Legislature(2021 - 2022)DAVIS 106
03/17/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 172 | TELECONFERENCED | |
| += | HB 292 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 172-MENTAL HEALTH FACILITIES & MEDS
3:15:11 PM
CO-CHAIR ZULKOSKY announced that the only order of business
would be HOUSE BILL NO. 172, "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." [Before the committee was CSHB 172(JUD).]
3:15:28 PM
CO-CHAIR ZULKOSKY opened public testimony on CSHB 172(JUD).
3:15:48 PM
BRENDA STANFILL, Executive Director, Alaska Network on Domestic
Violence and Sexual Assault (ANDVSA), stated that ANDVSA has
looked at the mandatory arrest statutes around domestic violence
and the alternatives to arrest. She expressed the understanding
that [perpetrators of domestic violence] with underlying mental
health issues would not benefit from being taken to jail after
an assault. She stated that, for the record, ANDVSA is working
with the administration "making sure we have the right
guardrails when it comes to victim notification." She expressed
concern that when [a perpetrator of domestic violence] is not
taken to jail but taken to a mental health crisis center, the
victim would need to receive adequate notification before the
individual in the crisis center is released. She stated that
ANDVSA has no desire to stop the bill from passing, but there
would need to be assurances. She stated that ANDVSA would be
working through regulation, policy, and training with the
Department of Law (DOL) and the Department of Health and Social
Services (DHSS) to make sure the right safety measures would be
in place to protect the victim.
3:18:03 PM
CO-CHAIR SNYDER questioned whether ANDVSA supports the use of
law enforcement to ensure the victims of domestic violence are
notified when the perpetrator is released from a crisis center.
She questioned whether statute or regulation should be used to
ensure this notification.
MS. STANFILL suggested that some small changes to the statute
would need to be made. She stated that the victim would need to
be notified when [the individual in the crisis stabilization
center has been released], and this notification should be
mandatory. She recommended there be a requirement that contact
information for the attending officer and his/her agency be
provided. She expressed the understanding that the legislative
language concerning regulation and policy would need "tightening
up." The changes in the regulatory language would concern the
licensing of the crisis centers. The changes in policy language
would concern the determination of whether an individual should
be transported to the crisis center or to jail. She offered
that this would involve training law enforcement to recognize
who would benefit from the crisis center or who should go to
jail. She concluded that this could all be done through
regulation, policy, and training.
3:20:06 PM
REPRESENTATIVE MCCARTY asked if this referenced the difference
between criminal and noncriminal proceedings. He stated that
when someone commits domestic violence, normally the individual
would go to jail for the crime of assault, by definition. He
questioned what the deciding factor would be when an individual
has mental health issues.
MS. STANFILL explained that frequently these types of cases
involve an adult child, who lives with his/her parents, and has
a behavioral health issue. She provided the example of an adult
child with bipolar disorder, who has gone off his/her medication
and is aggressive. She added that when this individual is
arrested and put in jail, he/she would not be getting the right
help. She suggested that, often times, the aggression would be
directed towards the mother or father, and, under the definition
of domestic violence, this would be a domestic violence crime,
which looks different from domestic violence between spouses,
for example. In the case of an adult child, it may be
beneficial to take him/her to a crisis stabilization center so
medication could be monitored.
MS. STANFILL, in response to a follow-up question, confirmed
that the guidelines in the statute would need to be addressed.
She stated that ANDVSA is working with the language to make sure
the officer and his/her agency, such as dispatch, are notified,
so the abused individual could be informed when the [the
perpetrator of domestic violence] has been released from the
crisis stabilization center.
3:23:31 PM
The committee took an at-ease from 3:23 p.m. to 3:25 p.m.
