Legislature(2021 - 2022)BUTROVICH 205

04/27/2021 01:30 PM HEALTH & SOCIAL SERVICES

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01:33:27 PM Start
01:33:58 PM SB124
03:02:59 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 124 MENTAL HEALTH FACILITIES & MEDS TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
-- Public Testimony RESCHEDULED TO APRIL 29 --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         April 27, 2021                                                                                         
                           1:33 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Mia Costello                                                                                                            
Senator Lora Reinbold                                                                                                           
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 124                                                                                                             
"An  Act relating  to admission  to  and detention  at a  subacute                                                              
mental health  facility; establishing  a definition  for 'subacute                                                              
mental  health facility';  establishing a  definition for  'crisis                                                              
residential  center';  relating  to the  definitions  for  'crisis                                                              
stabilization   center';  relating   to   the  administration   of                                                              
psychotropic  medication  in  a   crisis  situation;  relating  to                                                              
licensed facilities; and providing for an effective date."                                                                      
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 124                                                                                                                  
SHORT TITLE: MENTAL HEALTH FACILITIES & MEDS                                                                                    
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
04/12/21       (S)       READ THE FIRST TIME - REFERRALS                                                                        
04/12/21       (S)       HSS, FIN                                                                                               
04/27/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
STEVE WILLIAMS, Chief Operating Officer                                                                                         
Alaska Mental Health Trust                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Gave an overview of SB 124.                                                                               
                                                                                                                                
HEATHER CARPENTER, Senior Policy Advisor                                                                                        
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented the sectional analysis for SB 124.                                                              
                                                                                                                                
GENNIFER MOREAU, Director                                                                                                       
Division of Behavioral Health                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Answered questions on SB 124                                                                              
                                                                                                                                
STEVEN BOOKMAN, Senior Assistant Attorney General                                                                               
Civil Human Services Division                                                                                                   
Department of Law                                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Answered questions on SB 124.                                                                             
                                                                                                                                
ELIZABETH RIPLEY, President and CEO                                                                                             
Mat-Su Health Foundation                                                                                                        
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
KENNETH MCCOY, Acting Chief                                                                                                     
Anchorage Police Department                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
ELIZABETH KING, Director                                                                                                        
Behavioral Health and Workforce                                                                                                 
Alaska State Hospital and Nursing Home Association                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
SHIRLEY HOLLOWAY, Ph.D., President                                                                                              
National Alliance on Mental Illness (NAMI)                                                                                      
Vice President NAMI Alaska                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:33:27 PM                                                                                                                    
CHAIR DAVID WILSON called the Senate Health and Social Services                                                               
Standing Committee meeting to order at 1:33 p.m. Present at the                                                                 
call to  order were Senators  Costello, Begich, Hughes,  Reinbold,                                                              
and Chair Wilson.                                                                                                               
                                                                                                                                
              SB 124-MENTAL HEALTH FACILITIES & MEDS                                                                        
                                                                                                                                
1:33:58 PM                                                                                                                    
CHAIR WILSON  announced the consideration  of SENATE BILL  NO. 124                                                              
"An  Act relating  to admission  to  and detention  at a  subacute                                                              
mental health  facility; establishing  a definition  for 'subacute                                                              
mental  health facility';  establishing a  definition for  'crisis                                                              
residential  center';  relating  to the  definitions  for  'crisis                                                              
stabilization   center';  relating   to   the  administration   of                                                              
psychotropic  medication  in  a   crisis  situation;  relating  to                                                              
licensed facilities; and providing for an effective date."                                                                      
                                                                                                                                
He noted  it was the  first hearing for  SB 124, sponsored  by the                                                              
Senate  Rules  Committee by  request  of  the governor.  He  asked                                                              
Steven Williams and Heather Carpenter to introduce the bill.                                                                    
                                                                                                                                
1:35:31 PM                                                                                                                    
STEVE  WILLIAMS, Chief  Operating  Officer,  Alaska Mental  Health                                                              
Trust,  Anchorage, Alaska,  explained  that SB  124 is  part of  a                                                              
larger  effort to  improve  Alaska's psychiatric  crisis  response                                                              
system  and  began his  presentation,  Implementing  A  Behavioral                                                              
Health  Crisis  System of  Care  by  reading  slide 2,  Change  Is                                                              
Needed:                                                                                                                         
                                                                                                                                
     Currently, Alaskans in crisis are primarily served by                                                                    
    law    enforcement,   emergency    rooms,   and    other                                                                  
     restrictive environments                                                                                                 
        • Behavioral health crisis response is outside the                                                                      
          primary scope of training for law enforcement,                                                                        
          and reduces focus on crime prevention                                                                                 
        • Emergency rooms are not designed for and can be                                                                       
          overstimulating    to   someone    in   an    acute                                                                   
          psychiatric crisis                                                                                                    
                                                                                                                                
MR.  WILLIAMS stated  that individuals  are often  inappropriately                                                              
placed in  emergency rooms and  restrictive environments,  such as                                                              
jails.  SB   124  provides   an  opportunity   to  create   needed                                                              
innovative change to Alaska's psychiatric system.                                                                               
                                                                                                                                
    SB 124 will:                                                                                                              
        • Effectuate a "No Wrong Door" approach to                                                                              
          stabilization services                                                                                                
        • Enhance options for law enforcement and first                                                                         
          responders to efficiently connect Alaskans in                                                                         
         crisis to the appropriate level of crisis care                                                                         
        • Support more services designed to stabilize                                                                           
          individuals who are experiencing a mental health                                                                      
          crisis                                                                                                                
          • 23-hour crisis stabilization centers                                                                                
          • Short-term crisis residential centers                                                                               
                                                                                                                                
MR.  WILLIAMS   elaborated   that  No  Wrong   Door  means   first                                                              
responders   who  encounter   a  person   in  psychiatric   crisis                                                              
specifically know which  facility is best equipped to  deal with a                                                              
patient's needs  and take them there.  The No Wrong  Door approach                                                              
allows  first responders  to  spend  less time  making  transfers.                                                              
Areas that  have implemented the  system report transfer  times of                                                              
3-10 minutes. Transfer  time in Alaska is several  hours. The bill                                                              
will allow  the Department  of Health  and Social Services  (DHSS)                                                              
to designate and  license lower levels of acute  psychiatric care.                                                              
SB  124  describes   these  as  23-hour  and   residential  crisis                                                              
stabilization   centers.  These   licensed   centers  can   accept                                                              
individuals who are  in emergency custody holds and  those who are                                                              
there involuntarily.                                                                                                            
                                                                                                                                
1:39:01 PM                                                                                                                    
MR. WILLIAMS  stated that the goal  of the No Wrong  Door approach                                                              
is to have a  behavioral health emergency system  analogous to the                                                              
911  physical health  emergency  system. A  person experiencing  a                                                              
behavioral  health  emergency would  be  able to  quickly  receive                                                              
help at their  location and be  transported to a facility  for 23-                                                              
hour stabilization  if needed.  They would  be admitted  for short                                                              
term stabilization if further help was needed. (Slide 3, Goal)                                                                  
                                                                                                                                
