Legislature(2021 - 2022)BUTROVICH 205
04/27/2022 01:30 PM Senate JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB124 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 124 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 124-MENTAL HEALTH FACILITIES & MEDS
1:49:40 PM
CHAIR HOLLAND reconvened the meeting and 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."
[CSSB 124(HSS) was before the committee.]
CHAIR HOLLAND noted that he did not have an opportunity to thank
Mr. Larson, but he wanted to do so publicly.
1:50:33 PM
HEATHER CARPENTER, Health Care Policy Advisor, Office of the
Commissioner, Department of Health and Social Services, Juneau,
Alaska, stated that the department is carrying this bill in
conjunction with the Alaska Mental Health Trust Authority.
1:51:09 PM
STEVE WILLIAMS, Chief Executive Officer, Alaska Mental Health
Trust Authority, Anchorage, Alaska, co-provided a PowerPoint on
Crisis Now. He reviewed 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
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 explained that the way the state currently responds
to Alaskans in mental health or behavioral health crisis is
broken. The state uses law enforcement and other first
responders to address the crisis in need. The tools to access
the treatment to the highest level of service they require are
often costly. The state does not have anything in the middle to
fill out that continuum. SB 123 intends to address that middle
section so the state is not reliant on limited access to
designated evaluation treatment facilities.
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
1:51:59 PM
MS. CARPENTER stated that the department has Designated
Evaluation and Treatment facilities (DETs), which are facilities
designated by the department to serve an individual experiencing
an acute psychiatric crisis who needs an inpatient level of
care, either involuntary commitment and or voluntary care.
Currently, DET facilities are only in four communities: Juneau
Bartlett Regional Hospital with 12 beds, Fairbanks Memorial
Hospital with 20 beds, Mat-Su Regional Medical Center with 16
beds, and Anchorage Psychiatric Institute (API). When space is
unavailable at DETs, these individuals must wait in an emergency
room. However, emergency rooms are not designed to serve someone
in a psychiatric emergency because they can be overstimulating.
Suppose someone is being held there before being transported.
Medical care providers must put them on a one-to-one observation
and remove things from the room to avoid injuries. It is not a
therapeutic environment.
MS. CARPENTER turned to the graphics on slide 3, GOAL: Design
and implement a behavioral health crisis response system
analogous to the physical health system. The top graphic depicts
a physical health emergency, showing a person in crisis, 9-1-1,
ambulance/fire, emergency department, and inpatient unit. The
Behavioral Health Emergency on the low section of the slide
shows the sequences of a person in crisis, including the crisis
call center, mobile crisis team, and 23-hour stabilization
center.
1:53:43 PM
MR. WILLIAMS added comments about slide 3. He stated that this
slide illustrated what is meant by "No Wrong Door." This bill
allows for the full implementation of the model by creating
locations for facilities where services can be provided for
voluntary or involuntary status during a behavioral health
crisis. He emphasized that it enhances the options for law
enforcement by allowing them to take someone directly to a
location where the appropriate mental health professionals can
meet their needs. When fully implemented in communities, they
will have options to have a 23-hour stabilization center and a
short-term residential center to treat someone for up to seven
days. SB 124 is a path forward since mobile crisis teams respond
instead of law enforcement or emergency medical personnel. It is
an intentionally-designed system that the department and AMHTA
had reviewed in other states, spending the last couple of years
working with other states to examine and understand their models
and translate them to Alaska.
1:55:19 PM
MS. CARPENTER reviewed slide 4, Stakeholder Engagement. She
related that over the last six years, the department has been
working very intentionally to improve the system of care. It has
been done hand-in-hand with the Trust and its many stakeholders.
One key item was in 2016 when the legislature passed Senate Bill
74, a comprehensive Medicaid reform bill. While it had metrics
to improve access and contain costs, one key provision was the
requirement for the department to apply for a Section 1115
waiver from the Centers for Medicare and Medicaid Services to
redesign Alaska's behavioral health system. The 1115 waiver
requests the federal government waive the standard rules to
allow the state to try new programs and systems. It must be
cost-neutral to the federal government. She stated that the goal
of using the 1115 waiver was to have more treatment options,
including Crisis Stabilization Centers and Crisis Residential
Centers in all nine regions of the behavioral health waiver. She
pointed out that 23 new lines of services in the Medicaid
program use that waiver.
MS. CARPENTER stated that the department and Trust also are
working to establish a "No Wrong Door" system. Most people who
need mental health treatment in Alaska are seen voluntarily. The
state needs a robust and improved Crisis Psychiatric Response
System for those in a crisis who cannot ask for that help. She
said that system must be able to respond quickly so law
enforcement and first responders can benefit.
