Legislature(2021 - 2022)BUTROVICH 205
04/27/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB124 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 124 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 27, 2021
1:33 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 124
"An Act relating to admission to and detention at a subacute
mental health facility; establishing a definition for 'subacute
mental health facility'; establishing a definition for 'crisis
residential center'; relating to the definitions for 'crisis
stabilization center'; relating to the administration of
psychotropic medication in a crisis situation; relating to
licensed facilities; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 124
SHORT TITLE: MENTAL HEALTH FACILITIES & MEDS
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
04/12/21 (S) READ THE FIRST TIME - REFERRALS
04/12/21 (S) HSS, FIN
04/27/21 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
STEVE WILLIAMS, Chief Operating Officer
Alaska Mental Health Trust
Anchorage, Alaska
POSITION STATEMENT: Gave an overview of SB 124.
HEATHER CARPENTER, Senior Policy Advisor
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for SB 124.
GENNIFER MOREAU, Director
Division of Behavioral Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 124
STEVEN BOOKMAN, Senior Assistant Attorney General
Civil Human Services Division
Department of Law
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 124.
ELIZABETH RIPLEY, President and CEO
Mat-Su Health Foundation
Wasilla, Alaska
POSITION STATEMENT: Testified in support of SB 124.
KENNETH MCCOY, Acting Chief
Anchorage Police Department
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 124.
ELIZABETH KING, Director
Behavioral Health and Workforce
Alaska State Hospital and Nursing Home Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 124.
SHIRLEY HOLLOWAY, Ph.D., President
National Alliance on Mental Illness (NAMI)
Vice President NAMI Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 124.
ACTION NARRATIVE
1:33:27 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:33 p.m. Present at the
call to order were Senators Costello, Begich, Hughes, Reinbold,
and Chair Wilson.
SB 124-MENTAL HEALTH FACILITIES & MEDS
1:33:58 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 124
"An Act relating to admission to and detention at a subacute
mental health facility; establishing a definition for 'subacute
mental health facility'; establishing a definition for 'crisis
residential center'; relating to the definitions for 'crisis
stabilization center'; relating to the administration of
psychotropic medication in a crisis situation; relating to
licensed facilities; and providing for an effective date."
He noted it was the first hearing for SB 124, sponsored by the
Senate Rules Committee by request of the governor. He asked
Steven Williams and Heather Carpenter to introduce the bill.
1:35:31 PM
STEVE WILLIAMS, Chief Operating Officer, Alaska Mental Health
Trust, Anchorage, Alaska, explained that SB 124 is part of a
larger effort to improve Alaska's psychiatric crisis response
system and began his presentation, Implementing A Behavioral
Health Crisis System of Care by reading slide 2, Change Is
Needed:
Currently, Alaskans in crisis are primarily served by
law enforcement, emergency rooms, and other
restrictive environments
• Behavioral health crisis response is outside the
primary scope of training for law enforcement,
and reduces focus on crime prevention
• Emergency rooms are not designed for and can be
overstimulating to someone in an acute
psychiatric crisis
MR. WILLIAMS stated that individuals are often inappropriately
placed in emergency rooms and restrictive environments, such as
jails. SB 124 provides an opportunity to create needed
innovative change to Alaska's psychiatric system.
SB 124 will:
• Effectuate a "No Wrong Door" approach to
stabilization services
• Enhance options for law enforcement and first
responders to efficiently connect Alaskans in
crisis to the appropriate level of crisis care
• Support more services designed to stabilize
individuals who are experiencing a mental health
crisis
• 23-hour crisis stabilization centers
• Short-term crisis residential centers
MR. WILLIAMS elaborated that No Wrong Door means first
responders who encounter a person in psychiatric crisis
specifically know which facility is best equipped to deal with a
patient's needs and take them there. The No Wrong Door approach
allows first responders to spend less time making transfers.
Areas that have implemented the system report transfer times of
3-10 minutes. Transfer time in Alaska is several hours. The bill
will allow the Department of Health and Social Services (DHSS)
to designate and license lower levels of acute psychiatric care.
SB 124 describes these as 23-hour and residential crisis
stabilization centers. These licensed centers can accept
individuals who are in emergency custody holds and those who are
there involuntarily.
1:39:01 PM
MR. WILLIAMS stated that the goal of the No Wrong Door approach
is to have a behavioral health emergency system analogous to the
911 physical health emergency system. A person experiencing a
behavioral health emergency would be able to quickly receive
help at their location and be transported to a facility for 23-
hour stabilization if needed. They would be admitted for short
term stabilization if further help was needed. (Slide 3, Goal)
1:41:21 PM
At ease
1:43:13 PM
CHAIR WILSON reconvened the meeting.