1:41:21 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:43:13 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
1:43:14 PM                                                                                                                    
MR. WILLIAMS  pointed  out that  a transfer by  the mobile  crisis                                                              
team to  a 23-hour stabilization  center is critical for  a person                                                              
in  a  psychiatric  crisis. The  system  drastically  reduces  the                                                              
amount  of  time  law  enforcement   spends  making  transfers  to                                                              
appropriate medical  care. He noted  that the system  is sponsored                                                              
by the  Substance  Abuse Mental  Health Services  Administration),                                                              
National  Alliance on  Mental  Illness, Crisis  Intervention  Team                                                              
International  (a   law  enforcement  organization),   the  Action                                                              
Alliance on Suicide Prevention and several others.                                                                              
                                                                                                                                
In  2019  stakeholder   organizations  consisting   of  healthcare                                                              
providers,  state agencies,  first  responders, nonprofits,  local                                                              
governments, and  tribal organizations began participating  in the                                                              
assessment of  community strengths  and weaknesses. This  was done                                                              
so psychiatric crisis  response could be redesigned.  Mr. Williams                                                              
said  he   has  met   with  300   organizations  and   individuals                                                              
throughout the process. (Slide 4, Stakeholder Engagement)                                                                       
                                                                                                                                
The 1115 Behavior  Health Waiver is the foundation  for being able                                                              
to implement  systematic change. It is  the work of DHSS  to apply                                                              
and  be awarded  the waiver.  The service  and support  behavioral                                                              
health  providers  give  their  communities  is  enhanced  by  the                                                              
waiver. The  waiver provides funding  for pieces of  the emergency                                                              
behavioral response  system. The parts of the  system mentioned in                                                              
SB  124 are  23-hour  Stabilization and  Short-term  Stabilization                                                              
Centers.  (Slide  5,  Enhanced  Psychiatric  Crisis  Continuum  of                                                              
Care)                                                                                                                           
                                                                                                                                
1:47:38 PM                                                                                                                    
MR. WILLIAMS read slide 6, Crisis Stabilization (23-Hour):                                                                      
                                                                                                                                
      Provides prompt crisis observation and stabilization                                                                      
      services, offers low barrier access to mental health                                                                      
     and substance use care in a secure environment                                                                             
        • No wrong door - walk-in, referral and first                                                                           
          responder drop off                                                                                                    
      • High engagement/Recovery oriented (Peer Support)                                                                        
      • Staffed 24/7, 365 with a multi-disciplinary team                                                                        
        • Immediate assessment and stabilization to                                                                             
          avoid higher levels of care where possible                                                                            
        • Safe and secure                                                                                                       
        • Coordination with community-based services                                                                            
                                                                                                                                
He  defined   a  Crisis   Stabilization   Center  as  a   location                                                              
designated and licensed  by DHSS that would provide  up to twenty-                                                              
three hours and  fifty-nine minutes of crisis  stabilization care.                                                              
An individual's mental  needs would be assessed  but their medical                                                              
and  behavioral   needs   could  also  be   addressed.  Having   a                                                              
designated   locale  would   alert  first   responders  that   the                                                              
individual would be accepted right away.                                                                                        
                                                                                                                                
MR.  WILLIAMS   read  slide   7,  Short-Term  Crisis   Residential                                                              
Stabilization Center:                                                                                                           
                                                                                                                                
         A 24/7 medically monitored, short-term, crisis                                                                         
    residential    program   that    provides    psychiatric                                                                    
     stabilization                                                                                                              
                                                                                                                                
        • Safe and   secure        serves   voluntary   and                                                                     
          involuntary placements                                                                                                
        • High engagement/Recovery oriented (Peer Support)                                                                      
        • Multi-disciplinary treatment team                                                                                     
        • Short term with 16 or fewer beds                                                                                      
        • Stabilize and restore      avoid need for                                                                             
          inpatient hospitalization where possible                                                                              
        • Coordination with community-based services                                                                            
                                                                                                                                
MR. WILLIAMS  said a short-term  crisis center  is one step  up in                                                              
care from  23-hour care  and is  where a person  would be  sent if                                                              
they could  not be stabilized at  the lower level. It  is recovery                                                              
oriented  and   designed  to  accept  voluntary   and  involuntary                                                              
patients.                                                                                                                       
                                                                                                                                
In   speaking   to  the   outcomes   Georgia   experienced   after                                                              
implementing a crisis  system, he stated that for  every 100 calls                                                              
received,  the  crisis   call  center  resolves  90   of  them.  A                                                              
dispatched mobile crisis  team, consisting of a peer  and a mental                                                              
health  professional, resolves  7 out  of the  10 remaining  cases                                                              
through  assessment,  de-escalation,   and  referrals  to  support                                                              
services.  The remaining  three individuals  are transported  to a                                                              
23-hour stabilization  center where  1 out of  the initial  100 is                                                              
admitted to short term care.                                                                                                    
                                                                                                                                
By  having  a   progression  that  provides   early  intervention,                                                              
qualified  personnel and  appropriate levels  of care, the  impact                                                              
on  first responders  can  be significantly  minimized.  Moreover,                                                              
individuals  get  faster  and  better  care.  (Slide  8,  Enhanced                                                              
Crisis Response)                                                                                                                
                                                                                                                                
1:51:43 PM                                                                                                                    
MR. WILLIAMS  noted that  the point  where first responders  spend                                                              
excessive  amounts  of  time  waiting  to  make  transfers  is  at                                                              
emergency  holding places.  He  shared a  difficult,  frustrating,                                                              
yet  common  experience many  state  troopers  face. In  Mat-Su  a                                                              
trooper  picked  up  an  individual   experiencing  a  psychiatric                                                              
crisis. The trooper  was unable to resolve the  situation on-site,                                                              
handcuffed the individual  and attempted to find a  local place of                                                              
transfer. Unsuccessful  in finding a  place to accept  the patient                                                              
in Mat-Su,  he drove  to Anchorage.  As the  officer searched  for                                                              
care  the in-crisis  individual, who  had not  committed a  crime,                                                              
spent the officer's  entire eight-hour shift in  handcuffs. (Slide                                                              
10, Current Flow for Involuntary Commitment)                                                                                    
MR. WILLIAMS commented  that under the new system  law enforcement                                                              
and mobile  crisis teams  would be  able to  take patients  to 23-                                                              
hour crisis  stabilization centers.  Transfers take less  than ten                                                              
minutes  in Georgia  and Phoenix,  Arizona,  where 23-hour  crisis                                                              
stabilization centers  have been established. (Slide  11, Proposed                                                              
Statutory Changes)                                                                                                              
                                                                                                                                
He  asked   members  to   picture  what   the  redesigning   of  a                                                              
psychiatric crisis  system could look  like and what SB  124 would                                                              
help  effectuate.  It would  ensure  people get  appropriate  care                                                              
swiftly,  keep  them  out  of  jails   and  emergency  rooms,  and                                                              
minimize  the  impact on  first  responders  (Slide 12,  Flow  for                                                              
Involuntary Commitment with Statutory Changes)                                                                                  
                                                                                                                                
1:57:13 PM                                                                                                                    
HEATHER  CARPENTER, Senior  Policy Advisor,  Department of  Health                                                              
and  Social  Services   (DHSS),  Juneau,  Alaska,   presented  the                                                              
sectional analysis for SB 124:                                                                                                  
                                                                                                                                
