Legislature(2001 - 2002)
03/04/2002 01:35 PM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 302-MENTAL HEALTH PROFESSIONALS
SENATOR WILKEN, sponsor of SB 302, explained that the measure
deals with an expansion of mental health providers. He then read
the following sponsor statement.
SB 302 recognizes the growth in the clinical, medical
health profession and broadens the mental health
professional definition to include: 1) a licensed
clinical social worker; 2) a licensed marital and
family therapist; and 3) a licensed professional
counselor. The current Title 47 definition was written
in 1986, prior to the passage of Alaska's licensing
requirements governing these master level mental health
clinicians.
The more inclusive mental health professional
definition increases the capacity of Alaska's mental
health system to protect our youth and adult who are
experiencing acute psychiatric crises in our
communities. Today not enough mental health
professionals are authorized under the current
definition to respond to some critical public safety
situations, particularly in rural Alaska. And yet
there are hundreds of licensed professionals who are
qualified to aid these Alaskans but cannot.
SB 302 recognizes this problem and updates the Title 47
definition. The expanded mental health professional
definition, as stated in SB 302, increases the number
of trained professionals who will be: 1) allowed to
provide mental health treatment for prisoners; 2)
authorized to evaluate children and minors in custody
to determine placement in residential treatment
centers; 3) required to report incidents of harm to
vulnerable adults; and 4) allowed to conduct civil
commitment evaluation.
SENATOR WILKEN referred members to the bill's zero fiscal note
and a chart in members' packets that compares the training
requirements for mental health providers in Alaska. He noted that
members' packets also contain about 12 letters of support. He
offered to answer questions.
CHAIRWOMAN GREEN announced that Senators Davis, Ward, Wilken,
Leman were present.
DR. LEONARD ABEL, manager of the Community Mental Health Services
Program at the Department of Health and Social Services (DHSS),
informed members one of the top priority programs in his unit is
psychiatric emergency services. That is what SB 302 is about, and
its passage is very important. Currently, on any given day,
psychiatric emergency services happen in 32 catchment areas
around the state, delivered by about 140 mental health
professionals. Any time - day or night - a psychiatric emergency
occurs, those professionals go out, assess the individual to
determine the presence or absence of a mental illness, and
whether that illness will endanger self or others. Right now,
there are not enough people who meet the current statutory
definition to deliver that service; only physicians, licensed
psychologists and psychological associates or MSWs with two years
of experience are able to. When that definition was put in place,
there was no social work licensing law. It appears that the
intent at the time was to cover everyone who was practicing.
Now, social workers, marriage and family therapists and
professional counselors are licensed. A client must be sent to a
hospital, if the mental health provider does not fall within the
definition, he or she cannot file an ex parte order, the normal
procedure. As a result, providers must be very creative and
usually rely on 7 AAC 47.705, the order for emergency evaluation,
commonly known as the peace officer's application. They must ask
a VPSO or trooper to assess the client, even though the mental
health provider has a master's degree in their field. The problem
is that to use the emergency evaluation, the situation must be
imminently dangerous. If the VPSO does not see a gun in the
person's hand or a bottle of pills, they will not be shipped out.
The standard is much higher.
DR. ABEL referred to the chart provided by Senator Wilken and
noted that under practice definitions, psychologists,
psychological associates, clinical social workers, marriage and
family therapists and licensed professional counselors can
diagnose and treat. Diagnosis is the essential feature of
emergency services. The definition in AS 47.30.915 pertains
specifically to the commitment process but it is referenced in
other areas of statute, one being under the requirements for
reporting on vulnerable adults. Therefore, marriage and family
therapists and professional counselors are not required to
report. Changing this definition would automatically require them
to report. Also, AS 47.30.915 is referenced in statutes related
to placement of children in juvenile detention facilities. This
bill would allow more professionals to make those assessments.
Finally, the statutes referring to adults in correctional
facilities references the same statute so the definition change
would also affect that group of people. He urged members to pass
the bill.
CHAIRWOMAN GREEN asked Dr. Abel if there is anything about the
legislation that makes him uneasy about authorizing a mental
health provider to do something for which he or she is not
qualified.
DR. ABEL said there is not because they are all qualified to do
essential emergency assessment.
CHAIRWOMAN GREEN asked if there are continuing education
requirements for mental health providers.
DR. ABEL said there are; to the best of his knowledge all
professions must pass a qualifying examination and have
professional references.
CHAIRWOMAN GREEN asked if providers who refer a person on for
emergency treatment are trained adequately and regularly with
continuing education courses.
DR. ABEL said the answer lies somewhere in between. Assessment
for emergency treatment is a standard part of training but it is
not a major part unless it is the provider's specialty area. For
example, all physicians have standard training in surgery but are
not necessarily surgeons.
CHAIRWOMAN GREEN asked if the passage of SB 302 would prompt
additional coursework.
