Legislature(2021 - 2022)ADAMS 519
04/13/2022 09:00 AM House FINANCE
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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 | |
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
April 13, 2022
9:01 a.m.
9:01:29 AM
CALL TO ORDER
Co-Chair Merrick called the House Finance Committee meeting
to order at 9:01 a.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Kelly Merrick, Co-Chair
Representative Dan Ortiz, Vice-Chair
Representative Ben Carpenter
Representative Bryce Edgmon
Representative DeLena Johnson
Representative Andy Josephson
Representative Bart LeBon
Representative Sara Rasmussen (via teleconference)
Representative Steve Thompson (via teleconference)
Representative Adam Wool
MEMBERS ABSENT
None
ALSO PRESENT
Heather Carpenter, Health Care Policy Advisor, Office of
the Commissioner, Department of Health and Social Services;
Steve Williams, Chief Executive Officer, Alaska Mental
Health Trust Authority.
PRESENT VIA TELECONFERENCE
Steven Bookman, Senior Assistant Attorney General,
Department of Law; James Cockrell, Commissioner, Department
of Public Safety; Mark Regan, Legal Director, Disability
Law Center; Shirley Holloway, National President and Alaska
Vice President, National Alliance on Mental Illness; Dr.
Helen Adams, Alaska Chapter, American College of Emergency
Physicians.
SUMMARY
HB 172 MENTAL HEALTH FACILITIES & MEDS
HB 172 was HEARD and HELD in committee for
further consideration.
Co-Chair Merrick reviewed the agenda for the meeting.
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."
9:02:07 AM
HEATHER CARPENTER, HEALTH CARE POLICY ADVISOR, OFFICE OF
THE COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
introduced herself.
STEVE WILLIAMS, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL
HEALTH TRUST AUTHORITY, provided a PowerPoint presentation
titled "Transforming a Behavioral Health Crisis System of
Care: HB 172 Mental Health Facilities and Meds," dated
April 13, 2022 (copy on file). He thanked members for
hearing HB 172 to address the psychiatric crisis in Alaska.
Mr. Williams began the presentation on slide 2 to discuss
why change was needed. He explained that the Alaska Mental
Health Trust Authority (AMHTA) had been looking at a
variety of systems that would help bring about change,
including working with community stakeholders, members of
law enforcement, and patient advocates.
Ms. Carpenter continued to address the need for change on
slide 2. She indicated that currently, Alaskans in crisis
were primarily served by law enforcement, emergency rooms,
and other restrictive environments. Some communities in the
state had Designated Evaluation and Treatment (DET) centers
which were facilities designated by the Department of
Health and Social Services (DHSS) to serve individuals
experiencing an acute psychiatric crisis and need of an in-
patient level of care. The DET centers could serve patients
that needed involuntary commitment under the Title 47
statutes but the centers could also serve voluntary
patients. The DET centers only had capacity in Juneau,
Fairbanks, the Matanuska-Susitna Valley, and Anchorage.
Co-Chair Merrick indicated Representative Thompson had
joined the meeting online and Representative Wool had
joined the meeting in person.
9:04:49 AM
Mr. Williams continued to slide 3: "HB 172 is a Path
Forward." He explained that HB 172 would facilitate a
transformation of the behavioral health system of care. He
summarized the slide as follows:
HB172 will:
1) Effectuate a "No Wrong Door" approach to
stabilization services
2) Enhance options for law enforcement and first
responders to efficiently connect Alaskans in crisis
to the appropriate level of crisis care
3) Support more services designed to stabilize
individuals who are experiencing a mental health
crisis
- 23-hour crisis stabilization centers
- Short-term crisis residential centers
4) Protect patient rights
Co-Chair Merrick indicated the committee had been joined by
Representative Edgmon.
Representative Wool recalled a horrendous recent incident
in the state in which an 11-year-old was threated to be
held involuntarily, pepper sprayed, and handcuffed. He
asked if the situation would fall under the bill.
Mr. Williams agreed that it was a tragic situation.
Representative Wool added that the parents were in the room
with the child at the time of the incident.
Mr. Williams indicated that he was aware of the
circumstances. He thought it was an excellent example of
the way in which the system was broken. If the
comprehensive system proposed by HB 172 was in place at the
time of the indecent, the school and law enforcement would
have had different tools and there may have been a
different outcome.
Representative Wool asked if the option for involuntary
commitment would apply to 11-year-olds.
