Legislature(2015 - 2016)CAPITOL 106

02/10/2015 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:03:20 PM Start
03:03:43 PM Presentation: Alaska Mental Health Trust Authority
03:51:47 PM Presentation: Nami
04:10:28 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentations: TELECONFERENCED
- Mental Health Trust
- NAMI Juneau & Other Invited Guests
+ Department Presentation: TELECONFERENCED
- Health & Social Services
+ Bills Previously Heard/Scheduled TELECONFERENCED
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       February 10, 2015                                                                                        
                           3:03 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Paul Seaton, Chair                                                                                               
Representative Neal Foster                                                                                                      
Representative Louise Stutes                                                                                                    
Representative David Talerico                                                                                                   
Representative Geran Tarr                                                                                                       
Representative Adam Wool                                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Liz Vazquez, Vice Chair                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: ALASKA MENTAL HEALTH TRUST AUTHORITY                                                                              
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PRESENTATION: NAMI                                                                                                              
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
                                                                                                                                
JEFF JESSEE, Chief Executive Officer                                                                                            
Alaska Mental Health Trust Authority                                                                                            
Department of Revenue                                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented an overview PowerPoint on the                                                                  
Alaska Mental Health Trust Authority.                                                                                           
                                                                                                                                
DOV GARTENBERG, Executive Director                                                                                              
National Alliance on Mental Illness (NAMI) Juneau                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during a presentation by NAMI.                                                                 
                                                                                                                                
SHIRLEY HOLLOWAY, President                                                                                                     
National Alliance on Mental Illness (NAMI) Alaska                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during a presentation by NAMI.                                                                 
                                                                                                                                
JOHN HARTLE, Board Member                                                                                                       
National Alliance on Mental Illness (NAMI) Juneau                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during a presentation by NAMI.                                                                 
                                                                                                                                
CRYSTAL BORLAND, Incoming Executive Director                                                                                    
National Alliance on Mental Illness (NAMI) Juneau                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during a presentation by NAMI.                                                                 
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:20 PM                                                                                                                    
                                                                                                                                
CHAIR PAUL  SEATON called  the House  Health and  Social Services                                                             
Standing   Committee    meeting   to    order   at    3:03   p.m.                                                               
Representatives Seaton, Talerico, Tarr,  and Wool were present at                                                               
the call to order.   Representatives Foster and Stutes arrived as                                                               
the meeting was in progress.                                                                                                    
                                                                                                                                
^PRESENTATION: Alaska Mental Health Trust Authority                                                                           
       PRESENTATION: Alaska Mental Health Trust Authority                                                                   
                                                                                                                              
3:03:43 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  first order of business would be                                                               
a presentation by the Alaska Mental Health Trust Authority.                                                                     
                                                                                                                                
3:04:30 PM                                                                                                                    
                                                                                                                                
JEFF JESSEE, Chief Executive Officer,  Alaska Mental Health Trust                                                               
Authority, Department  of Revenue, presented a  PowerPoint titled                                                               
"Trust."      He   directed  attention   to   slide   1,   "Trust                                                               
Beneficiaries,"   and   listed   people  with   mental   illness,                                                               
developmental   disabilities,   chronic   alcoholism,   substance                                                               
related disorders,  Alzheimer's disease, dementia,  and traumatic                                                               
brain  injury as  beneficiaries of  the  trust.   He stated  that                                                               
prevention was a  big part of the  work by the Trust  with a hope                                                               
to  avoid many  of these  conditions.   He moved  on to  slide 2,                                                               
"Established Focus Areas,"  and shared that the  five focus areas                                                               
were   disability  justice,   substance   abuse  prevention   and                                                               
treatment,  beneficiary  employment   and  engagement,  workforce                                                               
development, and housing and long-term  services and support.  He                                                               
listed  the current  priorities  in this  legislative session  to                                                               
include:  restore funding for  the homeless assistance program as                                                               
this  was a  true  safety  net for  the  homeless;  and, work  on                                                               
Medicaid  expansion  and its  reform  in  order to  fundamentally                                                               
alter the trajectory of the  program to make it more sustainable,                                                               
slide  3, "Current  Priorities."   He expressed  his belief  that                                                               
Medicaid expansion could  be a catalyst for  Medicaid reform, and                                                               
a  more sustainable  budget over  time.   He shared  that he  had                                                               
explained to the Senate Finance  Committee that the mental health                                                               
bill would start  to review the budget in a  broader context, and                                                               
not review  each department and  program in its  own "stovepipe."                                                               
He offered  an example of  the Behavioral Health  program, noting                                                               
that it had an impact on recidivism,  and hence was a part of the                                                               
Department  of Corrections  (DOC) budget.   He  pointed out  that                                                               
many problems  with recidivism  were not  controlled by  DOC, but                                                               
were  in the  Department  of Health  and  Social Services  (DHSS)                                                               
budget.    He  laid  the   responsibility  for  this  "stovepipe"                                                               
approach on  the finance sub  committees, as they did  not review                                                               
budgets in  conjunction with each  other.  He offered  his belief                                                               
that  the House  Finance  Committee initiated  the separation  of                                                               
departments,  and instead  the budgets  should be  reviewed as  a                                                               
whole.                                                                                                                          
                                                                                                                                