     Section 1:  Amends AS 12.25.031(i)(1) to  define "crisis                                                                 
     stabilization  center"  as   a  subacute  mental  health                                                                   
     facility  that has  a maximum  stay of 23  hours and  59                                                                   
     minutes.                                                                                                                   
                                                                                                                                
She stated the statute was added last session as HB 290, an                                                                     
alternative    to    arrest    procedure,     sponsored    by                                                                   
Representative Claman, and passed as SB 120.                                                                                    
                                                                                                                                
     Section  2:   Amends  AS  47.30.705(a)  to   expand  the                                                                 
     category  of who  can cause  a person to  be taken  into                                                                   
     custody for  delivery to  a crisis stabilization  center                                                                   
     or  an  evaluation  facility.  The  new  language  would                                                                   
     allow "a 'mental  health professional' as defined  in AS                                                                   
     47.30.915(13),  or  a physician  assistant  licensed  by                                                                   
     the State Medical  Board to practice in this  state," in                                                                   
     addition to a peace officer.                                                                                               
                                                                                                                                
She  noted that  a  definition  sheet for  involuntary  commitment                                                              
statutes  was provided.  All  provider  types being  deleted  were                                                              
captured  in the  definition of  a mental  health professional.  A                                                              
physician assistant  was not in the definition of  a mental health                                                              
provider, so it was specifically included in Section 2.                                                                         
                                                                                                                                
     Clarifies  that a person  is taken  "into custody"  by a                                                                   
     peace officer  and then delivered to the  nearest crisis                                                                   
     stabilization center or evaluation facility.                                                                               
                                                                                                                                
MS. CARPENTER commented that the desire is to divert care to the                                                                
most appropriate facility and receive immediate care, instead of                                                                
being placed in an emergency room or jail.                                                                                      
                                                                                                                                
     Clarifies that  a person taken  into custody may  not be                                                                   
     placed  in jail  or other  correctional facility  except                                                                   
     for  protective   custody  purposes  while   they  await                                                                   
     transportation to  a subacute mental health  facility or                                                                   
     an evaluation facility.                                                                                                    
                                                                                                                                
     Replaces  "crisis stabilization  center" with  "subacute                                                                   
     mental health  facility" to  align with the  definitions                                                                   
     in  Section  15 which  categorize  crisis  stabilization                                                                   
     center  as  a  subtype  of   a  subacute  mental  health                                                                   
     facility.                                                                                                                  
                                                                                                                                
     Section  3: Adds a  new subsection  (c) to AS  47.30.705                                                                 
     that  requires a  peace officer  to prioritize  delivery                                                                   
     to a  crisis stabilization center  if one exists  in the                                                                   
     area served by the peace officer.                                                                                          
                                                                                                                                
She added  the desire  is not  to have  a peace officer  transport                                                              
someone from  Dillingham  to Anchorage. However,  if someone  were                                                              
having a crisis  in Houston and a stabilization  center existed in                                                              
Wasilla,  the  peace  officer  would   prioritize  delivering  the                                                              
individual to the Wasilla center rather than an emergency room.                                                                 
                                                                                                                                
     Section  4:   Adds  a  new  section  AS   47.30.707  for                                                                 
     admission to  and detention at a subacute  mental health                                                                   
     facility  with the following  options  and rights for  a                                                                   
     patient:                                                                                                                   
       (a) Creates legal parameters for emergency admission                                                                     
           and   holds   at   a  23-hour   59-minute   crisis                                                                   
           stabilization  center. It  also requires  a mental                                                                   
           health   professional  to   examine  the   patient                                                                   
           (respondent)  delivered to a crisis  stabilization                                                                   
           center within 3 hours after arrival.                                                                                 
        (b) Creates a new  process for evaluation, stabil-                                                                      
           ization,   and  treatment  at  crisis  residential                                                                   
           centers   which   provides   a  less   restrictive                                                                   
           alternative     to     traditional     involuntary                                                                   
           commitment  holds at  a Designated Evaluation  and                                                                   
           Treatment    Facility   (DET)   or    the   Alaska                                                                   
           Psychiatric   Institute   (API).   If   there   is                                                                   
           probable  cause  to  believe the  person's  crisis                                                                   
           could  be  stabilized  by  admitting to  a  crisis                                                                   
           residential     center,    the    mental    health                                                                   
           professional  in charge at the  23-hour, 59-minute                                                                   
           crisis  stabilization  center  can  apply  to  the                                                                   
           court  for  an  ex  parte  detention  order  after                                                                   
           which  the person  could be  detained at a  crisis                                                                   
           residential center for no more than 120 hours.                                                                       
                                                                                                                                
2:02:08 PM                                                                                                                    
MS. CARPENTER noted  that the meaning of  professional  in charge                                                               
was  defined  in  AS 47.30.915.17  as  the  senior  mental  health                                                              
professional  at a  facility,  or that  persons   designee in  the                                                              
absence of  a mental  health professional. It  means the  chief of                                                              
staff, or the physician designated by the chief of staff.                                                                       
                                                                                                                                
        (c) Retains the option to use the current process of                                                                    
           application  for an  ex parte  order for  delivery                                                                   
           to  a hospital designated  as a DET (such  as API)                                                                   
           if  the individual  is determined  to still  be in                                                                   
           acute  behavioral health crisis and  needs further                                                                   
           evaluation.                                                                                                          
        (d) Requires that if at any time during an                                                                              
           involuntary  hold  at  a  subacute  mental  health                                                                   
           facility,   the  patient  (respondent)  no  longer                                                                   
           meets  the standards  for a stabilization  hold or                                                                   
           detention, that they be released.                                                                                    
        (e) Provides for the patient's (respondent's)                                                                           
           rights   when  being   involuntarily  held   at  a                                                                   
           subacute mental health facility.                                                                                     
                                                                                                                                
2:03:13 PM                                                                                                                    
She offered that  some examples of patient's rights  are the right                                                              
to communicate  immediately with a  guardian or attorney  of their                                                              
choice, the right  to be represented by an attorney  and the right                                                              
to be notified of their rights.                                                                                                 
                                                                                                                                
        (f) Allows for the patient (respondent) to convert                                                                      
           to voluntary status for care.                                                                                        
        (g) Allows a subacute mental health facility to                                                                         
           administer    crisis    psychotropic    medication                                                                   
           consistent  with  the  practice  permitted  in  AS                                                                   
           47.30.838    for    evaluation   and    designated                                                                   
           treatment facilities.                                                                                                
        (h) Adds language to clarify how time is calculated                                                                     
            in this section for the 23-hour, 59- minutes and                                                                    
            120- hour periods.                                                                                                  
                                                                                                                                
2:04:09 PM                                                                                                                    
                                                                                                                                
     Section  5: Provides  clarifying edits  to AS  47.30.710                                                                 
     and  adds  language  to  allow   admission  to  subacute                                                                   
     mental  health  facilities  (in addition  to  evaluation                                                                   
     facilities).                                                                                                               
                                                                                                                                