3:25:57 PM
FAITH MYERS, Affiliate, Mental Health Advocates, advised that an
amendment needs to be added to the legislation to prevent events
such as that which occurred in Alaska 60 years ago, when
legislation had been passed which created multiple private
psychiatric facilities. The facilities had detained, evaluated,
and treated patients. She voiced the opinion that these
facilities had been allowed to "keep secrets" from the public
and the legislature. The secrets had involved patients'
complaints, injuries, and traumatic events. She cautioned that
the same mistake could be made again, unless there is a
requirement that psychiatric facilities receiving state funding
record statistics on the number and types of patient injuries.
This would need to include the cause, the complaint, and the
resolution. She stated that traumatic events include patients
strapped to gurneys, isolated, restrained, and handcuffed during
transportation.
3:28:18 PM
RENEE RAFFERTY, Regional Director of Behavioral Health,
Providence Health and Services, stated that she has worked
closely with many stakeholders over the last three years in an
effort to support the transformation of Alaska's behavioral
health crisis system. She described that it is currently a
fractured system of services, and many individuals are unsure
where to go when in a crisis. These individuals often end up in
the prison system or in a hospital emergency room. She stated
that the proposed legislation would provide a "No wrong door"
approach for anyone experiencing a mental health or substance
abuse crisis. She expressed the opinion that stakeholder
engagement, including emergency medical services (EMS), law
enforcement, and health care providers, is crucial. She offered
her support for the Crisis Now model, which extends the
timeframe for patient stabilization, voluntary and involuntary.
She mentioned that the model has been replicated all over the
nation, and statistics show that individuals treated in this
model stabilize faster. She shared that she has worked in the
mental health field for 30 years and has never experienced this
type of collaborative effort. She listed multiple involved
organizations.
3:32:03 PM
BRENT JOHNSON, representing self, spoke in support of HB 172.
He shared that over the past seven years he has been a law
enforcement officer. He stated that he has had a "front row
seat" to the "explosion" of citizens suffering from mental
health crises. He described the rise in crises as the result of
controlled substance abuse and the lack of mental health
treatment facilities. He stated that he has been involved with
the collaborative process, traveling outside of Alaska to see
the systems in other areas. He said the behavioral health
system in Alaska "is broken," describing it as "a revolving
door" that does not help anyone. He argued that, while put in
the position of attempting to stabilize individuals who need
professional care, valuable first-responder time is taken away.
He stated that crisis stabilization centers would allow a "No
wrong door" approach. He stated that, after seeing
implementation in other states and agencies, he firmly believes
this would be the best path forward.
3:34:07 PM
MICHELLE BAKER, Acting Vice-President, Behavioral Services,
Southcentral Foundation (SCF), testified in support of HB 172.
She shared that the SCF provides services throughout
Southcentral Alaska, serving over 65,000 people. She informed
the committee that SCF plans on opening an adult crisis
stabilization center on the campus of the Alaska Native Medical
Center. Using the Crisis Now model, she said, rather than
relying on the emergency department, individuals would be
treated with trained behavioral health staff in a more
appropriate and therapeutic environment. She indicated that the
Crisis Now model has strong support from behavioral health
providers, law enforcement, and the community. She expressed
the opinion that using the "No wrong door" approach offers
better care for individuals in behavioral health emergencies.
While most individuals come for help voluntarily, she stated
there are a small number who are involuntary. She emphasized
that this small number of individuals would need to be evaluated
promptly and receive care in a crisis stabilization center. She
stated that while SCF is planning for the development of these
programs, the legal framework in HB 172 would be necessary for
successful implementation and operation. She cautioned that if
the legislation does not pass, the program design would be
greatly impacted, and individuals would be referred back to the
emergency rooms, and health care costs and the system would be
affected. She stated that SCF strongly supports the passage of
the legislation to meet the needs of those in crisis by giving
providers, law enforcement, and EMS the flexibility and options
to deliver care. She urged that HB 172 pass in the current
legislative session.
3:36:54 PM
JARED KOSIN, President and CEO, Alaska State Hospital and
Nursing Home Association, stated that the association supports
HB 172. He emphasized and reiterated that the behavioral health
crisis care system is "broken," and hospitals see the effects of
this every day. He stated that, with nowhere else to turn,
Alaskans in behavioral health crises go to emergency rooms
looking for help, which is not the best environment.
