Legislature(2011 - 2012)CAPITOL 106
02/24/2011 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Mental Health Trust Authority | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 24, 2011
3:18 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Sharon Cissna
Representative Bob Miller
MEMBERS ABSENT
Representative Paul Seaton
Representative Charisse Millett
COMMITTEE CALENDAR
PRESENTATION: ALASKA MENTAL HEALTH TRUST AUTHORITY
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
JEFF JESSEE, Chief Executive Officer
Alaska Mental Health Trust Authority
Department of Revenue
Anchorage, Alaska
POSITION STATEMENT: Presented an overview of the Alaska Mental
Health Trust Authority.
ACTION NARRATIVE
3:18:54 PM
CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:18 p.m.
Representatives Keller, Dick, and Miller were present at the
call to order. Representatives Herron and Cissna arrived as the
meeting was in progress.
^Presentation: Alaska Mental Health Trust Authority
Presentation: Alaska Mental Health Trust Authority
CHAIR KELLER announced that the only order of business would be
a presentation by the Alaska Mental Health Trust Authority.
3:19:46 PM
JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust
Authority, Department of Revenue, reported that currently there
was a history project researching the history of the Trust,
developing a data base, and planning a website. Referring to
the territorial days in Alaska, and the barbaric mental health
system, he explained that any person experiencing difficulty
with support arising from mental disability was charged with the
crime of being an "Insane Person at Large" by the territorial
officials. He shared that hundreds and hundreds of Alaskans
were charged and transported to Morningside Hospital in Oregon,
and their families were never apprised of what happened to them.
MR. JESSEE ascertained that mental health became an issue during
the statehood discussions, as the federal government had paid
for Morningside Hospital in Oregon, but upon statehood, Alaska
would have to pay for this. This resulted in passage of the
Alaska Mental Health Enabling Act of 1956, which consisted of
three parts: money to build a psychiatric hospital in Alaska, an
annual decrease of operating monies, and a land trust for Alaska
Mental Health Trust lands. He reported that some of this money
was used to build the first wing of the Alaska Psychiatric
Institute (API), as well as to purchase a motel in Valdez to
house people with development disabilities, Harborview
Developmental Center. The decreasing federal operating money
was used to wean Alaska off federal money. The land trust was
modeled off the university and school land trusts, was the first
and only mental health land trust, and was increased to 1
million acres from the original 500,000 acres upon the outrage
for this irresponsible action by Nebraska Representative Miller.
The land trust was designed to generate money for mental health
services. He listed the Mental Health Trust land to include
land around the Homer Spit, Kenai River frontage, and the big
trees around Haines. He whimsically observed that just a few
acres in the Prudhoe Bay area would have guaranteed the
financial future for mental health in Alaska.
3:26:43 PM
The committee took a brief at-ease.
3:27:10 PM
MR. JESSEE declared that the State of Alaska had selected the
most valuable land possible from the federal government. He
recounted that the Church of Scientology in San Diego had a
local newspaper print an expose about a gulag being built in the
frozen north to send communists and other dissidents. This
distracted attention from statehood. At statehood, Alaska
received 100 million acres of land, which was lumped with the 1
million acres of Alaska Mental Health Trust land, resulting in
half of this land being given away to Alaskans through land
lotteries, homesteads, and agricultural demands at less than
fair market value. He noted that this use of Mental Health
Trust land unraveled in the late 1970s when local governments
were allowed to select state land for local purposes. This
local process selected more than 27 percent of The Trust land,
as it was so well located.
