HOUSE BILL NO. 60 "An Act relating to mental health education." Co-Chair Merrick invited Representative Claman to begin. 2:24:37 PM REPRESENTATIVE MATT CLAMAN, SPONSOR, introduced HB 60. He read a prepared statement: "Co-chairs, members of the House Finance Committee, thank you for hearing House Bill 60, which amends the existing K-12 public school health education statute to include mental health education guidelines. Currently the health curriculum guidelines, developed by the state Board of Education and Early Development, include learning about prevention and treatment of diseases; "good" health practices like diet, exercise, and personal hygiene; and "bad" health habits such as substance abuse, alcoholism, and physical abuse. But the guidelines do not address mental health. House Bill 60 is not an unfunded mandate. The legislation maintains local control of curriculum by allowing school districts to choose to adopt the mental health guidelines. When a local school district makes its decision, we should have guidelines for the district to follow. This bill was brought to my attention in 2019 by a college student who successfully advocated for similar legislation when he was in high school in Virginia. We then worked with a group of Alaska high school students advocating for increased mental health resources in Alaska's schools. These students spoke of their own struggles with mental health as well as those of their peers some students even said their mental health struggles began as early as elementary school. But what we continued to hear from these students was that, while they learned about signs, symptoms, and treatments for physical health at school, there wasn't much conversation about mental health with their friends and teachers. Alaska's adolescent suicide rate is three times higher than the nationwide rate. And our state adolescent suicide rates are increasing. According to the 2019 Alaska High School Youth Risk Behavior Survey, which surveyed 1,875 students in grades 9-12 from 39 high schools across the state, the percentage of students who have attempted suicide has doubled since 2007. And given that 50% of all lifetime cases of mental illness begin by age 14, and 75% by age 24, we need to start having these conversations about mental health with our children. Early data from 2020 and 2021 suggest that the COVID-19 pandemic and its impact on youth has exacerbated the mental health crisis. The U.S. Surgeon General declared a youth mental health crisis in December of 2021, and in his advisory, he emphasized the "devastating" impact that the pandemic has had on our children. This bill requires the State Board of Education and Early Development to work with representatives from tribal and mental health organizations to update the health education standards to include guidelines on mental health education. Once the legislation passes, it will be up to school districts across Alaska whether to use these guidelines to incorporate mental health into their health education curriculum. As is the case with current health education curriculum, the Department of Education and Early Development is available to assist schools in incorporating health standards into local curricula. To be clear, this bill does not create or mandate that schools adopt a curriculum. We have a responsibility to treat the current mental health crisis in Alaska as a serious public health issue. This bill underscores the notion that mental health is just as important as physical health and should be treated as such. We must normalize conversations about mental health starting at an early age, just as we do with physical health, in order to destigmatize mental illness and increase knowledge on the fundamental aspects of mental health as well as the causes, risk factors, and treatments for mental illness." Representative Claman deferred to his staff to present the sectional analysis for HB 60. 2:28:13 PM EMMA POTTER, STAFF, REPRESENTATIVE MATT CLAMAN, reviewed the sectional analysis in a prepared statement: "Good afternoon members of the House Finance Committee. For the record, my name is Emma Potter and I am staff to Representative Matt Claman. Thank you for hearing House Bill 60. Section 1 of House Bill 60 adds intent language stating that it is the intent of the legislature that the Board of Education and Early Development develop guidelines for instruction in mental health in consultation with the Department of Health and Social Services, regional tribal health organizations, and representatives of national and state mental health organizations. Section 2 amends AS 14.30.360(a) by removing the word "physical" when referencing instruction for health education and adding "mental health" to the list of curriculum items each district includes in their health education programs. Section 3 amends AS 14.30.360(b) by adding that, in addition to establishing guidelines for a health and personal safety education program, the state board shall establish guidelines for developmentally appropriate instruction in mental health. Section 4 amends the uncodified law of the State of Alaska by providing that the State Board of Education and Early Development shall develop the aforementioned mental health guidelines within two years after the effective date of this Act. Thank you for hearing this bill. I would also like to inform the committee that online for invited testimony we have Jason Lessard from National Alliance on Mental Health Anchorage chapter as well as Justin Pendergrass, a suicide prevention specialist at MY House in Wasilla." 