Individuals are forced to wait in emergency rooms for days or
weeks for a bed to open in a specialty psychiatric hospital. He
stated that addressing these struggles will take time and
action, and the formal implementation of crisis stabilization
centers would be a critical step for advancing system change.
He thanked all the stakeholders for their work.
3:38:28 PM
JOSH NOLDER, Captain, Anchorage Police Department, shared that
he had the opportunity to travel to Phoenix, Arizona, where he
witnessed the Crisis Now model in action. He stated that the
model and the comprehensive system were impressive. He
suggested that law enforcement was able to focus on crimes, as
opposed to being thrust into the gaps of the mental health
system. He stated that, more importantly, the [Crisis Now
model] shows a higher level of care for citizens, with better
outcomes. He said in Alaska the system is "a revolving door,
where ... too many citizens suffering from mental illness are
back into the community ... and often times back on the streets,
suffering from homelessness."
3:40:15 PM
MARK SIMON, M.D., representing self, shared that he works as an
emergency physician and in addiction treatment. He also shared
that he went to Phoenix to review the Crisis Now model. He
said, "It just makes sense." He stated that there is not a
system for psychiatric care in Alaska, and the proposed
legislation would provide an opportunity to create one. He
reasoned that creating something new would be much easier than
changing an existing system. He referenced three important
pieces of the Crisis Now model: ambiance, results, and focus on
care. He stated that the ambiance in emergency rooms and
hospitals is stark and rigid, and people who are in crisis do
not need this. He stated that for better results some of the
personnel in the Crisis Now model would be peers. Peers with
lived experiences would engage individuals in crisis to help put
them at ease; individuals would less likely escalate and need
medication or restraint. He stated that focus on care would
enable the individuals in crisis to move home as safely as
possible. He stated that in the medical system there is little
time to gather resources. With a lack of information, the
safest option often is to retain individuals in the hospital.
3:42:25 PM
REPRESENTATIVE PRAX confirmed that Dr. Simon works at Fairbanks
Memorial Hospital. He noted that this hospital was not on
DHSS's crisis center list.
DR. SIMON stated that he does not know whether Fairbanks
Memorial Hospital would be active in the program. He explained
that he is not testifying on behalf of the hospital but from a
personal standpoint.
CO-CHAIR ZULKOSKY reminded Representative Prax that locations
for crisis stabilization providers have not yet been identified,
as this would require statutory passage and then approval by
DHSS. She questioned Heather Carpenter on this point.
3:44:24 PM
HEATHER CARPENTER, Healthcare Policy Advisor, Department of
Health and Social Services, in response, stated that the first
step for providers would be voluntary participation through the
Section 1115 Medicaid waiver ("1115 waiver"). She stated that,
as of now, DHSS and the Alaska Mental Health Trust Authority
(AMHTA) have engaged with Fairbanks Memorial Hospital to ensure
its services would work under the model. She stated that the
hospital operates a designated evaluation and treatment center,
but there are other providers in Fairbanks already starting to
provide [Crisis Now] services. She pointed out that a crisis
stabilization center recently opened in downtown Fairbanks, and
a mobile crisis team has started operations. She added that
these services are not being run by the hospital.
3:45:32 PM
KATHLEEN WEDEMEYER, Deputy Director, Citizens Commission on
Human Rights, Alaska and Washington Chapters, shared that the
Citizens Commission on Human Rights is a psychiatric watchdog
group. She expressed the opinion that HB 172 has multiple
issues which need addressing. She pointed out that the 72-hour
timeframe in the Crisis Now model would work only if an
individual was picked up on a Monday or Tuesday, otherwise the
hold period would average closer to five or six days. She
suggested that this would need to be remedied to be a legitimate
72 hours. She referenced that minors are mentioned in the
legislation, but specific protocols have not been worked out
regarding parental notification, provisions for treatment, and
psychotropic medication, particularly in the seven-day facility.
