Legislature(2025 - 2026)DAVIS 106
01/22/2026 03:15 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB147 | |
| HB232 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 147 | TELECONFERENCED | |
| *+ | HB 232 | TELECONFERENCED | |
HB 232-MINOR MENTAL HEALTH: AGE OF CONSENT
3:31:53 PM
CHAIR MINA announced that the final order of business would be,
HOUSE BILL NO. 232, "An Act relating to the examination and
treatment of minors; relating to consent for behavioral and
mental health treatment for minors 16 years of age or older; and
providing for an effective date."
3:34:37 PM
REPRESENTATIVE ANDREW GRAY, Alaska State Legislature, as prime
sponsor, presented HB 232. He emphasized that the proposed
legislation would lower the age of consent for mental health
care to age 16 from age 18. Doing so would allow people of such
ages to seek mental health care for up to five appointments
without the prior consent of their parents or guardians, which
is currently prohibited.
3:35:23 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, as an invited
testifier [and sponsor of companion bill SB 90], She said that
the bill was motivated by "both data and experience." She began
her testimony by explaining that she was currently working as a
part-time nurse practitioner in the Anchorage School District,
primarily working with middle school students. While her
primary practice concerns student physical health, she also does
mental health screening. It is in this capacity that she
observed a staunch rise in mental health issues since the
Coronavirus 19 (COVID-19) Pandemic, saying that "the multiplier
[was] four or five times what it was before Covid."
SENATOR GIESSEL, walking through the process of said mental
health screening, emphasized the barrier that consent of care
poses for mental health treatment in Alaska children. Senator
Gissel reported that only one-third of parents allow their child
to seek mental health treatment. This is despite Senator
Gissel's observation that, after the initial mental health
screening, the desire expressed among the screened students is
almost unanimous consent. Referring to the book Attack of the
Teenage Brain: Understanding and Supporting the Weird and
Wonderful Adolescent Learner, by Dr. John Medina of the
University of Washington School of Medicine, she shared that the
average age of the onset of mental health issues usually begins
around age 14 and explained how a person's mind works to develop
as a teenager. Drawing on both the development of key
structures in the brain and the increased likelihood for people
of this age to engage with risky behavior, she argued that this
was the most critical time for mental health intervention. She
said that early prevention is always more effective than later
treatment and emphasized that Alaska led the nation in suicide
rates. Additionally, she highlighted the resistance to
treatment expressed by parents when they are informed of their
child's mental health. She said that the proposed legislation
would allow a youth to pursue care for five sessions of therapy.
After that point, the child must attain consent from a parent or
guardian and highlighted that HB 232 would not allow for a child
to be prescribed with any medication from the services rendered.
SENATOR GIESSEL further expressed support for the bill, stating
that many of the mental health issues of teenagers are better
addressed through counselling rather than medication. She
highlighted the ways that HB 232's therapy scheme could help
parents as well as their children. This would be by means of
the counseling schedule provided in HB 232. Under the proposed
legislation, a therapy schedule would give parents a better idea
as to how to help their children and give them an opportunity to
be involved in their child's counseling. Among such ways is
that such initial counseling would prevent parents from needing
to find means of coordination around and transportation to third
party care providers. She also sighted the increased risk of
substance abuse for teens with undiagnosed depression and
anxiety. Additionally, she stated that HB 232 aligned with
policy priorities of the American School Counselors Association.
SENATOR GIESSEL, to illustrate her reasons for supporting HB
232, referred to a bill passed by the Senate that allowed
schools to set up mental health clinics within their premises
with billing services, HIPPA (Health Insurance Portability and
Accountability Act) compliant computers systems, et cetera. She
cited contractor arrangements in both the Anchorage and
Fairbanks School Districts as models for how this legislation
would work in practice.
3:47:18 PM
REPRESENTATIVE MEARS commented on her support for the proposed
legislation and shared that she was grateful to know what her
children were going through as they were teenagers. She thanked
Senator Giessel for her work.