     Adds  language to  allow a  mental health  professional,                                                                   
     after examination, to either:                                                                                              
          1. Hold the person at a crisis stabilization                                                                          
             center;                                                                                                            
          2. Admit the person to a crisis residential                                                                           
             center;                                                                                                            
          3. Readmit the person to a crisis residential                                                                         
             center if it is within 24 hours of a previous                                                                      
             admission with department prior authorization;                                                                     
          4. Hospitalize the respondent; or                                                                                     
          5. Arrange for emergency hospitalization.                                                                             
                                                                                                                                
     Section  6: Adds a  new subsection  (c) to AS  47.30.710                                                                 
     to  require  application for  an  ex  parte order  if  a                                                                   
     judicial order is not in place.                                                                                            
                                                                                                                                
     Adds  a  new  subsection  (d)  outlining  the  patient's                                                                   
     (respondent's)  right  to request  a  court hearing  and                                                                   
     receive  representation  by  a public  defender  if  the                                                                   
     patient (respondent)  is readmitted  within 24  hours of                                                                   
     a discharge and is not willing to stay voluntarily.                                                                        
                                                                                                                                
     Section 7: Amends  AS 47.30.715 to clarify  the facility                                                                 
     type  as   an  "evaluation  facility"  and   to  require                                                                   
     admission of  the patient (respondent)  when it  is safe                                                                   
     to  do so for  a 72-hour  evaluation to  determine if  a                                                                   
     petition for 30-day commitment should be filed.                                                                            
                                                                                                                                
MS.  CARPENTER explained  the reason  for adding  the language  is                                                              
facilities can  have different staffing  patterns or there  may be                                                              
several highly  acute patients in  one facility at the  same time.                                                              
Such circumstances  can require a  2:1 staffing ratio.  A facility                                                              
must have the  clinical staff available for treatment  before they                                                              
can  admit a  new patient,  even if  a bed  is vacant.  This is  a                                                              
clinical  judgement in  order to  ensure the  patient number  does                                                              
not  exceed  capacity   or  result  in  unnecessary   injuries  to                                                              
patients or  providers. This  also ensures  a facility  can comply                                                              
with  all the  patient  safety conditions  required  by the  joint                                                              
commission and Centers for Medicare  and Medicaid Services (CMS).                                                               
                                                                                                                                
     Section  8: Amends  AS  47.30.805(a),  a computation  of                                                                 
     time  statute, to  include  computation for  proceedings                                                                   
     or transportation to a crisis residential center.                                                                          
                                                                                                                                
2:07:22 PM                                                                                                                    
MS. CARPENTER said  only a physician, advanced  practice nurse, or                                                              
physician   assistant   can   determine   the  need   for   crisis                                                              
medication.                                                                                                                     
                                                                                                                                
     Section  9:  Amends  AS  47.30.838(c)   to  include  the                                                                 
     subacute  mental  health  facility  type as  a  type  of                                                                   
     facility  authorized to  administer psychotropic  crisis                                                                   
     medication  when there is a  crisis situation  where the                                                                   
     patient   requires  immediate   medication  to   prevent                                                                   
     significant physical harm to themselves or others.                                                                         
                                                                                                                                
                                                                                                                                
She explained  that crisis medication  can be given when  there is                                                              
a  crisis  situation  or  impending  crisis  situation.  A  crisis                                                              
happens  when medication  must  be  used immediately  to  preserve                                                              
life  or prevent  significant  physical  harm. Only  a  physician,                                                              
advanced nurse  practitioner or  physician assistant can  make the                                                              
determination; a  regular nurse cannot. Providers  universally say                                                              
that  physical   restraint  is   much  worse  for   patients  than                                                              
medication.                                                                                                                     
                                                                                                                                
An  order  for  crisis medication  is  initially  valid  for  only                                                              
twenty-four hours.  It may be renewed for up  to seventy-two hours                                                              
total. A  facility can  administer crisis  medication for  no more                                                              
than  three crisis  periods  without  court approval.  This  means                                                              
medication can  be renewed  for up to  nine 24-hour  periods. This                                                              
almost  never  happens  because   regularly  scheduled  medication                                                              
reduces the use of crisis medication.                                                                                           
                                                                                                                                
     Section 10:  Adds a new section  to AS 47.30  to require                                                                 
     the department  to adopt regulations to  implement these                                                                   
     changes to the involuntary commitment statutes.                                                                            
                                                                                                                                
     Section  11:  Amends  AS 47.30.915(7)  to  clarify  that                                                                 
     "evaluation  facility"  means   a  department-designated                                                                   
     hospital or crisis residential center.                                                                                     
                                                                                                                                
MS  CARPENTER  explained  that   technically,  using  the  current                                                              
definition  of the term  healthcare facility,  a hospice  facility                                                              
could be  an evaluation  and treatment center.  DHSS would  not do                                                              
this, but it demonstrates why precise language is needed.                                                                       
                                                                                                                                
     Section  12: Amends  the definition  of "peace  officer"                                                                 
     in  AS  47.30.915(15)  to   include  "emergency  medical                                                                   
     technician; paramedic; or firefighter."                                                                                    
                                                                                                                                
2:09:39 PM                                                                                                                    
MS.  CARPENTER  said  the  amendment in  Section  12  changes  the                                                              
definition  of  peace officer  so  that  SB  124 aligns  with  the                                                              
established definition of mobile crisis teams in Anchorage.                                                                     
                                                                                                                                
     Section   13:    Amends   AS   47.30.915    to   provide                                                                 
     definitions:                                                                                                               
        • "subacute mental health facility" is defined in                                                                       
          AS 47.32.900.                                                                                                         
        • "crisis residential center" means a subacute                                                                          
          mental health facility that has a maximum stay of                                                                     
          120 hours.                                                                                                            
        • "crisis stabilization center" means a subacute                                                                        
          mental health facility that has a maximum stay of                                                                     
          23 hours and 59 minutes.                                                                                              
                                                                                                                                
     Section  14:   Amends  the  licensing  statutes   in  AS                                                                 
     47.32.010(b)  to change  "crisis stabilization  centers"                                                                   
     to "subacute mental health facilities."                                                                                    
                                                                                                                                
MS.   CARPENTER   stated   the  term    subacute   mental   health                                                              
facilities  is  used to encapsulate  a comprehensive set  of wrap-                                                              
around services  that can occur  in a variety of  different crisis                                                              
settings. The umbrella  term affords the state  the flexibility to                                                              
grow the suite of crisis services over time.                                                                                    
                                                                                                                                
     Section  15: Adds  a new  paragraph to  AS 47.32.900  to                                                                 
     define   "subacute  mental   health  facility"  in   the                                                                   
     licensing statutes.                                                                                                        
                                                                                                                                
     Section 16: Repeals AS 47.32.900(5).                                                                                     
                                                                                                                                
     Section  17: Adds a  new section  to the uncodified  law                                                                 
     to  clarify that  DHSS will  consider previously  issued                                                                   
     "crisis  stabilization  center"  licenses as  a  license                                                                   
     for "subacute mental health facility."                                                                                     
                                                                                                                                
      Section 18: Adds a new section to the uncodified law                                                                    
        to allow the department to adopt regulations to                                                                         
     implement this act.                                                                                                        
                                                                                                                                
      Section 19: Provides for an immediate effective date                                                                    
     for the bill                                                                                                               
                                                                                                                                