Ms. Carpenter responded that it did apply to minors, though
there were different protections for minors, and parents
had certain protections as well. The facility types
proposed in the bill could serve youth patients and some
were specifically designed to serve youth patients.
9:08:01 AM
Ms. Carpenter reviewed the building blocks of psychiatric
crisis system reform on slide 4. She indicated DHSS had
been working to improve its system of care over the last
six years. The work had been done in tandem with AMHTA and
input from stakeholders. Some of the changes that had been
made were listed on the slide as follows:
1) SB74 Medicaid Reform (2016)
- Improve Access, quality, outcomes, and contain
costs
2) 1115 Behavioral Health Waiver
- Targets resources and services to "super
utilizers"
- Provides flexibility in community behavioral
health services and supports
- Creates new crisis service types that promote
interventions in the appropriate settings and at
the appropriate levels
3) System must be intentionally designed and promote a
"no wrong door" philosophy
9:09:58 AM
Mr. Williams turned to slide 5 and indicated that the goal
of the legislation was to design and implement a behavioral
health crisis response system analogous to the physical
health system. The trust wanted to follow the model on the
slide and make it possible for a person in crisis to call a
crisis call center and be transferred to a mental health
professional who could respond to and ideally deescalate
the situation on the phone. If the situation could not be
deescalated on the phone, there would be available
resources other than the default law enforcement response,
such as a mobile crisis team. The model on the lower part
of the slide depicting the process by which a behavioral
health emergency should be addressed was used nationally.
He indicated several entities supported the model and
significant research had been done with the model.
Representative Carpenter asked if a situation involving
substance abuse would be considered a physical or mental
health crisis. He wondered how a responder would determine
which response was needed.
Mr. Williams replied that the dispatcher on the phone would
assess the situation and dispatch the appropriate response.
The department did not want law enforcement to make the
determination in mental health or substance abuse
situations.
Representative Carpenter asked that if law enforcement was
not doing the assessment, who would be doing the assessment
and how would it apply to drug related emergencies. An
officer might not be able to distinguish between a mental
health issue and another issue.
Mr. Williams responded that if an officer in the field
noticed that an individual required medical attention, the
officer would take the individual to the hospital. However,
if an officer were to take an individual to the hospital,
it would not be a quick turnaround as it involved
substantial paperwork. If the department were to use a "no
wrong door" approach, law enforcement could take a person
to the 23-hour crisis stabilization center and put them in
the care of mental health professionals if the officer
thought a person was having a mental health crisis.
Co-Chair Merrick thought Commissioner Jim Cockrell from the
Department of Public Safety was online.
Co-Chair Merrick indicated Representative Rasmussen had
joined the meeting online.
Representative Josephson asked if the crisis call center
was the 9-8-8 number.
Mr. Williams explained that the state was working towards
implementing the number.
Representative Josephson asked if a person was in crisis
due to an overdose and it was a repeat problem, would law
enforcement have access to the information given to
dispatch at 9-8-8.
9:17:24 AM
Ms. Carpenter responded that she would have to confer with
the legal department because there might be issues with
potential HIPAA violations.
Representative Wool supported the legislation. He thought
that the confluence of mental health crises and law
enforcement had been an issue. He offered an example of a
constituent who had a child with mental health issues that
had committed a crime. It was a tug-of-war between
determining whether a situation was criminal or a
behavioral health issue. He wondered if the bill helped to
clarify such a situation.
Ms. Carpenter responded that the first ten sections of the
Committee Substitute (CS) for the bill made conforming
edits to the alternative to arrests statutes under HB 290
in 2020, which was eventually folded into SB 120. The past
bill allowed for peace officers to determine whether a
crime could be diverted into treatment in mental health
crisis situations. She viewed HB 172 as a necessary "part
two" to SB 120 to ensure that involuntary commitment
statutes reflected the full continuum. It would ensure that
a person brought to a 23-hour crisis center could not
simply leave once the officer that brought them to the
center left. Currently, the state could only serve the
person in a voluntary way. An individual could only be
diverted with a prosecutor's sign-off under HB 272.
Representative Wool commented that the converse of the
situation would be if a police officer decided an incident
was a crime and brought a person to jail. He wondered at
what point it could be determined that the situation was
behavioral health related rather than criminal. He asked if
it was as easy to undo as a situation in which a person
wrongfully ended up in a crisis center.