1:56:59 PM
MR. WILLIAMS briefly reviewed slide 4, GOAL: Design and
implement a behavioral health crisis response system analogous
to the physical health system. The top of slide 4 illustrates
what Ms. Carpenter spoke about earlier. If someone collapses in
the grocery store, a bystander can pick up their phone and dial
9-1-1, knowing that someone will answer the call, initiate the
appropriate response, and emergency personnel will respond.
MR. WILLIAMS reiterated that the bottom of the slide shows the
Behavioral Health Emergency System that is analogous to the
physical health emergency system. He said Arizona, Georgia, and
other states currently operate this system. The Substance Abuse
Mental Health Services Administration (SAMHSA), the National
Alliance on Mental Illness (NAMI), the National Action Alliance
on Suicide Prevention (Action Alliance), and the National
Association of State Mental Health Program Directors support
this system. He characterized it as a well-understood model
considered a model of excellence.
1:58:17 PM
MR. WILLIAMS reviewed slide 6, Stakeholder Engagement. He
described the opportunity of the broken system, the lawsuit that
followed in 2018 filed by the Public Defender Agency and the
Disability Law Center. Although they viewed it as the time to
change the system, it was not something the Alaska Mental Health
Trust Authority (AMHTA) or the department could do
independently. It includes state agencies, including the
Department of Public Safety (DPS), the Department of Corrections
(DOC), beneficiary advocates and nonprofits, Alaska State
Hospital and Nursing Home Association (ASHNHA), the Alaska
Behavioral Health Association, the Alaska Mental Health Board,
tribal organizations, and local governments. Over 100
organizations have been engaged in this effort, representing
over 300 participants helping guide and intentionally design
this system. The AMHTA and the department continue to hold work
groups, primarily in Fairbanks, Anchorage, the Mat-Su Valley,
and Bartlett Hospital, although Bartlett is more on point for
that effort.
1:59:48 PM
MS. CARPENTER reviewed slide 7, Enhanced Psychiatric Crisis
Continuum of Care. She directed attention to the suite of
services in the center of the slide. She noted that community-
based services and inpatient care would continue to be offered.
She highlighted that the mobile crisis team, 23-hour
stabilization, and short-term stabilization are billable in the
Medicaid program via the 1115 waiver.
2:00:37 PM
MR. WILLIAMS reviewed slide 8 Crisis Stabilization Center (23
hour). He said this slide provides a little more detail on
stabilization.
• 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
MR. WILLIAMS stated that ideally, members of a mobile crisis
team would bring someone to this location, but law enforcement
could also bring someone to the center. The Crisis Stabilization
Center would operate 24/7, 365 days per year. Staff would
include medical professionals, mental health professionals, and
people who have gone through a behavioral health crisis, engaged
in treatment, and are on a path to recovery. Those who have gone
through the program can assure the patient that the center will
meet their needs.
2:01:48 PM
MR. WILLIAMS reviewed slide 9, Short-Term Crisis Residential
Stabilization Center
• 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 during the first
23 hour period, allowing up to seven days, rather than being
sent to DETs like API. It is recovery oriented and designed to
accept voluntary and involuntary patients. Again, these crisis
centers services are provided by medical professionals, mental
health professionals, peers, and individuals with mental health
crisis experience.
2:02:33 PM
MR. WILLIAMS reviewed slide 10, Enhanced crisis response would
reduce the number of people entering the most restrictive levels
of care. This slide provides a snapshot of the review of 10
years of data from Georgia.
MR. WILLIAMS stated that for every 100 calls received, the
crisis call center resolved 90 of them by phone. A dispatched
mobile crisis team consisting of a peer and a mental health
professional resolved 7 of the 10 remaining cases through
assessment, de-escalation, and referrals to support services.
The remaining three individuals were transported to a 23-hour
stabilization center, where 1 out of the initial 100 was
admitted for short-term care. No law enforcement or emergency
medical services intervention was needed. The remaining three
individuals were taken to a 23-hour crisis stabilization center
where the medical, mental health professionals, and a peer met.
Two of the three cases were resolved in less than 24 hours. The
final person was taken to the higher level of care, where their
situation was resolved.
MR. WILLIAMS noted that having a full continuum of care can
resolve the situation without the default response of law
enforcement or taking someone to a DET or API.
2:04:46 PM
MS. CARPENTER turned to slide 11, Alaska Statute Title 47.
Collaborative Approach to Transforming our Response to
Alaskans in a Behavioral Health Crisis SB124 Mental
Health Facilities & Meds
2:04:57 PM
MS. CARPENTER provided a brief history, stating that in 2016 the
legislature passed Medicaid reform. The Trust subsequently
worked with the department to identify the Crisis Now model as
the path forward to further the 1115 waivers. The team pulled
together communities and stakeholders to look at this first-
hand. The Trust has sponsored trips to Arizona for policymakers
and law enforcement to walk through their facilities. In
addition, the department settled the lawsuit with the Public
Defenders and Disability Law Centers that was filed in 2018.
