SB 90-MINOR MENTAL HEALTH: AGE OF CONSENT    4:08:54 PM CHAIR DUNBAR reconvened the meeting and announced the consideration of SENATE BILL NO. 90 "An Act relating to the examination and treatment of minors; relating to consent for behavioral and mental health treatment for minors 16 years of age or older; and providing for an effective date." 4:09:09 PM SENATOR CATHY GIESSEL, speaking as the sponsor of SB 90, stated that she is an advanced practice registered nurse and board- certified family nurse practitioner with several years of experience in school-based clinics in both Anchorage and a rural school district. She explained that her support for SB 90 comes from direct experience working with youth and hearing their mental health concerns during screenings. She emphasized that SB 90 is both data-driven and motivated by compassion, noting that the average age of onset for mental health issues is 14 and early detection improves outcomes. She highlighted that suicide is the second leading cause of death nationally for individuals aged 15 to 34, and Alaska leads the nation in teen suicide rates, with 22 percent of high school students having considered suicide in 2023 and 43 percent reporting sadness or hopelessness. 4:10:53 PM SENATOR GIESSEL stated that SB 90 addresses access to mental health care by lowering the age of consent for behavioral health services from 18 to 16. She clarified that under SB 90, teens age 16 and older could receive up to five 90-minute sessions without parental consent. After those sessions, parental consent would be required unless contacting parents posed a risk to the minor, and clinicians would be required to document efforts to reach the parents. She noted that these parameters are further detailed in the Sectional Analysis for SB 90. SENATOR GIESSEL maintained that early mental health intervention reduces the risk of substance abuse and crisis escalation and helps teens engage more fully in treatment. She said SB 90 will promote teen responsibility, increase self-esteem, and ultimately strengthen families and communities by providing proactive care. She concluded that supporting SB 90 is a step toward addressing Alaska's youth mental health crisis. 4:13:49 PM SENATOR GIESSEL referenced a 2017 presentation by Dr. Joshua Sonkiss, a psychiatrist with Anchorage Community Mental Health Services, which explained how the teen brain, particularly the prefrontal cortex responsible for executive function, continues developing during adolescence. She stated that equipping teens with tools to manage stress and emotions can support brain development and long-term mental health. She also pointed to a behavioral health roadmap presented in April to the Committee, which recommended increasing access to school-based Medicaid services and youth use of prevention hotlines. She emphasized that SB 90 encourages engagement of teens and their families and builds overall family resilience while addressing Alaska's suicide crisis. 4:17:23 PM PAIGE BROWN, Staff, Senator Cathy Giessel, Alaska State Legislature, Juneau, Alaska, provided the sectional analysis for SB 90: [Original punctuation provided.]   Senate Bill 90   Sectional Analysis (Version A)   "An Act relating to examination and treatment of minors; relating to consent for behavioral health and mental health treatment for minors 16 years of age of older; and providing for an effective date." Section 1. Amends AS 25.20.025: Examination and  Treatment of Minors. This section adds youth who provide documentation demonstrating they are an unaccompanied homeless minor to the list of minors who can consent to medical treatment. This section would add behavioral and mental health services to the list of services an unaccompanied homeless minor, a minor living apart from their parents or legal guardian, and a minor who is the parent of a child, are able to consent to. 4:17:54 PM MS. PAIGE continued reading the sectional analysis of SB 90: [Original punctuation provided.] Section 2. Adds new subsections to AS. 25.20.025: Examination  and Treatment of Minors.  This section adds new subsections relating to documentation required by homeless unaccompanied minors for the purposes of giving consent. The documentation must state that the minor is: 1. 