She added that a parent or guardian would be more familiar with
the adolescent's history of trauma, behavioral health triggers,
and adverse reactions to drugs. She added that there needs to
be protection for minors, as well as parents and guardians, on
the process and notifications specific to this legislation. She
stated that the push for an increase in involuntary treatment is
completely opposite to advances in human rights. She cited that
a noncoercive approach has been outlined in a report by the
World Health Organization on community mental health services.
MS. WEDEMEYER stated that the proposed legislation lacks
accountability and oversight from legislators and system
managers. She said all facilities should be required to report
actual hold times to DHSS and the legislature. She continued
that, instead of focusing on system utilization, the legislation
should focus on health outcomes and tracking. She argued that
the increased use of involuntary commitment facilities
represents focus on the system and not on individual health.
She insisted that the bill has not been designed to address the
"real world needs" of the individuals who are the targets of the
legislation.
MS. WEDEMEYER offered that this version of HB 172 represents an
expansion of the public mental health system, which would
increase the use of forced detention and psychiatric drug
treatments. She argued that, for those admitted to treatment
centers, there should be a requirement for a physical
examination in order to diagnose any symptoms or ailments which
might mimic psychiatric disorders. She offered a quote from the
World Psychiatric Association, which she read:
A fundamental shift within the mental health field is
required, in order to end this current situation. This
means rethinking policies, laws, systems, services,
and practices across the different sectors which
negatively affect people with mental health conditions
and psychosocial disabilities, ensuring that human
rights underpin all actions in the field of mental
health. In the mental health service context
specifically, this means a move towards more balanced,
person-centered, holistic, and recovery-oriented
practices that consider people in the context of their
whole lives, respecting their will and preferences in
treatment, implementing alternatives to coercion, and
promoting people's right to participation and
community inclusion.
MS. WEDEMEYER concluded that individuals experiencing emotional
crises can represent harm to themselves or others; she argued
that the legislature must work out a system to safeguard the
public while working out safeguards for these individuals.
3:50:03 PM
ANN RINGSTAD, Executive Director, National Alliance on Mental
Health (NAMI) Alaska, testified in support of HB 172. She
shared NAMI is the nation's largest grassroots organization.
She cited that mental illness affects more than 1 in 5 adults,
or 50 million people in the nation. She offered that this
translates in Alaska to over 108,000 individuals. She stated
that emergency rooms and jails are not the appropriate "holding
rooms" to assist individuals who need professional evaluation
and treatment. She stated that a crisis response system is
needed which "offers help, not handcuffs." She argued that
crisis stabilization centers offer prompt support and
evaluation. The centers would more easily address an
individual's symptoms, evaluate the needed resources, and move
forward with resolution. She offered NAMI's support to the work
of AMHTA, along with the other collaborative efforts of
stakeholders. She concluded that there is still work to be
done, and the proposed legislation is an important step. She
stated that NAMI supports a future in Alaska where this type of
behavioral health system is in place.
3:52:43 PM
ED MERCER, Chief of Police, Juneau Police Department (JPD),
stated that in real-life situations law enforcement deals daily
with a high percentage of individuals with mental health issues.
He said law enforcement is aware that an individual in a mental
health crisis could commit a crime, and the proposed legislation
would provide an alternative to taking this individual to jail.
If an individual is taken to the hospital, the attending police
officer may be required to wait for hours; ultimately, the
individual could be released back out into the public. He
explained that this creates two issues: the individual is not
getting the assistance he/she needs, and the individual is at
risk of having another contact with law enforcement. He said
the Juneau community has been working with stakeholders to adopt
the Crisis Now model. He added that being able to bring an
individual to a stabilization center for "a cool-off period" and
treatment would be "a good thing." He expressed the opinion
that law enforcement would rather use violent-voluntary
compliance than "forcibly make somebody do something," as the
current system causes a "revolving door." He offered support
for the proposed legislation so the system could move towards
the [Crisis Now] model. He stated this would help law
enforcement deal with an issue that "is not going to go away."
He stated that JPD supports HB 172.