3:29:59 PM
MR. JESSEE recounted that as local government lawyers went to
file title for this land, it was discovered that 27 percent of
the land was Alaska Mental Health Trust land, and had been
obtained at no charge. This lead to questions over land title,
as it was recognized that the trustees were likely in breach of
the trust. The local governments went to the state legislature
in 1979, requesting clear title to the land, so the entire
Alaska Mental Health Trust land was redesignated as general
state land. However, legislature lawyers pointed out that, as
trustees for the mental health land trust, the legislature could
not take the land without paying for it. The legislature then
set up a Mental Health Trust income account to receive 1.5
percent of all state land sales. He pointed out that, however,
the Alaska State Legislature forgot to make any deposits, and,
in 1982, a Fairbanks lawyer, Steve Cowper, filed the original
Alaska Mental Health Trust lands lawsuit. He recounted Steve
Cowper's history as a legislator who "voted to steal the land,"
as a lawyer who filed the lawsuit to regain the land, and as the
governor who presided over two failed settlement attempts. In
1985, the Alaska Supreme Court, in a three page settlement,
stated that the land needed to be returned to the Alaska Mental
Health Land Trust, which began a decade of litigation and a
court ordered injunction on the 1 million acres which prohibited
any further use.
3:34:55 PM
MR. JESSEE explained that, as much of the land could not be
returned, a committee of land experts placed a value of about
$2.2 billion on the 1 million acres. He noted that a number of
failed settlement attempts followed, and then, in 1994, all the
stakeholders gathered to designate replacement for the lost
500,000 acres. This land was determined not to be worth as much
as the original land, so there was an agreement for a cash
compensation of $200 million.
3:38:44 PM
MR. JESSEE pointed to the dilemma for legislators, as trustees,
to apply a limited fiduciary responsibility to a limited set of
assets while considering its overall responsibility for public
trust. It was decided to appoint a substitute trustee with the
power to oversee the asset and spend money without a legislative
appropriation. He shared that a seven member board of trustees
was appointed by the governor, and confirmed by the legislature.
A plan was agreed upon to have the land managed by a separate
unit within the Department of Natural Resources (DNR), the trust
land office, which contracted with the trustees. The Alaska
Permanent fund would manage the money, and the Alaska Mental
Health Trust would pay its share of the expenses and get its
share of the profit. He specified that The Trust spent about
$160 million of general funds and $140 million of Medicaid funds
each year, while its assets generated about $23-$25 million each
year. He conveyed that the trustees recognized the need to be
catalysts for change to improve the mental health program.
3:43:26 PM
MR. JESSEE, reflecting on the $160,000 cost per resident at
Harborview in 1964, noted that the Alaska Mental Health Trust
Authority had wanted to close the facility, but the legislature
would not agree. He confirmed the need for community based
services, which would require additional investment to allow for
the transition.
3:45:43 PM
MR. JESSEE stated that the Trust had offered to pay for three
years of Harborview operation, if the Legislature would invest
the comparable amount of operating money into community
services. In this way, Alaska became only the second state in
the nation without an institution for the mentally retarded, but
community services were created.
3:47:53 PM
MR. JESSEE moved on to discuss women with chronic mental illness
in correctional institutions, who were in 23 hour segregation
from the main prison population. He reflected on discussions
with Representative Eldon Mulder, Co-Chair of Finance, and the
subsequent financial and operating plan designed by The Trust.
He noted that the Alaska Mental Health Trust Authority offered
to pay 100 percent of the cost in year one, 67 percent in year
two, and 33 percent of the cost in year three, which allowed
incremental adjustments to the state budget for those three
years.
3:52:55 PM
MR. JESSEE stated that The Alaska Mental Health Trust Authority
was a "data driven, outcome focused organization."
3:53:17 PM
MR. JESSEE, in response to Chair Keller, said that a little over
900,000 acres, with subsurface rights, was being managed by The
Trust. He noted that some land, specifically land with timber,
was easily convertible to cash. He pointed out that The Trust
land office had a different mandate and different regulations
than DNR, as it only had to maximize revenue from the land over
time. He agreed that there were instances of controversy with
local communities, and that, if possible, The Trust tried to
accommodate the local community. He offered some examples of
land leases and sales. He pointed to the upcoming exploration
license for low grade coal on 160,000 acres of The Trust land.
4:00:23 PM
CHAIR KELLER asked if there was a time that The Alaska Mental
Health Trust Authority would be self sufficient.
MR. JESSEE, in response, said no. He declared that it was
unlikely that The Trust would generate $160 million each year.
He confirmed that oil and gas were the revenue generators, and
that revenue was being generated from hard rock minerals, coal,
and a few other deposits.