Individuals who had committed no crime were waiting at
correctional facilities because there was no room at API or
another DET to treat their psychiatric crisis. As part of that
settlement, the department had to put forward statutory fixes
that would allow an evaluation to occur at other places besides
the highest level of care. That effort led to the development of
SB 124.
2:06:07 PM
MS. CARPENTER turned to slide 12, Key Takeaways.
SB 124 Does:
Create a "no wrong door" approach to providing medical care to a
person in psychiatric crisis
• Provide law enforcement with additional tools to protect
public safety
• Expand the number of facilities that can conduct a 72-hour
evaluation
• Add a new, less restrictive level of care
• Facilitate a faster and more appropriate response to a
crisis, expand the types of first responders that can
transport an individual in crisis to an appropriate crisis
facility
SB124 Does Not:
• Interfere with an officer's authority or ability to make an
arrest
• Change who has the current statutory authority to
administer crisis medication
• Change current statutory authority for who can order an
involuntary commitment
• Reduce the individual rights of the adult or juvenile in
crisis; the parents' rights of care for their child; or
existing due process rights of the individual in crisis
MS. CARPENTER elaborated on slide 12. She said it is a win for
patients, hospitals, emergency rooms, and law enforcement. The
bill would provide less restrictive care options for a person
suffering from a mental health crisis. It frees up medical
resources and beds for patients. It gives police officers
broader options for handling someone suffering from a mental
health crisis, including the Mobile Crisis Team response. This
bill does not interfere with an officer's authority or ability
to arrest because the officer has the discretion to make those
decisions. It doesn't change the current statutory authority for
who can administer crisis prescriptions, which is a physician,
physician's assistant, or an advanced nurse practitioner. It
does not change the current statutory authority for the person
who can order an involuntary commitment.
2:07:35 PM
MR. WILLIAMS reviewed slide 13, Current Flow for Involuntary
Commitment, which consisted of a graphic flowchart of the
current system. He focused on the bottom left corner, which read
"Hospital ED, Jail, Secure Facility." This provides the current
initial response today for someone in crisis, whether that is
the level of response they need or not. Instead, it means
someone doesn't seem safe, so this is where they are taken
because these are the only tools available today.
2:08:22 PM
MR. WILLIAMS turned to slide 14, Flow for Involuntary Commitment
with Statutory Changes. He highlighted the bottom left-hand
corner, which now has several additional tools to build out the
continuum of care. Although law enforcement and emergency
medical services (EMS) are still represented, it would add a
Mobile Crisis Team would and a Crisis Stabilization Center (23-
hour) to API and hospital emergency rooms. He emphasized that
the Mobile Crisis Team would access the lower levels of care
needed rather than using the current default response. This
would relieve law enforcement from responding to people with a
behavioral health crisis and allow them to handle traditional
law enforcement activities, such as protecting public safety and
investigating crimes. This model only moves the patient up to
higher levels of care after professionals have assessed the
individual and determined that the next level of care is
necessary.
2:09:42 PM
MS. CARPENTER paraphrased slide 15, SB 124 Committee Substitute
Highlights (for Version I)
Key Improvements
1) Adds new language for a "health officer", newly
defined in Section 28
2) Changes length of stay from up to 5 days to up to
7 days at a Short-term Crisis Residential Center
3) Adds provisions for protecting patient rights
• 72 hrs. clock for an ex-parte hearing starts when
a person (respondent) is delivered to a Crisis
Stabilization or Crisis Residential Center;
• Attorney is appointed for the respondent;
• Court shall notify the respondent's guardian, if any
• Computation for seven-days at a Short-term Crisis
Residential Center includes time the respondent
was receiving care at a Crisis Stabilization
Center, if applicable
4) Adds a new section (Sec. 32) directing the
Department of Health & Social Services and the Alaska
Mental Health Trust Authority to submit a report and
recommendations to the Legislature regarding patient
rights.
• Patient grievance and appeal policies
• Data collection on patient grievances, appeals
and the resolution
• Patient reports of harm, restraint and the
resolution
• Requirements that could improve patient
outcomes and enhance patient rights
MS. CARPENTER elaborated that the court must notify the
respondent's guardian because the court has the state's only
complete list of guardians, including public and private
guardians. Section 32 was added based on feedback from
stakeholders who wanted the bill to look at some things,
including patient grievances and appeals and data collection on
reports of harm or restraint. The department thought it would be
best to do this comprehensively. It requested one year to bring
together a broad group of stakeholders to examine and make
recommendations on statutory changes and how to develop and
place the data on Dashboard. The group included individuals with
lived experiences, patient advocates, the Disability Law Center,
the ombudsman, Alaska Mental Health Board, and psychiatric care
providers to examine and make recommendations on statutory
changes and how to develop and place the data on Dashboard.