Ms. Carpenter would have to consult the criminal side of
the Department of Law for more information. There was a
robust option of therapeutic courts in the state that had
been successful at ensuring treatment through restorative
justice.
9:21:51 AM
Vice-Chair Ortiz noted that the bill referenced there being
limited space in DET centers. He wondered if there were any
23-hour crisis stabilization centers in operation in the
state.
Ms. Carpenter replied that there were providers that had
started to develop services through the 1115 behavioral
health waiver. The services would look different in
different communities.
9:23:16 AM
Mr. Williams discussed stakeholder engagement on slide 6.
The slide was an illustration of the diverse stakeholder
involvement and collaboration that had been occurring over
the past several years in order to transform the mental
health system. There had been over 100 organizations that
had engaged in collaboration.
Ms. Carpenter reviewed slide 7 which showed the enhanced
psychiatric crisis continuum of care. It explained where
the new suite of services would fit between the current
community-based services. She noted that mobile crisis
teams, 23-hour stabilization, and short-term stabilization
were all services billable to Medicaid.
Representative LeBon asked Ms. Carpenter to provide a short
explanation of a 1115 waiver.
Ms. Carpenter explained that an 1115 waiver allowed the
state to waive the normal rules and test out a new suite of
services for a five-year period of time. Many states had
1115 waivers for years and the time frame did not
necessarily mean the project would not be renewed. The
rules could be waived as long as it was cost neutral to the
federal government.
9:26:36 AM
Co-Chair Merrick asked how many years the state was into
the five-year period.
Ms. Carpenter responded that the state was in year four but
clarified that the federal government had split the state's
waiver to fast-track the substance use disorder waiver
first.
9:27:03 AM
Mr. Williams advanced to slide 8 and offered a high-level
overview of what care looked like at a 23-hour crisis
stabilization center. The bill created a no wrong door
approach and allowed an organization to provide services to
both voluntary and involuntary patients. He summarized from
the slide as follows:
• No wrong door - walk-in, referral, and first responder
drop off
• Staffed 24/7, 365 with a multi-disciplinary team
• High engagement/Recovery oriented (Peer Support)
• Immediate assessment and stabilization to avoid higher
levels of care where possible
• Safe and secure
• Coordination with community-based services
Co-Chair Merrick asked if the peer support individuals were
voluntary positions or paid positions.
Mr. Williams replied that they were paid positions.
Representative Josephson asked whether a court order would
be needed should the holding time exceed 23 hours.
Ms. Carpenter replied that it was 23 hours and 59 minutes
because anything over 24 hours was considered in-patient
care. It was a billing mechanism to avoid billing for more
expensive services.
Representative Josephson thought there might be a need for
additional magistrates.
Ms. Carpenter replied that there was a small fiscal note
that would be addressed later in the meeting. The fiscal
note was to reflect the addition of new clerk positions,
not magistrates.
9:30:18 AM
Mr. Williams advanced to slide 9 to discuss the details of
the short-term crisis residential stabilization center. The
slide depicted the next level of care above the 23-hour
center and would allow a person to receive care for up to
seven days. Rather than automatically taking someone to the
highest-level care facility first, it allowed a crisis team
to intervene earlier to prevent future problems.
Mr. Williams turned to slide 10 and reported that the
enhanced crisis response would reduce the number of people
entering the most restrictive levels of care. The slide
showed an infographic of over ten years of crisis call data
analysis in the state of Georgia. For every 100 calls to
the crisis hotline in Georgia, 90 of the calls were
resolved over the phone. A mobile crisis team was
dispatched to the location of the remaining ten callers,
and the team resolved seven of the ten calls. Two of the
remaining three situations were resolved at the center.
That left only one individual who was admitted to a short-
term stabilization center. He noted that Alaska had mobile
crisis teams operating in Fairbanks and Anchorage. The team
in Fairbanks had been operating around the clock since
November of 2021 and had a resolution rate of 88 percent,
which was above Georgia's resolution rate.
9:33:28 AM
Representative Johnson asked if the crisis calls were
coming through 9-1-1.
Mr. Williams replied that in other states that had the plan
fully implemented, the calls went through a "care traffic
control center." If a call went through 9-1-1 and dispatch
determined that it was a mental health related issue and
did not require a public safety response, the call would be
transferred to a mental health professional. In Fairbanks,
dispatch and the care center were working together to
dispatch the mobile crisis team through 9-1-1. The goal was
to ensure that calls could be transferred either direction
depending on whether the situation was determined to be of
a mental or physical health concern.
