HB 43-CONVERSION THERAPY PROHIBITIONS  3:05:55 PM CHAIR PRAX announced that the first order of business would be HOUSE BILL NO. 43, "An Act relating to professional and occupational licensing; and relating to treatment to change the sexual orientations or gender identities of children and vulnerable adults." 3:06:36 PM REPRESENTATIVE SARA HANNAN, Alaska State Legislature, as prime sponsor, introduced HB 43. She stated that the proposed legislation came out of her work on the Suicide Prevention Council, as it is tasked to find the root causes of suicide and ways to promote harm reduction for Alaskans. She reported that conversion therapy had been found to be a contributor to suicidal behavior and ideation. She expressed the opinion that the first step to solve Alaska's mental health crisis is to look at the statistics for at risk populations. She reported that people who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ) are at a higher risk of suicide than peers, and people who have been subjected to conversion therapy to change their sexual orientation exhibit an additional rate of risk. She reported that 20 other states have conversion therapy bans. She added that it has been deemed by multiple national psychology organizations as an unscientific practice. She iterated that HB 43 focuses on the licensure and regulation of health care practitioners. She noted that a committee substitute has been drafted to remove unwanted language from the original version and to keep the focus on licensure, as intended. 3:10:12 PM REPRESENTATIVE Ruffridge moved to adopt the proposed committee substitute (CS) for HB 43, Version 33-LS0186\B, Dunmire, 2/14/23, ("Version B") as the working document. There being no objection, Version B was before the committee. 3:10:53 PM HUNTER MEACHUM, Staff, Representative Sara Hannan, Alaska State Legislature, on behalf of Representative Hannan, prime sponsor, presented the sectional analysis for HB 43, Version B [copy included in the committee packet], which reads as follows [original punctuation provided]: HB 43 would prohibit physicians, physician assistants, psychiatrists, psychologists, psychological associates, and other "practitioners of the healing arts" licensed by the state from treating a person under the age of 18 or a vulnerable adult with a therapy or regimen that seeks to change their sexual orientation or gender identity. Section 1 amends AS 08.01.077 to include treating an individual under the age of 18 or a vulnerable adult with a "conversion therapy" as among the grounds a department or board may consider for disciplining or sanctioning a person licensed, certified, or regulated by that department or board. Section 2 adds a new subsection under AS 47.17.024 to stipulate that a practitioner of the healing arts licensed under state statute may not treat an individual under the age of 18 with a therapy or other regimen that seeks to change the individual's sexual orientation or gender identity. Religious healing practitioners are exempted from the prohibition. Section 2 also specifies certain varieties of counseling to which the prohibition does not apply. Section 3 of the bill adds a new subsection to AS 47.24 to stipulate that a practitioner of the healing arts licensed under state statute may not treat a vulnerable adult with a therapy or other regimen that seeks to change the individual's sexual orientation or gender identity. Again, religious healing practitioners are exempted from the prohibition, and the section also specifies certain varieties of counseling to which the subsection does not apply. Section 4 states that the provisions of the bill apply to conduct that occurs on or after the effective date of the Act. 3:13:59 PM MATHEW SHURKA, Co-Founder and Chief Strategist, National Center for Lesbian Rights, Born Perfect Campaign, provided invited testimony on HB 43, Version B. He explained that the Born Perfect Campaign represents survivors of conversion therapy. He stated that 20 states and 120 municipalities have passed similar legislation and ordinances prohibiting conversion therapy have been passed, all with bipartisan support. He asserted that evidence backs the understanding that conversion therapy is harmful, fraudulent, and can cause lifelong damage, including potential suicide. He explained that he is 1 of the 700,000 Americans who have experienced conversion therapy. He stated that Born Perfect tracks conversion therapy survivors and their experiences from first-hand accounts. He expressed the understanding that in Alaska there is a referral system between licensed practitioners, pastors, and other individuals who recommend conversion therapy. As an example, he shared his personal history of 5 years in conversion therapy, which started at the age of 16. He emphasized that all the therapists he saw were licensed by their corresponding state. He shared that after coming out as gay to his father, his father found a therapist who believed that being gay was a curable mental illness. The therapist insisted that all people were innately heterosexual and being gay was caused by childhood trauma. He stated that he had trusted his father and began the therapy; however, the therapist was puzzled because of the lack of any childhood trauma present. His therapists posited that he was experiencing "same sex attraction" because