2:12:10 PM
MS. CARPENTER paraphrased slide 16, SB 124 Committee Substitute
Highlights (ver. 1).
Key Improvements Continued
5) Adds requirement that notifications in the alternative
to arrest statutes also go to the peace officer's employing
agency to ensure victim notification will happen even if
the arresting officer is off duty. (Sections 4, 6, and 10)
6) Addresses statutes found unconstitutional by the Alaska
Court System to align with the court rulings.
• Amends the definition of "gravely disabled" in AS
47.30.915(9)(Section 26)
• Clarifies standards for court to order
administration of noncrisis medication (Sections 22
& 23)
7) Adds sections that requires further notification of
parents, guardians and other family members when a patient
is admitted. (Sections 11 &13)
MS. CARPENTER stated that domestic violence advocates requested
item 5. Mr. Jim Gottstein, Psychiatric Rights, requested
Sections 22 and 23. The previous committee added sections that
require further notification of parents, guardians, and other
family members when a facility admits a patient.
2:14:09 PM
SENATOR KIEHL directed attention to slide 10. He asked for a
sense of the scope of mental health crisis calls and
hospitalizations in Alaska.
CHAIR HOLLAND wondered about the percentage of 911 calls that
the Behavioral Health Emergency process could divert.
2:15:09 PM
MR. WILLIAMS answered that in 2018 the Department of Health and
Social Services (DHSS) and the Alaska Mental Health Trust
Authority (AMHTA) began examining how to redesign the system.
The Trust contracted with RI International, a group that
operates a similar model in Arizona, which assessed the call
volume and need in Anchorage, Fairbanks, and the Mat-Su Valley.
MR. WILLIAMS stated that the department and the Trust considered
how to build out the system in those communities based on their
assessment. He agreed that 100 crisis calls do not necessitate
admission for 100 people to a 23-hour Crisis Stabilization
Center or API. He pointed out that slide 10 was intended to
illustrate the current high volume of crisis calls that could be
resolved via the telephone. He indicated that he does not have
those figures. He added that Alaska has a Careline for those in
crisis [1-877-266-4357].
2:16:42 PM
MS. CARPENTER offered to provide statistics for Fairbanks Mobile
Crisis Teams, which operate quite successfully, surpassing the
national average.
2:17:03 PM
SENATOR MYERS asked whether the Trust and department were trying
to create a dedicated number similar to 911.
MR. WILLIAMS answered no; the intention was to use the existing
number and not create a new number. He described the way the
model works in other states. If someone calls 911, the
dispatcher will go through their triage. If the dispatcher
determines that the person is having a behavioral health crisis,
they will do a warm transfer to mental health professionals who
will respond to them by phone. The reverse can also happen, such
that if a person calls the crisis line and the dispatcher
recognizes that this is a public safety issue, they will
transfer the call to 911.
2:18:08 PM
SENATOR MYERS directed attention to slide 7. He offered his view
that this looks like a good model. He expressed concern about
how this process would operate in smaller communities without a
mobile crisis team. He related his understanding that Fairbanks
would not have a 23-hour stabilization center anytime soon. He
further asked at what point patients would be transported from
their home communities to hubs, such as Fairbanks or Anchorage.
MS. CARPENTER answered that the 1115 waiver would initiate the
new services in each state region. She acknowledged that all
rural villages would not have a 23-hour Stabilization Center or
a short-term Crisis Stabilization Center, but a hub community
such as Kotzebue could add one. The only option to treat someone
having a mental health crisis is to transport them to Anchorage
or Fairbanks. Under the new model, the patient would be closer
to home, where the family could have more access. The person
could be stabilized by the tribal behavioral health provider and
receive community outpatient care when they go home. She stated
that the department and the Trust built in flexibility when they
developed the statutes to provide a statewide solution. If a
community only has a short-term Crisis Stabilization Center, the
patient initially will not need to go to a 23-hour Crisis
Stabilization Center. She highlighted the goal is to work with
communities and avoid overbuilding services because the provider
needs to be financially solvent and not require the state to
subsidize the program with general fund dollars. She stated the
goal was to stabilize an individual, if possible, at home via
the call line or by providing services close to home. If this
can be accomplished, it will reduce the number of people that
need to be transported to city hubs, saving state dollars.
Currently, if someone in crisis is not stable enough to travel
on commercial airlines, the department must charter a plane to
the rural location to bring them to Anchorage or Fairbanks.
