HOUSE BILL NO. 172 "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." 1:35:54 PM Co-Chair Merrick indicated that the bill was first heard in committee on April 13, 2022. HEATHER CARPENTER, HEALTH CARE POLICY ADVISOR, OFFICE OF THE COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, relayed she was available for questions. 1:36:30 PM Co-Chair Merrick OPENED public testimony. 1:37:02 PM AT EASE 1:37:15 PM RECONVENED ED MERCER, CHIEF OF JUNEAU POLICE, JUNEAU (via teleconference), supported the legislation. He characterized the current mental health system as a revolving door where people in a mental health crisis did not receive proper help and were returned to the street. Therefore, police officers spent a lot of time responding to mental health crises. He related that if a call did not involve criminal activity the only option was to transport the individual to a hospital. If the situation did involve criminal activity, the only option for an officer was to put a mentally ill person in jail. An officer often encountered the same people suffering from mental health issues back out on the street and were forced to deescalate situations. He indicated that the bill would allow officers to transport the mentally ill individual to a crisis stabilization center as an alternative to an arrest. He believed that the bill would save officers time by establishing a faster handoff to mental health officials who would be better equipped to help the individuals. The legislation would stop the revolving door approach by granting people a 23 hour and 59 minutes cooling off period and gave them access to providers trained to help. He strongly supported the bill and believed it would be good for the state and the Juneau community when dealing with citizens suffering from mental illness. 1:40:36 PM FAITH MYERS, MENTAL HEALTH ADVOCATES, ANCHORAGE (via teleconference), spoke in support of the bill on the condition that Representative Rasmussen added an amendment to the bill requiring statistics on the mentally ill be kept and shared with the legislature and the general public. She provided a brief history of mental health in Alaska. She shared that between 1904 and 1968, many Alaska Natives were sent to a mental health facility out of state called Morningside in Oregon and no records were kept or shared with the state. She indicated that currently, private psychiatric facilities write the patient grievance procedures and the appeal process according to AS. 47.30.847. In addition, the patient advocate worked for the hospital. She communicated that the way the state provided psychiatric care needed much revision. She supported the keeping and sharing of psychiatric statistics for patients' treatment, care, injuries, traumatic events, and complaints. 1:43:01 PM LISA GENTEMANN, SELF, EAGLE RIVER (via teleconference), testified against the bill. She believed the provisions were open to abuse of power and the bill was unconstitutional. She provided an example pertaining to her daughter and son in law living in Fort Benning regarding a Captain who was admitted to a mental hospital. She opined that when a person was pulled out of their daily routine it was destabilizing. She stated that the bill would allow Alaskans to be detained against their will indefinitely. She added that the bill would allow patients to be given psychotropic medications against their will and once admitted the patient lost all their constitutional rights. She spoke to the numerous problems in mental health facilities. She favored amending the bill to include patient consent. She stated that counseling and medications should not be forced on people. She asked the committee to vote against the legislation. 1:45:58 PM BRENDA MCFARLAND, CITY OF FAIRBANKS, FAIRBANKS (via teleconference), spoke in favor of the bill. She relayed that she was speaking on behalf of the City of Fairbanks. She stressed that the bill was critical to the success of the Crisis Now rollout taking place in Fairbanks. She shared that she was a coordinator for the Crisis Now program and the mobile crisis teams had been operating since October 2021. She reported that the teams were dispatched through an emergency dispatch center and responded to people in crisis alongside or independent of law enforcement and resolved 80 percent of the calls onsite. The team also offered next day appointments at Alaska Behavioral Health or Tanana Chiefs Conference. She indicated that presently, people in crisis were calling and asking for the Mobil Response Team. She emphasized that the person in crisis still needed a place to go to calm down and seek help. The Crisis Stabilization Center was a necessary part of crisis response. She offered that currently, the first responders were required to take the person in crisis to the hospital Emergency Room (ER). She shared that when the option was presented as the only option it further escalated the situation. The bill ensured people received appropriate healthcare quickly, provided the patient a choice, kept patients out of costly hospital stays, and minimized the impacts on first responders. Co-Chair Merrick indicated that Representative Edgmon joined the meeting. 1:48:15 PM ARTHUR DELAUNE, SELF, FAIRBANKS (via teleconference), shared that he was the father of a Native man diagnosed with fetal alcohol spectrum disorder and co-occurring mental health disorders including anxiety and depression. His son had given him permission to testify. The testifier wanted to personalize the issue and illuminate how mental health patients were currently treated in facilities. He shared the story of the way his son had been treated. He detailed that his son had tried to commit suicide in the past and was taken to the ER and placed in a padded cell for many hours. His son was agitated and begged to leave. His father agreed on the condition his son went to the Crisis Counselor at the Fairbanks Mental Health Facility. When they arrived at the facility, they were told they could only place his son on a waiting list. There had been a cumbersome paperwork process. There was a 14-day wait for an intake and he experienced another intake 7 days later. His son ultimately had to wait 34 days to speak to a therapist. On day 35 his son had called and stated he wanted to kill himself. He had been admitted to the Fairbanks Memorial Hospital and 5 hours later admitted to the behavioral health ward and did not see a doctor for 22 hours after check in. He provided further detail about the story. He was referred back and forth between Fairbanks Community Mental Health and Tanana Chiefs Conference and by day 41 he had not received services. He emphasized that his son had been caught between two mental health organizations and a very broken mental health system. He stressed that the services were absolutely needed and people in crisis needed immediate help. He implored the committee to pass the bill. Representative Thompson thanked Mr. Delaune for sharing his personal story. 