3:55:58 PM
REPRESENTATIVE PRAX questioned the amount of time saved by law
enforcement if the proposed legislation were to pass.
MR. MERCER responded that when an individual is brought to the
hospital, law enforcement could spend four to six hours until a
determination has been made that the individual could leave or
be retained. He stated that if the individual leaves the
hospital, then a mental health follow-up would happen.
MR. MERCER, in response to a follow-up question, explained that
law enforcement deals with this scenario "more often than one
would think." He stated that law enforcement sees some of the
same individuals in mental health crises on a daily basis. Law
enforcement tries to assist, but this could happen two or three
times a week for a single individual. He offered the
understanding that, when an individual is having a mental health
crisis, the "time is now" to try to help them. He stated that,
if an individual is released back into the public, an officer
would most likely be sent back to the residence [to address a
similar issue].
3:58:16 PM
REPRESENTATIVE MCCARTY offered that he was impressed by the
program in Phoenix. He mentioned that because of the
communication mechanism, authorities knew in advance the details
of the person in transport to the crisis center. He added that
the handoff was "very fast." He questioned Mr. Mercer's
impression of the procedure in Phoenix and the model proposed by
the legislation.
MR. MERCER voiced the opinion that the model would expedite law
enforcement's ability to create a rapport with the crisis staff.
He explained that it would be like triage; law enforcement would
arrive at the center, speak with the providers, and hand over
the individual. He stated that in Juneau there is open
communication with [law enforcement], the hospital, and the
Juneau Area Mental Health Initiative (JAMHI). He envisioned
that the legislation would only be "a good thing," giving all
involved more ability to help, and jail would not be the only
option.
4:00:57 PM
SHAYNE LACROIX, Police Commander, Palmer Police Department,
offered his support and the support of the Palmer Police
Department for HB 172. He stated that, as already testified,
there are an inordinate number of calls to law enforcement
concerning individuals who are experiencing a mental health
crisis. He said that the solutions currently available to law
enforcement are not in the best interest of "the public we serve
or the individual in crisis." He shared that he had been in
Phoenix to view the facilities, and the Matanuska-Susitna Valley
is working on a Crisis Now program. He stated that the proposed
legislation would create an opportunity for individuals in
crisis to get care immediately, and potentially long term.
4:02:31 PM
CO-CHAIR ZULKOSKY, after ascertaining there was no one else who
wished to testify, closed public testimony on CSHB 172(JUD).
4:03:12 PM
REPRESENTATIVE PRAX remarked that several testifiers were
skeptical of the legislation. He questioned whether these
testifiers were "in the loop" with the Division of [Behavioral]
Health and other organizations.
4:03:46 PM
MS. CARPENTER invited Steve Williams to join in supplying an
answer to the question. She responded that she and Mr. Williams
have worked closely with shareholders over the last several
years. She stated that the work began when the 1115 waiver was
implemented, before the Crisis Now model had been introduced.
She said DHSS has provided outreach all around the state. She
stated that a "need gap analysis" for the 1115 waiver included
the building blocks for the Crisis Now model.
4:04:51 PM
STEVE WILLIAMS, Chief Executive Officer, Alaska Mental Health
Trust Authority, Department of Revenue, emphasized that the
process of getting to the point of [introducing this
legislation] has been ongoing since 2018. He referenced the
many statewide organizations and individuals that have been a
part of the dialogue. He stated that there has been an effort
to reach out to organizations and individuals to engage those
who can help inform the transformation, so it can be done the
best way possible. He referenced that AMHTA has tried to listen
and work with Ms. Myers and address her concerns. He stated
that Section 26 in the current version of the legislation
represents the Division of Behavioral Health and AMHTA's
demonstrated effort to address concerns in a collaborative way
which would obtain information from various perspectives to
identify potential improvements.
4:06:43 PM
REPRESENTATIVE PRAX voiced his understanding that Ms. Wedemyer
has concerns. He expressed the belief that the legislation
would be an incomplete solution to the entirety of mental health
challenges. He expressed the concern that the focus on
stabilizing people in crisis and returning them to society would
lead to the over reliance on medication, rather than some other
approaches.