CHAIR KELLER asked for a breakdown to the $160 million
expenditures.
MR. JESSEE replied that the settlement required the State of
Alaska to have a separate bill for the mental health program,
which was detailed by department, division, and budget request.
4:03:16 PM
MR. JESSEE stated that the $25 million which The Trust generated
each year just happened to be the right amount of money to help
improve the $300 million program. He opined that the Alaska
State Legislature would have required more income from The Trust
if it was generating more income.
CHAIR KELLER asked to clarify that The Trust did not want to be
more than a catalyst for change.
MR. JESSEE replied that it was not likely that The Trust would
offer more base support. He pointed to the $1.3 million spent
for mini grants of up to $3,000 each to improve the lives of
beneficiaries. He defined that 80 percent of the mini grant
requests were for dental care; once that need was recognized,
then the Trust supplied funding to add dental care to the
Medicaid program.
4:06:51 PM
REPRESENTATIVE DICK reflected on the problems that a family
member had with mental health issues and the lack of support and
services. He commented on the exhaustion and desperation of
many family members. Reflecting on the dearth of available
services, he questioned the benefits for the expenditure of $160
million. He declared that his was a "painful, dismal view of
the mental health services in Alaska."
MR. JESSEE agreed that these were some excellent points, and
that Alaska had struggled with many of these issues since before
statehood. He pointed to some administration decisions which
had eliminated funding in lieu of Medicaid. He declared that
Medicaid was a dependency promoting medical model. He
established the need to be extremely ill before there was help
from the community mental health center because most of the
funding had to be billable to Medicaid. He pointed out that
this did not allow for help to an individual who was not yet in
crisis.
4:12:07 PM
MR. JESSEE said there were incremental gains toward safe,
affordable, permanent housing, and for support services to keep
people in this housing. He informed that there had been very
few supportive housing units for people with mental illness, but
that there was now an increase in funding to almost $10 million
annually for this population. He approved of the support that
this afforded the families of the mentally ill.
4:14:03 PM
REPRESENTATIVE DICK opined that there was difficulty with the
system when the person was over 18, as concerned family members
could not become involved. He asked about the federal funding,
which stipulated that an individual over 18 was free to make
their own choices.
MR. JESSEE agreed, but pointed out that both federal and state
law stated that legal authority was necessary to engage in
another adult's business. He offered that guardianship was a
way to make legal decisions on another adult's behalf.
REPRESENTATIVE DICK offered another personal story.
4:18:09 PM
MR. JESSEE, in response to Representative Dick, described the
mental health crisis intervention training for police officers,
and noted that Anchorage PD was nationally recognized for this
training. He agreed that previously, an individual was sent to
Alaska Psychiatric Institute (API), but that currently there was
a psychiatric emergency room at Providence Hospital. He
affirmed that supportive housing was now available upon
discharge. He directed attention to the therapeutic courts, as
there was a cyclic occurrence of misdemeanors among the mentally
ill. He explained that the therapeutic court assigned a case
manager, who would connect the mentally ill to services
available in the community. He shared stories of the success of
these courts.
4:22:23 PM
REPRESENTATIVE DICK asked if these services were available in
the bush.
MR. JESSEE replied that there was now a wellness court in Bethel
and a mental health court in Anchorage because a judge had
recognized the need. He shared that Senator Lyda Green had
requested a mental health court in Palmer, but that he had
cautioned her about the initial costs. He offered to help
create a mental health court with Alaska Mental Health Trust
monies. He agreed that general funds would be necessary to
finance the court after three years, but he pointed out that the
investment would be for a known result. He accepted the blame
for the Trust creating successful programs, and then requesting
operating financing from the Legislature.
4:26:52 PM
CHAIR KELLER opined that the legislature was concerned with the
expansion of programs, as there was a financial breaking point.
He pointed to the limited amount of money and the necessity of
balancing the distribution. He declared the need to receive
value for the expenditures.
4:30:29 PM
REPRESENTATIVE DICK offered his belief that accountability
allowed the Legislature to prioritize for what was working.