he was too close to his mother and sisters and not close enough to his father. The treatment began by removing his ability to speak to his mother or his sisters for three years, and this was to discourage his use of "feminine behaviors." MR. SHURKA stated that he developed severe depression and suicidal thoughts during the second year of his treatment, even though he believed that the treatment was working. He shared that he was eventually encouraged to engage sexually with women and given step-by-step instructions on how to do so. However, he expressed that this form of treatment had caused him extreme anxiety, to the point he was not able to perform sexually. Even though he was a "healthy 17-year-old boy" who did not suffer from erectile dysfunction, his therapist gave him Viagra through a prescription written in his father's name, claiming this would allow him to be more confident in pursuing relationships with the opposite sex. He reported that his parents spent over $35,000 for the conversion therapy and he eventually dropped out of college because of anxiety and depression. He described the experience as artificial, humiliating, and demeaning. He argued that every licensed therapist should know conversion therapy is fraudulent, as it has no scientific backing. He argued that no therapist licensed by the state should be able to prescribe conversion therapy to children. He said that his organization has been working with therapists who used to conduct conversion therapy for decades but now publicly denounce the practice. He stated that 25 of these therapists have signed a letter in support of HB 43. 3:20:48 PM CHAIR PRAX asked whether the letter was included in the committee materials. MR. SHURKA stated that it was not yet but would be given to the committee as soon as possible. 3:21:30 PM CASEY PICK, Director, Law and Policy, The Trevor Project, provided invited testimony on HB 43, Version B, via a written statement, which was read for the record by Mr. Shurka. The statement read as follows [original punctuation provided]: Good afternoon, my name is Casey Pick and I am the Director of Law and Policy for the Trevor Project. I am also an attorney with over a decade's experience with LGBTQ legislation [in support] of laws like this one. I'd like to thank [you for] the opportunity to express the Trevor Project's strong support of House Bill 43, which protects youth under the age of 18 from sexual orientation/gender identity change efforts, sometimes known as conversion therapy, at the hands of licensed professionals. 20 states and nearly 100 municipalities have passed similar legislation, which has been consistently upheld, was carefully crafted, and now tailored to protect the mental health and wellbeing of LGTBQ youth. Alaska should be proud to join their ranks. The Trevor Project is the leading suicide prevention and crisis intervention organization dedicated to serving LGBTQ young people. They work every day to save young lives by providing support through free and confidential 24/7 telephone lifeline, chat, and text platforms. To further our mission of ending LGBTQ youth suicide, Trevor is dedicated to seeing the end of conversion therapy. In doing so, we are aligning with every major medical and mental health organization in condemning these practices as harmful, ineffective, unethical, and founded on unscientific theories [which have] been debunked for decades. Trevor also conducts in-depth research into issues effecting the mental health of the youth we serve. Our 2022 national survey on LGBTQ mental health surveyed nearly 34,000 respondents between the ages of 13-24 and found that 17 percent of these youth reported being threatened with subjected to conversion therapy (the breakdown is 11 percent threatened and 6 percent subjected to the practice). Tragically, LGBT youth who reported being subjected to or threated with conversion therapy have also attempted suicide at more than twice the rate of their peers who did not, at rates of 28 percent versus 11 percent. However, research also shows these youth are more than two and a half times more likely to report multiple suicide attempts in the previous 12 months (between 2021 and 2022). You can read more about this peer reviewed article in the American Journal of Public Health. In the past year alone, our crisis services have responded to over 700 contacts from Alaska alone, which we estimate is a small fraction of the LGBTQ youth in Alaska who seriously considered suicide in the past year. Nationally, many of the young people we serve are conversion therapy survivors or are afraid their family members will put them through this. Our counselors don't ask about conversion therapy directly when a youth calls in during a crisis, but in the last year 1,300 contacts across the U.S. explicitly raised the topic themselves. These contacts came from almost every state and from more than 600 different cities and towns across the country. Some of these youth contact us because their parents are threatening to send them to conversion therapy. Others call us because they are actually undergoing such treatments and it's not working, and their feelings of isolation and failure contribute to suicidal thoughts and behaviors. Many are afraid to come out because they fear it will result in somebody trying to change