16 years of age or older 2. Does not have a fixed, regular, adequate nighttime residence; and 3. Is not in the care and physical custody of a parent or guardian, And the document must be signed by: 1. A director or designee of a director of a governmental or nonprofit entity that receives funds to provide assistance to those who are homeless; 2. A local educational agency liaison for homeless youth, a local educational agency foster care point of contact, or a licensed clinical social worker employed by a school in the state; 3. An attorney that represents the minor; or 4. The minor and 2 adults with actual knowledge of the minor's situation. Section 3. Adds a new section to AS. 25.20: Parent and  Child. This section would give a minor aged 16 years or older the ability to consent to receive five 90-minute sessions of outpatient behavioral or mental health appointments, without obtaining the consent of the minor's parent or guardian. It then outlines what would happen in the case a minor needed continued treatment. Section 4. Amends AS. 47.10.084(c): Legal custody,  guardianship, and residual parental rights and  responsibilities. This section adds the new section from section 3 to the list of exceptions of a parent's residual rights and responsibilities. Section 5. Amends AS. 47.12.150(c): Legal custody,  guardianship, and residual parental rights and  responsibilities. This section adds the new section from section 3 to the list of exceptions of a parent's residual rights and responsibilities. Section 6. Effective date.    This section provides for an effective date of January 1, 2026. 4:19:45 PM SENATOR GIESSEL highlighted that in SB 90, page 3, line 1-3, the bill states that a mental health provider may not prescribe medication to a minor receiving behavioral or mental health services. 4:20:52 PM CHAIR DUNBAR commented that he was going to inquire about that and thanked her for specifically mentioning the provision. SENATOR GIESSEL responded that the language was included by design. She also noted that Section 3, page 5, line 2, specifies that treatment must meet the standard of care commonly accepted among health professionals in Alaska, not random people. CHAIR DUNBAR asked about the origin of the five-appointment limit in SB 90. He acknowledged that selecting such numbers often involves finding a rational standard but wondered if this specific number was based on policies in other states or developed independently. 4:21:16 PM MS. BROWN stated that the five-session limit in SB 90 was based on a statute in Idaho with a similar structure. She explained that Idaho allows minors to access a limited number of sessions without parental consent and stated her belief that Idaho also sets the minimum age at 16. 4:21:35 PM CHAIR DUNBAR acknowledged the general agreement on the importance of youth accessing behavioral and mental health services, particularly in reducing issues like suicidal ideation. He questioned whether the primary challenge that SB 90 addresses is difficulty in reaching some parents or situations where contacting parents could pose a danger to the child. SENATOR GIESSEL deferred to Ms. Ireland who works in school- based clinics. She said Ms. Ireland could give data related to the difficulty in obtaining parental consent. 4:22:40 PM CHAIR DUNBAR announced invited testimony on SB 90. 4:22:56 PM JEN GRIFFIS, Vice President, Policy and Advocacy, Alaska Children's Trust, Anchorage, Alaska, provided the following invited testimony on SB 90: Today I'm testifying in support of Senate Bill 90, which would allow 16- and 17-year-olds the ability to provide self-consent to receive up to five behavioral health treatment sessions. Alaska Children's Trust believes in a future where Alaska's children, youth, and families have the knowledge, skills, supports, and resources that they need to thrive. Achieving this vision means ensuring that the next generation of parents has access to the behavioral health support they need so they can enter young adulthood as healthy as possible. Senate Bill 90 creates a pathway for 16- and 17-year-olds to receive behavioral health support in situations where it might be challenging to obtain parental consent. This legislation acknowledges the wide variety of situations our Alaskan youth find themselves in by carefully navigating the importance of involving parents in the treatment process while also affirming and empowering 16- and 17-year-olds seeking behavioral health treatment. According to Kids Count 2024, two out of every five high school students in Alaska report feeling persistently sad or hopeless for an extended period of time during the previous year. This number has moved steadily upwards since 2009, increasing almost 60 percent in the past decade. The option for youth to consent to behavioral health treatment is a policy choice implemented in states across the country. Research demonstrates that allowing youth to self- consent for behavioral health services can support youth engagement in treatment and empower youth to make informed decisions, leading to more effective care and reducing risky behaviors. The policy changes in Senate Bill 90 seek to increase youth access to behavioral health services by balancing youth autonomy with parental involvement, supporting Alaska's youth as they seek treatment for their health and well- being. We encourage your support of Senate Bill 90, and thank you for the opportunity to testify today. 