:42 AM
SENATOR BUNDE noted that Mr. Jessee seems enthusiastic and asked
if the Trust is willing to fund the pilot program.
MR. JESSEE said the Trust is not able to carry that financial
burden. It has focused on five areas including disability
justice, "but this is really pretty heavy lifting for us, but we
don't intend to just look the other way." If the state makes the
investment, the Trust will help make sure it is implemented as
planned and make sure the program is rigorously evaluated so the
state will know the return on its investment.
SENATOR BUNDE said $11 million for 10 people is a lot for the
state, as well.
9:35:25 AM
SENATOR FRENCH said the fiscal note says $1.9 million.
SENATOR BUNDE said that is $1.9 million per year for six years.
LONNIE WALTERS, Chair, Governor's Advisory Board on Drug and
Alcohol Abuse, said he is also president of Substance Abuse
Directors Association of Alaska. He said he is also a treatment
provider and a recovering alcoholic. He questioned the concept
of people wanting treatment before they can get sober. He was
forced into treatment himself, and has been sober for 25 years.
The treatment gave him a chance to open his mind while sober. A
few years later he got into the substance abuse field in
Washington where there are two involuntary commitment centers.
He committed 23 people and saw the highest success rate with
that program. Everybody wants to sober up, but they just can't.
It is a debilitating disease that ruins lives. The toll it takes
on Alaska is unimaginable, he opined.
9:39:02 AM
MR. WALTERS said there is no facility in Alaska, and there is a
waiting list because treatment budgets have been cut
drastically. A person needing to be committed needs it right
away, and "you can't wait two or three or four months to get
them into a center." He really supports an involuntary
commitment center. He said two women on Prince of Wales Island
have died in the ten years he has been there, and he believes
that having the center would have saved them. This group has the
highest usage of courts, police, and ambulances, and it really
needs some help, he concluded.
SENATOR FRENCH asked about the length of stay for a patient.
MR. WALTERS said the law in Alaska is similar to Washington
where commitment would be for 90 days, and another 90 days could
follow. One center actually had a courthouse inside it, so a
recommitment proceeding would occur in the center.
9:41:53 AM
MR. WALTERS said anything less than 90 days would be foolish.
"These people take an awful lot of time."
SENATOR BUNDE said this is aimed at people who have co-occurring
issues, and he asked where API [Alaska Psychiatric Institute]
comes in. Mr. Walters is in Craig, and a facility in Anchorage
for 10 people wouldn't be accessible to him. He said it seems as
if "we're shoveling against the tide."
9:43:54 AM
MR. WALTERS said he is looking at this as a pilot project, and
if it works it will be extended and his clients may benefit.
SENATOR ELLIS said it is a small pilot project with a
significant investment, but it is worthwhile given the other
costs that can be avoided. The bill is not specific about a
location, but the existing [Salvation Army] Clithroe Center
needs to be relocated, so that will provide an opportunity to
house the program there.
9:45:23 AM
SENATOR STEVENS asked how success will be determined.
SENATOR ELLIS said he is not sure; he is a policymaker and
layperson, but it would likely be a longitudinal tracking study.
What we are doing now is not working, and there is a tremendous
cost by a tiny group of people-let alone the human aspects of
this. This is in existing statutes, and judges will determine if
the treatment on demand is justified, he explained. It is a
little disconcerting to consider this measure, he stated, but it
is overdue in Alaska-a state with severe problems. Experts will
do the evaluation, and if a compelling case cannot be made for
the program, "we can pull the plug at any time."
9:47:42 AM
SENATOR FRENCH said he expects there will be proof that the
program will save the state money. By looking at the costs
before and after the commitment, he surmised that the state will
come out ahead financially. It will be a win for all of us. The
money saved will be clear, irrespective of the lives saved.
SENATOR ELLIS said it will be far more measurable than
prevention or other programs. There will be a control group, and
it will be very measurable.
9:49:48 AM
CHAIR MCGUIRE said that during the four years she was on the
House Judiciary Committee she could see a direct correlation of
cuts to the community treatment and mental health programs and
the increase in those individuals going to jail. SB 100 could
help reach individuals before the heinous crime is committed.
They may not have committed that big crime yet that locks them
up in jail. "So we're trying to get to those folks."
9:51:11 AM
ANNA SAPPAH, Governor's Advisory Board for Alcohol and Drug
Abuse, said she is also the secretary for the Meeting the
Challenge program, which is a recovery advocacy program
sponsored by the Substance Abuse Directors Association. She
supports SB 100, which can help save lives. Ms. Sappah is a
recovered heroin addict and has the disease of addiction. She
has been clean for over 11 years, and the reason for that is she
was able to receive appropriate treatment, which is the key to
addicts being able to stop using long enough to learn the life
skills to live without the drugs or alcohol. She noted that
after treatment, 12-step groups can be a valuable component. "I
am not a bad person because I am an addict, I am a person with a
disease, and I have to be active in my recovery," she stated.
When she was using, she was a drain on public funds, couldn't
raise her children, and was a victim of domestic violence. After
treatment she has become a productive citizen who works full
time, attends college, and parents her own children. She is also
a volunteer and board member of the program she graduated from.