3:09:56 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON asked  that he  speak about  the way  in which  the                                                               
mental  health   trust  fund  worked,  its   structure,  and  its                                                               
independence and relationship with the legislature.                                                                             
                                                                                                                                
REPRESENTATIVE TARR reflected on  an interagency working group as                                                               
a means  to share  the budgetary  information, and  asked whether                                                               
there was an  existing model for an  infrastructure to facilitate                                                               
this coordination.                                                                                                              
                                                                                                                                
MR.  JESSEE replied  that  interagency  collaborative groups  did                                                               
exist, and  he listed the  Criminal Justice Working  Group, which                                                               
includes the  Department of Administration, Department  of Public                                                               
Safety,  Department   of  Corrections,  Department  of   Labor  &                                                               
Workforce  Development,  and  Department  of  Health  and  Social                                                               
Services.   He  reported  that both  legislative bodies  included                                                               
intent language  in the budget  for agencies to  continue working                                                               
together  in  the development  of  a  recidivism reduction  plan,                                                               
which  includes  the  Department of  Corrections,  Department  of                                                               
Public Safety, the Alaska Court  System, Department of Health and                                                               
Social  Services, Department  of Labor  & Workforce  Development,                                                               
Alaska Housing Finance Corporation,  and the Alaska Mental Health                                                               
Trust Authority.                                                                                                                
                                                                                                                                
3:12:19 PM                                                                                                                    
                                                                                                                                
MR. JESSEE  spoke about the  Alaska territorial days  when anyone                                                               
with  a mental  disability  was convicted  for  being "an  insane                                                               
person at large" and was  sent to Morningside Hospital in Oregon.                                                               
At  statehood,  Alaska would  have  needed  to begin  payment  to                                                               
Morningside Hospital and,  as there was not any  means to support                                                               
this  unpopular  program,  the Mental  Health  Enabling  Act  was                                                               
passed.   This act provided  money for  the first wing  of Alaska                                                               
Psychiatric Hospital,  an in-state mental hospital,  and bought a                                                               
motel in Valdez to house  people with developmental disabilities.                                                               
He  explained that  this act  also provided  some federal  money,                                                               
which was  reduced over a  few years,  and created a  one million                                                               
acre land  trust for  the state  to generate  additional revenue.                                                               
He offered an  anecdote, sharing that the  original proposed land                                                               
trust  was for  one half  million acres,  but while  the proposed                                                               
bill  was   in  committee,   the  Representative   from  Nebraska                                                               
complained about  the idea and  mockingly suggested  offering one                                                               
million acres,  with the idea  that the proposed bill  would then                                                               
be  defeated.   He  shared  that the  land  trust had  originally                                                               
selected some  of the  most valuable land  in the  state however,                                                               
almost half  of that land had  been passed on for  less than face                                                               
value.   He reported that  this generated  a law suit,  which was                                                               
finally  settled in  1995,  with the  re-creation  of the  mental                                                               
health trust  and a return  of some substitute land  to replenish                                                               
the one million acres.  He  noted that these lands were developed                                                               
by the Alaska  Mental Health Trust Land Office  in the Department                                                               
of Natural  Resources.   He relayed  that there  was also  a cash                                                               
endowment of  $200 million that  had grown  to $500 million.   He                                                               
declared that  the most  important part was  a Board  of Trustees                                                               
who were  able to  oversee management of  these assets  and spend                                                               
the  revenue  from these  assets  to  improve the  mental  health                                                               
program,  without   any  legislative  approval  except   for  the                                                               
administrative budget.  He declared  that the majority of funding                                                               
came   through   state  government,   in   order   to  create   a                                                               
comprehensive,  integrated mental  health program,  instead of  a                                                               
separate grant system.                                                                                                          
                                                                                                                                