1:53:27 PM MIKE CARSON, CHAIR, MATSU OPIOID TASK FORCE, MAT-SU (via teleconference), testified in support of the bill. He shared a true story about a woman named Kelsey Green. He had permission to share the story. The woman was addicted to heroin and at one point arrested, taken to the Anchorage Jail, and began to experience withdraw symptoms. She died within 5 days in jail without receiving any stabilization care or help. He believed that if Kelsey had been taken to a crisis stabilization center, she would still be alive today. He spoke to the endless possibilities that could have taken place in her life if Kelsey had lived. He supported stabilization centers. He thanked the committee for hearing his testimony. Co-Chair Merrick CLOSED public testimony. 1:56:00 PM AT EASE 1:56:49 PM RECONVENED Co-Chair Merrick asked for a review of the fiscal notes. SAMANTHA CHEROT, PUBLIC DEFENDER, ALASKA PUBLIC DEFENDER AGENCY (via teleconference), reviewed the published fiscal impact fiscal note (FN 9 (ADM) for the Department of Administration (DOA), Public Defender Agency. She explained that individuals who were held past 48 hours before a petition was filed for up to seven days had a right to council and a hearing. The fiscal note addressed the need for one attorney in Anchorage, one paralegal in Palmer and one paralegal in in Anchorage, and a law office assistant in Fairbanks. She indicated that the narrative analysis on the fiscal note described the basis for the need. 1:57:49 PM Co-Chair Merrick moved to the next fiscal note. Ms. Carpenter reviewed the published fiscal impact fiscal note (FN 11 (DHS) from the Department of Health and Social Services (DHSS), Designated Evaluation and Treatment. She pointed to the Interagency Receipts (IA) fund source and noted that the receipts were accepted via receipt authority from Medicaid funding as designated on the departments other fiscal note. She elaborated that the funding was matched by a General Fund (GF) Mental Health (MH) fund source. The fiscal note increased in the outyears because DHSS anticipated that more facilities were expected to open in the future. She furthered that GF would increase because not all of the facilities were eligible for Disproportionate Share Hospital (DSH) funds, which was how the department currently matched funding for Designated Evaluation and Treatment (DET) Centers. She indicated that DSH funds were only available for hospitals and non- tribally operated hospitals. She reiterated that DHSS anticipated the growth of both the Designated Evaluation and Stabilization (DES) and Designated Evaluation and Treatment (DET) Centers to expand into each of the 9 behavioral health regions but only facilities that were hospitals could receive DSH funds. The state was required to pay for involuntary commitment. She listed the current DET hospitals: Fairbanks Memorial Hospital, Bartlett Regional Hospital, and Mat-Susitna Regional Medical Center. She added that the fiscal note included additional costs associated with implementing HB 172 for one full-time employee in Anchorage and a Reimbursable Services Agreement (RSA) to the Department of Law (DOL). 2:00:34 PM Ms. Carpenter continued to review the published fiscal impact Department of Health and Social Services fiscal note (FN 6 (DHS) for Medicaid Services. She indicated that the fiscal note accompanied the prior fiscal note and showed the Medicaid Federal Receipts fund source and included the Medicaid funding for the facilities that qualified for the DSH funding. NANCY MEADE, GENERAL COUNSEL, ALASKA COURT SYSTEM (via teleconference), reviewed the published fiscal impact fiscal note (FN 10 (CRT) for Judiciary, Trial Courts. She communicated that the fiscal note covered the cost of two Range 12 clerks for the added tasks of notifying guardians during a crisis center admission as well as for involuntary commitment proceedings. A good percentage of the respondents had been previously appointed guardians to help administer their affairs. In addition, the majority of mental commitment proceedings, and most likely a majority of the crisis center admissions were filed with the court system during non-traditional work hours on weekends and nights. She noted that the court system had a full-time magistrate to cover the off hours but the new task of researching the respondents' status as a protected person, and notifying the guardian of the next hearing, cannot reasonably be performed by that magistrate in light of his or her many other obligations so the help was a necessity. She determined that the court system could accomplish the work during the daytime without additional help. Representative Josephson perceived that the magistrates would see an increased workload due to the bill. He asked if there was concern over the matter. Ms. Meade was not concerned about the issue. She explained that the individuals in crisis typically ended up in court either for a criminal arraignment or for an ex parte hearing for an involuntary mental commitment. The bill would result in nearly the same number of hearings, but the hearings would be slightly different. 2:05:58 PM Co-Chair Merrick moved to the last fiscal note. KELLY HOWELL, SPECIAL ASSISTANT TO THE COMMISSIONER, DEPARTMENT OF PUBLIC SAFETY (via teleconference), reviewed the published zero fiscal note (FN 4 (DPS) from the Department of Public Safety, Alaska State Trooper Detachments. She commented that the bill added a new subsection to AS 47.30.705 that required a peace officer to prioritize transporting a mentally ill individual to a crisis stabilization center if one existed in the community. She did not anticipate an increase in cost and believed that the department could implement and comply with the changes with minimal fiscal impact. Representative Edgmon remarked that fiscal notes were one dimensional and did not reflect potential savings. He thought the bill was one of the most critical pieces of legislation during the current session. He noted that it would save dollars and lives in the future. HB 172 was HEARD and HELD in committee for further consideration.