2:21:26 PM
MR. WILLIAMS added that it is important to recognize that this
sets up the framework for communities, but it does not mandate
that communities establish these centers. In terms of demand,
Fairbanks may not need all of these facilities currently, but if
the population were to increase, the structure and framework
would be in place to meet community members' needs
2:22:16 PM
SENATOR HUGHES commented that she heard the bill in the Senate
Health and Social Services Committee. The committee considered
seven amendments that brought up concepts, but the amendments
had unresolved issues. She indicated some SHSS members asked her
to revisit the issues in SJUD. She expressed her interest in
reconsidering those amendments at some point.
SENATOR HUGHES asked whether anything in SB 124 would expand the
power or authority or broaden the scope related to involuntary
commitment, such as someone appearing at the person's door
telling them they are being involuntarily committed. She noted
that the rumor is that SB 124 could expand the power for someone
with political disagreements or religious differences to be
involuntarily committed and given psychotropic drugs against
their will.
2:24:28 PM
MS. CARPENTER answered no. She directed attention to the new
language in Section 12, which would require a peace officer to
have probable cause. She read:
(a) A peace officer who has probable cause to believe
that a person is gravely disabled or is suffering from
mental illness and is likely to cause serious harm to
self or others of such immediate nature that
considerations of safety do not allow initiation of
involuntary commitment procedures set out in AS
47.30.700, may cause the person to be taken into
custody ....
MS. CARPENTER explain that when a mental health professional has
a person delivered to a facility, they must meet the criteria.
The court would review if the person can be held. If a mental
health professional were to lie on the application and the
person doesn't meet the criteria, they would be subject to a
felony conviction and risk their professional licensure.
SENATOR HUGHES wondered if Mr. Williams had anything to add.
2:25:48 PM
MR. WILLIAMS answered no.
2:25:53 PM
SENATOR HUGHES related her understanding that passing SB 124
would make things less restrictive and provides greater patient
protections against involuntary commitment. She reiterated
rumors about the bill were that it would make it easier to
commit someone involuntarily. Instead, it's more important than
ever to have the bill pass. She encouraged anyone with questions
to contact members because this bill is an improvement over the
existing statute.
2:27:18 PM
CHAIR HOLLAND clarified that besides a peace officer, the
portion of Section 12 Ms. Carpenter read also includes a health
officer, mental health professional, or physician assistant
licensed by the State Medical Board to practice in this state.
He acknowledged that some might see that as an expansion of
persons who can make involuntary commitment decisions since the
only person empowered to make those decisions previously were
peace officers. He wondered whether a peace officer was the best
person to make those decisions. He offered his view that it is
an improvement to include the health care professionals. He
asked whether the health officer would typically be a mobile
crisis team member.
MS. CARPENTER agreed. She stated that the bill also would change
the definition of a peace officer to align with other statutes.
She indicated that the definition in Section 27 would have the
meaning given in AS 01.10.060(a). She directed attention to the
deleted terms in Section 27 in the new definition of health
officer, which was a creative method to make a new term that
made sense. In addition, an emergency medical technician,
paramedic, or firefighter was added to the mobile crisis team.
She said the other deleted terms all fell under the definition
of mental health professionals. She noted that a physician's
assistant was also added to the definition.
2:29:34 PM
SENATOR KIEHL highlighted that the legislature balances
protecting public safety and people's rights to the greatest
extent possible. He referred to slide 14. He would like to
understand the treatment flow better when someone is in crisis.
He wondered whether any of the steps could be skipped. He
related a scenario where someone had a break from reality and
became violent. He asked whether that person would need to go
through the 23-hour intervention first or could a court order be
issued to provide more serious treatment to protect public
safety.
MS. CARPENTER answered yes. She referred to Section 14, which
sets up the statutory requirements for using crisis
stabilization centers or crisis residential centers. Section 15
relates to the current hospitalization track. The bill does not
remove any tools, so if the situation warrants it and it's not
appropriate to go to the first two centers, it's possible to
petition the court directly for the hospital track. Meanwhile,
the crisis stabilization center would offer better care
initially than waiting in a hospital emergency room. It still
allows the professionals to make the best decisions for the
patient.
CHAIR HOLLAND turned to invited testimony.
2:33:12 PM
JAMES COCKRELL, Commissioner, Department of Public Safety,
Anchorage, Alaska, offered his view that SB 124 would
significantly improve the state's response to anyone
experiencing a mental health crisis. He stated that on a
personal level, he had a family member who spent 81 days in
prison and was in and out of emergency rooms. All of the calls
were directed to law enforcement to handle. Not only did it not
help his family member, but it put the person in the system.
However, it did not address the problem.
2:35:24 PM
SENATOR HUGHES asked what officers currently encounter because
the behavioral crisis model is not yet established.