2:01 p.m.
DR. ABEL said the division is looking at ensuring that everyone
will get training and be made familiar with the commitment
process. The division does that on an ongoing basis anyway but
if the bill passes, it would make another effort.
SENATOR LEMAN said that according to the chart no professional
references are required for family and marital therapists, while
they are for all other providers. He asked if that was an
oversight.
DR. ABEL said it was an oversight that was taken care of in the
licensing regulations.
SENATOR LEMAN said he is aware of another situation in which a
requirement was put in regulation that required something without
statutory authority. He asked if someone could refuse to provide
references because they are not required by statute.
DR. ABEL said he was not sure he could answer that question.
SENATOR LEMAN said if it is true, that could be fixed in this
piece of legislation, especially if it is not controversial.
CHAIRWOMAN GREEN took public testimony.
MS. SUZANNE PRICE, Fairbanks Community Mental Health Center, said
she has been involved in the mental health field for almost 30
years, and in Alaska since 1986. In 1986, almost every mental
health center had a licensed psychologist, and sometimes two.
She cannot think of one mental health center today that is
operated by or with a licensed psychologist. Most workers are
Masters level MSWs, marital and family therapists, and
professional counselors. She is one of a few psychological
associates. The changing patterns of who is working in the field
have been enormous over the last 15 years. Fifteen years ago, all
case managers had Masters level degrees; now they have bachelors
degrees while supervisors have masters level degrees. As the
profession evolves and changes and the licensing requirements
change, the statues and regulations need to change. She is
finding it very difficult to provide enough services with the
available manpower.
MS. SHARON BULLOCK, clinical director of the Fairbanks Community
Mental Health Center, agreed that the mental health field has
changed over the last 15 years. SB 302 would allow a wider range
of people to do emergency assessments. However, a community
mental health center often employs people fresh out of college
with a masters degree therefore 24-months is a bit long to wait
before that person can perform that duty. All employees are
under the supervision of a licensed clinical employee anyway. She
supports SB 302 but hopes the 24-month requirement can be changed
to 12 months. Her center has a difficult time retaining employees
because by the time they get the two years in, they move on.
MR. WAYNE MCCOLLUM, community support program director for the
Fairbanks Community Mental Health Center, expressed concern about
the licensed staff shortage problem in Alaska. He said that
trying to recruit clinicians for the Bush is very difficult
because the wages are not very competitive so they end up with
people without the kinds of degrees needed to meet the existing
regulations.
MS. DIANE WEBER, director of the Yukon-Koyukuk Mental Health in
Galena, which represents six villages off of the road system and
in very rural areas, voiced support for SB 302. The bill is
important to her region because under the current statute, her
clinic is required to have a clinician with a Ph.D. or a MSW to
do an emergency commitment and there are none in her region. That
means that civil commitment is nearly impossible. In addition,
the health center is unable to use police officers to do
commitments. There are no police officers in her only area and
only two troopers cover a region the size of Israel. The troopers
are too busy with other duties. An additional problem is that
people need a psychological evaluation before her center can
access the Division of Mental Health's transfer system to
transport them to a hospital. She agreed it is very difficult to
get a mental health professional with a master's degree to take a
job in the Bush, let alone one who is licensed. She said the
process of supervision for licensing is thorough and requires
authorization by a licensing board. Her final point was that
assessment for lethality for suicide is not a terribly complex
procedure and anyone with a master's degree in a mental health
field is capable of doing that. Passing SB 302 will help to save
lives.
2:13 p.m.
MS. ANNE HENRY, Division of Mental Health and Developmental
Disabilities, explained that in answer to a question by Senator
Leman, the requirement for references for psychologists and
psychological associates is also in regulation rather than
statute. She said the error on the chart was on oversight on her
part but noted that placing that requirement in regulation is not
unusual.
SENATOR LEMAN said in that case, the committee probably does not
need to make any changes.
CHAIRWOMAN GREEN suggested waiting for the sunset legislation for
those professions to put the requirement in statute.
MS. HENRY then said, regarding the request to reduce the time of
experience from 24 to 12 months, the 24 month requirement is in
current statute as it defines what significant experience is in
the field of mental illness for social workers who are allowed to
do this work.
CHAIRWOMAN GREEN asked, "So, I mean, we're sort of bound by the
current statute to leave it - consistent with here?"
MS. HENRY said if the committee chooses to reduce the time of
experience to 12 months, the division would be comfortable with
that change as it would open up access to a few more folks to do
this work.
SENATOR WILKEN said he would look into whether or not to reduce
the time of experience to 12 months and bring it up to the next
committee.
SENATOR LEMAN moved SB 302 from committee with individual
recommendations and its accompanying zero fiscal note. There
being no objection, the motion carried.
| Document Name | Date/Time | Subjects |
|---|