2:12:16 PM                                                                                                                    
SENATOR  HUGHES asked  how  a person  having  a behavioral  health                                                              
crisis will be handled if they have broken a law.                                                                               
                                                                                                                                
MR.  WILLIAMS   replied  the  situations  described   during  this                                                              
meeting did not involve laws being broken.                                                                                      
                                                                                                                                
SENATOR  HUGHES  asked  if  there  was  support  from  Alaska  law                                                              
enforcement.                                                                                                                    
                                                                                                                                
MR.  WILLIAMS answered  he  is  partnering with  Fairbanks  Police                                                              
Department,  Alaska State Troopers,  Anchorage Police  Department,                                                              
and other first responders.                                                                                                     
                                                                                                                                
2:14:00 PM                                                                                                                    
SENATOR  BEGICH asked  if the  state is  anticipating that  tribal                                                              
entities  will  provide  crisis  stabilization  centers  in  rural                                                              
communities.  He  wondered  whether  they would  be  eligible  for                                                              
matching federal  funds. He also  wanted to know  if consideration                                                              
had  been given  to  rural staffing  concerns.  He  asked how  the                                                              
hospital  and  other two  facilities  came  to  be listed  in  the                                                              
fiscal note and where they would be located.                                                                                    
                                                                                                                                
MS. CARPENTER  replied that DHSS  does anticipate  tribal partners                                                              
setting up  services. Services can  be billed to  Medicaid through                                                              
the 1115 Health  Waiver. By statute the department  is required to                                                              
pay  for those  who do  not have  insurance  but need  involuntary                                                              
commitment   care.    Traditionally   payment   is    made   using                                                              
Disproportionate Share  Hospital (DSH) funds,  which is a  50   50                                                              
match  of state  and federal  funds.  Tribal health  organizations                                                              
are not  eligible for  federal match through  DSH, and  the fiscal                                                              
notes reflect that.                                                                                                             
                                                                                                                                
DHSS  has  several  tribal  partners   interested  in  setting  up                                                              
services  in rural  communities, such  as Kotzebue  and Nome.  The                                                              
model will look  different for rural Alaska. The  trust is working                                                              
with  tribal partners  to determine  how  to scale  the model  for                                                              
rural communities.                                                                                                              
                                                                                                                                
2:16:51 PM                                                                                                                    
SENATOR  BEGICH asked  where the  hospitals would  be located  and                                                              
how the estimates in the second fiscal note were identified.                                                                    
                                                                                                                                
MS. CARPENTER deferred  to Gennifer Moreau who  helped prepare the                                                              
fiscal note.                                                                                                                    
                                                                                                                                
GENNIFER  MOREAU,   Director,  Division   of  Behavioral   Health,                                                              
Department  of  Health  and  Social  Services  (DHSS),  Anchorage,                                                              
Alaska,  replied   that  DHSS  has  been  working   through  trust                                                              
sponsored   stakeholder   engagements    and   the   1115   waiver                                                              
implementation  path.  DHSS  has received  requests  for  approval                                                              
from  agencies   across  the  state  to  provide   Medicaid  based                                                              
services,  short  term  crisis  residential  centers  and  23-hour                                                              
stabilization  centers. Estimates  were based  on those  agencies'                                                              
requests for department approval.                                                                                               
                                                                                                                                
2:18:55 PM                                                                                                                    
SENATOR  REINBOLD asked  if  there have  been  any formal  letters                                                              
written in support of SB 124.                                                                                                   
                                                                                                                                
CHAIR  WILSON responded  that  a letter  of  support arrived  just                                                              
before the meeting and will be shared with members.                                                                             
                                                                                                                                
MR. WILLIAMS replied  that the trust has not  received any letters                                                              
from law  enforcement to date.  However, since 2019  when training                                                              
efforts  and  the  process  of  developing  a  better  psychiatric                                                              
response system began, law enforcement has been very supportive.                                                                
                                                                                                                                
2:21:07 PM                                                                                                                    
SENATOR REINBOLD  remarked that she has  a bill to repeal  SB 120.                                                              
She requested an explanation of how SB 124 works with SB 120.                                                                   
                                                                                                                                
MS. CARPENTER  answered that  Section 1 of  SB 124 interacts  with                                                              
SB  120  by  amending one  definition.  Everything  else  both  in                                                              
involuntary commitment and licensing statute, stands alone.                                                                     
                                                                                                                                
SENATOR REINBOLD requested  a list of the medications  that can be                                                              
administered  within   the  first  23-hours  of   admission  to  a                                                              
facility.   People  can   have   serious   adverse  reactions   to                                                              
psychotropic drugs, she said.                                                                                                   
                                                                                                                                
MS. CARPENTER replied  she will speak with the  Alaska Psychiatric                                                              
Institute    psychiatrist   regarding  examples   of  administered                                                              
drugs.  She  explained  that the  medication  given  would  change                                                              
depending  on  the   clinical  judgement  of  the   provider.  She                                                              
reminded  members  that  providers   must  physically  restrain  a                                                              
patient  if  they are  not  able  to give  crisis  medication  and                                                              
physical restraint is worse for patients.                                                                                       
                                                                                                                                
2:23:18 PM                                                                                                                    
SENATOR  REINBOLD   responded  she   understands  people   can  be                                                              
freaked-out by  being restrained  but taking medications  can have                                                              
severe consequences.  She asked  where the numbers  and statistics                                                              
presented on slide  8 came from. The graphic  depicted outcomes of                                                              
100  calls to  a crisis  center.  She asked  how many  involuntary                                                              
commitments  have   been  sent  to  the  subacute   mental  health                                                              
facility based on the graphic.                                                                                                  
                                                                                                                                
MR. WILLIAMS replied  that the data for the graphic  came from the                                                              
state  of  Georgia based  on  ten  years  of information  and  1.5                                                              
million callers.  Data gathered in Phoenix,  Arizona, demonstrated                                                              
similar results using the same operating model.                                                                                 
                                                                                                                                
SENATOR  REINBOLD asked  for a  list  of medications  that can  be                                                              
administered in the first 23 hours.                                                                                             
                                                                                                                                
MR. WILLIAMS responded he does not have a list.                                                                                 
                                                                                                                                
CHAIR  WILSON said  Ms. Carpenter  would obtain  a sample  list of                                                              
medications  because the  medication administered  depends on  the                                                              
type of crisis a patient is going through.                                                                                      
                                                                                                                                
2:25:20 PM                                                                                                                    
SENATOR REINBOLD stated  she has ex parte concerns  and asked when                                                              
she could ask questions about SB 120.                                                                                           
                                                                                                                                
CHAIR  WILSON answered  that  the next  Department  of Health  and                                                              
Social Services Committee meeting might be an appropriate time.                                                                 
                                                                                                                                
SENATOR COSTELLO  asked how care  of a minor  is dealt with  in SB
124.                                                                                                                            
                                                                                                                                
MS. CARPENTER  replied that  the system works  for minors  so long                                                              
as a facility accepts  them. DHSS would need to know  if a 23-hour                                                              
stabilization  center   or  crisis  residential  center   has  the                                                              
capacity to  accept minors.  DHSS does  have some facilities  that                                                              
are  preparing to  establish  minor  services. Ketchikan  is  very                                                              
interested in serving minors.                                                                                                   
                                                                                                                                