3:15:46 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  asked about the  relationship of the  mental health                                                               
trust budget during the legislative budget process.                                                                             
                                                                                                                                
MR. JESSEE  explained that the  mental health budget,  as opposed                                                               
to the  capital budget or  the operating budget, was  designed to                                                               
look at the  mental health program in aggregate in  order to view                                                               
the   budget's  interrelationship   and  find   efficiencies  and                                                               
effectiveness changes to the system.   He stated that the finance                                                               
committees   deconstructed   the   mental  health   budget   into                                                               
departmental  components,  and  reviewed  the  interrelationships                                                               
before reconstructing  it for a  sustainable budget.   He likened                                                               
the mental health  trust as venture capital for  the state mental                                                               
health program.   He pointed out that the Trust  spends about $25                                                               
million each  year for the  mental health program.   He mentioned                                                               
the Bring the  Kids Home program for reducing the  number of kids                                                               
sent out of state  from 437, at a cost of  $45 million each year.                                                               
Currently there  are only 88  kids housed  out of state,  and the                                                               
money has  been re-invested for  in-state services.   He reported                                                               
that  the Trust  spent about  $16 million  of its  funds to  help                                                               
organize, start pilot projects,  and facilitate the re-investment                                                               
of outside dollars into in-state services.                                                                                      
                                                                                                                                
MR.   JESSEE  moved   on  to   slide  4,   "Prevention  &   Early                                                               
Intervention."                                                                                                                  
                                                                                                                                
3:18:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES  asked about the  means of access  to these                                                               
funds.  She shared that people  in rural Alaska were aware of the                                                               
Trust  but did  not know  of  any way  to access  or utilize  the                                                               
benefits.                                                                                                                       
                                                                                                                                
MR.  JESSEE replied  that two  thirds  of the  Trust funding  was                                                               
spent through state government, and  offered an example for money                                                               
allocated to the  Department of Health and Social  Services for a                                                               
program which was then distributed  to grantees in the community.                                                               
He mentioned start-up  funding for the Bethel  Sobering Center to                                                               
help inebriates from the streets in  Bethel.  He noted there were                                                               
also  some individual  grants  for  up to  $2,500  for things  to                                                               
improve their quality of life.                                                                                                  
                                                                                                                                
REPRESENTATIVE STUTES asked who the trust providers were.                                                                       
                                                                                                                                
MR. JESSEE explained that the  providers were anyone who received                                                               
a  grant  from  the  various   agencies  who  were  partners  for                                                               
services.                                                                                                                       
                                                                                                                                
REPRESENTATIVE STUTES  offered an anecdote for  an explanation as                                                               
to determining who was a provider.                                                                                              
                                                                                                                                
MR. JESSEE explained  that, as the Trust was  venture capital for                                                               
the  program,  they did  not  provide  base funding  to  provider                                                               
agencies.   He offered an  anecdote to explain who  an individual                                                               
would  visit  if  they  need  services.   He  stated  that  these                                                               
programs and  systems for care  were developed with  funding from                                                               
the   Trust,   but  that   the   Trust   only  offered   indirect                                                               
participation for mental health services.                                                                                       
                                                                                                                                
REPRESENTATIVE  STUTES   asked  for   an  example   regarding  an                                                               
individual  who  was   not  eligible  for  any   benefits.    She                                                               
referenced an  earlier House Health and  Social Services Standing                                                               
Committee presentation  for tele-medicine, noting that  the tele-                                                               
medicine provider did not facilitate  any further connections for                                                               
help.                                                                                                                           
                                                                                                                                
MR. JESSEE said that in  many parts of Alaska tele-psychiatry was                                                               
the  number one  use  of  tele-medicine.   He  explained that  an                                                               
individual who was  not eligible for tribal services  may have to                                                               
pay or  find a  private provider.   That individual  would either                                                               
need  insurance, be  eligible  for Medicaid,  or  have money,  in                                                               
order  to  pay.    He  stated that  without  any  of  these,  the                                                               
individual would  be "in big trouble"  as they would have  a hard                                                               
time accessing  services.  He  declared that this was  "why we're                                                               
talkin' about Medicaid expansion."                                                                                              
                                                                                                                                