SB 100 can reduce fetal alcohol problems, reduce expenditures of
corrections and courts, and better serve people with co-
occurring disorders. "Addicts do recover and treatment is
effective," she concluded.
9:53:38 AM
NATHAN JOHNSON, Division Manager, Anchorage Department of Health
and Human Services, said he supports SB 100. His department is
engaged in an ongoing struggle with substance abuse. The impacts
on the community cannot be overstated, he said. It's a massive
problem, and when it is ignored, the great costs are
perpetuated. For meaningful impact, treatment availability is
critical, especially for pregnant women. An Alaskan F.A.S. baby
costs $2.95 million in his or her lifetime. He explained that
involuntary commitments have been difficult without secure
facilities. The community service patrol (CSP) picks people up
who are endangering themselves or others. They have about 20,000
admissions per year, and about 250 people in Anchorage get
admitted about 100 to 150 days each year. That means they are
picked up almost every other day.
9:55:59 AM
MR. JOHNSON said some people are picked up almost every day.
"We're cycling them through at a great cost to public resources,
to tax dollars, and there is really no hope for treatment. It's
sort of a catch and release." Anchorage spends about $1.4
million for the CSP annually and another million to try to
address treatment issues. Those dollars are not even addressing
police and other emergency services. It is a heavy burden on the
taxpayer and the inebriates. Give them a moment of clarity to
turn their lives around, he said.
9:57:59 AM
SENATOR FRENCH requested more information on those numbers.
SENATOR BUNDE asked if people can be involuntarily committed to
API [Alaska Psychiatric Institute].
JOHN STOLPMAN, Alaska Psychiatric Institute (API), Anchorage,
said yes, it happens everyday.
SENATOR BUNDE asked if API could be used by someone with a
mental problem and a substance abuse problem.
MR. STOLPMAN said API will want to send those with a primary
substance abuse problem to that kind of program, instead of
taking them into the minimal bed space in their facility.
10:00:07 AM
SENATOR ELLIS said there might be some frustration in saying
that the mental illness must be the predominant characteristic
of a person, and these people are under the influence of alcohol
or drugs. So it becomes a difficult choice for API. "We built a
smaller API…and the idea was that the new API would be smaller
and we would come through with building up the community-based
services to handle folks…and API would be for the most severe or
acute situations." He said API is in a more difficult situation
today because of legislative decisions, he stated, and API is
not an option for the involuntary commitment beds.
CHAIR MCGUIRE asked about the life of a person involuntarily
committed to Clithroe and the use of Naltrexone.
10:01:59 AM
MR. STOLPMAN said the biggest challenge is getting someone to
the facility. The number of beds has been reduced around the
state, "and our waiting list is getting ridiculous." Some
clients wait four months to get in, and that is not appropriate
for a committed client. If someone is actually able to come in
when there is a true emergency, the client is incorporated as
anyone else who is in the recovery process. The process is
challenging and difficult. The commitment law is 30 days, and
after review, it can be extended for 90 days, twice. The
facility offers the option of going to a medical provider to
consider Naltrexone for aftercare. There is a six-month
aftercare program, which is the true test.
CHAIR MCGUIRE asked about the in-house treatment.
10:04:35 AM
MR. STOLPMAN said it is case by case; there is a dual diagnosis
unit working with severe mental health issues. Education and
adaptation of living with mental illness is part of it. It can
be very involved depending on a person's problems.
SENATOR STEVENS asked people have health insurance.
MR. STOLPMAN said it is extremely rare for someone to have
insurance. He spoke of a recent case dealing with "Tricare," and
"they don't even pay a dime for residential substance abuse
treatment." "The payment part is quite challenging and
fortunately the Salvation Army is very forgiving about all
that."
10:06:00 AM
SENATOR BUNDE asked how many beds are in the Clithroe Center.
MR. STOLPMAN said the detox facility was essentially cut in
half, from 17 to 8 due to funding cuts. Detox is the first point
of entry for involuntary commitments, and then they go into
treatment. There are 12 men's treatment beds, 16 beds for women,
and 12 dual-diagnosis treatment beds. The center is getting
calls everyday, but the next opening is in June, he said.
SENATOR BUNDE said it sounds like there are about 30 long-term
involuntary-commitment beds.
MR. STOLPMAN said the center doesn't set aside beds for
involuntary cases; it takes anyone who needs treatment. The
length of stay is the same either way, he added.
10:07:26 AM
SENATOR BUNDE asked the cost per client per day.
MR. STOLPMAN he can get back on that.
SENATOR BUNDE asked if Clithroe would run the pilot program.
MR. STOLPMAN said he assumes his facility would have a very high
interest in working with this project.
SENATOR ELLIS asked if the existing Clithroe program is a non-
secure facility. "You have some involuntary commitments, but if
people are ambulatory and refuse to be there, they don't have to
be there?"
10:09:10 AM
MR. STOLPMAN said yes. It is a big obstacle. Anyone can walk
away at any time, and there is "nothing we can do about that."
SENATOR ELLIS said that is the important distinction, and the
bill is taking the step of a secure facility for the high
flyers. It is a big step in terms of freedom, human dignity, and
how to deal with substance abuse. The problem is driving the
state to this point of trying something new, he said.
CHAIR MCGUIRE said she would set SB 100 aside.
| Document Name | Date/Time | Subjects |
|---|