1:43:14 PM
MR. WILLIAMS pointed out that a transfer by the mobile crisis
team to a 23-hour stabilization center is critical for a person
in a psychiatric crisis. The system drastically reduces the
amount of time law enforcement spends making transfers to
appropriate medical care. He noted that the system is sponsored
by the Substance Abuse Mental Health Services Administration),
National Alliance on Mental Illness, Crisis Intervention Team
International (a law enforcement organization), the Action
Alliance on Suicide Prevention and several others.
In 2019 stakeholder organizations consisting of healthcare
providers, state agencies, first responders, nonprofits, local
governments, and tribal organizations began participating in the
assessment of community strengths and weaknesses. This was done
so psychiatric crisis response could be redesigned. Mr. Williams
said he has met with 300 organizations and individuals
throughout the process. (Slide 4, Stakeholder Engagement)
The 1115 Behavior Health Waiver is the foundation for being able
to implement systematic change. It is the work of DHSS to apply
and be awarded the waiver. The service and support behavioral
health providers give their communities is enhanced by the
waiver. The waiver provides funding for pieces of the emergency
behavioral response system. The parts of the system mentioned in
SB 124 are 23-hour Stabilization and Short-term Stabilization
Centers. (Slide 5, Enhanced Psychiatric Crisis Continuum of
Care)
1:47:38 PM
MR. WILLIAMS read slide 6, Crisis Stabilization (23-Hour):
Provides prompt crisis observation and stabilization
services, offers low barrier access to mental health
and substance use care in a secure environment
• No wrong door - walk-in, referral and first
responder drop off
• High engagement/Recovery oriented (Peer
Support)
• Staffed 24/7, 365 with a multi-disciplinary
team
• Immediate assessment and stabilization to
avoid higher levels of care where possible
• Safe and secure
• Coordination with community-based services
He defined a Crisis Stabilization Center as a location
designated and licensed by DHSS that would provide up to twenty-
three hours and fifty-nine minutes of crisis stabilization care.
An individual's mental needs would be assessed but their medical
and behavioral needs could also be addressed. Having a
designated locale would alert first responders that the
individual would be accepted right away.
MR. WILLIAMS read slide 7, Short-Term Crisis Residential
Stabilization Center:
A 24/7 medically monitored, short-term, crisis
residential program that provides psychiatric
stabilization
• Safe and secure serves voluntary and
involuntary placements
• High engagement/Recovery oriented (Peer
Support)
• Multi-disciplinary treatment team
• Short term with 16 or fewer beds
• Stabilize and restore avoid need for
inpatient hospitalization where possible
• Coordination with community-based services
MR. WILLIAMS said a short-term crisis center is one step up in
care from 23-hour care and is where a person would be sent if
they could not be stabilized at the lower level. It is recovery
oriented and designed to accept voluntary and involuntary
patients.
In speaking to the outcomes Georgia experienced after
implementing a crisis system, he stated that for every 100 calls
received, the crisis call center resolves 90 of them. A
dispatched mobile crisis team, consisting of a peer and a mental
health professional, resolves 7 out of the 10 remaining cases
through assessment, de-escalation, and referrals to support
services. The remaining three individuals are transported to a
23-hour stabilization center where 1 out of the initial 100 is
admitted to short term care.
By having a progression that provides early intervention,
qualified personnel and appropriate levels of care, the impact
on first responders can be significantly minimized. Moreover,
individuals get faster and better care. (Slide 8, Enhanced
Crisis Response)
1:51:43 PM
MR. WILLIAMS noted that the point where first responders spend
excessive amounts of time waiting to make transfers is at
emergency holding places. He shared a difficult, frustrating,
yet common experience many state troopers face. In Mat-Su a
trooper picked up an individual experiencing a psychiatric
crisis. The trooper was unable to resolve the situation on-site,
handcuffed the individual and attempted to find a local place of
transfer. Unsuccessful in finding a place to accept the patient
in Mat-Su, he drove to Anchorage. As the officer searched for
care the in-crisis individual, who had not committed a crime,
spent the officer's entire eight-hour shift in handcuffs. (Slide
10, Current Flow for Involuntary Commitment)
MR. WILLIAMS commented that under the new system law enforcement
and mobile crisis teams would be able to take patients to 23-
hour crisis stabilization centers. Transfers take less than ten
minutes in Georgia and Phoenix, Arizona, where 23-hour crisis
stabilization centers have been established. (Slide 11, Proposed
Statutory Changes)
He asked members to picture what the redesigning of a
psychiatric crisis system could look like and what SB 124 would
help effectuate. It would ensure people get appropriate care
swiftly, keep them out of jails and emergency rooms, and
minimize the impact on first responders (Slide 12, Flow for
Involuntary Commitment with Statutory Changes)
1:57:13 PM
HEATHER CARPENTER, Senior Policy Advisor, Department of Health
and Social Services (DHSS), Juneau, Alaska, presented the
sectional analysis for SB 124:
Section 1: Amends AS 12.25.031(i)(1) to define "crisis
stabilization center" as a subacute mental health
facility that has a maximum stay of 23 hours and 59
minutes.