3:25:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR   asked  for  examples  of   direct  service                                                               
provider groups that were offered grants.                                                                                       
                                                                                                                                
MR. JESSEE  offered RuralCap, NAMI, and  Tanana Chiefs Conference                                                               
as groups  which the  Trust had offered  grants, noting  that the                                                               
Trust provided about 175 grants.                                                                                                
                                                                                                                                
REPRESENTATIVE TARR  suggested that  a referral  to one  of these                                                               
agencies was another way for individuals to access services.                                                                    
                                                                                                                                
MR. JESSEE  offered another example  of the network  of community                                                               
health  aides  in the  tribal  health  system.   He  shared  that                                                               
behavioral  health aides  were now  being trained  for behavioral                                                               
health services in rural clinics,  and that a training manual and                                                               
handbook was necessary for this training.   As this manual was an                                                               
expensive  endeavor,  the Trust  funded  that  manual because  it                                                               
enhanced the program.                                                                                                           
                                                                                                                                
REPRESENTATIVE WOOL  asked whether the Trust  only worked through                                                               
the tribal health network.                                                                                                      
                                                                                                                                
MR.  JESSEE replied  that, although  the  behavioral health  aide                                                               
program was through the tribal  health network, they did not only                                                               
work with tribal health agencies.                                                                                               
                                                                                                                                
3:28:02 PM                                                                                                                    
                                                                                                                                
MR. JESSEE returned attention to slides  5 - 6, and the impact of                                                               
adverse early childhood experiences.   He stated that the more of                                                               
these experiences stacked up in  childhood the worse the outcomes                                                               
were over  time, such as:  physical abuse and  neglect, emotional                                                               
abuse  and neglect,  sexual abuse,  alcohol or  drug user  in the                                                               
household, an incarcerated  household member, chronic depression,                                                               
or one  or no  parents.   He stated that  some of  these outcomes                                                               
were fairly obvious, pointing out  that the odds ratio of suicide                                                               
attempts  correlated with  these  adverse childhood  experiences,                                                               
slide  7.    This  pattern followed  very  consistently  and,  he                                                               
pointed out  the correlations of  adverse experiences  with heart                                                               
disease, asthma  and other  physical ailments  were not  quite as                                                               
obvious.    He  reported  that   it  was  necessary  to  build  a                                                               
sustainable budget  so that attention  could be focused  on these                                                               
adverse experiences.  He lamented  that these programs were often                                                               
not  addressed until  it  was a  struggle to  find  the money  to                                                               
invest in these programs.                                                                                                       
                                                                                                                                
3:30:23 PM                                                                                                                    
                                                                                                                                
[Chair Seaton passed the gavel to Representative Talerico]                                                                      
                                                                                                                                
MR.  JESSEE moved  on to  slide  10, "Prevention  Programs."   He                                                               
asked how it  was determined for what was the  "best bang for the                                                               
buck."   He  spoke about  the nurse  family partnership  for low-                                                               
income families, which identified at-risk  families at the time a                                                               
child was  born, and  set up  a nurse  partnership.   He declared                                                               
that  this was  a  very  cost effective  program,  and cited  the                                                               
Washington  State Institute  for Public  Policy studies  on early                                                               
intervention strategies.   He stated that  the early intervention                                                               
and  prevention  programs  were  some  of  the  best  returns  on                                                               
investment, as they  headed off the problems at the  front end so                                                               
they were  not being paid for  later.  He reported  that the cost                                                               
per family  was about $9,800  but the benefit was  about $26,000.                                                               
He stated that the early  childhood education program had an even                                                               
stronger cost benefit.                                                                                                          
                                                                                                                                