them. Some are looking for support to get out of conversion therap. Especially relevant to our discussion today, it is not uncommon for young people to call us expressing relief that conversion therapy is illegal where they live currently. There is one more piece of research I would like to share with you today. Medical experts have known for decades that conversion therapy contributes to elevated rates of mental health struggles, including depression, anxiety, substance abuse, and suicide attempts. In 2022 JAMA Pediatrics, a peer reviewed journal of the American Medical Association, published an article which used health economics to find an annual direct cost of conversion therapy in the United States, which is $650 million. Worse, the indirect cost associated with depression, suicide attempts, etcetera, totals more than $8 billion nationwide. While it is powerful to hear these harms put in terms of dollars and cents, I need to remind you that these astronomical figures represent the suffering of individuals, of our friends, neighbors, students, and children. As to the concern that is sometimes raised that protections like this interfere with the ability of parents to raise their children, that is simply not the case. It is long established that the fundamental rights of parents do not include endangering their children by forcing them to undergo medical practices that have been rejected by the scientific community [and] had [been] discredited [as] harmful. The law protects against the forms of child endangerment. In fact, this bill will protect parents from being taken advantage of and from the heartbreaking way these practices tear families apart. As to questions raised by conversion therapy proponents about the constitutionality of protections for youth from these practices, policy makers can be assured that multiple federal courts, including the ninth circuit court of appeals once again in January of this year, have upheld similar laws protecting youth from conversion therapy. The power of states to regulate medical treatments including professional therapy to insure the public's health and safety is long established in supreme court precedent. Indeed, it is [the] core purpose of professional licensing boards to regulate potentially dangerous medical treatments, conversion therapy is no exception. This bill does not restrict any protected first amendment speech, it prohibits discredited treatments by state licensed mental health care professionals. It does not apply to clergy or to individuals who provide purely religious instruction. It also does not prevent anyone from publishing, discussing, or advocating any viewpoints or beliefs regarding sexual orientation, gender identity, or anything else. We want youth in Alaska to grow up knowing they are loved supported, [and] can thrive as their authentic selves. This bill [would] not only provide a real remedy for survivors of conversion therapy but also serve to educate the families of these youth who come out that this practice [is] discredited and dangerous. For these reasons, on behalf of the youth who depend on our services, the Trevor Project strongly supports House Bill 43. Thank you for your consideration. 3:29:08 PM DUSTIN MORRIS, Alaska Director, American Foundation for Suicide Prevention, expressed support for HB 43, Version B, on behalf of the foundation. He stated that the mission of the foundation is to save lives and provide hope to those who are suicidal. He mentioned that in addition to the states that have already passed similar legislation, Utah is posed to be the twenty-first state. He asserted that Alaska should be on par with the rest of the country in protecting Alaska's children. He suggested that passing Version B would align with Governor Dunleavy's promise to make Alaska the most pro-child state in the nation. He reported that one in eight LGBTQ children have attempted suicide in the last year, and this has contributed to the rising suicide rates in Alaska. He noted that the 220 suicides in 2021 serves as the highest on record in the state. He stated that more could be done to support all Alaskans, but especially youth and vulnerable populations. He reiterated that passing the proposed legislation would meet this goal. He emphasized that every major health organization has negated conversion therapy, as it has no scientific basis. He posited that the committee members are aware of the mental health issues facing Alaskans, and he argued that this would be one step forward towards a solution. 3:31:48 PM LEVI FOSTER, representing self, shared that he was born in Anchorage and raised in Wasilla. He stated that he came out as gay at the age of 16. He related that he had been "terrified" of the potential consequences of coming out; however, he did not want to hide an integral part of himself from his family. He stated that after his parents sought advice from a bishop at their church, a therapist was suggested. He reported that the therapist told his family he suffered from "same sex attraction," and the therapist described it as a "curable psychological disorder." He stated that, as a 16-year-old, he was told by the therapist he was "broken and needed to be fixed" and was "unlovable." He explained that this was damaging, as it became a subconscious fear, which took decades to undo. He stated