She stated the statute was added last session as HB 290, an
alternative to arrest procedure, sponsored by
Representative Claman, and passed as SB 120.
Section 2: Amends AS 47.30.705(a) to expand the
category of who can cause a person to be taken into
custody for delivery to a crisis stabilization center
or an evaluation facility. The new language would
allow "a 'mental health professional' as defined in AS
47.30.915(13), or a physician assistant licensed by
the State Medical Board to practice in this state," in
addition to a peace officer.
She noted that a definition sheet for involuntary commitment
statutes was provided. All provider types being deleted were
captured in the definition of a mental health professional. A
physician assistant was not in the definition of a mental health
provider, so it was specifically included in Section 2.
Clarifies that a person is taken "into custody" by a
peace officer and then delivered to the nearest crisis
stabilization center or evaluation facility.
MS. CARPENTER commented that the desire is to divert care to the
most appropriate facility and receive immediate care, instead of
being placed in an emergency room or jail.
Clarifies that a person taken into custody may not be
placed in jail or other correctional facility except
for protective custody purposes while they await
transportation to a subacute mental health facility or
an evaluation facility.
Replaces "crisis stabilization center" with "subacute
mental health facility" to align with the definitions
in Section 15 which categorize crisis stabilization
center as a subtype of a subacute mental health
facility.
Section 3: Adds a new subsection (c) to AS 47.30.705
that requires a peace officer to prioritize delivery
to a crisis stabilization center if one exists in the
area served by the peace officer.
2:00:18 PM
MS. CARPENTER added the desire is not to have a peace officer
transport someone from Dillingham to Anchorage. However, if
someone were having a crisis in Houston and a stabilization
center existed in Wasilla, the peace officer would prioritize
delivering the individual to the Wasilla center rather than an
emergency room.
Section 4: Adds a new section AS 47.30.707 for
admission to and detention at a subacute mental health
facility with the following options and rights for a
patient:
(a) Creates legal parameters for emergency
admission and holds at a 23-hour 59-minute
crisis stabilization center. It also
requires a mental health professional to
examine the patient (respondent) delivered
to a crisis stabilization center within 3
hours after arrival.
(b) Creates a new process for evaluation,
stabil-ization, and treatment at crisis
residential centers which provides a less
restrictive alternative to traditional
involuntary commitment holds at a
Designated Evaluation and Treatment
Facility (DET) or the Alaska Psychiatric
Institute (API). If there is probable cause
to believe the person's crisis could be
stabilized by admitting to a crisis
residential center, the mental health
professional in charge at the 23-hour, 59-
minute crisis stabilization center can
apply to the court for an ex parte
detention order after which the person
could be detained at a crisis residential
center for no more than 120 hours.
2:02:08 PM
MS. CARPENTER noted that the meaning of professional in charge
was defined in AS 47.30.915.17 as the senior mental health
professional at a facility, or that persons designee in the
absence of a mental health professional. It means the chief of
staff, or the physician designated by the chief of staff.
(c) Retains the option to use the current
process of application for an ex parte
order for delivery to a hospital designated
as a DET (such as API) if the individual is
determined to still be in acute behavioral
health crisis and needs further evaluation.
(d) Requires that if at any time during an
involuntary hold at a subacute mental
health facility, the patient (respondent)
no longer meets the standards for a
stabilization hold or detention, that they
be released.
(e) Provides for the patient's (respondent's)
rights when being involuntarily held at a
subacute mental health facility.
2:03:13 PM
She offered that some examples of patient's rights are the right
to communicate immediately with a guardian or attorney of their
choice, the right to be represented by an attorney and the right
to be notified of their rights.
(f) Allows for the patient (respondent) to
convert to voluntary status for care.
(g) Allows a subacute mental health facility
to administer crisis psychotropic
medication consistent with the practice
permitted in AS 47.30.838 for evaluation
and designated treatment facilities.
(h) Adds language to clarify how time is
calculated in this section for the 23-hour,
59- minutes and 120- hour periods.
2:04:09 PM
Section 5: Provides clarifying edits to AS 47.30.710
and adds language to allow admission to subacute
mental health facilities (in addition to evaluation
facilities).
Adds language to allow a mental health professional,
after examination, to either:
1. Hold the person at a crisis stabilization
center;
2. Admit the person to a crisis residential
center;
3. Readmit the person to a crisis residential
center if it is within 24 hours of a
previous admission with department prior
authorization;
4. Hospitalize the respondent; or
5. Arrange for emergency hospitalization.
Section 6: Adds a new subsection (c) to AS 47.30.710
to require application for an ex parte order if a
judicial order is not in place.