3:32:42 PM                                                                                                                    
                                                                                                                                
MR. JESSEE  shared slide 11,  "Juvenile Offenders,"  and directed                                                               
attention to  the success  of the various  strategies.   He spoke                                                               
about the  Scared Straight  program, describing  it as  a program                                                               
that took kids to the jail  and walked them around, while telling                                                               
them  that this  was the  result of  their current  actions.   He                                                               
declared   that   not   only   did  this   not   work,   it   was                                                               
counterproductive and had  a one percent chance  for any positive                                                               
outcome.   He explained, in  that kids  have an inherent  fear of                                                               
the unknown,  once they were  made aware  of the inside  of jail,                                                               
they were  no longer  as deterred  by it.   He suggested  that it                                                               
might be  better not telling  them what jail  would be like.   He                                                               
spoke about  the DARE program,  which brought police  officers in                                                               
uniform into  the schools to  talk with young students  about the                                                               
evils of  drugs and alcohol.   He stated that  although teachers,                                                               
kids, principals, and  the police all loved this  program, it did                                                               
not work.   He opined  that it was unclear  why it did  not work,                                                               
but offered his  belief that as the young students  aged, they no                                                               
longer listened to  any authority figures.  He  emphasized that a                                                               
program that  did work brought  recovering teen-age  addicts into                                                               
the  classroom to  speak.    He acknowledged  that  the offer  to                                                               
principals for eliminating  the police officer visits  in lieu of                                                               
visits by addicts was often a challenge.                                                                                        
                                                                                                                                
3:34:51 PM                                                                                                                    
                                                                                                                                
MR. JESSEE moved on to  slide 12, "Recidivism," and declared that                                                               
something  had to  change  in order  "to turn  the  curve on  the                                                               
corrections population,"  or it  would be  necessary to  build an                                                               
additional  $300  million  prison   with  a  $50  million  annual                                                               
operating  budget.   He  declared that  this was  not  a path  to                                                               
sustainability.   Moving on to  slide 13, "Monetary  Benefits and                                                               
Costs of  Evidence-Based Public Policies  that Affect  Crime," he                                                               
explained that  Case Management with swift  and certain graduated                                                               
sanctions  was   very  effective  and   had  a  good   return  on                                                               
investment.    He  pointed  out that  the  same  case  management                                                               
without swift and certain penalties  was less effective, but cost                                                               
the  same.   He  explained that  a  current program,  Probationer                                                               
Accountability with Certain Enforcement  (PACE), had been piloted                                                               
in Alaska and  was ready for expansion if there  was funding.  He                                                               
explained  that the  PACE program  did  not wait  for someone  on                                                               
probation  to do  a series  of  little things  with no  penalties                                                               
until  a larger,  more serious  violation; instead,  a small  but                                                               
certain penalty,  24 hours  in jail, was  applied the  first time                                                               
they stepped  out of  line.   He declared  that this  program was                                                               
very  effective.   He stated  that  the budget  could be  brought                                                               
under control with smart investment  in these strategies, that it                                                               
was necessary to  use the data, keep track of  the data, and stop                                                               
funding the programs that were not accomplishing expectations.                                                                  
                                                                                                                                
3:36:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked about the McDowell study.                                                                             
                                                                                                                                
MR. JESSEE, in  response to Representative Tarr,  shared that the                                                               
McDowell Group had  studied the cost of excessive  use of alcohol                                                               
to  the  state.   The  report  had listed  the  cost  to be  $1.2                                                               
billion, including: criminal justice  costs, Office of Children's                                                               
Services,   the   court   systems,  public   safety,   and   lost                                                               
productivity.   He pointed  out that, although  there was  a $1.2                                                               
billion cost to  the state, the alcohol industry  only paid about                                                               
$40  million in  taxes.   He  offered his  belief  that no  other                                                               
industry would  be allowed to leave  a "$700 million mess  in the                                                               
community."                                                                                                                     
                                                                                                                                
3:38:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL,  suggesting   that  the  program  solutions                                                               
"sound a little counter intuitive,"  asked whether there were any                                                               
problems with convincing others that these worked.                                                                              
                                                                                                                                
MR.  JESSEE replied  that it  was  only necessary  to review  the                                                               
data.   He  offered an  example  of Housing  First, which  housed                                                               
homeless people  with chronic alcohol  problems.  He  pointed out                                                               
that  there had  been  initial  resistance to  the  program.   He                                                               
stated  "homelessness is  not cheap,"  listing  costs for  health                                                               
care through the  emergency room, police, fire,  and court costs.                                                               
He referenced an article about  "Million Dollar Murray," in which                                                               
the author  followed a homeless  man in San Diego,  and recounted                                                               
the costs to  the community, which were $1 million.   He reported                                                               
that housing allowed for improved  health and reduced pick-ups by                                                               
the police, resulting in savings for  the community.  He shared a                                                               
story  about Anchorage  assembly  persons being  shown a  similar                                                               
housing  for  homeless  program  in  Seattle,  which  was  highly                                                               
touted.  He stated "you gotta look at the data."                                                                                
                                                                                                                                