9:34:56 AM
Representative Johnson wanted to better understand the
statistics on slide 10. She asked whether the 100 crisis
calls listed had already been transferred.
Mr. Williams reminded the committee that the example on the
slide related to the system in place in Georgia. He thought
that the 100 calls had already gone through the crisis
center rather than to 9-1-1.
Representative Johnson thought 10 percent of crisis calls
needing a crisis dispatch team seemed high.
Mr. Williams responded that the 10 percent meant that 90
percent of the 100 calls were resolved over the phone.
Representative Johnson had worked answering a crisis line.
She did not think dispatching a crisis team happened
frequently.
9:36:56 AM
Representative Josephson had the opposite thought as
Representative Johnson. He did not understand how 90
percent of the calls could be resolved without dispatching
help.
Mr. Williams responded that many of the calls were
situations in which a person simply needed someone to talk
to. The ability to connect with someone helped to resolve
many crises.
Representative Wool thought that it was difficult to
determine whether a situation was behavioral health related
or if the Alaska State Troopers needed to be called. He
offered an example of a suicidal individual who had a gun
that could be arrested for "waving a gun around." He
understood that it was a mental health situation but that
others might want the person arrested due to the
irresponsible handling of the weapon. He asked what was
done at such a confluence.
9:39:31 AM
Mr. Williams explained that what Representative Wool had
described was the current system in Alaska with the
exception of Fairbanks and Anchorage. He relayed that if a
call came in, the troopers would be dispatched and that
there was no other option.
Ms. Carpenter added that the bill would help fill the gaps
of the situation described by Representative Wool. If a
mobile crisis team responded in the situation, the team
would see there was a need for law enforcement due to the
weapon and safety concerns. Under the bill, the individual
in crisis could get transferred to a crisis center and get
the treatment they needed.
Mr. Williams explained that communities were currently
relying on law enforcement and psychiatric treatment in all
situations, and potentially criminal justice if it was
deemed necessary.
9:41:07 AM
Representative Josephson asked if someone with a behavioral
health issue was waving a weapon around, would it be
considered a felony if other people were present in the
room. She thought that constituents would be very angry if
the individual was diverted to a crisis center, but the
incident happened again three months later and resulted in
violence. She asked for comments.
Ms. Carpenter indicated Commissioner Cockrell was online.
The situation described by Representative Josephson was the
reason why the Department of Corrections was the largest
provider of mental health services in the state. The goal
was to provide early treatment to individuals to prevent
dangerous situations from happening.
Representative Josephson commented that success was reliant
on the early treatment working and being appropriately
funded.
9:43:36 AM
Representative Johnson suggested that at some point, public
safety would need to reenter the situation.
Mr. Williams responded that was already happening in
Fairbanks. If a situation was beyond the skillset of a
mobile crisis team, the team could always bring in the
appropriate first responder to provide support.
9:44:39 AM
Ms. Carpenter reviewed Title 47 on slide 11. She wanted to
provide additional context on the work DHSS and AMHTA had
done through close work with stakeholders. A cross section
of individuals went on a sponsored trip in 2019 to Phoenix,
Arizona to look at the behavioral health model in action.
The model was built off the 1115 waiver to improve the
system of care. In 2018, the department was sued by the
Disability Law Center because people on a Title 47
involuntary commitment hold were waiting in jails and other
correctional facilities to get into an Alaska Psychiatric
Institute (API) center. At the time there were only two DET
hospitals: one in Fairbanks and one in Juneau. The
department settled the case in 2020 and worked with the
Department of Law and AMHTA to improve the system of care.
The bill was the result of the collaborative work.
Ms. Carpenter presented the key takeaways from the
presentation on slide 12. The bill was a win for patients,
hospitals and emergency rooms, and law enforcement. She
elaborated that it was a win for patients because it
created a less restrictive system of care for individuals
who were suffering from mental illness. It was a win for
hospitals and emergency rooms because it would offer more
resources to free up emergency room beds for people who
were being held on observational holds until a DET bed was
available. It helped law enforcement because the bill
provided police officers with broader options for handling
individuals experiencing a mental health crisis, such as
mobile crisis teams. The bill did not interfere with an
officer's ability to make an arrest. It also did not change
the statutory authority of who could make an involuntary
commitment or who can administer crisis medication.