Adds a new subsection (d) outlining the patient's
(respondent's) right to request a court hearing and
receive representation by a public defender if the
patient (respondent) is readmitted within 24 hours of
a discharge and is not willing to stay voluntarily.
Section 7: Amends AS 47.30.715 to clarify the facility
type as an "evaluation facility" and to require
admission of the patient (respondent) when it is safe
to do so for a 72-hour evaluation to determine if a
petition for 30-day commitment should be filed.
MS. CARPENTER explained the reason for adding the language is
facilities can have different staffing patterns or there may be
several highly acute patients in one facility at the same time.
Such circumstances can require a 2:1 staffing ratio. A facility
must have the clinical staff available for treatment before they
can admit a new patient, even if a bed is vacant. This is a
clinical judgement in order to ensure the patient number does
not exceed capacity or result in unnecessary injuries to
patients or providers. This also ensures a facility can comply
with all the patient safety conditions required by the joint
commission and Centers for Medicare and Medicaid Services (CMS).
Section 8: Amends AS 47.30.805(a), a computation of
time statute, to include computation for proceedings
or transportation to a crisis residential center.
2:07:22 PM
MS. CARPENTER said only a physician, advanced practice nurse, or
physician assistant can determine the need for crisis
medication.
Section 9: Amends AS 47.30.838(c) to include the
subacute mental health facility type as a type of
facility authorized to administer psychotropic crisis
medication when there is a crisis situation where the
patient requires immediate medication to prevent
significant physical harm to themselves or others.
She explained that crisis medication can be given when there is
a crisis situation or impending crisis situation. A crisis
happens when medication must be used immediately to preserve
life or prevent significant physical harm. Only a physician,
advanced nurse practitioner or physician assistant can make the
determination; a regular nurse cannot. Providers universally say
that physical restraint is much worse for patients than
medication.
An order for crisis medication is initially valid for only
twenty-four hours. It may be renewed for up to seventy-two hours
total. A facility can administer crisis medication for no more
than three crisis periods without court approval. This means
medication can be renewed for up to nine 24-hour periods. This
almost never happens because regularly scheduled medication
reduces the use of crisis medication.
Section 10: Adds a new section to AS 47.30 to require
the department to adopt regulations to implement these
changes to the involuntary commitment statutes.
Section 11: Amends AS 47.30.915(7) to clarify that
"evaluation facility" means a department-designated
hospital or crisis residential center.
MS CARPENTER explained that technically, using the current
definition of the term healthcare facility, a hospice facility
could be an evaluation and treatment center. DHSS would not do
this, but it demonstrates why precise language is needed.
Section 12: Amends the definition of "peace officer"
in AS 47.30.915(15) to include "emergency medical
technician; paramedic; or firefighter."
2:09:39 PM
MS. CARPENTER said the amendment in Section 12 changes the
definition of peace officer so that SB 124 aligns with the
established definition of mobile crisis teams in Anchorage.
Section 13: Amends AS 47.30.915 to provide
definitions:
• "subacute mental health facility" is defined
in AS 47.32.900.
• "crisis residential center" means a subacute
mental health facility that has a maximum
stay of 120 hours.
• "crisis stabilization center" means a
subacute mental health facility that has a
maximum stay of 23 hours and 59 minutes.
Section 14: Amends the licensing statutes in AS
47.32.010(b) to change "crisis stabilization centers"
to "subacute mental health facilities."
MS. CARPENTER stated the term subacute mental health
facilities is used to encapsulate a comprehensive set of wrap-
around services that can occur in a variety of different crisis
settings. The umbrella term affords the state the flexibility to
grow the suite of crisis services over time.
Section 15: Adds a new paragraph to AS 47.32.900 to
define "subacute mental health facility" in the
licensing statutes.
Section 16: Repeals AS 47.32.900(5).
Section 17: Adds a new section to the uncodified law
to clarify that DHSS will consider previously issued
"crisis stabilization center" licenses as a license
for "subacute mental health facility."
Section 18: Adds a new section to the uncodified law
to allow the department to adopt regulations to
implement this act.
Section 19: Provides for an immediate effective date
for the bill
2:12:16 PM
SENATOR HUGHES asked how a person having a behavioral health
crisis will be handled if they have broken a law.
MR. WILLIAMS replied the situations described during this
meeting did not involve laws being broken.
SENATOR HUGHES asked if there was support from Alaska law
enforcement.
MR. WILLIAMS answered he is partnering with Fairbanks Police
Department, Alaska State Troopers, Anchorage Police Department,
and other first responders.