3:48:40 PM
REPRESENTATIVE FIELDS commented that a counselor is a good
alternative to an automated intelligence chat bot, which has
been known to encourage suicide, and he asked why HB 232 would
not lower the age of mental health consent to 14. He asked
committee members to lower the age of consent to receive mental
health care, citing that girls age faster than boys, and he
questioned why the legislation contained only five appointments.
SENATOR GIESSEL answered that the proposed legislation was meant
to be seen as incremental. She acknowledged that about half of
the states with similar legislation have a lower age of consent-
with one state offering services as young as 12 years old-and
agreed that age 14 would be ideal. She said that the five
appointments idea was brought to her by Representative
Ruffridge, that it was implemented by another state, and that
the two of them thought it was "a really good structure." The
state in question also prohibited the use of drugs during
treatment.
REPRESENTATIVE FIELDS commented that he would be curious if
there would be interest among both committee members and the
bill's sponsors in adding a provision that would further lower
the age of consent for mental health treatment to 14 but could
understand if doing so would diminish support for the bill.
3:51:24 PM
REPRESENTATIVE PRAX shared his concern that the proposed
legislation might drive parents away from the public school
system. He shared his opinion that the root of the problem with
mental health care access in Alaska was parents, not children,
citing Senator Giessel's own testimony that roughly two thirds
of parents do not consent to mental health care when informed of
their child's mental state. Citing conversations the
representative has had with his own constituents over similar
measures, Representative Prax expressed concern that enacting
the bill would thus increase the rate of parents taking their
children out of the public school system. His concern was
rooted in both how teenagers would most likely have to contract
such treatment under their parents' insurance policy and that
schools are mandatory reporters when it comes to their student's
mental health, and there was "a legal term, I can't think of it
right now, for children who have yet to reach the age of
majority."
SENATOR GIESSEL explained that not all services outlined in the
proposed legislation would be offered in school settings only.
She further emphasized that emancipated minors -the legal term
Representative Prax was presumably referring to- are also being
turned away from behavioral health services clinics because of
the age of consent required to receive mental health services.
In other cases, Senator Giessel argued, the parents may have
been incarcerated or disappeared. She spoke to the large number
of children who are aware of the issues that burden them but
cannot seek the healthcare that they need because of various
kinds of home-life dysfunction. She clarified that the two
thirds figure that she stated in her original testimony was due
either to a lack of response or a negative response.
REPRESENTATIVE PRAX further commented that the lack of ability
to communicate with parents was to blame for this issue, as they
"have the say-so in our society," not their children. Thus, his
concern was if by endorsing this legislation, the committee was
"enabling, to a degree, parents to not be parents" rather than
encouraging parents to get involved in the child's mental health
treatment.
3:58:17 PM
REPRESENTATIVE FIELDS said that minor logistical issues are to
blame for many issues of parental consent. He said to
illustrate his point, "I see [this] all the time in my school,
and it's unbelievable how hard it is to get notes back ... for
something as simple as even as ice skating at recess."
SENATOR GIESSEL echoed Representative Field's remarks and said
that she is seeing a lot of children with unstable home lives
having to sacrifice their own mental health to survive. To
illustrate her point, Senator Giessel cited conversations
surrounding the lack of sleep that certain students receive each
night as an indicator of both physical and mental health. In
response, some students tell her that they usually go to bed at
3:00am and must get up at 5:00am, because their mother "goes out
at night," thus, they must watch their younger siblings, worried
that their "mom won't come back." Additionally, she also cited
that while SB 90 was being considered by the Senate, there were
four sequential student suicides in the same school of the North
Slope Burrough.
4:01:01 PM
REPRESENTATIVE GRAY commented on his opinion that it might be a
waste of time to "force a 17-year-old to do anything." Thus, he
suggested that the proposed legislation would be more productive
because it would allow the child to make their own mental health
care decisions. He drew upon his own life experience to
illustrate his point.