MR. COCKRELL said that since statehood, Alaska has expected
local law enforcement or the Alaska State Troopers to respond to
mental health crises. Even with police training, police officers
do not have the tools to do so and are not mental health
experts. He offered his view that the situation could be handled
much differently with the system proposed in SB 124. He
estimated that approximately 75 percent of the instances of
mental health crises are not law enforcement related. He said it
is personally important to him and the department. The Alaska
State Troopers and the Department of Public Safety support SB
124.
2:37:31 PM
SENATOR HUGHES related her understanding that he was speaking
about the autistic boy who was pepper-sprayed. She said he told
three different encounters. She recalled an incident where a
minor or young adult was taken to Mat-Su Regional Medical
Center, but due to COVID-19, the person was held for five days
and could not see their family, which was not the appropriate
care. She heard anecdotally that a trooper drove around all day
with a person experiencing a mental health crisis because there
was no place to take them.
2:38:39 PM
COMMISSIONER COCKRELL agreed that troopers sometimes must take
mentally ill people into custody late in the evenings, trying to
find the appropriate place for the person to obtain treatment.
He related that the Mat-Su Regional Medical Center increased its
beds from 2 to 16, which is a massive help for the department
and the people needing mental health services. The Central
Peninsula Hospital only has two beds. The troopers typically
will take someone experiencing a mental health crisis to a
hospital, and the person waits in the emergency room for up to
two hours for a psychological evaluation. Currently, Alaska
State Troopers' policy is to handcuff anyone put in a patrol car
for their safety and to have control over them when they exit
the vehicle. However, he opined that is not the right approach
to take for those experiencing a mental health crisis.
COMMISSIONER COCKRELL recalled his first experience transporting
an 18- year-old woman from the Kenai Peninsula to API. She had
threatened suicide and was very frightened from that experience.
Those images have haunted him for over 40 years. He offered his
belief that the state should be a leader in mental health
issues, and it has an opportunity to do so.
2:41:44 PM
MARK REGAN, Legal Director, Disability Law Center, Anchorage,
Alaska, spoke in support of SB 124 because the rights of people
in crisis are protected under the bill.
MR. REGAN, in response to Senator Hughes' question on the
standards and methods used to bring someone in for involuntary
treatment or to evaluate them for civil commitment, stated that
the standard in current law would apply. A police officer or
anyone else must have probable cause that the person is likely
to harm themselves or others or that the person is gravely
disabled. SB 124 did not change this language.
MR. REGAN stated that the bill also protects the rights of
people at a crisis residential center or a crisis stabilization
center if the person in charge wants to hold the person for
longer. In those instances, the person in charge must go to a
magistrate or judge to request an ex parte order, which requires
appointing the public defender agency or another attorney to
represent them. This means the person will have an attorney at
the beginning of the process with an opportunity to have a
hearing within 72 hours if the crisis residential center
believes the problem will be resolved or stabilized within seven
days. Thus, the person will be able to present their case at the
hearing.
2:44:57 PM
MR. REGAN opined that the bill poses no greater risk for those
who want their rights protected or for people who do not wish to
be brought into the system involuntarily, which is part of the
civil commitment system for evaluation.
MR. REGAN provided background information. In 2018, the
overstressed evaluation system, particularly at API, collapsed.
At that point, API indicated that people would need to be held
in jail or hospital emergency rooms, awaiting their civil
commitment evaluations, which led to a lawsuit. At the same
time, the Trust and the state were working on a Crisis Now
proposal to provide therapeutic treatment rather than to place
people in crisis in a hospital emergency room or jail. The
settlement to the lawsuit was that a Crisis Now system would
partially replace the system with one that was easier on people
in crisis. He said he hoped that the bill would lead to an
improvement for people in crisis.
2:47:25 PM
HELEN ADAMS, Emergency Medical Physician, Alaska Chapter of
ACEP, Anchorage, Alaska, provided invited testimony in support
of SB 124. She stated that she is an emergency room physician
and she also serves on the board of the Alaska Chapter of the
American College of Emergency Physicians and the Alaska
Psychiatric Institute (API) Board.
DR. ADAMS suggested that this bill would be transformative for
Alaskans. She provided her perspective as the physician who
signs the paperwork for involuntary commitment. Thus, she makes
the determination whether someone is an immediate threat to
themselves or to others. She agreed that this bill would not
expand the provisions for involuntary commitment. The current
form designates peace officers, police officers, or physicians
as the ones to make the determination. This bill would broaden
that list to include physician assistants.
DR. ADAMS offered her view that mental health providers and the
crisis stabilization center are valuable to Alaskans because
health care providers are more specifically trained to determine
when this provision should be used. The opportunities to create
a hold are not changing under the bill. However, the bill would
change who can make involuntary commitment decisions.