2:14:00 PM
SENATOR BEGICH asked if the state is anticipating that tribal
entities will provide crisis stabilization centers in rural
communities. He wondered whether they would be eligible for
matching federal funds. He also wanted to know if consideration
had been given to rural staffing concerns. He asked how the
hospital and other two facilities came to be listed in the
fiscal note and where they would be located.
MS. CARPENTER replied that DHSS does anticipate tribal partners
setting up services. Services can be billed to Medicaid through
the 1115 Health Waiver. By statute the department is required to
pay for those who do not have insurance but need involuntary
commitment care. Traditionally payment is made using
Disproportionate Share Hospital (DSH) funds, which is a 50 50
match of state and federal funds. Tribal health organizations
are not eligible for federal match through DSH, and the fiscal
notes reflect that.
DHSS has several tribal partners interested in setting up
services in rural communities, such as Kotzebue and Nome. The
model will look different for rural Alaska. The trust is working
with tribal partners to determine how to scale the model for
rural communities.
2:16:51 PM
SENATOR BEGICH asked where the hospitals would be located and
how the estimates in the second fiscal note were identified.
MS. CARPENTER deferred to Gennifer Moreau who helped prepare the
fiscal note.
GENNIFER MOREAU, Director, Division of Behavioral Health,
Department of Health and Social Services (DHSS), Anchorage,
Alaska, replied that DHSS has been working through trust
sponsored stakeholder engagements and the 1115 waiver
implementation path. DHSS has received requests for approval
from agencies across the state to provide Medicaid based
services, short term crisis residential centers and 23-hour
stabilization centers. Estimates were based on those agencies'
requests for department approval.
2:18:55 PM
SENATOR REINBOLD asked if there have been any formal letters
written in support of SB 124.
CHAIR WILSON responded that a letter of support arrived just
before the meeting and will be shared with members.
MR. WILLIAMS replied that the trust has not received any letters
from law enforcement to date. However, since 2019 when training
efforts and the process of developing a better psychiatric
response system began, law enforcement has been very supportive.
2:21:07 PM
SENATOR REINBOLD remarked that she has a bill to repeal SB 120.
She requested an explanation of how SB 124 works with SB 120.
MS. CARPENTER answered that Section 1 of SB 124 interacts with
SB 120 by amending one definition. Everything else both in
involuntary commitment and licensing statute, stands alone.
SENATOR REINBOLD requested a list of the medications that can be
administered within the first 23-hours of admission to a
facility. People can have serious adverse reactions to
psychotropic drugs, she said.
MS. CARPENTER replied she will speak with the Alaska Psychiatric
Institute psychiatrist regarding examples of administered
drugs. She explained that the medication given would change
depending on the clinical judgement of the provider. She
reminded members that providers must physically restrain a
patient if they are not able to give crisis medication and
physical restraint is worse for patients.
2:23:18 PM
SENATOR REINBOLD responded she understands people can be
freaked-out by being restrained but taking medications can have
severe consequences. She asked where the numbers and statistics
presented on slide 8 came from. The graphic depicted outcomes of
100 calls to a crisis center. She asked how many involuntary
commitments have been sent to the subacute mental health
facility based on the graphic.
MR. WILLIAMS replied that the data for the graphic came from the
state of Georgia based on ten years of information and 1.5
million callers. Data gathered in Phoenix, Arizona, demonstrated
similar results using the same operating model.
SENATOR REINBOLD asked for a list of medications that can be
administered in the first 23 hours.
MR. WILLIAMS responded he does not have a list.
CHAIR WILSON said Ms. Carpenter would obtain a sample list of
medications because the medication administered depends on the
type of crisis a patient is going through.
2:25:20 PM
SENATOR REINBOLD stated she has ex parte concerns and asked when
she could ask questions about SB 120.
CHAIR WILSON answered that the next Department of Health and
Social Services Committee meeting might be an appropriate time.
SENATOR COSTELLO asked how care of a minor is dealt with in SB
124.
MS. CARPENTER replied that the system works for minors so long
as a facility accepts them. DHSS would need to know if a 23-hour
stabilization center or crisis residential center has the
capacity to accept minors. DHSS does have some facilities that
are preparing to establish minor services. Ketchikan is very
interested in serving minors.
SENATOR COSTELLO asked what provisions are in SB 124 that would
allow parents to be notified if their minor child was taken to a
facility.
MS. CARPENTER deferred to Mr. Bookman.
2:28:06 PM
STEVEN BOOKMAN, Senior Assistant Attorney General, Civil Human
Services Division, Department of Law, Anchorage, Alaska, replied
that [Section 4] incorporates the rights under 725 [AS
47.30.725]. One of those rights is the right to communicate at
the department's expense, with the respondent's guardian, if
any, or an adult designated by the respondent.