3:40:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked  about an update to  the development of                                                               
the Fairview  program which received  a $4  million appropriation                                                               
during the past year.                                                                                                           
                                                                                                                                
MR. JESSEE, in response, stated  that there were meetings between                                                               
the  Fairview community  and the  Division of  Behavioral Health.                                                               
He  reported  that  the  division  was  developing  an  assertive                                                               
community treatment  program, which  would immediately  follow up                                                               
on patients who missed an  appointment to help maintain stability                                                               
and keep them from cycling through the other expensive systems.                                                                 
                                                                                                                                
3:42:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES  expressed  her   alarm  over  an  earlier                                                               
comment that  an individual was "just  out of luck" if  they were                                                               
"not eligible for  native care, and you don't  have Medicaid, and                                                               
you don't  have any money."   She stated that these  were exactly                                                               
the people who most needed the benefits.                                                                                        
                                                                                                                                
MR.  JESSEE expressed  his  agreement, stating  that  he was  not                                                               
making light of this, or saying  that this was alright.  However,                                                               
this was  a fact  for the current  system of health  care.   If a                                                               
person was not insured, was  not eligible for tribal health care,                                                               
did not have  enough money to pay, and the  public system did not                                                               
have the capacity to serve them,  then it would be very difficult                                                               
to access the services.                                                                                                         
                                                                                                                                
REPRESENTATIVE STUTES questioned whether  this was the reason for                                                               
the mental  health trust fund.   She offered her belief  that, as                                                               
this was  a public, state owned  fund, there had to  be an avenue                                                               
of access  to treatment for the  people who did not  have medical                                                               
insurance, Medicaid, or money.                                                                                                  
                                                                                                                                
MR. JESSEE  replied that  he would totally  agree.   He explained                                                               
that  the Trust  had  $20 -  $25 million  to  spend annually  for                                                               
improvement  to the  program, whereas  the  entire mental  health                                                               
program budget,  including Medicaid, was  over $300 million.   He                                                               
pointed out  that placement of  every dollar from the  Trust into                                                               
additional capacity in  the service system would only  be "a drop                                                               
in the bucket."  He shared that  the Trust focused the use of its                                                               
dollars in a way to enhance  the overall system and allow service                                                               
to more people than by using  those dollars directly.  He pointed                                                               
to  support for  Medicaid  expansion, as  it  was estimated  that                                                               
5,000 more behavioral health  beneficiaries would become eligible                                                               
with  Medicaid  expansion.    He  stated that  it  would  not  be                                                               
possible for  the Trust to serve  those 5,000 people if  it spent                                                               
all of its money on direct  services.  He offered his belief that                                                               
it was  possible, should the  Trust spend its annual  $25 million                                                               
for direct services, for the  legislature to back out $25 million                                                               
of general funds.  There would  not be any more services, and the                                                               
Trust money would  be locked up.  Also, there  would no longer be                                                               
any Trust  money for investment  as venture capital,  which could                                                               
include money for mental health  courts, Housing First, and other                                                               
programs.  He explained that  venture capital dollars invested in                                                               
any public system  of care were no longer  available, except upon                                                               
rare occasion.   He declared that  the Trust money was  a "unique                                                               
tool."   He  emphasized  that  the Trust  could  not provide  the                                                               
direct services,  but it could  help with investments to  serve a                                                               
greater number of people.                                                                                                       
                                                                                                                                
REPRESENTATIVE STUTES expressed her understanding.                                                                              
                                                                                                                                
3:46:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR asked  about individuals  seeking behavioral                                                               
health services  through emergency  rooms, noting  that emergency                                                               
rooms were  not equipped  for these  services.   She acknowledged                                                               
that, as  this was the  last resort  for many people,  they would                                                               
not  be  turned away  but  would  not  receive service  from  the                                                               
appropriately trained personnel.                                                                                                
                                                                                                                                
MR. JESSEE expressed  his agreement.  He noted  that the original                                                               
plan  during   the  recent   rebuilding  of   Alaska  Psychiatric                                                               
Institute (API),  had been for  a 200 bed hospital;  however, the                                                               
Trust  had  expressed its  preference  for  more community  based                                                               
care.   He  shared that  a  psychiatric emergency  room was  then                                                               
developed  at  Providence  Alaska Medical  Center  in  Anchorage,                                                               
which could be used  in lieu of API.  He  reported that the local                                                               
hospitals in  Juneau and Fairbanks  also had mental  health units                                                               
for  psychiatric   emergencies,  although  the   Mat-Su  Regional                                                               
Medical  Center did  not have  this capacity.   He  declared that                                                               
emergency mental health care was very important.                                                                                
                                                                                                                                