DR. ADAMS said she means no disrespect to police officers who
must make decisions under incredibly stressful conditions, such
as when a person is undergoing a mental health crisis on a
bridge. Other times, the situation is more nuanced, such as when
an officer is in someone's home where angry people are yelling.
It may not be clear which people are in crisis. Further, people
are involuntarily committed sometimes because they displayed
inappropriate behavior when a police officer's presence
triggered a trauma response. However, once the patient is alone
with a mental health clinician trained to deescalate the
situation, sometimes the person can be treated, released, and
use outpatient resources. She characterized the bill as
transformative for everyone.
DR. ADAMS described her experience working a shift at a facility
with 52 beds, with 18 patients being held voluntarily or
involuntarily in emergency room beds awaiting placement. At the
same time, 19 people with medical ailments waited 2-4 hours to
be seen. She opined that the state needs a 23-hour stabilization
center, which might lead to a seven day or longer treatment. She
viewed SB 124 as an improvement.
2:52:03 PM
SENATOR HUGHES wondered if a person's medical condition could
worsen in the waiting room.
DR. ADAMS agreed. She stated that holding people with mental
health disorders in the emergency room (ER) awaiting beds harms
them. She explained that proper mental health treatment provides
soothing and restorative treatment. Patients receive group
therapy and therapeutic activities with an occupational
therapist. However, the ER is devoid of those resources. She
explained that those mental health patients awaiting placement
are in uncomfortable clothing, in rooms stripped of all wires
and tools they might use to harm themselves. A stranger sits on
a stool outside a glass door, watching their every movement.
They have zero privacy or natural light. A physician and mental
health clinician must check them once a day. She characterized
this as putting mental health patients in solitary confinement
while awaiting placement, which is harmful. These practices
should be used as short-term solutions to keep people safe from
their self-harming attempts until they can be placed in a proper
clinical environment.
DR. ADAMS agreed that patients with appendicitis could rupture
because doctors do not have beds available to perform
examinations. Further, many mental health patients sit in police
vehicles in hospital parking lots awaiting treatment for hours.
These patients have no criminal history but need help. She had
checked on people with a mental health condition in cuffs,
somewhat hogtied, to ensure that the cuffs did not hamper their
circulation. Once these patients are under the hospital's care,
medical staff must check these patients within an hour of being
placed in restraints. Thus, this bill could transform the
system.
2:55:34 PM
SENATOR KIEHL remarked that her comments comport with what he
has heard in the Juneau community. He asked about an emergency
room physician's ability to assess whether someone needs to go
to a 23-hour facility, a 7-day facility, or for a longer
commitment. He asked how confident she was about the resources
an emergency room had to make those determinations.
DR. ADAMS offered her view that as this process rolls out, it
will result in more innovative treatment. Some communities will
be more equipped than others. Each facility will need to create
its triage process and make decisions on a case-by-case basis.
She stated that acutely violent, dangerous, patients would
likely be cared for at larger hospitals with more security
staff. She predicted that those patients would probably be
sedated. Anyone who has harmed themselves by ingesting
substances and is very intoxicated or drugged poses a threat to
society. These patients must be managed at the highest security
facilities, such as Mat-Su, Alaska Regional or Providence
hospitals, with sufficient capabilities to care for their
medical and psychiatric needs. She anticipated that patients
would deescalate faster because medical professionals could meet
them at their level with a peer and mental health professional.
She predicted that patients and staff would be safer. She
suggested that people might be surprised that historically
violent patients react differently in peer-appropriate settings.
Those patients may use the 23-hour and 7-day resources better
than anticipated. She stated that medical personnel at the new
facilities would know when they could not handle someone and
needed transfer the person having a crisis to the higher level
of facilities such as hospitals.
2:58:55 PM
SENATOR KIEHL stated that she addressed that fewer individuals
displaying violent behavior will be in emergency rooms under the
bill.
DR. ADAMS agreed.
2:59:54 PM
ANN RINGSTAD, Executive Director, NAMI Alaska, Fairbanks,
Alaska, provided invited testimony in support of SB 124. She
read prepared remarks.
[Original punctuation provided.]
Thank you for giving us an opportunity to provide
testimony in support of SB 124, regarding crisis
residential centers and crisis stabilization centers.
NAMI Alaska is part of the National Alliance on Mental
Illness, the nation's largest grassroots mental health
organization dedicated to building better lives for
the millions of Americans affected by mental illness.
Mental illness affects more than 1 in 5 adults (50
million people) in the U.S. In Alaska, which
translates to over 108,000 individuals more than
three times the population of Juneau!
We know first-hand how those with mental health
challenges can struggle with an inadequate system of
care, especially those who are experiencing a
behavioral health crisis.