SENATOR COSTELLO asked whether the minor gets to choose who is
informed or whether it is in statute that a parent will be
communicated with.
MR. BOOKMAN responded both; statute provides that the guardian
and an adult designated by the respondent be notified. This is
also in AS 47.30.775 labeled Commitment of Minors, which
addresses how earlier provisions, including the 725 rights
statute [AS 47.30.725] applies to minors. It further states that
any notices required to be served on the respondent shall also
be served on the parent or guardian of a minor and any parents
or guardians shall be notified that they may appear as parties
and retain an attorney or have an attorney appointed for them.
2:30:09 PM
SENATOR HUGHES requested the committee reach out to law
enforcement for letters of support. She was relieved to know the
system is for individuals who have not committed a crime. She
asked how much time Alaska law enforcement officers would gain
if they did not have to deal with mental health crises. She
asked if there is data showing improved patient outcomes, such
as fewer 911 calls. She specifically was interested in suicide,
since it is a problem in Alaska. She speculated a suicidal
individual might be more receptive to help from a healthcare
worker than law enforcement.
MR. WILLIAMS replied that he does not have all the data points
requested but offered the Anchorage Police Department (APD)
averages 400 behavioral health crisis calls per month.
He stated the amount of time saved by Phoenix, Arizona, law
enforcement not responding to behavioral health crises was
thirty-seven full time equivalents (FTEs). Those thirty-seven
FTEs were applied to resolving criminal matters. He did not have
suicide information available but would inquire about it.
2:34:09 PM
SENATOR REINBOLD stated she sees similarities between HB 76 and
SB 124 in changing definitions. Section 12 changed the
definition of peace officer. Section 2 deleted licensed
psychiatrists, physicians and other qualified professions and
replaced them with peace officers and physician assistants. She
offered her belief that experienced people should be the ones to
commit individuals. Another concern with SB 124 is in Section
14, which includes maternity centers, nursing homes and
residential childcare as listed facilities. She stated there are
multiple significant changes in SB 124 and recommended the bill
be reviewed closely.
CHAIR WILSON stated SB 124 will be heard several times.
2:37:29 PM
SENATOR HUGHES asked if concerns regarding provider types and
facilities could be addressed.
MS. CARPENTER replied that the concerns mentioned are minor
changes. In Section 2 licensed psychiatrists, physicians and
others are being deleted because they are included in the
definition of a mental health professional, as found in Alaska
Statute 47.30.915.13. Physician assistant was specifically
mentioned in SB 124 because it is not included in the definition
of a mental health provider.
The change to the definition of peace officer only applies to
involuntary commitment statutes. It is being amended to add
EMTs, paramedics and firefighters to accommodate Anchorage
model of a mobile crisis team.
Section 14 is a conforming change with state licensing statutes
found in AS 47.32. The healthcare facilities Senator Reinbold
mentioned are listed in licensing statute because they are
facilities that are licensed by DHSS, through state healthcare
facility licensing. It is licensing statute, not involuntary
commitment statute.
EMTs are only allowed to do the first emergency hold. They
cannot do holds at crisis stabilization centers. Those holds are
done according to current statute.
2:39:30 PM
ELIZABETH RIPLEY, President and CEO, Mat-Su Health Foundation,
Wasilla, Alaska, stated she represents the Mat-Su Health
Foundation on the Mat-Su Regional Medical Center Board of
Directors. The foundation shares ownership in Mat-Su Regional
Medical Center and invests its share of profits back into the
community through grants and scholarships to improve the health
and wellness of Alaskans living in Mat-Su.
MS. RIPLEY said SB 124 would allow the Crisis Now model to be
developed in Mat-Su and Alaska. She reported that during twenty-
four community forums, as part of the 2013 Mat-Su Community
Health Needs Assessment, the people of Mat-Su were asked what
their top five health concerns where. The top five answers were
all mental health and substance abuse related. Residents told
the foundation they wanted an improved and coordinated system of
care that would make treatment for behavioral health more
readily accessible.
To better understand the gaps and challenges in care across the
behavioral health continuum, the foundation examined the
behavioral health crisis response system in Mat-Su. It found the
Mat-Su Regional Medical Center Emergency Department saw 2,391
behavioral health patients in 2013 for a total of 6,053 visits,
which cost an estimated $23 million. These patients had higher
charges, more frequent visits and were more likely to return to
the hospital within 30 days. An additional $1.6 million was
spent on law enforcement, 911 dispatch and transportation.
Alaska State Troopers responded to 851 health related emergency
calls. Ambulance services responded to an average of 432 calls.
Since then, the prevalence of mental health and substance abuse
crises has increased in Mat-Su and statewide.