SENATOR COSTELLO  asked what provisions  are in SB 124  that would                                                              
allow parents to  be notified if their minor child  was taken to a                                                              
facility.                                                                                                                       
                                                                                                                                
MS. CARPENTER deferred to Mr. Bookman.                                                                                          
                                                                                                                                
2:28:06 PM                                                                                                                    
STEVEN  BOOKMAN, Senior  Assistant Attorney  General, Civil  Human                                                              
Services Division,  Department of Law, Anchorage,  Alaska, replied                                                              
that  [Section   4]  incorporates   the   rights  under   725  [AS                                                              
47.30.725]. One  of those  rights is the  right to communicate  at                                                              
the  department's  expense,  with the  respondent's  guardian,  if                                                              
any, or an adult designated by the respondent.                                                                                  
                                                                                                                                
SENATOR COSTELLO  asked whether  the minor gets  to choose  who is                                                              
informed  or whether  it  is  in statute  that  a  parent will  be                                                              
communicated with.                                                                                                              
                                                                                                                                
MR. BOOKMAN  responded both;  statute provides  that the  guardian                                                              
and an  adult designated  by the respondent  be notified.  This is                                                              
also  in  AS   47.30.775  labeled  Commitment  of   Minors,  which                                                              
addresses  how  earlier  provisions,   including  the  725  rights                                                              
statute [AS 47.30.725]  applies to minors. It further  states that                                                              
any notices  required to  be served on  the respondent  shall also                                                              
be served  on the parent  or guardian of  a minor and  any parents                                                              
or guardians  shall be  notified that they  may appear  as parties                                                              
and retain an attorney or have an attorney appointed for them.                                                                  
                                                                                                                                
2:30:09 PM                                                                                                                    
SENATOR  HUGHES   requested  the   committee  reach  out   to  law                                                              
enforcement for letters  of support. She was relieved  to know the                                                              
system  is for individuals  who  have not committed  a crime.  She                                                              
asked how  much time  Alaska law  enforcement officers  would gain                                                              
if  they did  not have  to  deal with  mental  health crises.  She                                                              
asked if  there is  data showing  improved patient outcomes,  such                                                              
as fewer  911 calls. She specifically  was interested  in suicide,                                                              
since  it  is a  problem  in  Alaska. She  speculated  a  suicidal                                                              
individual  might be  more  receptive to  help  from a  healthcare                                                              
worker than law enforcement.                                                                                                    
                                                                                                                                
MR. WILLIAMS  replied that  he does not  have all the  data points                                                              
requested  but  offered  the  Anchorage  Police  Department  (APD)                                                              
averages 400 behavioral health crisis calls per month.                                                                          
                                                                                                                                
He  stated the  amount  of time  saved  by Phoenix,  Arizona,  law                                                              
enforcement  not  responding  to   behavioral  health  crises  was                                                              
thirty-seven  full  time equivalents  (FTEs).  Those  thirty-seven                                                              
FTEs were applied  to resolving criminal matters. He  did not have                                                              
suicide information available but would inquire about it.                                                                       
                                                                                                                                
2:34:09 PM                                                                                                                    
SENATOR REINBOLD  stated she sees  similarities between HB  76 and                                                              
SB  124   in  changing   definitions.  Section   12  changed   the                                                              
definition   of  peace   officer.  Section   2  deleted   licensed                                                              
psychiatrists,  physicians  and  other qualified  professions  and                                                              
replaced them  with peace officers  and physician  assistants. She                                                              
offered her belief  that experienced people should be  the ones to                                                              
commit  individuals. Another  concern with  SB 124  is in  Section                                                              
14,   which  includes   maternity  centers,   nursing  homes   and                                                              
residential childcare  as listed facilities. She  stated there are                                                              
multiple significant  changes in SB  124 and recommended  the bill                                                              
be reviewed closely.                                                                                                            
                                                                                                                                
CHAIR WILSON stated SB 124 will be heard several times.                                                                         
                                                                                                                                
2:37:29 PM                                                                                                                    
SENATOR  HUGHES asked  if concerns  regarding  provider types  and                                                              
facilities could be addressed.                                                                                                  
                                                                                                                                
MS.  CARPENTER  replied  that the  concerns  mentioned  are  minor                                                              
changes.  In  Section 2  licensed  psychiatrists,  physicians  and                                                              
others  are  being  deleted  because  they  are  included  in  the                                                              
definition  of a mental  health professional,  as found  in Alaska                                                              
Statute   47.30.915.13.  Physician   assistant  was   specifically                                                              
mentioned in SB  124 because it is not included  in the definition                                                              
of a mental health provider.                                                                                                    
                                                                                                                                
The change  to the  definition of  peace officer  only applies  to                                                              
involuntary  commitment  statutes.  It  is being  amended  to  add                                                              
EMTs,  paramedics  and  firefighters  to  accommodate  Anchorage                                                                
model of a mobile crisis team.                                                                                                  
                                                                                                                                
Section 14  is a conforming  change with state licensing  statutes                                                              
found  in AS  47.32. The  healthcare  facilities Senator  Reinbold                                                              
mentioned  are  listed  in  licensing  statute  because  they  are                                                              
facilities  that are licensed  by DHSS,  through state  healthcare                                                              
facility  licensing.  It  is licensing  statute,  not  involuntary                                                              
commitment statute.                                                                                                             
                                                                                                                                
EMTs  are  only allowed  to  do  the first  emergency  hold.  They                                                              
cannot do holds  at crisis stabilization centers.  Those holds are                                                              
done according to current statute.                                                                                              
                                                                                                                                
2:39:30 PM                                                                                                                    
ELIZABETH  RIPLEY, President  and CEO,  Mat-Su Health  Foundation,                                                              
Wasilla,  Alaska,   stated  she   represents  the  Mat-Su   Health                                                              
Foundation  on  the  Mat-Su  Regional   Medical  Center  Board  of                                                              
Directors.  The foundation  shares  ownership  in Mat-Su  Regional                                                              
Medical  Center and  invests its  share of profits  back into  the                                                              
community through  grants and scholarships  to improve  the health                                                              
and wellness of Alaskans living in Mat-Su.                                                                                      
                                                                                                                                
MS. RIPLEY  said SB  124 would allow  the Crisis  Now model  to be                                                              
developed in Mat-Su  and Alaska. She reported that  during twenty-                                                              
four  community  forums, as  part  of  the 2013  Mat-Su  Community                                                              
Health  Needs Assessment,  the people  of Mat-Su  were asked  what                                                              
their top  five health concerns  where. The top five  answers were                                                              
all  mental health  and substance  abuse  related. Residents  told                                                              
the foundation they  wanted an improved and coordinated  system of                                                              
care  that  would  make  treatment   for  behavioral  health  more                                                              
readily accessible.                                                                                                             
                                                                                                                                