4:02:31 PM
REPRESENTATIVE PRAX asked if an opt-in provision at the
beginning of the school year could be used as a possible
solution to address mental health concerns raised by HB 232,
drawing on other medical "power of attorney" and "ice-skating at
school" situations to illustrate his point.
SENATOR GIESSEL stated that such powers already exist within a
school setting for physical care, that it would ultimately be up
to school districts to decide such powers, and later referred to
the invited testifiers. Ultimately, Senator Gissel said that
she would look into the proposal.
4:05:19 PM
REPRESENTATIVE RUFFRIDGE asked Senator Giessel if there was any
idea of how Section 3, subsection (f) of HB 232 would be
implemented. Section 3, subsection (f) of HB 232 read as
follows:
(f) The parent or guardian of a minor is relieved of
all financial obligation to the provider of a service
under this section.
REPRESENTATIVE RUFFRIDGE shared his concern that Section 3,
subsection (f) would prohibit a healthcare provider from
refusing care if a student were to be uninsured, saying that if
a student seeking the services HB 232 provides for may be
prevented from doing so due to the language contained in the
bill. He described Section 3, subsection (f)'s wording as
"rigid" and warned it could prevent clinics from receiving
remuneration for mental health services.
SENATOR GIESSEL explained that a student's health insurance
would be billed, likely through Medicaid. She said that pro-
bono care would be provided if healthcare was not available and
said that Section 3, subsection (f) of HB 232 would not prohibit
any such refusal to provide care. She also added that many
clinical social workers that she has spoken to often recognized
the desperation of potential patients and thus offered pro bono
care.
4:08:30 PM
REPRESENTATIVE SCHWANKE asked how HB 232 would reconcile its
abdication of parental control largely in response to Senator
Gissle's earlier comment that the aim of the bill was to "get
parents involved," whereas Representative Schwanke said the bill
would do the opposite. Representative Schwanke also asked if
there was any evidence to support the claim that preventative
mental health care was effective. She shared her concern that
the proposed legislation would deter parents from enrolling
their children in public schools.
SENATOR GIESSEL answered that it was impossible to quantify
whether preventative mental health care was effective, stating
that such a statement was akin to someone saying, "We've saved
money because we've vaccinated against measles." She emphasized
the importance and good faith of mental health care services
being provided, saying that such mental health issues were
playing out in both school and family settings. To further
illustrate her point, she cited reports from teachers and
parents from schools that had such programs that a "huge
difference in the classroom" is made by such services. Thus,
Senator Gissel expressed her optimism that parents of students
who receive such services would be achieved by improvements in
student behavior.
4:13:44 PM
CHAIR MINA shared that during her time visiting with the
National Conference of State Legislators (NCSL) working to
address youth mental health and homelessness, her conversations
revolving around lowering the age of consent for mental health
care were seen as a solution to these issues.
4:15:56 PM
TERESA WROBEL, Policy & Advocacy Program Specialist, Alaska
Children's Trust, gave invited testimony on HB 232. She
emphasized that the proposed legislation would allow teenagers
in Alaska to seek the healthcare that they need. She shared a
series of statistics related to suicidality and mental health in
Alaska youth and spoke to how a young person in poor mental
health might not be able to safely address their issues with
their parents. She said that research on youth mental health
consent suggests that the age of consent for treatment being
lower supports positive outcomes all throughout a person's
teenage years and into adulthood. She cited the lowering of
risk of future substance abuse, "unsafe coping mechanisms,"
family conflict, and involvement in the child welfare system.
She emphasized the bill's intentionally limited scope in the
services provided, stating that there was no authority under the
bill to prescribe medication, that the bill did not remove
parents from the broader behavioral health system, and that it
provided a narrow opportunity for intervention.
4:19:33 PM
LANCE JOHNSON, Chief Operating Officer, Alaska Behavioral Health
Association, gave invited testimony on HB 232. He highlighted
that HB 232 was not primarily about access to mental health care
in schools and pointed out 1,000 emergency room visits for
suicide attempts by children between the age of 11 and 14 and
between the ages of 15 to 19 between the years 2021 and 2024.