MR. JESSEE observed that The Trust tried to be data driven. He
pointed out that The Trust had paid for the longitudinal study
which compared the number of days the participants in mental
health court had spent in corrections and in API for the year
prior and the year after mental health court. He confirmed a
significant reduction for both days in correction and costs,
compared to the cost of the program.
4:33:10 PM
MR. JESSEE shared an example of the Bring the Kids Home program.
Although there had not been a guarantee that Bring the Kids Home
would save money, he declared that the reinvestment in
residential psychiatric treatment centers (RPTC) in Alaska had
resulted in a decline in money spent. He expressed frustration
that key components of the service system for the program had
not been put in place, as these would allow for the final
success of the initiative. He asked to be told what
programmatic outcome was desired, or how much the Legislature
wanted to spend, so that The Trust could build the best possible
programs. He stated the need to work in concert, and to review
the cost benefit of each program.
4:36:14 PM
CHAIR KELLER replied that he wanted a comprehensive view of each
program.
4:37:00 PM
REPRESENTATIVE CISSNA reflected on the history of the Bring the
Kids Home program and the Alaska Youth Initiative (AYI). She
requested that work be primarily on the community based
programs, especially for preventative programs. She opined that
Alaska invested in illness, not prevention.
4:39:43 PM
MR. JESSEE summarized that a mental health continuum of care
should start with the support of families within the community,
and only when those supports were insufficient would there be a
move to the next level of care. He declared that institutional
or out of state care should be the last resort.
MR. JESSEE offered his belief that it was necessary to invest in
prevention and early intervention services, but the legislature
did not have the tolerance for a long term investment.
Consequently, the Trust had chosen to deliver specific short
term results, and to use the savings to invest in in-state care.
4:42:09 PM
MR. JESSEE stressed that long term solutions were only
attainable with investments in prevention. He compared the
group homes to larger facilities, and pointed to the better
quality of life, and the comparative ease for divesting this
asset if it became unnecessary.
MR. JESSEE offered an example of families with autistic children
and the difficulties these families faced. He detailed that The
Trust built and funded an autism resource center to help keep
autistic children in the home and to become productive citizens.
He pointed to the results and suggested that the ongoing
expenses should now be budgeted from the state general funds.
4:45:18 PM
REPRESENTATIVE DICK explained that these requests should have
been brought to the House Health and Social Services Standing
Committee, and not the House Education Standing Committee.
4:46:15 PM
REPRESENTATIVE MILLER shared a personal family account of
autism, and agreed with those needs as outlined by Mr. Jessee.
He agreed that although unlimited funding could not be supplied,
the emotional and financial costs were not quantifiable.
4:48:56 PM
CHAIR KELLER opined that costs had to be quantified as it was
not possible to solve all the problems.
4:49:40 PM
REPRESENTATIVE CISSNA offered her belief that the politics of
the impossible had changed. She pointed to the current use of
telemedicine carts in rural communities. She asked if the
autism resource center had telemedicine capabilities.
MR. JESSEE replied that telemedicine and telepsychiatry were
part of the autism resource center plan. He stressed the need
for cost effectiveness of programs, and he stated that the Trust
had discontinued programs that were too expensive. He expressed
agreement for the development of more data, but he cautioned
that "data costs money. If you're gonna spend money on data,
you need to have a pretty good idea going in, of what it is that
you're gonna do with it when you buy it." He established that
he had banned the phrase "It would be interesting to know" as it
was necessary to know upfront how the information could affect a
decision.
4:53:46 PM
CHAIR KELLER replied that data was essential to make decisions.
MR. JESSEE suggested that a bill to mandate behavioral health
coverage in private health insurance plans would relieve the
State of Alaska of that responsibility. He acknowledged the
balance between fiscal realities and directive to private sector
industries. He confirmed that when individuals were not
responsible for paying for their own needs, then the state would
pay, and he offered the mandatory helmet laws as an example.
4:56:47 PM
REPRESENTATIVE CISSNA suggested that the "cost of not doing
things" was very expensive.
4:58:15 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:58 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| mental health trust.pdf |
HHSS 2/24/2011 3:00:00 PM |