Finally, it would not 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.
Mr. Williams moved to slide 13 which showed the current
flow for involuntary commitment. He drew attention to the
bottom left portion of the slide and explained that a
hospital emergency department, jail, or secure facility
were the primary locations that could currently hold a
person who needed care. If DETs were at capacity, people
were waiting at emergency rooms or correctional facilities.
9:49:09 AM
Representative Carpenter returned to the last bullet on
slide 12. The bullet stated that it was not reducing the
parents' rights or an individual's rights. He wondered
about the decision-making power of a peace officer. He
wondered how allowing a peace officer to decide whether a
child needed a hold would not be reducing the rights of a
parent. He asked if a trooper would have the right to take
a child away from their parents.
Ms. Carpenter explained that the bullet he was referring to
meant that the bill was not reducing an individual's rights
from the rights that individuals currently had. Minors had
the same rights as adults in the civil commitment statutes
and would also get appointed a guardian ad litem by the
court. Both minors and parents would have their own
attorneys appointed to them. If for some reason a parent
did not agree with the suggestion of the child's attorney,
the parent would have representation also. She thought
Commissioner Cockrell could better to respond to the
question.
Representative Carpenter could wait until invited testimony
to ask further questions.
9:51:31 AM
Mr. Williams reported that the flow for involuntary
commitment with statutory changes was depicted on slide 14.
He drew attention to the bottom left portion of the slide
and explained that it was different than slide 13 because
there was the addition of a mobile crisis team and a crisis
stabilization center. It also maintained law enforcement
and hospitals as part of the system but were no longer the
default solution for everyone. Additionally, the new system
would allow a person in need to be sent to a crisis
residential center instead of defaulting to a DET location.
If someone needed longer-term care, the DETs would still be
available.
Ms. Carpenter reviewed the committee substitute highlights
for HB 172 (version N) on slide 15. The department, the
trust, and other stakeholders had collaborated to make
improvements to the bill. There was new language that
changed the term "peace officer" to "health officer" in
Section 25. Another change included new provisions for
protecting patient rights as follows:
• 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
Ms. Carpenter continued that the bill included the addition
of Section 29, which directed DHSS and AMHTA to submit a
report and recommendations to the legislature regarding
patient rights. The goal was to increase transparency with
additional reporting. There also had to be a robust public
comment period and the comments needed to be considered
before any plan could be completed.
9:55:51 AM
Representative Carpenter appreciated the work that had been
done to protect patient rights. He wondered about parental
rights. He was concerned about parents' rights and that the
rights might be limited.
Ms. Carpenter indicated parents would receive counsel and
notifications from the court. She deferred to an invited
testifier from the Department of Law who handled Title 47
cases.
9:57:11 AM
STEVEN BOOKMAN, SENIOR ASSISTANT ATTORNEY GENERAL,
DEPARTMENT OF LAW (via teleconference), responded that the
bill did not affect the constitutional rights of parents to
direct the care of their children. The 23-hour center was
something that could be utilized on an involuntary basis by
an emergency hold, which was a process that was already in
place. However, in order to authorize a longer stay, it had
to be approved by a judge. The statutes stated that the
child had to be discharged if the child no longer met the
standards for needing assistance. He wanted to make sure
that in cases where parents were not involved, the child
could still receive care. He argued that by offering fewer
restrictions it would make it easier for parents to be
involved.
Representative Carpenter asked if statute currently allowed
a law enforcement officer to remove a child in a mental
health crisis and take the child to a facility without the
parents' consent.
Mr. Bookman responded that was in current law. The question
was not whether there was a disagreement on what was best
for the child, but whether the child had a mental illness
and had the potential to hurt themselves and others and was
unsafe.
Representative Carpenter commented that if a child was
unsafe, that was up to the discretion of the law
enforcement officer. If the parents disagreed with the law
enforcement officer, the parents' ability to make a
decision for their child would be put in the hands of the
state.
Mr. Bookman responded that he was accurate.
10:01:21 AM
Ms. Carpenter continued to review the key improvements
resulting from HB 172 on slide 16 as follows:
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 23)
• Clarifies standards for court to order
administration of noncrisis medication (Sections
19 & 20)
10:02:54 AM
Representative Josephson directed attention to slide 13
which detailed the current flow for involuntary commitment.
He asked how it would apply to a homeless person.