To further illustrate his point, he stated a situation within
his organization of cases where a 9-year-old, an 11-year-old,
and a 12-year-old committed suicide within the same year. He
also cited a personal experience in which a 16-year-old
attempted to reach out to him, but due to difficulties in
obtaining parental consent, this individual attempted suicide.
He said that the cost of waiting for mental health care could
cost a child their life and explained that children seeking such
services might never be able to receive parental consent. This
could especially be the case if, according to Mr. Johnson, the
parent is a source of abuse in that child's life and because of
the continued stigma associated with seeking mental health care.
He stated that while outcomes improve for patients with parental
involvement, the bill was aimed at situations where "families
choose not to participate." He said that pro-bono services
could be paid for by community health grants and pointed to
Minnesota and New Mexico as evidence of youth suicide declining
since the introduction of youth mental health consent laws. He
suggested a language change to the proposed legislation lines 29
and 31 and highlighted the need for treatment in mental health
related substance use disorders, prefer adding language to
included substance abuse treatment under the state plan and
Medicaid 1115 waiver services. Mr. Johnson stated that doing so
would give students under the age of 16 access to substance
abuse treatment services. This is because such services are
usually offered under the Medicaid 1115 wavier services system.
To the same end, he also suggested changing the language in the
bill where "mental health provider" is mentioned to instead read
"mental health and/or substance use disorder provider". He
cited that in his own professional experience; cases of suicide
are often assisted with various controlled substances. Chief
Operating Officer Johnson continually stated his support for
both offering more service through the bill and lowering the age
of consent within the bill stating that "youth today are exposed
to so much more at a younger age."
4:28:46 PM
REPRESENTATIVE FIELDS suggested a technical language change to
the proposed legislation and asked how the term "medical" should
be applied throughout Alaska Statutes concerning mental health
treatment.
MR. JOHNSON explained that the term "medical" was not very well
defined in Alaska Statutes and said that the word would need to
be clarified, but that a more complete definition would include
mental health and substance use disorder care.
4:30:39 PM
REPRESENTATIVE PRAX asked if a child seeking mental health
services would be able to obtain them in a youth shelter. He
further asked if a parent refusing to give consent for mental
health care would be reported to the Office of Child Services
(OCS), citing mandatory reporting requirements.
MR. JOHNSON answered that youth shelters are one such point of
access. He said that there have been cases reported to OCS
particularly in "non-response" cases, but there were a lot of
nuances to be measured in the possible reporting of a parent to
OCS. He also stated that passage of the bill would reduce the
chances of OCS's services being used, as it would provide other
channels for family conflict resolution.
4:35:37 PM
REPRESENTATIVE GRAY returned to Representative Field's technical
question regarding the word "medical" and explained that the
word's application in the context of HB 232 would simply outline
how the word may be applied, not the definition of it.
4:36:50 PM
REPRESENTATIVE SCHWANKE asked Mr. Johnson to explain how the
service of a suicide hotline might differ from the services
offered by a mental health care office.
MR. JOHNSON explained that people on the help line or "988" are
trained professionals, just like folks in mental health care
facilities, but folks in those facilities would be able to
provide more specialized, personalized care. However, in cases
where there may be something more to [a person's expressed
mental state], Mr. Johnson stated that these professionals would
do referrals to local agencies, which he noted is common.
4:38:20 PM
REPRESENTATIVE MEARS shared that one of the goals of her
membership on the House Health and Social Services Standing
Committee was to "address problems upstream" and asked how poor
mental health could influence substance misuse.
MR. JOHNSON said that the potential for substance misuse in a
youth experiencing poor mental health was great. He also cited
that current statutes give minors consent for the diagnosis and
treatment of both pregnancy and venereal disease, thus he
supports expanding such consent authority to mental health and
substance abuse care.