2:29:37 PM Representative Rasmussen asked for someone from the Department of Education and Early Development (DEED) to offer the department's opinion on the legislation. KELLY MANNING, DEPUTY DIRECTOR, DIVISION OF INNOVATION AND EDUCATION EXCELLENCE, DEPARTMENT OF EDUCATION AND EARLY DEVELOPMENT (via teleconference), asked that the question be repeated. Representative Rasmussen asked for the department's position on the legislation. Ms. Manning indicated the department would implement the bill if it were to be adopted. Representative Rasmussen asked if Ms. Manning anticipated any challenges in implementing the bill. Ms. Manning indicated the process would take about two years and would include a standard update process and stakeholder input. Representative LeBon thought local school board participation would be warranted. He asked if school districts could opt in or out. Representative Claman responded that the bill intended to establish guidelines, but districts would not necessarily be required to follow all of the guidelines. Representative LeBon asked if most school districts already had a mental health policy or program. He asked about the Anchorage School District (ASD) in particular. Representative Claman did not believe ASD had adopted a specific mental health policy. He thought this was partially because there were no state guidelines in place. 2:34:59 PM Representative LeBon wondered if there would be a minimum standard for mental health across districts. Representative Claman relayed that the bill was not a mandate. Rather, it intended to provide a curriculum to districts. He thought it would be particularly helpful in rural districts that had fewer resources to devote to mental health. Representative Rasmussen asked how the bill would help prevent or reduce suicide rates. Representative Claman thought there needed to be a greater comfort level in having open discussions about mental health. He thought it was important for kids to feel like the resources were available to them. 2:37:14 PM Representative Rasmussen shared an experience of losing a friend to suicide. She shared the concern but could not see how the bill would increase comfort levels in talking about mental health. She wondered if there might be a group of teachers that had additional training. She was still trying to understand how the bill would result in fewer suicides. Representative Claman responded that the current situation was that students were confiding in teachers who did not have any relevant training and had no guidelines to follow. The bill would result in teachers in the building having appropriate training and students would have a knowledgeable person to turn to rather than potentially receiving misinformation due to lack of training. He had heard from students that having more teachers with appropriate training would make a difference. Representative Rasmussen relayed her son was in kindergarten in ASD and his school employed health teachers. She thought that some mental health training had already occurred within ASD. She wondered if the bill should be attached to the Department of Health and Social Services (DHSS) instead of DEED. Representative Claman indicated that DEED had tremendous experience in setting guidelines and establishing curricula. The focus was on the schools and he thought involving DHSS would make the process more complicated. 2:41:24 PM Representative Edgmon was intrigued by the bill. He understood the practical reasoning for it. He thought the bill would bring the topic of mental health to the Board of Education and he did not think the board dealt with mental health related matters. Representative Claman replied that his whole point of the bill was to introduce guidelines for mental health education in schools, not to force it on districts. Representative Edgmon thought there were already a number of health-related subjects under the purview of DEED. He asked if he had given an accurate assessment. Representative Claman responded in the affirmative. Representative Edgmon looked forward to additional discussion surrounding the bill. 2:44:03 PM Representative Carpenter agreed there was a need to increase the discussion around mental health. He had a technical question around the removal of "physical" in the bill. He was concerned that curriculum would no longer include physical health. Representative Claman did not read the language as excluding physical health in any way. He did not think including mental health would exclude physical health. He would not object to adding the words "physical health" to the language of the bill for clarity. Representative Carpenter argued that the use of the word "heath" meant both mental and physical health. He understood that including "mental health" specifically was to emphasize the issue. He suggested that some curriculum that would be encouraged under the bill were already implemented by the school districts. Ms. Manning replied that the state would update standards and the districts would then decide how the standards would be implemented. She offered to distribute further details to the committee on current implementation. Co-Chair Merrick thought additional details would be helpful. Representative Claman explained that the deletion of "physical health" was important because he did not think the language inherently included mental health. However, he did not think there would a problem with adding the language back to the list of curriculum that the bill hoped to encourage. 