that he had expressed to his therapist that he wanted a happy life and love from his parents; however, his therapist had said he would only achieve this if he "pushed" himself to be straight. He reported that after the original treatments were unsuccessful, his therapist suggested he be sent to a more intensive therapy program. From the experience at the new facility, he began questioning the efficacy of the treatments to be "reprogrammed." He recalled that at the new facility emotional abuse and manipulation was extremely transparent, as there were no signs of it accomplishing its purpose, as not a single individual in therapy had changed. He described that the other patients had deep despair, which was proof the treatments were breaking their mental health into pieces. MR. FOSTER stated that the teachings of conversion therapy stressed the concept that being gay was to be forever alone, and this caused many patients to hide their true nature. He shared that he had reached a breaking point and decided to either leave the facility or end his life. While he was able to escape, most of the patients he met have since taken their own lives. He explained that after leaving the facility he did not have contact with his parents until he was 18, and this was to ensure they could not send him back. He shared that when he did reconnect with his parents, they were remorseful and angry, as they felt deceived by the therapists and religious leaders. He shared that before his mother passed away in 2016, she had conveyed to him that she wished she had provided the support he needed when he came out. He said that today he lives with his husband in New York and has found happiness and love despite the trauma he experienced. He stated that he is still healing from the past, and he expressed the hope that sharing his story will help prevent similar hurt to LGBTQ children across Alaska. He asked the committee to take this bill as an opportunity to stand with the consensus of medical professionals in the awareness that conversion therapy is an unscientific practice, so the perpetuation of "abuse disguised as therapy" will stop. 3:38:28 PM REPRESENTATIVE HANNAN urged the committee to listen and feel these testimonies. She pointed out that Alaska has "horrifying" statistics for suicide. She stated that breaking down the complex issue of providing legislative help for the mental health crisis is difficult; however, she asserted that Version B could make real headway in reducing harm for at-risk youth. 3:39:43 PM REPRESENTATIVE SUMNER noted that Section 2 of the bill lists the types of therapy and treatments being prohibited; however, gender transition therapy would not be effected by the bill. He questioned an explanation of the difference between conversion and gender transition therapy. 3:40:20 PM MS. MEACHUM explained that the proposed legislation defines what conversion therapy is and states which therapies are acceptable. She directly quoted the definition of conversion therapy found in Section 2, as follows: a therapy or another regimen that seeks to change the individual's sexual orientation or gender identity, including efforts to change behavior or gender expression or reduce or eliminate sexual or romantic attraction or feelings toward a person of the same gender. This subsection does not apply to counseling that provides support and assistance to an individual undergoing gender transition or counseling that provides acceptance, support, and understanding of an individual or facilitates an individual's coping, social support, and identity exploration and development. 3:41:43 PM REPRESENTATIVE SUMNER expressed his continuing confusion about the difference between providing counseling to change someone's gender and conversion therapy to change someone's sexual orientation. He noted other issues, positing that a child could be convinced to receive other types of [potentially harmful] therapy. 3:43:04 PM REPRESENTATIVE HANNAN clarified that the language of the bill was designed to prohibit therapy harmful to those coming out as gay, but not meant to restrict practitioners who support transgender children through therapy. She reiterated that the goal of the proposed legislation would be to prevent licensed therapists from "converting" someone. 3:44:11 PM REPRESENTATIVE RUFFRIDGE expressed that he shared Representative Sumner's confusion on Section 2. He stated that from an objective standpoint, the bill reads as a prohibition of all therapy seeking to change a patient's gender identity or sexual orientation, and it is not specific to conversion therapy. MS. MEACHUM expressed the opinion that the bill would not prohibit counselling to support gender-affirming care, as it does not dictate that a particular kind of orientation is "not okay." She explained that the first part of the subsection defines "conversion therapy" as treatments that seek to change the sexual orientation or gender identity of an individual. 3:46:41 PM REPRESENTATIVE FIELDS inquired how other states have defined conversion therapy bans. He posited that not including language about what would still be allowed would make the bill easier to interpret. MS. MEACHUM replied that she would report back to the committee with the requested information. 3:47:18 PM CHAIR PRAX announced that CSHB 43, Version B, was held over.