4:42:23 PM
HEATHER IRELAND, Executive Director, Anchorage School Based
Health Centers, gave invited testimony on HB 232. She said, "If
you want to make a difference in adolescent mental health, you
would pass this bill." She spoke to the work, vision, and
mission of Anchorage School Based Health Centers since its
founding in 2010. While her organization screens for a wide
variety of health risks, Ms. Ireland stated that the
organization has seen an increase in the number of students who
exhibit signs of depression and behavioral health challenges.
This observation, according to Ms. Ireland, is acknowledged by
schools themselves. She spoke to the willingness of youth in
Alaska to seek mental health care treatment, so long as they
would not have to share their medical needs with their parents,
a figure she states is about twenty five percent. Ms. Ireland
attributes this to the stigma that parents have associated with
mental illness treatment, which the younger generation has
"moved past." She cited the example of Colorado, which lowered
the age of consent for mental health treatment from age 16 to
12, the result of which was "like a lightning bolt." She said
that the three states that have the lowest youth suicide rates
have the age of consent required to receive mental health care
at an age lower than 16, whereas the three states that have the
highest rates of youth suicide - Alaska included - have the age
of consent at age 18. She also cited a 2018 study out of
Minnesota to support school-based mental health clinics, which
found that such programs reduced self-reported suicide by
fifteen percent. She pointed to grants as an option for the
funding of care and services that would be allowed under HB 232.
4:48:02 PM
REPRESENTATIVE PRAX asked Ms. Ireland at what point she would
report a parent to OCS for not allowing their child to receive
mental health care.
MS. IRELAND said that her answer would have to be on a case-by-
case basis. In her experience, much of her work is related to
physical exams required for participation in high school sports.
This, Ms. Ireland admitted, could have a self-selecting effect
for "higher functioning" students interested in school
activities, rather than more severely depressed students who,
"aren't engaged in their learning." She added, "Those are often
times kids who aren't in school as much because it's hard for
them to get there." Most likely, Ms. Ireland stated that a
self-harm or more suicidal student would receive priority in the
OCS reporting process.
4:50:24 PM
BELLA GUNTHER-CHAVEZ, Student, South Anchorage High School, gave
invited testimony on HB 232. She emphasized student support for
HB 232 and spoke to the limited mental healthcare services
available in her high school. To illustrate her point, she
stated that at her high school, there were only school
counselors, with basic training in therapy and whose primary
jobs are to help students with their class scheduling. Yet
according to Ms. Gunther-Chavez, students often arrive at their
counselor's office in the middle of a mental health crisis,
further drawing on their own personal experience. She detailed
the numerous impacts of a parent denying their child consent to
receive mental health care and said, "At the end of the day,
only the person who is struggling knows." To further illustrate
her point, she told a story of a friend who "seemed perfectly
fine." She continued as follows:
She was socially engaged and involved in school and
extracurriculars. However, she was secretly struggling
with her mental health, and no one knew. Tragically,
she attempted to take her life. Thankfully, she is
still with us today. Shortly after her attempt,
doctors diagnosed her with a major depressive
disorder; a neurological brain disorder that impacted
her mood, changing the status of her mental health.
MS. GUNTHER-CHAVEZ said while teens ideally share their mental
health challenges with their parents, many parents brush off
such concerns, leading to worse outcomes for students. Ms.
Gunther-Chavez argued that HB 232 would empower students to make
their own health decisions, stating, "Teens can be their best
advocates if we let them." She shared her vow to honor people
who had lost their lives to poor mental health and thanked the
committee members for their consideration of the proposed
legislation.
4:53:32 PM
REPRESENTATIVE GRAY thanked Ms. Gunther-Chavez for her testimony
and congratulated her on doing a great job.
4:54:17 PM
PAIGE BROWN, Staff, Senator Cathy Giessel, Alaska State
Legislature, as an invited testifier, read sectional analysis
[included in the committee file] for HB 232, which read as
follows [original punctuation included].