3:48:27 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:48 p.m. to 3:51 p.m.                                                                       
                                                                                                                                
^PRESENTATION: NAMI                                                                                                           
                       PRESENTATION: NAMI                                                                                   
                                                                                                                              
3:51:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TALERICO   announced  that  the  next   order  of                                                               
business  would be  a presentation  by the  National Alliance  on                                                               
Mental Illness (NAMI).                                                                                                          
                                                                                                                                
3:52:37 PM                                                                                                                    
                                                                                                                                
DOV GARTENBERG,  Executive Director, National Alliance  on Mental                                                               
Illness  (NAMI) Juneau,  stated  that the  NAMI organization  had                                                               
1,100 national  affiliates and that NAMI  Juneau served Southeast                                                               
Alaska.  He  reported that there had been up  to 11 affiliates in                                                               
Alaska, and that  it had started in the 1970s,  when large mental                                                               
hospitals were closing down and  adult children were returning to                                                               
their homes.  The national  organization was developed as a grass                                                               
roots organization  when local groups  were formed to  respond to                                                               
this situation.                                                                                                                 
                                                                                                                                
3:54:16 PM                                                                                                                    
                                                                                                                                
SHIRLEY HOLLOWAY, President, National  Alliance on Mental Illness                                                               
(NAMI) Alaska, briefly shared her  first contact with NAMI, about                                                               
4 years  ago, when her  mentally ill daughter  committed suicide.                                                               
She had  then contacted  Jeff Jesse,  asking him  for suggestions                                                               
for organizations  to work with,  and he introduced her  to NAMI.                                                               
She lauded  that NAMI  offered immediate  support to  her family,                                                               
meeting  with  her daughter's  children,  her  siblings, and  her                                                               
parents.  She touted that NAMI  provided a level of support "that                                                               
was  unbelievable"   and  for  which  she   was  still  grateful.                                                               
Subsequently, she  became the Vice  President of  NAMI Anchorage,                                                               
and now, she is the President  of NAMI Alaska.  She declared that                                                               
her mission  is for  NAMI to  provide a  service to  families not                                                               
available  through any  other agencies.   She  detailed that  her                                                               
experiences  with experts  during her  daughter's mental  illness                                                               
never  suggested  there was  a  program  in support  of  families                                                               
living with an  individual with mental illness.   She offered her                                                               
desire  to  have  trained  NAMI staff  everywhere  in  Alaska  to                                                               
support and  advocate for  families, so  that other  families did                                                               
not have to  suffer as her family had suffered.   She offered her                                                               
belief  that this  is "one  of the  most cost  effective programs                                                               
you'll ever hear  about."  She acknowledged  the fiscal challenge                                                               
to the state, and offered for NAMI to be a part of the solution.                                                                
                                                                                                                                
3:57:43 PM                                                                                                                    
                                                                                                                                
JOHN HARTLE,  Board Member, National  Alliance on  Mental Illness                                                               
(NAMI) Juneau,  shared that he  became involved with NAMI  when a                                                               
family  member  was  suffering  from a  mental  disability.    He                                                               
reiterated the cost effectiveness of  the NAMI program, and noted                                                               
that it received some funding through  the TRUST.  He stated that                                                               
NAMI offers courses  to family members, taught  by volunteers and                                                               
are free  to families.   These courses  and the  course materials                                                               
were  developed  by the  national  organization  to teach  family                                                               
members about  the course  of treatment  for mental  illness, the                                                               
medications,  the symptoms,  and expectations  for outcomes.   He                                                               
declared that  this was a "life  ring thrown to me  in the middle                                                               
of the sea."  He shared that he  had no idea where to turn during                                                               
this family member  crisis.  He stated that NAMI  was a statewide                                                               
volunteer  organization,  and had  hopes  for  funding from  RFPs                                                               
through the Division  of Behavioral Health, in  the Department of                                                               
Health  and Social  Services.   He  asked that  the committee  be                                                               
supportive.  He  pointed out that NAMI was unique  as it provided                                                               
services and information to family  members, whereas other mental                                                               
health providers would  not ever return his phone  calls, as they                                                               
were   terrified  of   the  Health   Insurance  Portability   and                                                               
Accountability  Act  (HIPPA).   He  declared  that services  were                                                               
needed  for family  members in  order to  provide support  to the                                                               
individuals suffering from  mental illness.  He  stated that this                                                               
support was very effective in providing better outcomes.                                                                        
                                                                                                                                