Ms. Carpenter responded that it could mean the individual
would be discharged to a homeless shelter and would still
receive community resources.
Representative Wool wondered if smaller communities had
short-term residential facilities.
Ms. Carpenter indicated there were communities across the
state that were in different stages of establishing the
facilities. She reminded the committee that the services
provided in the facilities were billable to Medicaid. For
example, Providence Hospital in Anchorage was looking at
the crisis model and deciding between building designs. She
could follow-up with the information on which communities
had asked for approval through the department to stand-up
the voluntary facilities.
Representative Carpenter asked at which point in the
process would Medicaid billing begin. He wondered when the
demand for federal dollars would appear.
Ms. Carpenter responded that it would depend on the model.
A mobile crisis team would provide Medicaid billable
services once the team arrived on the scene. The next
billable service would begin when an individual entered
into a 23-hour crisis center. She expected some providers
in larger communities to design facilities so that the 23-
hour center and the longer-term facilities were right down
the hall from each other to make the transition easy.
10:05:56 AM
Representative Carpenter asked to return to slide 10 which
depicted the crisis response in Georgia. He asked what the
financial incentive was to weed out 90 of the 100 crisis
calls. It appeared to him that the business model was more
successful as the amount of people admitted into facilities
increased.
Ms. Carpenter highlighted that the crisis center was the
only piece that was not billable to Medicaid. It was not a
service covered by the 1115 waiver. It was important to
provide an appropriate response and appropriate level of
care to the people who needed it. It was not about making
money and Medicaid was not the highest payer in the state.
However, Medicaid was covering about 85 percent of the cost
in the model on slide 10.
Co-Chair Merrick indicated the committee would move to
invited testimony.
10:08:04 AM
JAMES COCKRELL, COMMISSIONER, DEPARTMENT OF PUBLIC SAFETY
(via teleconference), spoke to the Department of Public
Safety's support for the bill. He also supported the bill
personally. He had a close family member who had
experienced a mental health crisis, was arrested, and spent
81 days in jail. The offense should not have been deemed a
criminal case because the individual was experiencing a
mental health crisis. Too often law enforcement officers
responding to mental health crises would state that
training did not equate to a professional response to a
mental health crisis. On many occasions, the presence of a
uniformed officer escalated the situation because the
individual experiencing the crisis assumed they were going
to jail. He thought the state was behind the rest of the
country in responding to such crises. The bill would make a
significant difference for the people of Alaska and would
help move the state in the right direction.
Representative Wool was reassured by Commissioner
Cockrell's words. He referred to the aforementioned
incident where an 11-year-old in the Matanuska-Susitna
Valley was pepper sprayed and handcuffed. He asked at what
point could an individual get treatment if there was a
crime affiliated with a mental health incident. He asked
how inappropriate jailing could be avoided and if
Commissioner Cockrell had any insight into possible
solutions. He supported the legislation.
10:13:58 AM
Commissioner Cockrell responded that if the crisis process
proposed by the bill was in place when the incident with
the 11-year-old occurred, law enforcement would not have
been present on the scene. He spoke to the trooper on the
scene and thought the trooper took the appropriate actions
based on the circumstances. However, there had to be a
better way to deal with similar situations than what was
currently in place. He reiterated that the legislation was
a huge step in the right direction.
Representative Wool thought his question had been answered.
He was more concerned with an individual being sent to jail
when it was the inappropriate place for them. He thought
this would be more difficult to undo once prosecutors and
judges were involved and hoped constraints could be
loosened when someone with a mental health issue had
committed a crime. He agreed that the correctional
facilities were not the best places to treat mental health
issues.
Commissioner Cockrell agreed. Looking at his personal
experience with his background in law enforcement, he felt
helpless trying to deal with his relative that was in
prison for 81 days when they were in crisis. He thought as
the system continued to grow, there would be more
partnerships between law enforcement and mental health
crisis teams. At some point in time, a person could be
charged with a crime after they received help for the
mental illness. He reiterated that the bill represented
progress but it would be a process to work out the kinks.
10:19:14 AM
Representative Edgmon asked for clarification on the
difference between law enforcement, peace officers, and
police officers. He asked whether the bill fully
encapsulated law enforcement, which would include Village
Public Safety Officers (VPSO).
Commissioner Cockrell replied that he did not think the
bill would affect the ability of VPSOs to step into a
greater role.