To better  understand the gaps and  challenges in care  across the                                                              
behavioral   health  continuum,   the   foundation  examined   the                                                              
behavioral health  crisis response system in Mat-Su.  It found the                                                              
Mat-Su  Regional Medical  Center  Emergency  Department saw  2,391                                                              
behavioral health  patients in 2013  for a total of  6,053 visits,                                                              
which cost  an estimated  $23 million.  These patients  had higher                                                              
charges, more  frequent visits and  were more likely to  return to                                                              
the  hospital  within 30  days.  An  additional $1.6  million  was                                                              
spent  on  law  enforcement,  911   dispatch  and  transportation.                                                              
Alaska State  Troopers responded  to 851 health related  emergency                                                              
calls. Ambulance  services responded to  an average of  432 calls.                                                              
Since then,  the prevalence of  mental health and  substance abuse                                                              
crises has increased in Mat-Su and statewide.                                                                                   
                                                                                                                                
2:41:47 PM                                                                                                                    
MS. RIPLEY said  the average annual growth rate for  visits to the                                                              
Mat-Su Regional  Medical Center  Emergency Department  by patients                                                              
with behavioral  health diagnoses  grew twenty  percent from  2015                                                              
to 2017 due to  the opioid epidemic and lack  of treatment access.                                                              
In 2016, 3,443  patients with behavioral health  diagnoses went to                                                              
the  Mat-Su Regional  Medical Center  Emergency Department.  Their                                                              
charges  totaled   $43.8  million,   which  does  not   count  the                                                              
additional  cost born  by law  enforcement or  Mat-Su Borough  EMS                                                              
for dispatch and ambulance services. Additionally, from 2014 -                                                                  
2017  the number  of behavioral  health  assessments required  for                                                              
patients in  crisis in the emergency  department grew from  349 to                                                              
more than 1000.                                                                                                                 
                                                                                                                                
She  reported  that  Mat-Su  Regional   Medical  Center  opened  a                                                              
sixteen-bed behavioral  health wing  last January, which  provides                                                              
in-patient behavioral  health treatment.  It has reduced  boarding                                                              
in  the emergency  department  but not  eliminated  it. There  are                                                              
still  people  who  need  detox,  space to  sober  up,  and  other                                                              
behavioral  health services  that  do not  necessarily require  an                                                              
emergency department visit or in-patient treatment.                                                                             
                                                                                                                                
2:43:01 PM                                                                                                                    
MS.  RIPLEY  said despite  the  work  of  the foundation  and  its                                                              
partners   to  create   treatment   upstream   of  the   emergency                                                              
department,   there  are   still   many  people   needing   crisis                                                              
intervention  downstream.   Cost-effective  options   are  needed,                                                              
which is why  the Mat-Su Health Foundation became  involved in the                                                              
Crisis Now model.  Research estimated Mat-Su has  2,583 behavioral                                                              
health crisis episodes  occurring annually. These  could be served                                                              
by  any level  of crisis  services  within the  Crisis Now  model.                                                              
About 2,500  of these episodes,  can be  served by the  Crisis Now                                                              
call-line   or  mobile   crisis   team.  The   rest  may   require                                                              
involuntary holds  in crisis facilities  provided by SB  124. Mat-                                                              
Su is  projected to  need nine short  term residential  beds under                                                              
the Crisis Now model.                                                                                                           
                                                                                                                                
Ray Michaelson, Program  Officer of the Health  Minds portfolio at                                                              
the foundation,  has been  meeting with  thirty behavioral  health                                                              
providers  and  emergency  system  partners  over  the  last  nine                                                              
months  to   establish  these  needed   services  in   the  Mat-Su                                                              
community.  The  Mat-Su  Health   Foundation  has  budgeted  grant                                                              
dollars  to help  support  capital and  start-up  costs. The  1115                                                              
Health Wavier should  help cover some of the  operating costs. The                                                              
foundation is  committed to getting  Crisis Now into  operation in                                                              
Mat-Su.  Legislation  is  needed  to  make  it  legally  possible.                                                              
Legislation will  make a new option possible  to support residents                                                              
who  experience  behavior  health  crises. It  also  supports  law                                                              
enforcement and  healthcare workers.  She respectfully  asked that                                                              
SB 124 be moved forward.                                                                                                        
                                                                                                                                
2:44:51 PM                                                                                                                    
KENNETH  MCCOY,   Acting  Chief,   Anchorage  Police   Department,                                                              
Anchorage, Alaska,  stated the  Anchorage Police Department  (APD)                                                              
supports building  a complete  crisis response system,  consisting                                                              
of  a  crisis  call  center,  mobile  crisis  teams,  and  23-hour                                                              
stabilization centers.  These components of the system  are needed                                                              
to adequately address mental and behavioral health.                                                                             
                                                                                                                                
Law  enforcement's response  has not  led to  desired outcomes.  A                                                              
large percentage  of situations  end with  the police  using force                                                              
against  people who  are in  a mental  health  crisis. The  police                                                              
department  recognizes that  these  situations  are better  suited                                                              
for  mental and  behavioral health  professionals.  About half  of                                                              
the mental and  behavioral health calls APD receives  result in an                                                              
officer taking the  individual into custody and  transporting them                                                              
to a  jail or emergency room.  Sometimes officers  and individuals                                                              
are left  for hours  at a  time in  the police  vehicle trying  to                                                              
find an appropriate safe location to drop the person off.                                                                       
                                                                                                                                
CHIEF MCCOY  said it is a  drain on police resources,  which could                                                              
be better spent  investigating actual crime. Being in  the back of                                                              
a   police   car   increases   emotional   trauma   for   citizens                                                              
experiencing  a mental  health crisis.  APD  recognizes there  are                                                              
situations   when  law   enforcement  is   the  most   appropriate                                                              
response, such as  when crimes have been committed  or weapons are                                                              
reported.  A  crisis system  augments  what  APD  can do  for  the                                                              
community.                                                                                                                      
                                                                                                                                
2:49:24 PM                                                                                                                    
SENATOR   REINBOLD   expressed   concerns   about   changing   the                                                              
definition of peace  officer, the ability to administer  drugs and                                                              
minor parental  consent. She asked  for a description of  a person                                                              
in a [behavioral health crisis].                                                                                                
                                                                                                                                
CHIEF MCCOY replied  there are times when people  are seen walking                                                              
on  streets in  obvious  mental  distress causing  a  disturbance.                                                              
There  is not  a lot  an  officer can  do.  A crime  has not  been                                                              
committed so  taking them to jail  is not appropriate and  they do                                                              
not  require  an emergency  room  level  of medical  care.  Having                                                              
professionals  in the field  respond to the  individual is  a win-                                                              
win  for the  community.  Law  enforcement  has found  that  their                                                              
uniforms, lights,  and radios  can act as  a catalysis for  use of                                                              
force.  Police   are  provided   with  some  crisis   intervention                                                              
training,  but it is  not enough.  The resources  of SB  124 would                                                              
compliment law enforcement and better serve the community.                                                                      
                                                                                                                                
2:52:58 PM                                                                                                                    
SENATOR REINBOLD asked  if he can identify any  way [the emergency                                                              
behavioral health crisis system] can be abused.                                                                                 
                                                                                                                                
CHAIR  WILSON  replied that  the  department  [DHSS] will  get  an                                                              
answer to the committee.                                                                                                        
                                                                                                                                