4:01:25 PM                                                                                                                    
                                                                                                                                
CRYSTAL BORLAND,  Incoming Executive Director,  National Alliance                                                               
on Mental Illness  (NAMI) Juneau, offered an overview  of some of                                                               
the  NAMI programs,  referring to  the handout  titled "Improving                                                               
Lives:" [Included  in members' packets].   She directed attention                                                               
to a 12 week course, Family  to Family, which was taught by peers                                                               
with  an  evidence  based, nationally  based,  curriculum.    She                                                               
relayed  that  it  touched  on  medications,  treatment  options,                                                               
coping  strategies,  and  diagnosis  of mental  illness,  and  it                                                               
showed the family how to  communicate better and more effectively                                                               
with their loved one.  She  shared that once the individuals were                                                               
able to  cope and  communicate with their  loved one,  they would                                                               
become  better advocates.   She  stated that  the program,  along                                                               
with support  from the family  and the community, also  worked to                                                               
keep  people out  of  institutionalized care,  which  was a  cost                                                               
savings.  She  listed some of the other  program offerings, which                                                               
included NAMI  Basics and  support groups  for both  families and                                                               
people living with mental illnesses.                                                                                            
                                                                                                                                
4:03:24 PM                                                                                                                    
                                                                                                                                
MR.   GARTENBERG   relayed  that   NAMI   was   a  peer   support                                                               
organization, and not  a direct service organization.   He stated                                                               
that NAMI Anchorage and NAMI  Juneau continues to receive grants,                                                               
as well  as raising money  from other  sources.  He  relayed that                                                               
the  Trust had  stepped in  for  support when  the state  funding                                                               
ended.   He offered  his belief  that, as much  of the  state was                                                               
under served,  a NAMI presence  statewide had  early intervention                                                               
possibilities.  He  said that NAMI had  motivated individuals for                                                               
getting the  word out and  connecting with providers  and leaders                                                               
in the communities  to ensure there was education  and support in                                                               
the local community.  He  shared that the NAMI training standards                                                               
required presentation of information  and connection with people.                                                               
He explained  that the peer  support nature of  the organization,                                                               
its  great  strength,  required  funding  for  training  and  the                                                               
creation of  affiliates in  other areas.   He declared  that NAMI                                                               
did  not have  the  resources to  expand  with other  affiliates,                                                               
although the  TRUST had  indicated it would  work with  the state                                                               
for  expansion.   He reiterated  that  the cost  benefits to  the                                                               
family and  to the state  from early intervention  were enormous.                                                               
He shared an  anecdote about the NAMI Basics  program for parents                                                               
with adolescents  who were  showing signs  of early  onset mental                                                               
illness, although still undiagnosed.                                                                                            
                                                                                                                                
4:08:01 PM                                                                                                                    
                                                                                                                                
MS.  HOLLOWAY thanked  the committee  and pointed  out that  most                                                               
states provided state  funding for NAMI, whereas  in Alaska, NAMI                                                               
was only receiving money from the  Trust.  She said that NAMI had                                                               
been  able to  raise some  money for  training, and  was able  to                                                               
train  14 people  from  communities throughout  the  state.   She                                                               
pointed out  that this training  offered the potential  for these                                                               
people  to return  to  their communities  and  provide that  same                                                               
level of  support and  training to  people in  their communities.                                                               
She reported that NAMI was also  working with GCI for a more cost                                                               
effective  on-line delivery.    She expressed  her  hope for  any                                                               
support to the program.                                                                                                         
                                                                                                                                
REPRESENTATIVE  TARR expressed  her appreciation,  especially for                                                               
the use of community volunteer programs.                                                                                        
                                                                                                                                
4:10:28 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:10 p.m.                                                                                                          

Document Name Date/Time Subjects
Mental Health Trust Authority_HSS 2-10.pdf HHSS 2/10/2015 3:00:00 PM
Presentation: Mental Health
NAMI - National Alliance for Mental Illness- info sheets.pdf HHSS 2/10/2015 3:00:00 PM
Presentation- Mental Health