2:41:47 PM
MS. RIPLEY said the average annual growth rate for visits to the
Mat-Su Regional Medical Center Emergency Department by patients
with behavioral health diagnoses grew twenty percent from 2015
to 2017 due to the opioid epidemic and lack of treatment access.
In 2016, 3,443 patients with behavioral health diagnoses went to
the Mat-Su Regional Medical Center Emergency Department. Their
charges totaled $43.8 million, which does not count the
additional cost born by law enforcement or Mat-Su Borough EMS
for dispatch and ambulance services. Additionally, from 2014 -
2017 the number of behavioral health assessments required for
patients in crisis in the emergency department grew from 349 to
more than 1000.
She reported that Mat-Su Regional Medical Center opened a
sixteen-bed behavioral health wing last January, which provides
in-patient behavioral health treatment. It has reduced boarding
in the emergency department but not eliminated it. There are
still people who need detox, space to sober up, and other
behavioral health services that do not necessarily require an
emergency department visit or in-patient treatment.
2:43:01 PM
MS. RIPLEY said despite the work of the foundation and its
partners to create treatment upstream of the emergency
department, there are still many people needing crisis
intervention downstream. Cost-effective options are needed,
which is why the Mat-Su Health Foundation became involved in the
Crisis Now model. Research estimated Mat-Su has 2,583 behavioral
health crisis episodes occurring annually. These could be served
by any level of crisis services within the Crisis Now model.
About 2,500 of these episodes, can be served by the Crisis Now
call-line or mobile crisis team. The rest may require
involuntary holds in crisis facilities provided by SB 124. Mat-
Su is projected to need nine short term residential beds under
the Crisis Now model.
Ray Michaelson, Program Officer of the Health Minds portfolio at
the foundation, has been meeting with thirty behavioral health
providers and emergency system partners over the last nine
months to establish these needed services in the Mat-Su
community. The Mat-Su Health Foundation has budgeted grant
dollars to help support capital and start-up costs. The 1115
Health Wavier should help cover some of the operating costs. The
foundation is committed to getting Crisis Now into operation in
Mat-Su. Legislation is needed to make it legally possible.
Legislation will make a new option possible to support residents
who experience behavior health crises. It also supports law
enforcement and healthcare workers. She respectfully asked that
SB 124 be moved forward.
2:44:51 PM
KENNETH MCCOY, Acting Chief, Anchorage Police Department,
Anchorage, Alaska, stated the Anchorage Police Department (APD)
supports building a complete crisis response system, consisting
of a crisis call center, mobile crisis teams, and 23-hour
stabilization centers. These components of the system are needed
to adequately address mental and behavioral health.
Law enforcement's response has not led to desired outcomes. A
large percentage of situations end with the police using force
against people who are in a mental health crisis. The police
department recognizes that these situations are better suited
for mental and behavioral health professionals. About half of
the mental and behavioral health calls APD receives result in an
officer taking the individual into custody and transporting them
to a jail or emergency room. Sometimes officers and individuals
are left for hours at a time in the police vehicle trying to
find an appropriate safe location to drop the person off.
CHIEF MCCOY said it is a drain on police resources, which could
be better spent investigating actual crime. Being in the back of
a police car increases emotional trauma for citizens
experiencing a mental health crisis. APD recognizes there are
situations when law enforcement is the most appropriate
response, such as when crimes have been committed or weapons are
reported. A crisis system augments what APD can do for the
community.
2:49:24 PM
SENATOR REINBOLD expressed concerns about changing the
definition of peace officer, the ability to administer drugs and
minor parental consent. She asked for a description of a person
in a [behavioral health crisis].
CHIEF MCCOY replied there are times when people are seen walking
on streets in obvious mental distress causing a disturbance.
There is not a lot an officer can do. A crime has not been
committed so taking them to jail is not appropriate and they do
not require an emergency room level of medical care. Having
professionals in the field respond to the individual is a win-
win for the community. Law enforcement has found that their
uniforms, lights, and radios can act as a catalysis for use of
force. Police are provided with some crisis intervention
training, but it is not enough. The resources of SB 124 would
compliment law enforcement and better serve the community.
2:52:58 PM
SENATOR REINBOLD asked if he can identify any way [the emergency
behavioral health crisis system] can be abused.
CHAIR WILSON replied that the department [DHSS] will get an
answer to the committee.
2:53:33 PM
ELIZABETH KING, Director of Behavioral Health, Alaska State
Hospital and Nursing Home Association (ASHNHA), Anchorage,
Alaska, said the Alaska State Hospital and Nursing Home
Association (ASHNHA) supports the intent of SB 124. Its members
continue to review the legislation and are working to see if
changes are needed. SB 124 is intended to support individuals
experiencing mental health crises through increased availability
of services, specifically by allowing the use of 23-hour crisis
care stabilization centers and short-term crisis residential
centers.