10:20:12 AM
Representative Carpenter asked about safeguards to ensure
that adults and children were not treated in the same
facilities. He asked how the bill would prevent children
from spending a long period of time away from parents
without parental consent.
Commissioner Cockrell thought Mr. Bookman had addressed the
question. The bill would not change the process that was
currently in place under Title 47. He was unaware of any
situation where Representative Carpenter's example would
occur. The only situation in which a police officer could
take a child away from a parent would be if the child was
seemingly in danger. There were mechanisms to return the
child to the parents and the child would most likely go
into the custody of the Office of Children's Services
(OCS). He did not know whether the scenario in question
could occur under the legal system.
10:21:36 AM
Representative Johnson was trying to envision how the law
would function with local police. She wondered if officers
would be encouraged to engage in some sort of training. She
also wanted to ensure that officers had access to crisis
facilities. She wondered if there would be a fiscal
responsibility placed on local law enforcement if the bill
were to pass.
Commissioner Cockrell replied that local law enforcement
would respond to mental health crises, not state law
enforcement like the troopers. Instead of responding with a
police officer, a mental health officer would respond if
the bill were to pass. He thought that the fiscal note
would be minimal. Realistically, it would likely save DPS
some money over time. He did not see it being a burden to
local law enforcement.
Representative Johnson suggested that a crisis team would
be resource to local police officers.
Commissioner Cockrell responded that was his understanding.
The implementation of crisis teams was intended to be a
resource for all local and state law enforcement.
Co-Chair Merrick intended to adjourn by 10:45 a.m.
10:25:35 AM
MARK REGAN, LEGAL DIRECTOR, DISABILITY LAW CENTER (via
teleconference), relayed that in Alaska, the way in which
people were receiving short-term mental health treatment
involved them being evaluated for civil commitment in the
long-term. Current law stated that someone in crisis would
be picked up and taken to a facility to get short-term
treatment and a 72-hour evaluation for potential further
treatment. However, current law did not match up well with
what people really needed. People needed short-term
treatment in a therapeutic setting, which was what the bill
would provide. Unfortunately, the current system had
difficulty providing short-term treatment.
Mr. Regan provided a situation in which an individual was
taken into an involuntary hold and brought to Central
Peninsula Hospital, but API was at capacity and the
individual could not be evaluated. The individual spent a
few days at the hospital in custody without being evaluated
and therefore not receiving treatment. The situation
worsened in 2018 when API was unable to take new patients
to do evaluations for various reasons. He relayed that API
indicated people would have to stay in jail longer awaiting
evaluation or would have to go to hospital emergency rooms.
He thought the system had essentially broken down. In
response, the Disability Law Center (DLC) and the public
defender sued. He explained that AMHTA and the state
proposed changing the system to ensure that crises would
trigger a crisis-now process for short-term treatment. It
would replace hospital emergency rooms and jails as places
to hold patients experiencing mental health crises. The
lawsuit was settled on the basis of encouraging the
implementation of crisis-now facilities. He explained that
Fiscal Notes 2 and 6 (with control codes tljiI and UDvnD
respectively, offered by DHSS) indicated that DLC helped
begin the process. He could not claim credit for it,
because the credit instead belonged to the trust and the
state. The bill would allow for individuals to receive
necessary short-term treatment without the difficulty of
being sent to an inappropriate facility like a jail or
emergency room. He wanted members to understand why the
bill was necessary.
Representative Edgmon asked Mr. Regan to speak to why the
issue was being addressed presently rather than five or ten
years ago.
Mr. Regan replied that typically, people in more rural
communities would be flown or taken to a hospital for the
72-hour evaluation and hold. There were situations that
could be resolved in a person's home community, but it
might be necessary that the person be flown to a larger
community. Generally, Alaska had not been successful at
providing community-based treatment and it was more common
for people to be flown to large hubs. The bill offered the
opportunity for relatively small communities to have at
least a crisis stabilization center to offer short-term
treatment. The other reason for the timing of the
legislation was money. He explained that the 1115 waiver
helped to provide money to communities across the state. He
thought a small hub community providing a crisis center was
preferable to flying an individual across the state to a
crisis center or an API. The bill would make it possible to
implement crisis centers in many more parts of the state.