She stated he is providing testimony for Dr. Shirley
Holloway, the president of NAMI national, and vice
president of NAMI Alaska because I think it
demonstrates the importance of this legislation. in
her previous testimony on HB 172 to the house Finance
Committee a few weeks back Doctor Holloway shared the
story of her daughter Kathleen's long journey with
mental illness and why she became involved with NAMI.
3:01:21 PM
MS. RINGSTAD continued to read prepared remarks.
[Original punctuation provided.]
Kathleen's last contact with her mother was when she
called her during a mental health crisis. Shirley was
out of state at the time and she immediately sprang
into action, calling her physicians, therapists,
neurologists anyone she could think of to provide
support. All who responded said they could maybe see
her in two weeks or maybe just take her to the ER and
they could deal with it. Four hours into her calls for
help, Shirley with boarding and plane to Anchorage to
get to Kathleen. She called the Anchorage police and
ask for their assistance. By the time they located
her, it was too late.
I agree with the ER physician who just testified. I
can personally vouch that emergency rooms are not the
appropriate 'holding rooms' to assist those
individuals who need professional evaluation and
treatment in an expedient fashion. ERs deal with
medical emergencies, not behavioral health
emergencies. I also agree with Steve William's
assessment of the current system is broken. If there
was a crisis response system in place 10 years ago,
Shirley story might have had a different outcome.
Subacute mental health facilities, including crisis
residential centers and crisis stabilization centers
are a proven care alternative offering prompt support
and evaluation to assist with the real issues of why
the individual was brought there in the first place,
evaluating what resources they may require, and taking
steps to help resolve their mental health challenges.
This "No wrong doorapproach to providing care to a
person in a psychiatric crisis will facilitate a
faster and more appropriate response to a behavioral
health crisis.
3:03:04 PM
We need to reimagine our crisis response system to one
that offers help, not handcuffs.
This legislation will ensure people get appropriate
care swiftly keep them out of jails, and emergency
rooms, and minimize the impact on first responders.
We support the work of the Alaska Mental Health Trust
Authority and the collaborative efforts of multiple
stakeholders including emergency service responders,
hospitals and health care providers, the Department of
Health and Social Services, Public Safety,
Corrections, and Law, and Trust beneficiaries
throughout the state who are a part of making the
Crisis Now initiative work in their communities.
There is still much work to be done, and this
legislation is an important step in the continuum of
care for mental health. I will also add that we
support the requirements to provide a report to the
legislature for one year mark of passage of this
legislation to assess the outcomes of the legislation
and provide recommendations to strengthen and improve
patient outcomes. With the identification of
recommended changes to state statutes, regulations,
and requirements.
We look forward to a future where this type of
behavioral health system is in place throughout
Alaska.
We strongly support SB 124 and ask you to support this
important legislation to provide a critical piece to
the Crisis Now continuum of care. Thank you, Mr.
Chairman for allowing me us to testify.
3:05:08 PM
CHAIR HOLLAND held SB 124 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Richard Ole Larson Resume_Redacted.pdf |
SJUD 4/27/2022 1:30:00 PM |
|
| Richard Ole Larson Board Application_Redacted.pdf |
SJUD 4/27/2022 1:30:00 PM |
|
| SB 124 DPS Juvenile Custody 3.17.22_.pdf |
SHSS 3/17/2022 1:30:00 PM SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 - Explanation of Changes Ver. I.pdf |
SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 - Sectional Anaylsis Ver. I.pdf |
SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 - Infographics - Proposed Statutory Changes to Title 47 3.6.22.pdf |
SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 - Letters of Support.pdf |
SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 Definitions in AS 47.30.915.pdf |
SHSS 3/8/2022 1:30:00 PM SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 Transmittal Letter.pdf |
SFIN 5/12/2022 1:00:00 PM SHSS 4/27/2021 1:30:00 PM SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 SJUD Amendment #1 (I.3).pdf |
SJUD 4/27/2022 1:30:00 PM SJUD 5/2/2022 1:30:00 PM SJUD 5/4/2022 1:30:00 PM |
SB 124 |
| SB 124 SJUD Amendment #2 (I.4).pdf |
SJUD 4/27/2022 1:30:00 PM SJUD 5/2/2022 1:30:00 PM SJUD 5/4/2022 1:30:00 PM |
SB 124 |
| SB 124 SJUD Amendment #3 (I.5).pdf |
SJUD 4/27/2022 1:30:00 PM SJUD 5/2/2022 1:30:00 PM SJUD 5/4/2022 1:30:00 PM |
SB 124 |
| SB 124 - Letter of Support - ANHB_4.6.2022.pdf |
SJUD 4/27/2022 1:30:00 PM |
HB 4 SB 124 |
| SB 124 - SJUD Presentation 4.27.2022.pdf |
SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 - SJUD Committee - Follow up 4.27.2022.pdf |
SJUD 4/27/2022 1:30:00 PM |
SB 124 |