There have been on going challenges with accessible, adequate,
and appropriate care for individuals experiencing mental health
crises. Alaska primarily relies upon law enforcement and
hospital emergency rooms for their care. Emergency rooms are one
of the most restrictive and expensive levels of care. Patients
who end up at emergency departments are often held for several
hours or days waiting for access to needed treatment. On
average, behavioral health patients stay in emergency
departments three times longer than patients with medical
diagnoses. SB 124 offers the ability to support patients in
crisis in a less restrictive environment and with a more
appropriate level of care, regardless of whether they have a
court order for involuntary commitment. The capacity to provide
crisis care for any Alaskan in need is the cornerstone to
building a successful model of crisis services.
2:56:06 PM
SHIRLEY HOLLOWAY, Ph.D., President, National Alliance on Mental
Illness (NAMI), Vice President NAMI Alaska, Anchorage, Alaska,
shared that she joined NAMI after losing her daughter to
suicide. NAMI is the largest grassroots mental health
organization in the nation. NAMI Alaska was created in 1984 and
serves the entire state with affiliates in Anchorage, Fairbanks,
Juneau, and the North Slope. On behalf of NAMI and as a parent
she testified in support of SB 124.
Alaska relies on law enforcement, EMS, and hospital emergency
rooms to serve people in behavioral health crises. Most
communities do not have appropriate facilities and services
where officers can take people to receive appropriate care. This
legislation will help to create a full continuum of behavioral
health crisis response services, particularly at the appropriate
lower levels of care. SB 124 will allow Alaska to implement
proven crisis response improvements. The nationally recognized
Crisis Now model, allows first responders to bring individuals
in crisis to a low to no barrier crisis stabilization center.
The current approach to crisis care is patchwork and delivers
minimal treatment for some people while others, often those who
have not been engaged in care, fall through the cracks. This
results in multiple hospital readmissions, life in the criminal
justice system, homelessness, early death, and suicide.
A comprehensive and integrative crisis network is the first line
of defense in preventing tragedies of public and patient safety,
civil rights, extraordinary and unacceptable loss of lives and a
waste of resources.
2:59:29 PM
MS. HOLLOWAY declared that there is a better way. Effective
crisis care that saves lives and dollars requires a systemic
approach. The Crisis Now model is a continuum of three
components that are already working in many communities to
prevent suicide, reduce wait time in emergency rooms and
correctional settings, and provide the best support for
individuals in crisis.
The Crisis Now model includes a crisis call center, centrally
deployed 24/7 mobile crisis teams and a 23-hour stabilization
and short-term residential center. It provides a safe and
appropriate behavioral crisis placement for those who can not be
stabilized by initial call center or mobile crisis team
response.
This new approach to the mental health crisis follows the
national guidelines of behavior health crisis care, using best
practices endorsed by the Substance Abuse and Mental Health
Services Administration (SAMHSA), US Department of Health and
Human Services. These guidelines were developed on the
experience of veteran crisis system leaders and administrators.
3:01:04 PM
MS. HOLLOWAY stated her testimony is personal:
I have a beautiful talented daughter who lived with
mental illness that I lost by suicide. For someone in
crisis there can now be an alternative to jail, API
[Alaska Psychiatric Institute], and hospital emergency
rooms. A more systemic response is needed, and this
legislation is critical to getting us where we need to
be to develop a comprehensive mental health response
system...
3:01:58 PM
CHAIR WILSON held SB 124 in committee.
3:02:59 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 3:02 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 124 Transmittal Letter.pdf |
SFIN 5/12/2022 1:00:00 PM SHSS 4/27/2021 1:30:00 PM SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 Version GS 1730 A.PDF |
SHSS 4/27/2021 1:30:00 PM |
SB 124 |
| SB 124 Sectional Analysis Version GS1730 A.pdf |
SHSS 4/27/2021 1:30:00 PM |
SB 124 |
| SB0124-1-3-041221-DHS-Y.PDF |
SHSS 4/27/2021 1:30:00 PM |
SB 124 |
| SB0124-2-3-041221-DHS-Y.PDF |
SHSS 4/27/2021 1:30:00 PM |
SB 124 |
| SB0124-3-2-041221-DPS-N.PDF |
SHSS 4/27/2021 1:30:00 PM |
SB 124 |
| SB 124 Infographics - Proposed Statutory Changes to Title 47 4.22.21.pdf |
SHSS 4/27/2021 1:30:00 PM |
SB 124 |
| SB 124 Definitions in AS 47.30.915.pdf |
SHSS 4/27/2021 1:30:00 PM |
SB 124 |
| SB 124 Introduction Presentation - Senate HSS - 04272021.pdf |
SHSS 4/27/2021 1:30:00 PM |
SB 124 |