2:53:33 PM                                                                                                                    
ELIZABETH  KING,  Director  of  Behavioral  Health,  Alaska  State                                                              
Hospital  and   Nursing  Home  Association   (ASHNHA),  Anchorage,                                                              
Alaska,  said   the  Alaska  State   Hospital  and   Nursing  Home                                                              
Association (ASHNHA)  supports the intent  of SB 124.  Its members                                                              
continue  to review  the legislation  and  are working  to see  if                                                              
changes  are needed.  SB 124  is intended  to support  individuals                                                              
experiencing mental  health crises through  increased availability                                                              
of services,  specifically by allowing  the use of  23-hour crisis                                                              
care  stabilization  centers  and  short-term  crisis  residential                                                              
centers.                                                                                                                        
                                                                                                                                
There have  been on  going challenges  with accessible,  adequate,                                                              
and appropriate  care for  individuals experiencing  mental health                                                              
crises.  Alaska   primarily  relies   upon  law  enforcement   and                                                              
hospital emergency  rooms for their care. Emergency  rooms are one                                                              
of the  most restrictive  and expensive  levels of care.  Patients                                                              
who end  up at emergency  departments are  often held  for several                                                              
hours  or  days  waiting  for  access   to  needed  treatment.  On                                                              
average,   behavioral   health    patients   stay   in   emergency                                                              
departments  three   times  longer  than  patients   with  medical                                                              
diagnoses.  SB  124 offers  the  ability  to support  patients  in                                                              
crisis  in  a  less  restrictive   environment  and  with  a  more                                                              
appropriate  level of  care,  regardless of  whether  they have  a                                                              
court order  for involuntary commitment.  The capacity  to provide                                                              
crisis  care  for  any  Alaskan  in need  is  the  cornerstone  to                                                              
building a successful model of crisis services.                                                                                 
                                                                                                                                
2:56:06 PM                                                                                                                    
SHIRLEY HOLLOWAY,  Ph.D., President,  National Alliance  on Mental                                                              
Illness  (NAMI), Vice  President NAMI  Alaska, Anchorage,  Alaska,                                                              
shared  that  she  joined  NAMI   after  losing  her  daughter  to                                                              
suicide.   NAMI   is  the   largest   grassroots   mental   health                                                              
organization in  the nation. NAMI  Alaska was created in  1984 and                                                              
serves the entire  state with affiliates in  Anchorage, Fairbanks,                                                              
Juneau, and  the North Slope.  On behalf of  NAMI and as  a parent                                                              
she testified in support of SB 124.                                                                                             
                                                                                                                                
 Alaska relies  on law  enforcement, EMS,  and hospital  emergency                                                              
rooms  to   serve  people  in   behavioral  health   crises.  Most                                                              
communities  do  not  have  appropriate  facilities  and  services                                                              
where officers can  take people to receive appropriate  care. This                                                              
legislation  will help to  create a  full continuum of  behavioral                                                              
health crisis response  services, particularly at  the appropriate                                                              
lower  levels of  care.  SB 124  will  allow  Alaska to  implement                                                              
proven  crisis response  improvements.  The nationally  recognized                                                              
Crisis Now  model, allows  first responders  to bring  individuals                                                              
in crisis to a low to no barrier crisis stabilization center.                                                                   
                                                                                                                                
The  current approach  to crisis  care is  patchwork and  delivers                                                              
minimal treatment  for some people  while others, often  those who                                                              
have  not been  engaged in  care,  fall through  the cracks.  This                                                              
results in  multiple hospital readmissions,  life in  the criminal                                                              
justice system, homelessness, early death, and suicide.                                                                         
                                                                                                                                
A comprehensive and  integrative crisis network is  the first line                                                              
of defense in  preventing tragedies of public  and patient safety,                                                              
civil rights, extraordinary  and unacceptable loss of  lives and a                                                              
waste of resources.                                                                                                             
                                                                                                                                
2:59:29 PM                                                                                                                    
MS.  HOLLOWAY  declared that  there  is  a better  way.  Effective                                                              
crisis  care that  saves  lives and  dollars  requires a  systemic                                                              
approach.  The   Crisis  Now  model   is  a  continuum   of  three                                                              
components  that  are  already  working  in  many  communities  to                                                              
prevent  suicide,   reduce  wait  time  in  emergency   rooms  and                                                              
correctional   settings,  and   provide  the   best  support   for                                                              
individuals in crisis.                                                                                                          
                                                                                                                                
The  Crisis Now  model includes  a crisis  call center,  centrally                                                              
deployed  24/7 mobile  crisis teams  and  a 23-hour  stabilization                                                              
and  short-term  residential  center.   It  provides  a  safe  and                                                              
appropriate behavioral  crisis placement for those who  can not be                                                              
stabilized  by   initial  call   center  or  mobile   crisis  team                                                              
response.                                                                                                                       
                                                                                                                                
This  new  approach  to  the  mental  health  crisis  follows  the                                                              
national  guidelines of behavior  health  crisis care, using  best                                                              
practices  endorsed  by  the Substance  Abuse  and  Mental  Health                                                              
Services  Administration  (SAMHSA), US  Department  of Health  and                                                              
Human   Services.  These   guidelines   were   developed  on   the                                                              
experience of veteran crisis system leaders and administrators.                                                                 
                                                                                                                                
3:01:04 PM                                                                                                                    
MS. HOLLOWAY stated her testimony is personal:                                                                                  
     I  have a  beautiful talented  daughter  who lived  with                                                                   
     mental illness  that I lost  by suicide. For  someone in                                                                   
     crisis  there can  now be  an alternative  to jail,  API                                                                   
     [Alaska Psychiatric  Institute], and hospital  emergency                                                                   
     rooms.  A more  systemic response  is  needed, and  this                                                                   
     legislation is  critical to getting us where  we need to                                                                   
     be  to develop  a comprehensive  mental health  response                                                                   
     system...                                                                                                                  
                                                                                                                                
3:01:58 PM                                                                                                                    
CHAIR WILSON held SB 124 in committee.                                                                                          
                                                                                                                                
3:02:59 PM                                                                                                                    
There  being no  further business  to come  before the  committee,                                                              
Chair  Wilson adjourned  the  Senate  Health and  Social  Services                                                              
Standing Committee meeting at 3:02 p.m.                                                                                         
                                                                                                                                

Document Name Date/Time Subjects
SB 124 Transmittal Letter.pdf SHSS 4/27/2021 1:30:00 PM
SB 124
SB 124 Version GS 1730 A.PDF SHSS 4/27/2021 1:30:00 PM
SB 124
SB 124 Sectional Analysis Version GS1730 A.pdf SHSS 4/27/2021 1:30:00 PM
SB 124
SB0124-1-3-041221-DHS-Y.PDF SHSS 4/27/2021 1:30:00 PM
SB 124
SB0124-2-3-041221-DHS-Y.PDF SHSS 4/27/2021 1:30:00 PM
SB 124
SB0124-3-2-041221-DPS-N.PDF SHSS 4/27/2021 1:30:00 PM
SB 124
SB 124 Infographics - Proposed Statutory Changes to Title 47 4.22.21.pdf SHSS 4/27/2021 1:30:00 PM
SB 124
SB 124 Definitions in AS 47.30.915.pdf SHSS 4/27/2021 1:30:00 PM
SB 124
SB 124 Introduction Presentation - Senate HSS - 04272021.pdf SHSS 4/27/2021 1:30:00 PM
SB 124