10:34:01 AM
SHIRLEY HOLLOWAY, NATIONAL PRESIDENT AND ALASKA VICE
PRESIDENT, NATIONAL ALLIANCE ON MENTAL ILLNESS (via
teleconference), supported the bill. She explained that
National Alliance on Mental Illness (NAMI) Alaska was part
of the national NAMI chapter, which was the largest
grassroots mental health organization dedicated to building
better lives for people impacted by mental illness. She
unfortunately became involved with NAMI when her daughter,
who had a mental illness, committed suicide during a mental
health crisis. She was out of town when her daughter
contacted her, and it was immediately clear that her
daughter was in crisis. She asked her daughter to go to the
emergency room, but her daughter had been there many times
before and had negative experiences. Her daughter had also
been to API which was a bad experience as well. She called
everyone she could to help her daughter: her daughter's
psychiatrist, therapist, neurologist, and others. She could
not find help. She relayed that this experience had lasted
for four hours while she waited to board a plane to be with
her daughter. As a last resort, she called the police and
explained the situation while she was boarding the plane.
Tragically, when the police found her daughter, it was too
late.
Dr. Holloway relayed that mental illness affected more than
one in five adults, which was about 50 million people in
the United States, or 108,000 people in Alaska. Emergency
rooms and jails were not appropriate holding rooms for
patients in a mental health crisis who needed expert care
as quickly as possible. The crisis system needed to offer
help, not handcuffs. She supported the multitude of
stakeholders and collaborators that came together to craft
the legislation. The bill would ensure that people received
appropriate services in a timely manner and take undue
pressure off of first responders. She noted that there was
more work to be done, but the legislation was a critical
step in providing a continuum of care for mental health.
She supported the requirement of a report due to the
legislature at the year mark to evaluate the effectiveness
of the legislation and provide opportunity for public
input.
Co-Chair Merrick thanked the testifier for sharing her
personal experience.
10:40:32 AM
DR. HELEN ADAMS, ALASKA CHAPTER, AMERICAN COLLEGE OF
EMERGENCY PHYSICIANS (via teleconference), had been part of
the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI)
program and returned to the state as an emergency room
doctor. She thought the crisis-now model would be
transformative for her job. There were a few different
categories of patients that she would share with the
committee. The first category was patients with psychiatric
illnesses who were experiencing an acute medical condition
due to their psychiatric illness. She offered an example of
an opioid overdose patient who would always and rightfully
be sent to the emergency department for medical
stabilization. Once the patient was stabilized, they would
be sent to the appropriate psychiatric care facility. She
relayed that the crisis-now model would not change the
process.
Dr. Adams indicated that she wanted to focus on patients
who were not experiencing medical emergencies but were in
crisis. These patients often showed up in the emergency
department because they did not know what else to do and
would sit unsupported in an emergency room for hours. The
experience of patients like this would be transformed by
the bill because patients would be able to call the crisis
hotline and access a professional quickly. The next
category was patients that were not experiencing a mental
health crisis. The bill would make it possible for these
patients to go through the crisis now system and avoid the
emergency department. She echoed Mr. Cockrell's earlier
comments that the presence of law enforcement often
escalated a situation. Under the new model, a crisis team
could verbally deescalate a situation. Often times,
security appeared on the scene of a crisis at the hospital
before she did, but she would be able to deescalate the
situation in minutes due to her training and she could
excuse security. Another example of de-escalation was the
presence of dogs with security officers to make patients
feel more comfortable. The other group of patients that
would benefit from the bill would be people who were in the
emergency room for any other reason. Patients experiencing
mental health issues were overwhelming the emergency
department, and if these patients had other resources,
other people in the emergency room would experience fewer
delays. She stressed streamlining the process and endorsed
the open-door policy.
Co-Chair Merrick thanked the testifiers and reviewed the
agenda for the afternoon.
HB 172 was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
10:46:12 AM
The meeting was adjourned at 10:46 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 172 - Explanation of Changes Ver. N.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 - Letter of Support - Alaska ACEP.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 - Infographics - Proposed Statutory Changes to Title 47 3.6.22.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 - Letter of Support - DPS.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 - Sectional Anaylsis Ver. N.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 - Supporting Document - Letters of Support.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 Definitions in AS 47.30.915.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 Public Testimony Rec'd by 041122.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 Transmittal Letter.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 - HFIN Presentation 4.13.2022.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 Public testimony Rec'd by 041222.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |
| HB 172 Public Testimony Rec'd by 041322.pdf |
HFIN 4/13/2022 9:00:00 AM |
HB 172 |