Legislature(2015 - 2016)CAPITOL 106
02/10/2015 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Mental Health Trust Authority | |
| Presentation: Nami | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
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 |