2:48:09 PM Representative Carpenter thought that the list of additional guidelines would exclude physical health. He was open to being corrected by the attorneys in the room. Representative Claman thought that the grammatical structure of the language mandated the inclusion of physical health. He thought it was a grammatical matter and that it was not ambiguous. Co-Chair Merrick indicated Legislative Legal Services was not available online. Representative Carpenter was concerned whether the bill would be effective at changing policy within local districts. He wondered how many of the districts would design significant curriculum. He asked if teachers would have to be specifically trained in mental health. Ms. Manning indicated that the goal of the board was to establish standards. She relayed that the guidelines could be expanded to include training but that it would impact the fiscal note. Representative Carpenter thought teachers needed additional training to provide sufficient education on subjects. He imagined that the districts would need more money. 2:51:34 PM Representative Johnson thought much of the issue came down to local control. She thought teachers would have to exclude other curriculum in order to make time for mental health education. She asked in which ways would the department encourage mental health education. Representative Claman rebutted that there was nothing in the bill that required DEED to do anything and that the bill was about local control. The bill intended to clarify that the state would provide guidelines to districts should the districts choose to provide mental health education. Representative Johnson thought it sounded like school districts would be encouraged to provide the education which seemed like a monetary issue to her. Teachers had a significant workload already, and she though that the state would be asking teachers to do more if the bill were to pass. She was concerned about adding guidelines in statute when the legislature was unaware of the content. Representative Claman responded that he thought it was a normal process for DEED and a range of community experts to convene and determine guidelines. The bill would create mental health guidelines which would be referred to by educators, and the state routinely created similar guidelines for educators. He thought there should be guidelines specific to mental health. Representative Johnson thought mental health was just as diverse as physical health. She asked whether family planning clinics and gender studies would be included under the mental health umbrella. She had received several questions about the topics being discussed in schools. 2:56:30 PM AT EASE 2:56:39 PM RECONVENED Representative Claman referred to a two-page document in members' packets that outlined Alaska content standards, "Skills for a Healthy Life" (copy on file). He predicted that if mental health was added to the document, it would still be a two-page document and would not become particularly extensive. Representative Johnson continued to express her concerns about adding to the burden on teachers. She remained concerned about taking away local control and wanted communities to be able to address mental health crises in the way the community saw fit. Representative Claman fundamentally disagreed with Representative Johnson. He stressed that the bill was not forcing districts to adopt the guidelines. He did not think it was reasonable to expect the legislature to approve any and all guidelines adopted by local or state agencies. He thought it was reasonable to allow DEED to determine the guidelines. He emphasized that the bill was not imposing anything on districts or requiring districts to adopt mental health guidelines. 2:59:55 PM JASON LASSARD, EXECUTIVE DIRECTOR, NATIONAL ALLIANCE ON MENTAL HEALTH ILLNESS (via teleconference), relayed that he had worked for Mental Health Advocacy Through Storytelling (MHATS) for the past three years which worked to destigmatize mental health and offer resources by telling true and personal stories. There was a significant amount of data that showed that access to mental health resources decreased suicide rates. He wanted to focus on a couple of data points. First was the prevalence of mental illness in the United States: one in five adults had a mental illness. Additionally, 50 percent of all lifetime mental illnesses would begin by age 14, and 75 percent began by age 24. The onset of mental illness largely occurred during teenage years and it was important for it to be addressed quickly, safely, and in evidence-based programs. Mr. Lassard relayed an individual's personal story wherein the individual did not feel comfortable talking about their mental health struggles due to societal stigmas and instead turned to the internet for help. The proposed bill was of critical importance to ensure that students had access to education and resources in their communities and did not have to look to places like the internet, which was rife with inaccuracies. He reiterated that the bill was not a mandate. He was regularly asked to provide mental health services to schools in his area and such conversations were already happening in schools without guidelines. He wanted to ensure that if and when a district was ready to engage in mental health education, that the programs were vetted and evidence based. He respectfully asked for members' support. The program was intended to simply destigmatize the conversations around mental health and suicide. It would be up to the communities to decide the focus of their own programs, whether it be suicide prevention, mental wellness, or something else. He would like to see the bill do more, but it was a good first step. Given the statistics he mentioned at the beginning of his testimony, he thought it was beyond time to address mental health in schools. He was available for questions. 