4:25:40 PM HEATHER IRELAND, Executive Director, Anchorage School-Based Health Centers, Anchorage, Alaska, providing the following invited testimony on SB 90: For over 10 years, I have served as executive director of Anchorage school-based health centers, a division of Christian Health Associates. Thank you for the opportunity to comment on the importance of Senate Bill 90. If you want to make a difference for adolescent mental health, you will pass this bill. I was thrilled to see that Senate Bill 90 was being brought forward, allowing 16- and 17-year-olds to access behavioral health services, even if only for a limited number of sessions, it has the potential to make a huge difference in their lives. We are grateful for the volunteer services Senator Giessel provided, and she spoke eloquently and comprehensively about the need for this bill. Anchorage School-Based Health Centers (ASBHC) is a nonprofit separate from the Anchorage School District but operating medical clinics in middle and high schools in Anchorage. We provide medical care to those who cannot access it in the community. Parental consent is required for students to receive the medical care from advanced nurse practitioners and doctors in our clinics, and like medical providers in the community, we bill Medicaid, private insurance, and Stride Care. But we also waive some fees for low- income families, and primarily we receive a grant from the municipality, as well as funding from the United Way and private donors through Pick Click Give. So, Anchorage school-based health centers have served thousands of students since the inception in 2010. 4:27:23 PM MS. IRELAND continued her invited testimony on SB 90: Our providers screen for many types of risk, and we have seen increasing numbers of students who exhibit symptoms of depression, anxiety, and other mental health challenges. Schools often concur with our initial assessment that some youth are struggling, and more often than not, students are willing to pursue behavioral health treatment. Unfortunately, parental consent is a huge barrier for youth to access the care that they desperately need and want. Frequently, youth are hesitant to ask their parents for treatment. My observation has been that adults are reluctant to give permission because of the stigma associated with mental illness, which the younger generation has often moved past. And it can also be logistically challenging for adults to give consent, especially in a school setting where families are not present. And finally, of course, some adults don't want their students discussing their personal life with a healthcare professional, despite how desperately they need the treatment. Years ago, through my networking with school-based health programs in other states, I learned that Colorado lowered their age of consent to 12, and previously it had been like 14 or 16. It was a lightning bolt. This is a way we can actually help kids. Sadly, after many years, Alaska has done nothing to change the situation. By allowing 16- and 17-year- olds to consent for their own care, youth can connect with a clinician who can assess their safety and broach the possibility of involving an adult in their treatment. Early access to care prevents issues from developing into a crisis, needing hospitalization, or worse. In 2018, a study out of Minnesota showed that school- based mental health programs reduced self-reported suicide by 15 percent. This is just one example of how increasing access can make a difference. Please pass Senate Bill 90, and please help youth who are struggling. 4:29:34 PM SENATOR TOBIN stated that she had a question regarding parental reactions to behavioral health treatment for minors. She expressed concern that some parents or guardians might deny consent out of fear that they could be held liable for neglect or harm. She asked Ms. Ireland whether she had any experience or knowledge related to that situation. 4:30:00 PM MS. IRELAND stated that clinicians and medical providers in her program have made reports of harm in various situations involving youth. She explained that these reports are typically not made without the student's knowledge and often involve communication with the student about the legal obligation to report, and sometimes include the parent if they are not the abuser. She emphasized that the Office of Children's Services is responsible for assessing such reports and determining the appropriate next steps. She noted that reports of harm can arise during behavioral health treatment, medical visits, or through conversations with mandated reporters such as teachers. She stated her belief that SB 90 would not significantly increase the occurrence of such reports. 4:31:36 PM CHAIR DUNBAR acknowledged that Senator Hughes joined the meeting at about 3:35 p.m. 4:32:00 PM CHAIR DUNBAR opened public testimony on SB 90. 4:32:22 PM ROGER BRANSON, representing self, Eagle River, Alaska, testified in support of SB 90. He stated that he is a longtime mental health advocate and described SB 90 as a critical tool to empower youth to define their own self-care. He emphasized the importance of involving individuals in their mental health recovery and treatment planning. 