Section 1. Amends AS 25.20.025: Examination and
Treatment of Minors. This section adds youth who
provide documentation demonstrating they are an
unaccompanied homeless minor to the list of minors who
can consent to medical treatment.
This section would add behavioral and mental health
services to the list of services an unaccompanied
homeless minor, a minor living apart from their
parents or legal guardian, and a minor who is the
parent of a child, are able to consent to.
Section 2. Adds new subsections to AS. 25.20.025:
Examination and Treatment of Minors.
This section adds new subsections relating to
documentation required by homeless unaccompanied
minors for the purposes of giving consent.
The documentation must state that the minor is:
1. 16 years of age or older
2. Does not have a fixed, regular, adequate nighttime
residence; and
3. Is not in the care and physical custody of a parent
or guardian, And the document must be signed by:
1. A director or designee of a director of a
governmental or nonprofit entity that receives funds
to provide assistance to those who are homeless;
2. A local educational agency liaison for homeless
youth, a local educational agency foster care point of
contact, or a licensed clinical social worker employed
by a school in the state;
3. An attorney that represents the minor; or
4. The minor and 2 adults with actual knowledge of the
minor's situation.
Section 3. Adds a new section to AS. 25.20: Parent and
Child.
This section would give a minor aged 16 years or older
the ability to consent to receive five 90-minute
sessions of outpatient behavioral or mental health
appointments, without obtaining the consent of the
minor's parent or guardian. A mental health provider
may not prescribe medication without consent of the
parent or guardian. After the fifth appointment, a
provider may continue to provide services to the minor
if:
1. Attempting to get consent from the minor's parent
of guardian would be detrimental to the minor's well-
being by:
a. The behavioral or mental health services are
related to allegations of neglect, sexual abuse, or
mental or physical abuse by the minor's parent or
guardian; or
b. The provider finds that requiring the consent of
the minor's parent or guardian would cause the minor
to reject services, failing to provide services would
be detrimental to the minor's well-being, the minor
sought services knowingly and willingly, and the minor
has the maturity to productively participate in
services.
2. The provider determines that contacting the parent
or guardian would not be detrimental to the minor's
well-being, the provider has informed the minor that
parental consent is required to continue services, the
provider has made at least two unsuccessful attempts
to contact the minor's parent or guardian by mail,
email, or phone, and the mental health provider has
the written consent of the minor.
If a provider continues treatment due to the belief
that obtaining consent from the minor's parent or
guardian would be detrimental to the minor's well-
being, the mental or behavioral health provider may
continue services with documentation of the
determination in the patient's clinical record,
written consent from the minor, and evaluations every
60 days about if the minor's well-being is continually
in question until either the provider discontinues
services, or the minor turns 18 years of age.
If a mental health provider has decided to continue
services due to the belief that obtaining the parent
or guardians consent would be detrimental to the
minor's wellbeing, they may not contact the minor's
parents or guardian without written consent from the
minor. A provider may not disclose the information to
the parent or guardian if the minor chooses to
discontinue services after being informed that they
must obtain parental consent after 5 sessions. A
provider may deny a minor's parent or guardian access
to any part of the minor's clinical record if the
provider has compelling reasons to deny the parent or
guardian access.
A parent or guardian is relieved of any financial
obligation to pay for services consented to by this
new section.
Nothing in this new section can be taken as an excuse
to remove liability or the person performing
examination or treatment for failure to meet typical
standards of care in the state.
Section 4. Amends AS. 47.10.084(c): Legal custody,
guardianship, and residual parental rights and
responsibilities.
This section adds the new section from section 3 to
the list of exceptions of a parent's residual rights
and responsibilities.
Section 5. Amends AS. 47.12.150(c): Legal custody,
guardianship, and residual parental rights and
responsibilities.
This section adds the new section from section 3 to
the list of exceptions of a parent's residual rights
and responsibilities.
Section 6. Effective date.
This section provides for an effective date of January
1, 2026.
4:59:11 PM
CHAIR MINA thanked the invited testifiers.
[HB 232 was held over.]