3:05:49 PM Representative Edgmon noted that Mr. Lassard had relayed that one in five adults had a mental illness. He asked what the numbers were for individuals aged 14 and older. Mr. Lassard thought it was 17 percent but could confirm the information and get it to the committee. Representative Carpenter asked about the responsibility of parents to speak about mental health to their children. He thought it was dangerous for the state to teach mental health to students. He argued that conversations about mental health should be between parents or doctors and children. Mr. Lassard indicated it was a district-level decision. The parents that were involved with their local districts would be part of the conversation and the decisions. He provided an example of a school in the state that attempted to address suicide but the school did not follow any guidelines or best practices. There was no space for students to ask questions or be part of the conversation and the misguided attempt had a profoundly negative effect on a number of students despite there being good intentions. It was a matter of setting basic standards and guidelines as laid out by experts and ensuring a safe environment for conversation. Representative Carpenter did not hear anything about empowering parents. Mr. Lassard reiterated that empowering parents happened at the local level. Parents would be part of the discussion on whether they wanted to bring the program to the local school district. 3:10:05 PM JUSTIN PENDERGRASS, SELF, WASILLA (via teleconference), spoke of his own mental health problems and suicidal ideations. He had fallen into a deep depression when he was young that nearly took his life, and as a result he became homeless for five years. He was enrolled in school and although it was a safe place for him, he was not learning anything about mental health and his education was not helping his situation. He eventually discovered the root of his mental illness and was able to get help. Since then, he had dedicated his life to helping others that suffered from similar mental illnesses. The opposite of suicide was connection, and therefore the only way to prevent suicide was to create connection. Mental illness was on the rise due to the increased isolation that had occurred over the past few years due to the pandemic. Mr. Pendergrass argued that the state had a responsibility to help youth in crisis, and the most reasonable place to provide help was within school districts. When he was young, he did not have a parent at home that could help him through the issues he was experiencing and did not have a safe place to be able to share his experience. His financial situation prevented him from getting help without his parents' assistance. He believed it was unjust for kids in similar situations to not have access to help. Mr. Pendergrass relayed that he was currently a suicide prevention specialist for individuals aged 14 to 24 and 66 percent of the induvials he worked with were struggling with suicide or mental health problems upon intake. The majority of the individuals he worked with were misdiagnosing themselves with a variety of disorders that they did not understand. He thought schools should be a place to build connections and become educated, but connections could not be made without there being a safe place to do so. He spoke about a school counselor who created a safe space for him as a teen and gave him a place to go when he needed one, but unfortunately the situation did not last long because it was not allowed by the school. He thought it was important for counselors to be able to provide mental health education and thought they were well- equipped to do so. The counselors understood that the problem was getting worse and there needed to be a way to address it. Co-Chair Merrick thanked Mr. Pendergrass for his testimony. 3:15:30 PM AT EASE 3:16:08 PM RECONVENED Representative Johnson thanked Mr. Pendergrass for testifying before the committee and for his work in mental health. She wanted to connect with him and local schools to help implement the changes in the districts. She reiterated her for his testimony. Representative Wool supported the bill and thought it was a good start. He thought mental health awareness and education were vital. He noted his daughter went to a weekly counseling class as part of the basic curriculum at her school. He relayed that his daughter did not think the mental health education received in schools was sufficient. Mental health was a serious problem and had been exacerbated by the pandemic. Teachers were required to get continuing education to maintain their license already and he did not think the bill would cause additional expenses. He thought mental health could be part of continuing education for teachers. Representative LeBon commented that curriculum committees needed to include robust parental participation. He thought the best curriculum committees were comprised mostly of parents who had children in the district. HB 60 was HEARD and HELD in committee for further consideration. 3:20:42 PM AT EASE 3:22:07 PM RECONVENED