MS. CARPENTER responded that Representative Prax made a good
point. She continued that, out of respect, she would have to
"agree to disagree" with [Ms. Wedemyer]. She explained that the
proposed legislation's focus would be on the highest level of
crisis situations, as this is what Title 47 addresses. She
stated that most individuals in Alaska who pursue mental health
care do so voluntarily. If an individual is taking medication,
he/she is doing this under a practitioner's care. She offered
that the proposed legislation would not address or change this;
rather, the legislation proposes to take the current statutory
authority, which would entail short-term crisis medication, and
apply this to stabilizing an immediate crisis - a crisis which
could possibly cause danger to the individual or others. She
stated that medication would be a last resort intervention,
authorized by an attending physician, nurse practitioner, or
physician assistant. She stated that medication would be
administered only when the other alternative is physical
restraint. She stated that providers have had to "do extreme
things," and studies have shown restraint would be far more
traumatic for the patient. She concluded that the ability to
administer medication would offer stabilization centers a last
resort tool.
4:10:05 PM
REPRESENTATIVE MCCARTY expressed excitement concerning the
proposed legislation. He stated that technological advances
would provide better assessment than in the past. He suggested
that some individuals may not be taking their medication and
questioned whether an individual's current medication level
could be verified, for example with lab work. He questioned
whether individual rights would be infringed if the individual
was tested for medication levels.
MS. CARPENTER responded that this is a good question, and she
would need time to supply an answer. She stated that the
proposed legislation would address only crisis medication, and
if an individual has not taken regularly scheduled medication,
he/she could not be forced to do so in an involuntary commitment
situation. She offered that, with patient flow, as individuals
leave [the crisis center], it would be helpful to work with
their regular providers.
REPRESENTATIVE MCCARTY, in follow up, expressed concern that
patients should be taken care of appropriately. He mentioned
the "Thorazine shuffle" and Haldol treatments in the early
1980s. He argued that this would not be "something we want to
go back to." He stated that, at the same time, the pendulum
should not move so far that staff and employees would be in
harm's way because of a patient's [behavioral crisis]. He
stated that there have been situations resulting in workers'
compensation payments or disability. He deduced that to put
staff in a harmful situation would not be fair.
MR. WILLIAMS commented that this is a good point. He stated
that the centers would be staffed with medical professionals,
mental health professionals, and people with lived experience.
He stated that this staff would cover some of the issues
mentioned. He added that medications would also be covered in
the legislation.
4:14:31 PM
REPRESENTATIVE KURKA requested a follow-up question on Ms.
Carpenter's statement concerning percentages of individuals in a
behavioral health crisis who voluntarily seek help. He
questioned the percentage of involuntary commitment patients in
the state's system.
MS. CARPENTER responded that she would work with Nancy Meade of
the Alaska Court System for updated, specific numbers on
nonvoluntary commitment in the state. She offered that Ms.
Meade recently testified in the Senate hearing on the proposed
legislation, and she would have the best numbers on court
filings.
4:15:44 PM
CO-CHAIR SNYDER requested a follow-up question on the topic of
utilizing [crisis] medications as a last resort. She questioned
Ms. Carpenter on an estimate of the frequency of use of "last
resort" medication.
MS. CARPENTER responded that she could not give an immediate
answer. She offered to look into the Alaska statistics but
suggested it may be more helpful to work with AMHTA and other
experts that could supply statistics from the [Criss Now model]
in Phoenix.
4:16:52 PM
REPRESENTATIVE MCCARTY voiced concerns about the suggested
friendly amendments. He stated that he would address those at
another time.
4:17:42 PM
CO-CHAIR ZULKOSKY announced that CSHB 172(JUD) was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 2022 GCDSE Letter of Support, 3.14.22.pdf |
HHSS 3/17/2022 3:00:00 PM |
HB 292 |