4:33:03 PM CHAIR DUNBAR paused public testimony to hear invited testimony from Ms. Ringstad. 4:33:30 PM ANN RINGSTAD, Executive Director, National Alliance on Mental Illness Alaska, Anchorage, Alaska, provided the following invited testimony for SB 90: NAMI Alaska is one of 48 state organizations under the umbrella of NAMI, the National Alliance on Mental Illness, the nation's largest mental health advocacy organization in the United States. Consider these facts: one in six youth ages six to 17 experience a mental health disorder each year in the United States; 50 percent of all mental illness develops by the time a student reaches the age of 14, and 75 percent by the time they reach the age of 25. Eight thousand Alaskans ages 12 to 17 have depression. High school students with depression are more than two times more likely to drop out than their peers. Almost 63 percent of Alaskans ages 12 to 17 who have depression did not receive any care in the past year. Behavioral health services are critical to support these youth. Delayed treatment can be detrimental. The earlier a mental health issue is detected, the better. And one more important fact: Alaska's suicide rates are sadly some of the highest in the nation. We rank number three. As the sponsor of the bill stated, SB 90 allows minors, 16 of age and older, who provide documentation they are living apart from their family and are homeless, to seek help for their mental health challenges. This would give them the ability to obtain mental health services and give their own consent for five 90-minute outpatient mental health sessions, with parental notification to determine the next steps unless parental consent would be detrimental to the well-being of the youth. This would allow them to receive timely services before their symptoms become worse. Lowering the age of consent for behavioral health care under these circumstances, from 18 to 16, may prove to save lives. Thank you for your consideration of these factors. 4:35:49 PM CHAIR DUNBAR resumed public testimony on SB 90. 4:36:18 PM STEVEN PEARCE, Director, Citizens Commission on Human Rights, Seattle, Washington, testified in opposition to SB 90. He stated that the Citizens Commission on Human Rights is a psychiatric watchdog group and expressed concerns regarding SB 90. He supported notifying parents when youth exhibit behavior that affects school performance and taking action through protective services if necessary but opposed turning schools into profit centers for psychiatric diagnosis and treatment. He argued that behavior is not a disease and claimed the theory of a chemical imbalance in the brain lacks supporting evidence, criticizing what he described as grooming individuals to believe behavior equates to disease and that medication is the solution. MR. PEARCE stated that if SB 90 is limited strictly to counseling, that might be more acceptable, but he raised concerns about violating informed consent. He emphasized that informed consent is fundamental to treatment and argued that limiting or removing parental involvement exceeds what is necessary. He asserted that schools and counselors should make a greater effort to reach parents and obtain authorization, and failure to do so reflects a breakdown in communication. He cited Tom Insel, former director of the National Institute of Mental Health, who acknowledged that decades of mental health efforts have not produced meaningful improvements, as evidenced by high rates of suicide, disability, and poor mortality data. 4:39:05 PM ED MARTIN, representing self, Kenai, Alaska, testified in opposition to SB 90. He stated he is 70 years old and has personal experience with mental health issues within his family. He opposed SB 90, asserting that allowing 16-year-olds to enter treatment without parental consent undermines parental rights. He expressed concern over minors receiving seven and a half hours of care without parental involvement and warned that such a policy could be legally challenged. He questioned the bill's fiscal impact and asked which nonprofits are involved and how the services would be funded. 4:41:44 PM CHAIR DUNBAR held public testimony open on SB 90. 4:41:50 PM SENATOR HUGHES stated that she shared some of Mr. Martin's concerns regarding SB 90. She said she supports seeking parental consent upfront and limiting exceptions to extreme situations, such as cases involving homeless youth. She noted that Idaho has since revoked a similar law, raising its age of consent back to 18. She recalled prior concerns that insurers might not cover services under this policy and requested and update. 4:43:45 PM CHAIR DUNBAR stated he also had a question related to billing for services and suggested the sponsor could address the questions at the next hearing of SB 90. 4:43:56 PM CHAIR DUNBAR held SB 90 in committee.